Outpatient management of pneumothorax after fine-needle aspiration: economic advantages for the hospital and patient.

PURPOSE: To evaluate the efficacy and cost savings of outpatient management of post-fine-needle aspiration (FNA) pneumothoraces with small-caliber catheters. MATERIALS AND METHODS: The authors retrospectively reviewed the medical and hospital billing records from 74 patients with enlarging or symptomatic post-FNA pneumothoraces treated with a small-caliber catheter. Forty patients (54%) were treated on an outpatient basis, 17 patients (23%) were treated on an inpatient basis, and 17 patients (23%) were monitored overnight in the emergency department. Only one patient initially treated on an outpatient basis had to return for inpatient observation and suction because of a persistent pneumothorax. RESULTS: The catheters remained in place overnight in 46 patients (33 outpatients, 12 emergency department patients, and one inpatient). The number of days the catheters were left in place was prolonged (range, 2-13 days) in seven outpatients, five emergency department patients, and 16 inpatients. The mean cost per patient for lung biopsy and pneumothorax management was as follows: outpatients, $1,689; emergency department patients, $2,403; and inpatients, $3,950. Elevated inpatient expense was related to the number of chest radiographs obtained, pharmacy charges, and room charges. Cost elevation for emergency department patients was related to pharmacy charges and the cost of overnight observation. CONCLUSION: Outpatient management of simple pneumothoraces with placement of small-caliber catheters attached to one-way chest drain valves proved to be safe, efficient, and economical.

Sigmoid sinus thrombosis associated with internal jugular venous occlusion: direct thrombolytic treatment.

PURPOSE: To report our experience with transfemoral direct venous thrombolysis and angioplasty to treat central venous and dural sinus occlusion. The cases presented are rare examples of internal jugular occlusion associated with sigmoid sinus thrombosis. METHODS AND RESULTS: Two middle-aged, symptomatic female patients were diagnosed with sigmoid sinus and internal jugular vein thrombosis. Venography was performed from a contralateral transfemoral approach, followed immediately by urokinase infusion directly to the occlusion using an intermittent "burst-bolus" technique. Successful thrombolysis of the sigmoid sinus and internal jugular vein was documented in both patients. In one case, a venous stenosis was treated with balloon angioplasty. Clinical signs and symptoms resolved in both patients. CONCLUSIONS: Occluded dural sinuses and central veins can be treated with direct administration of thrombolytic agents. When an underlying stenosis is identified, balloon dilation should be used to reduce the likelihood of recurrence.

Determining ICU visiting hours.

Visiting hours play an integral role in the intensive care unit (ICU) for both patients and health care providers. Family members offer support and comfort to patients during critical illnesses. Nurses, however, often view visiting hours as intrusive and time consuming. The issue of restricted versus open visiting hours continues in many ICUs, and the advantages and disadvantages of both types of visitation must be weighed before selecting the visiting hours appropriate for the institution.

Microbial etiology and clinical characteristics of distributive shock.

Although septic shock may be the most common cause of distributive shock, to our knowledge, no studies have defined the likelihood and type of infection among patients with distributive shock. We performed a retrospective study of 100 consecutive patients who were admitted to a city-county hospital with hemodynamic evidence of distributive shock. Forty-nine of 100 patients with distributive shock had microbiological documentation of infection. Six patients had clinical evidence of infection without microbiological documentation. Forty-five patients had no microbiological or clinical evidence of infection. Among patients with microbiologically documented infections, the incidence of infection due to aerobic gram-positive cocci equaled the incidence of infection due to aerobic gram-negative bacilli. Clinical parameters, such as the criteria for the systemic inflammatory response syndrome, were not useful in distinguishing the group with infections from the group without infections. In conclusion, many patients with distributive shock do not have evidence of infection.

The human lymph node germinal center cell: characterization and isolation by using two-color flow cytometry.

The germinal center of lymphoid tissues is a critical microenvironmental site of B cell activation and differentiation in response to antigenic stimuli. However, characterization of germinal center cells (GCC) in tissue sections has proved technically difficult. Therefore, we have employed two-color flow cytometric analysis of suspended human tonsillar lymphocytes in order to define more precisely the immunologic features of GCC. These cells were identified in suspension by virtue of their specific surface binding of the lectin peanut agglutinin (PNA), confirmed by tissue immunoperoxidase studies. Phycoerythrin-labeled lectin was used in combination with a variety of fluorescein-labeled antibodies in order to identify subpopulations of tonsillar lymphocytes. The majority of PNA+ cells were B cells, and both PNA+ and PNA- B cells stained for surface immunoglobulin light chains. PNA+ cells lacked surface IgD, but included cells with surface IgG and IgM. Both PNA+ and PNA- cells stained for B1, B2, BA-1, Leu-12, Leu-14, CR-I, and HLA-DR antigens, whereas CALLA was present only on PNA+ cells. There were differences between PNA+ and PNA- cells in the relative expression of B1 and B2 antigens, possibly reflecting differences in B cell activation or maturation. A small proportion of T cells were PNA+, including both helper/inducer and suppressor/cytotoxic phenotypes. PNA+ cells included both small and large lymphoid cells, and almost all DNA synthetic activity was associated with the large PNA+ cells. PNA+ B cells isolated by cell sorting had morphologic features characteristic of GCC. Therefore, PNA+ cells in suspension appeared to represent GCC, and features of these cells that cannot be convincingly shown in tissue section studies were demonstrated by flow cytometry.

The influence of infantile handling, age and strain on alcohol selection in mice.

Male mice from three inbred strains (C57B1/10J, BALB/cJ and C3H/2lbg) were assigned to infantile handling or control conditions. In a cross-sectional developmental design, handled and control mice were tested for two-choice selection of 10% (v/v) ethanol vs. tap water at 60, 90 or 120 days of age. The volume of fluid consumed from both tubes was recorded for fifteen days. In 60 day old mice, handling produced a trend toward increased total fluid consumption in the C57 mice and a trend toward increased ethanol selection in the BALBs. In 90 day old mice, there were trends noted toward handling-related decreased fluid consumption in BALBs. Also noted was a trend toward handling related increased ethanol selection in C57 mice. In 120 day old mice, a handling-related increase in alcohol selection was noted in the C3H strain.

Appetite for alcohol: influence of genetics and early experience.

Thirty male mice from three inbred strains (C57BL/10J, BALB/cJ, C3H/2Ibg) were assigned to infantile handling or control conditions. At sixty days of age, all animals were tested in a two-choice situation for selection of 10% ethanol vs. water. Consumption from both drinking tubes was recorded for 15 days and selection ratios for alcohol per total fluid volume were calculated. C57 mice demonstrated increased preference for alcohol as a result of early handling. The BALB strain, known for low preference for alcohol, showed increased preference for alcohol as well. C3H mice evinced a biphasic effect of early handling, showing an initially greater acceptance of alcohol as compared to controls, followed by decreased selection.