Non-directed bronchial lavage is a safe method for sampling the respiratory tract in critically ill patient.

Ventilated patients are at risk of acquiring ventilator-associated pneumonia. Various techniques are available for diagnosing ventilator-associated pneumonia including bronchoalveolar lavage, protected specimen brush and non-directed bronchoalveolar lavage. There is a paucity of evidence regarding the safety profile of these techniques, particularly non-directed bronchoalveolar lavage. This service evaluation aimed to establish whether non-directed bronchoalveolar lavage is a safe procedure. A prospective service evaluation of non-directed bronchoalveolar lavage on our adult intensive care unit was undertaken by a senior physiotherapist trained into carrying out the procedure, measuring pre- and post-procedure vital signs including heart rate (HR), tidal volume (VT), systolic blood pressure (SBP) and pulse oximetry (SpO2). Eighty-five episodes in 41 patients were included in the evaluation. There was a statistically significant difference between pre- and immediately post-procedure recordings for all vital signs measure. HR (min-1), means (SD) 87.1 (16.4), 91.5 (16.5), 87.5 (15.9), 87.7 (15.7) respectively pre, immediately, 5 min after and 30 min after procedure (P < 0.01). SBP mmHg, means (SD) 133.9 (26.1), 142.1 (25.6), 136.9 (25.3), 134.8 (23.4) pre, immediately, 5 min and 30 min after procedure (P < 0.01). VT mL, median (range) 0.523 (0.118-1.180), 0.512 (0.131-1.05), 0.519 (0.104-0.95), 0.534 (0.110-1.080) each pre, immediately, 5 min and 30 min post procedure (P < 0.05). SpO2 %, median (range) 98 (89-100), 100 (96-100), 98 (92-100), 97 (90-100) again each pre-, immediately post, 5 and 30 min post-procedure time-points (P < 0.0001). The statistically significant difference was not detected between pre-, 5 or 30 min post-procedure time-points. None of the changes observed were clinically significant and no untoward events happened to any of the subjects included. Non-directed bronchoalveolar lavage is a safe and inexpensive procedure that can be carried out easily in an intensive care setting by a trained physiotherapist, avoiding the need for invasive bronchoscopy.

Coping effectiveness: determinants and relevance to the mental health and affect of family caregivers of persons with dementia.

Family caregivers of persons with dementia (n = 141) rated their effectiveness in coping with a challenging symptom displayed by their relative, and completed measures of their ways of coping, their general (optimism) and specific (caregiving self-efficacy) outcome expectancies, their affect (positive and negative), and the mental health subscale of the SF-36. Hierarchical regression analyses revealed that coping effectiveness is more highly influenced by relatively stable outcome expectancies than by the ways of coping that are employed. In addition, optimism exerted a consistent and relatively strong impact on affect and mental health, overshadowing the influence of coping and judgments of its effectiveness. However, coping effectiveness not only had a significant main effect on the caregivers' mental health and negative affect, but also served a stress buffering function by reducing negative affect.

Cutaneous inoculation tuberculosis in a child.

Cutaneous tuberculosis remains a rare entity in the United States. We describe a case of cutaneous tuberculosis in a child.

Isolation of Bartonella (Rochalimaea) henselae: effects of methods of blood collection and handling.

Bartonella (Rochalimaea) henselae causes cat-scratch disease, bacillary angiomatosis, peliosis hepatis, and fever in humans. B. henselae can be difficult to culture axenically, and as many as 5 weeks may be required before colonies are visible. We compared how different methods of blood collection and handling affect isolation of this pathogen. Blood specimens from B. henselae-infected cats were collected in both EDTA and Isolator blood-lysis tubes and were subsequently plated onto rabbit blood-brain heart infusion agar by using three different schedules: plating immediately, plating after 24 h at 25 degrees C, and plating after 26 days at -65 degrees C. Colonies were counted 14 and 35 days after plating. Blood collected in tubes containing EDTA, frozen at -65 degrees C, and then plated on blood agar yielded a median of 60,000 CFU/ml, compared with 25,333 CFU/ml after collection in the Isolator tubes (P < 0.01). Frozen blood yielded the largest number of B. henselae colonies for any of the schedules tested. These results support previous observations that the Isolator system is more sensitive than tubes containing EDTA for isolation of B. henselae and suggest that, for cat blood, collection in tubes containing EDTA and subsequent freezing may further improve the sensitivity of detection of B. henselae.

Survey of veterinary professionals and other veterinary conference attendees for antibodies to Bartonella henselae and B quintana.

