Molecular analysis of Trichomonas gallinae in racing pigeons from Upper Silesia, Poland.

The aim of the study was the molecular analysis of ITS1/5.8S rRNA/ITS2 region of Trichomonas gallinae isolates from racing pigeon lofts in Upper Silesia, Poland. The analysed region is very useful for the taxonomy of the Trichomonadidae family and indicates the possible existence of different genotypes or species within the T. gallinae. A comparison of the complete ITS1-5.8S-ITS2 region of obtained sequences revealed two different sequences. Twenty-three of the isolates (62%) showed the first sequence (KU954106) while fourteen isolates (38%) showed the second sequence type (KU954107), which were homologous with sequences from Genbank. The phylogenetic analysis showed that the two T. gallinae genotypes which occurred in the pigeons from Upper Silesia are widespread among European countries.

Change on the horizontal and vertical meridians of the cornea after cataract surgery.

PURPOSE: To compare the course and magnitude of change on the horizontal and vertical meridians of the cornea after 5 different incisions for cataract: extracapsular cataract extraction (ECCE), 6 mm superior scleral tunnel (6Sup), 3 mm superior scleral tunnel (3Sup), 3 mm temporal scleral tunnel (3Temp), and 3 mm temporal corneal incision (3Cor). METHODS: Retrospective chart review of 665 cases of preoperative regular astigmatism. The preoperative keratometry (K) reading was subtracted from the postoperative K reading to determine mean net change on each meridian at 1 day, 1 week, 2 weeks, 1 month, 1.5 months, 2 months, 4 months, 6 months and 12 months and at 6 month intervals thereafter. After the superior incisions, the temporal changes on each meridian are well described by an analytic model with an initial and final plateau. The changes after the temporal incisions are described by a linear equation. RESULTS: After each superior incision, the steepness and length of the transition from the initial to final plateau for each meridian depend on incision length. Considering the uncertainty of measuring K, the corneal meridians stabilized 4.5 months after ECCE, 1.2 months after 6Sup, and 0.3 months after 3Sup. No significant change was detected on the horizontal and vertical meridians after 3Temp and 3Cor. CONCLUSION: The magnitude and the duration of changes on the horizontal and vertical meridians of the cornea after cataract surgery depend on both incision length and location. Small temporal incisions induce less change than superior incisions.

An evaluation of an acuity system as it applies to a cardiac catheterization laboratory.

Patient care using patient volume rather than acuity has been a long-standing problem in a cardiac catheterization laboratory in a central New Jersey Medical Center. The current pattern of staffing results in some of the nursing staff becoming unproductive from a patient care perspective. This recently has become a concern of the Vice President of Nursing who has the unpopular task of consolidating nursing positions. There is a very effective acuity measurement system, the Medicus Acuity System, in place for the various inpatient areas. This system also exists in the Emergency Department and is called EMERGE. The system collects and objectively weighs information regarding severity of patient needs or acuity. These data are collected daily and provide unit managers with information regarding hours of direct nursing care on their particular units. The information over time shows trends in direct care hours and allows these managers to target the average patient population. The system gives insight into units that require more and less nursing hours by hour of the day, day of the week, and month of the year. This makes overall housewide use of nursing personnel more patient-care appropriate and more financially sound, for example, in the summer months when acuity is shown to be higher. In today's managed care environment this author believes the practice of staffing units based on bed occupancy is now regarded as antiquated, inefficient, and impractical. This study investigated a modified version of the EMERGE tool and its ability to capture patient acuity as it relates to staffing in the cardiovascular laboratory (CVL). During the 5 days of data collection, 87 patients were cared for in the CVL. The modified EMERGE cards were completed on 54 of the 87 patients that week. This represented 62% of that total patient population. Each day data for 60% or more of the patients were entered into the study. The interrater reliability of the data collected was better than 98% each day with overall accuracy being 99.5%. This interrater reliability was based on the findings by the expert panel, who compared two or three (approximately 10%) of the actual nurses' notes to the matching EMERGE cards each day. More than 80% of the 54 patients were classified as Type 3, well above the Type 1 standard patient acuity category for the EMERGE system. Telemetry units with a majority of EMERGE Type 3 patients would require between 50 to 100 minutes of care per visit and would have a significant nursing workload. These units are where the CVL draws most of their patient population. In summary, this study reflects a growing trend in healthcare that requires justification of staffing through the productivity of workers. Acuity tools provide tangible and objective data about daily workload and productivity by measuring patient's needs. As managed care forces hospitals to cutt staff, acuity tools will become more important for evaluating productivity and retaining staff, especially nurses.

Comparison of the findings on preoperative dipyridamole perfusion scintigraphy and intraoperative transesophageal echocardiography: implications regarding the identification of myocardium at ischemic risk.

The evidence of myocardium at potential ischemic risk on preoperative dipyridamole perfusion scintigraphy was compared with that of manifest ischemia on intraoperative transesophageal echocardiography in 26 patients at high risk of a coronary event undergoing noncardiac surgery. The clinical outcome was also assessed. Induced intraoperative wall motion abnormalities were more common in patients and myocardial segments with, than in those without, a preoperative reversible perfusion defect (both p less than 0.05). Conversely, a preoperative reversible perfusion defect was more common in patients and segments with, than in those without, a new intraoperative wall motion abnormality (both p less than 0.05). Six patients, five with a reversible scintigraphic defect but only three with a new wall motion abnormality, had a hard perioperative ischemic event. Events occurred more often among patients with, than in those without, a reversible perioperative scintigraphic defect (5 [33%] of 15 vs. 1 [9%] of 11) but this difference did not reach significance (p = 0.14), probably owing to the sample size. Intraoperative wall motion abnormalities were all reversible and did not differentiate between risk groups; these findings were possibly influenced by treatment. These preliminary data support the known relation between reversible scintigraphic defects and perioperative events and identify another manifestation of ischemic risk in the relation between reversible scintigraphic defects and induced intraoperative wall motion abnormalities. The value of intraoperative echocardiography in identifying ischemia and guiding therapy in patients with a reversible scintigraphic abnormality should be further assessed.