OBJECTIVE: To determine serologic and epidemiologic characteristics of an occupational group potentially at risk for Bartonella sp infection. DESIGN: Epidemiologic survey. SAMPLE POPULATION: 351 veterinarians, veterinary technicians, and other individuals attending a veterinary conference in Ohio. PROCEDURE: A serum sample was obtained from each individual and tested for antibodies to Bartonella henselae or B quintana. A 24-question survey also was administered regarding demographic, occupational, and exposure information. RESULTS: 25 (7.1%) individuals were seropositive for B henselae or B quintana. Forty-seven, of whom 5 were seropositive, reported a history of illness consistent with cat-scratch disease and 18, of whom 3 were seropositive, reported a previous diagnosis of cat-scratch disease. Of the variables analyzed, only years of experience with cats was correlated with seropositivity. CLINICAL IMPLICATIONS: The overall seroprevalence for 2 species of Bartonella in this occupational group was only slightly higher than that reported from other surveys. Seroprevalences among veterinarians, veterinary technicians, hospital staff, and others were essentially identical. Small sample groups, high percentage of cat ownership among participants, unknown duration of seropositivity, and unknown prevalence of infection among cats were potential confounders.

Experimentally induced Bartonella henselae infections followed by challenge exposure and antimicrobial therapy in cats.

OBJECTIVES: To elucidate kinetics of Bartonella henselae bacteremia and IgG response, evaluate antibiotic therapy, and investigate challenge exposure in cats. ANIMALS: Specific-pathogen-free cats. PROCEDURE: Cats were inoculated with B henselae or B quintana and monitored. Convalescent cats were challenge exposed with B henselae. Amoxicillin, enrofloxacin, erythromycin, and tetracycline HCl were evaluated for effect on B henselae bacteremia. RESULTS: Cats developed B henselae bacteremia within 1 week; bacteremia persisted for longer than 2 months before subsiding spontaneously. IgG antibody titer developed shortly after onset of bacteremia; antibody co-existed with bacteremia for several weeks and remained detectable after bacteremia subsided. Cats inoculated with B quintana remained abacteremic. On challenge exposure to B henselae, cats previously infected with B henselae remained abacteremic; cats previously inoculated with B quintana supported B henselae infection. Tetracycline HCl and erythromycin depressed B henselae bacteremia; however, duration of bacteremia remained similar to that in untreated cats. Obvious signs of illness were not observed. CONCLUSIONS: Long-duration, high-titer B henselae infections were highly reproducible in cats. Convalescent cats were immune to reinfection. B quintana-inoculated cats did not have evidence of infection and were susceptible to B henselae challenge exposure. Antibiotic therapy was incompletely efficacious in terminating cat bacteremia. CLINICAL RELEVANCE: A cat with an inapparent B henselae infection must provisionally be regarded as a possible reservoir for infection for a minimum of 2 to 3 months. Convalescent cats are resistant to reinfection. Usual antibiotic therapy was not completely efficacious. Measurement of IgG antibody can be used to detect past or current infection.

Cluster of five children with acute encephalopathy associated with cat-scratch disease in south Florida.

Between August 12 and September 27, 1994, five children in South Florida were hospitalized at a single hospital because of encephalopathy, presenting as status epilepticus, associated with cat-scratch disease (CSD). Diagnoses were confirmed by using an indirect fluorescent antibody test to detect antibody to Bartonella henselae, the causative agent of CSD. These cases represent the first cluster of CSD encephalopathy cases to be recognized in the United States. The patients lived within 7 miles of each other and all reported contact with pet or stray cats before developing regional lymphadenopathy and encephalopathy. All recovered fully. A high proportion of 124 cats from the local area were seropositive (62%) or bacteremic (22%). This study suggests that B. henselae can be associated with geographically focal clusters of CSD encephalitis and should be considered in the evaluation of children with acute encephalopathy.

Epidemiologic observations on infection with Rochalimaea species among cats living in Baltimore, Md.

Cats from several sources in Baltimore, Md, were tested for seropositivity to Rochalimaea henselae and R quintana. Co-infection with Toxoplasma gondii or feline immunodeficiency virus was assessed as a risk factor for infection with Rochalimaea spp. Of 592 cats tested, 87 (14.7%) were seropositive for one or both Rochalimaea spp, although titers to R henselae were significantly higher than those to R quintana. Prevalence of seropositivity increased significantly with cat age and weight and was associated with seropositivity to T gondii but was not associated with gender. Prevalence of seropositivity was similar (12.5 to 14.4%) among groups of cats with some history of human contact but was higher among feral cats (44.4%). Whether cats are reservoirs or mechanical vectors of Rochalimaea spp that can cause diseases in people is still uncertain, but these findings indicated widespread infection of cats and suggested possible modes of transmission for Rochalimaea spp among cats.

Animal-associated opportunistic infections among persons infected with the human immunodeficiency virus.

A number of animal-associated infections occur in persons infected with the human immunodeficiency virus (HIV), including those due to Toxoplasma gondii, Cryptosporidium, Microsporida, Salmonella, Campylo-bacter, Giardia, Rhodococcus equi, Rochalimaea, and Listeria monocytogenes. Most of these infections, with the exception of those due to Rochalimaea, appear to be acquired by the immunosuppressed individual from sources other than exposure to animals. Drs. Glaser and colleagues review our current understanding of the role of exposure to animals, especially pets, in the natural history of these opportunistic infections. They suggest that the risk of zoonotic transmission is small and offer practical suggestions designed to reduce this low risk. They conclude that the benefits of animal companionship outweigh the risks to patients and that prohibition of pet ownership by individuals infected with HIV is not warranted.

Medical ultrasound imager based on time delay spectrometry.

A reflection mode proof-of-concept medical ultrasound imager based on time delay spectrometry has been developed and tested. The system uses a broad band swept-frequency signal operating up to 10 MHz. Signal processing using a fast Fourier transform (FFT) permits extraction of range information. The imager has a higher signal-to-noise ratio than pulse-echo systems which allows high resolution at greater depths. The time delay spectrometry (TDS) spread spectrum operates at lower peak intensities than pulse-echo and permits more control of the spectral content and amplitude of the signal. At present, the system is non-real time which degrades in vivo imaging because of averaging over several cardiac cycles and tissue movement.

Noninvasive assessment of atherosclerosis.

The application of ultrasound to clinical evaluation of the symptomatic patient requires less precision and accuracy than when it is used as an instrument to study atherogenesis. The clinician's goal is to locate hemodynamically significant lesions; studies of atherogenesis require auxometry (measurement of the growth of lesions) and the instruments used must have a sensitivity matched to an average growth rate that can be expected in a general population. This dictates that ultrasound equipment be designed specifically for high resolution imaging and the target vessels of choice appear to be the carotid arteries. Correlations of disease patterns among various vessel beds indicate that inferences can be made between coronary and carotid vessels on a population level, but should not be made on an individual basis. While the ultimate goal of the cardiologist is to be able to do repetitive, accurate, noninvasive scanning of coronary arterial lesions, present technology limits us to making such inferences about coronary disease from the best available substitute. The carotid appears to be the artery of choice for this purpose because of its proclivity toward developing the disease and its ready availability for clinical scanning. It is an important target in its own right, and should be of interest to cardiologists given the likelihood that the coronary bypass patient will tend to develop atherosclerosis in the cerebral system. The ideal noninvasive imaging equipment for today's clinician is one which offers flexibility in being able to image various vessel beds with the same transducer head. This flexibility, however, may not be appropriate for equipment which is designed for auxometric application. Rather, lesion tracking image systems will need to be designed for narrow application: all variables will be controlled to maximize precise visualization of the carotid artery. If we were to project an ideal, hypothetical carotid scanning device to track lesion change over one year, it would probably have the following characteristics: It would be a B-mode imaging system rather than a Doppler in favor of ther increased axial resolution offered by B-mode. It would function at 8 MHz to 10 MHz to provide maximum axial resolution. The crystal would be the maximum size permitted by anatomy. The near/far field transition would be focused at the depth of the carotid (1 cm to 2 cm) to offer maximum azimuthal resolution. The system would utilize a head positioner to orient the patient's neck the same way on repeat scans.(ABSTRACT TRUNCATED AT 250 WORDS)

Velocity and attenuation of sound in arterial tissues.

The velocity and attenuation of sound has been determined for freshly excised human and canine arterial tissues using a time delay spectrometer (TDS) technique. Frequency was swept from 0 to 10 MHz with data being taken in the range from 2 to 10 MHz. The velocity was determined using a comparison of the time delay for the received signal between a water path and a sample tissue of measured thickness. The velocity of sound was measured for various pathologies and related to biochemical assays of tissue. It was found to increase with increasing ultrasound attenuation of the tissue. The velocity was shown to increase with increased collagen, C, expressed as a percentage of wet weight of the tissue, [V = 17.8* C + 1561 m/s at 37 degrees C, r = 0.77] but was strongly dependent on tissue cholesterol or low levels of calcium. For highly calcified lesions, the velocity of sound was found to be approximately 2000 m/s at 37 degrees C.

Effects of ultrasound on catalase and malate dehydrogenase.

Catalase and malate dehydrogenase (MDH) were subjected to the sound field produced by a transversely oscillating wire driven at 20 kHz. Catalase was not inactivated under any conditions of sonication whereas MDH inactivation increased exponentially with the duration of sonication and depended upon the initial enzyme concentration. The inactivation was not the result of collapse cavitation or thermal inactivation and was probably related to the presence of acoustic microstreaming.

Effect of ultrasound on a bilayer lipid membrane.

The effects of continuous wave ultrasound at a frequency of 1 MHz in the intensity range of 0-1.4 W/cm2 on an oxidized cholesterol bilayer lipid membrane (BLM) were observed. Ultrasound at 1.5 W/cm2 broke the membrane; in the range from 0.5 to 1.4 W/cm2, it accelerated the draining of the bulk lipid solution from the annulus to the Teflon support. At all intensities it has no effect on the conductance, the capacitance, or the dependence of each on the voltage applied across the membrane. Electrical parameters were measured in the presence of aqueous solutions of NaCl, KCl, and distilled water. The motivation and results of this project are explained in relation to an overall objective of determining the specific effects of ultrasound on biological membranes.

Hemolysis near an ultrasonically pulsating gas bubble.

A small volume of an erythrocyte suspension was subjected to the action of a manipulated gas bubble set into stable oscillation at 20 kilohertz. Release of hemoglobin occurred when the oscillation amplitude exceeded a critical threshold. Hydrodynamic stresses resulting from acoustically induced small-scale eddying motion near the bubble may be the mechanism of hemolysis.