Comparison of transesophageal echocardiographic and scintigraphic estimates of left ventricular end-diastolic volume index and ejection fraction in patients following coronary artery bypass grafting.

Transesophageal echocardiography (TEE) has become a commonly used monitor of left ventricular (LV) function and filling during cardiac surgery. Its use is based on the assumption that changes in LV short-axis ID reflect changes in LV volume. To study the ability of TEE to estimate LV volume and ejection immediately following CABG, 10 patients were studied using blood pool scintigraphy, TEE, and thermodilution cardiac output (CO). A single TEE short-axis cross-sectional image of the LV at the midpapillary muscle level was used for area analysis. Between 1 and 5 h postoperatively, simultaneous data sets (scintigraphy, TEE, and CO) were obtained three to five times in each patient. End-diastolic (EDa) and end-systolic (ESa) areas were measured by light pen. Ejection fraction area (EFa) was calculated (EFa = (EDa - ESa)/EDa). When EFa was compared with EF by scintigraphy, correlation was good (r = 0.82 SEE = 0.07). EDa was taken as an indicator of LV volume and compared with LVEDVI which was derived from EF by scintigraphy and CO. Correlation between EDa and LVEDVI was fair (r = 0.74 SEE = 3.75). The authors conclude that immediately following CABG, a single cross-sectional TEE image provides a reasonable estimate of EF but not LVEDVI.

Transesophageal echocardiography and its potential for esophageal damage.

The purpose of this study was to determine whether the pressure produced by contact between a transesophageal echocardiography (TEE) probe and the esophagus was sufficient to cause esophageal damage. The authors studied the effects of sustained contact and associated surface pressure on the esophagus by a TEE probe in anesthetized dogs and humans. Contact pressure between the tip of the probe and the esophageal wall in dogs was measured using a previously described flat balloon of Silastic fitted to the end of a TEE probe and the recording system calibrated with a mercury manometer. In the dog studies, the probe was inserted, maximally flexed, and its position fixed for 4, 6, 8, and 12 h. The maximum surface pressure generated by contact between a probe and the esophageal wall was 10 mmHg. Subsequent pathologic studies failed to reveal either gross or microscopic evidence of tissue damage. The same system was used in short-term patient studies with the surface contact pressure transducer connected to a Camino Catheter 420 Digital Pressure Monitor. In five of six patients contact pressure was less than 17 mmHg despite maximal rotation of the TEE controls. However, one of the six patients developed very high contact pressure, up to 60 mmHg, between the probe and the esophagus. This patient had no history of esophageal disease but did have intrathoracic pathology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Respiratory distress syndrome in adults]. / Zespól niedomogi oddechowej doroslych.

The pathogenesis of the adult respiratory distress syndrome is described discussing the present state of knowledge on this problem. The diagnostic problems and the modern therapeutic possibilities are mentioned.

[Drownings]. / Utoniecia.

The epidemiology of drowning is described discussing the pathological mechanism of death during drowning, mentioning the characteristic types of drowning and outlining the main principles of treatment of drowned subjects.

Carcinoembryonic antigen in hepatocellular cancer.

Serum carcinoembryonic antigen (CEA) concentrations were found to be raised in 28 of 72 black patients (39%) with hepatocellular cancer (HCC). The degree of elevation was slight or moderate, except in 3 patients in whom values greater than 20 ng/ml were recorded. No significant correlation could be demonstrated in individual patients between the serum CEA concentration and various tests of liver function. The mean CEA value in the patients with cirrhosis in the non-tumorous liver was slightly higher than that in those without cirrhosis, but the difference did not reach statistical significance. There was no correlation between serum CEA and alpha-foetoprotein (AFP) levels.

Hepatitis B surface antigen produced by a human hepatoma cell line.

The human hepatoma cell line, PLC/PRF/5, was shown to produce hepatitis B surface antigen (HBsAg). Immunologically reactive material was present in the supernatant tissue culture medium in significant amounts, and was associated with spherical particles approximately 20 nm in diameter. The rate of antigen production by the cells was estimated at 500 ng/day/10(6) cells by reference to a purified HBsAg standard. All immunological activity was neutralized by specific antibody and the subtype was ad. The studies reported here broaden the scope of investigations on both the in vitro production of HBsAg and the association between this antigen and primary liver cancer.

Hepatitis-B surface antigen and antibody in Bantu patients with primary hepatocellular cancer.

Hepatitis-B surface antigen (HBsAg) was found in the serum of 58 of 158 (36-4%) southern African Bantu patients with primary hepatocellular cancer by counter immunoelectrophoresis and in 94 (59-5%) by radioimmunoassay (RIA). The prevalence of this antigen in the general Bantu population using these methods was 7% and 9% respectively. Antibody against HBsAg was detected in 11-6% of the patients by passive haemagglutination (PH) and 13-4% by RIA, and in 33-4% (by PH) of a control population. Antibody sub-types were predominantly "adw" (69-2%) with a lesser frequency of "ayw" (23%), while 7-8% were indeterminate. The corresponding figures in the controls were 80-4, 8-4 and 11-2%. HBsAg was more common in younger patients. No relationship could be demonstrated between hepatitis-B antigenaemia and the presence of alpha-foetoprotein in high concentration, although there were far fewer patients in the alpha-foetoprotein-negative group.