The concept of “baby lung”

Background The baby lung concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6-year-old child (300–500 g aerated tissue).Discussion The respiratory system compliance is linearly related to the baby lung dimensions, suggesting that the acute respiratory distress syndrome lung is not stiff but instead small, with nearly normal intrinsic elasticity. Initially we taught that the baby lung is a distinct anatomical structure, in the nondependent lung regions. However, the density redistribution in prone position shows that the baby lung is a functional and not an anatomical concept. This provides a rational for gentle lung treatment and a background to explain concepts such as baro- and volutrauma.Conclusions From a physiological perspective the baby lung helps to understand ventilator-induced lung injury. In this context, what appears dangerous is not the V_T/kg ratio but instead the V_T/baby lung ratio. The practical message is straightforward: the smaller the baby lung, the greater is the potential for unsafe mechanical ventilation.     

Positive thinking: An unfair burden for cancer patients?

This presentation challenges the purveyors of the importance of positive thinking in the cure of cancer. Psychological support should allow the patient to come to terms with his or her situation in a way that works for that individual within a caring and realistic environment. In no way should psychological support add an extra burden to an already devastated patient. By forcing positive mental attitude, health-care professionals are not allowing patients to face reality. Promoters of the cure that comes with positive thinking are quoted, as well as authors who question the promoters' intent and outcome. It is felt that positive thinking may be appropriate as one of many successful coping strategies. To attribute more to it or, worse, to insist that patients believe in its power to cure may be courting emotional disaster.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

A Computational Positron Emission Tomography Simulation Model for Imaging β-Amyloid in Mice

Purpose We aimed to develop a computational simulation model for -amyloid (A) positron emission tomography (PET) imaging.Procedures Model parameters were set to reproduce levels of A within the PDAPP mouse. Pharmacokinetic curves of virtual tracers were computed and a PET detector simulator was configured for a commercially available preclinical PET-imaging system.Results We modeled the effects of A therapy and tracer affinity on the ability to differentiate A levels by PET. Varying affinity had a significant effect on the ability to quantitate A. Further, PET tracers for A monomers were more sensitive to the therapeutic reduction in A levels than total brain amyloid. Following therapy, the decrease in total brain A corresponded to the slow rate of change in total amyloid load as expected.Conclusions We have developed a first proof-of-concept A-PET simulation model that will be a useful tool in the interpretation of preclinical A imaging data and tracer development.     

Effect of rational and irrational beliefs on intensity and “inappropriateness” of feelings: A test of rational—emotive theory

This study tested the central rational-emotive hypothesis that greater inappropriate emotional distress is caused by irrational rather than rational beliefs about undesirable situations. Ellis and Harper (1975) have suggested that inappropriate emotions (such as anger) differ qualitatively from appropriate emotions (such as annoyance). Previous research, however, indicates that irrational beliefs are associated with greater appropriate as well as inappropriate negative emotions. In this study, a 3 ×2 pretest—posttest factorial design was used, in which 10 undergraduates of either sex were randomly assigned to one of three treatments, which involved imagining being in a situation. The control condition comprised an emotionally neutral scene, while the two experimental treatments contained rational and irrational statements about being left alone by one's partner at a party. The experimental manipulation was successful, and both inappropriate and appropriate negative emotions were found to be greater in the irrational condition as compared to the neutral or rational condition. Thus irrational beliefs were shown to have an effect on emotions, but the emotions associated with irrational beliefs differed from those associated with rational beliefs in quantity rather than in quality.     

History of psychotherapeutic intervention in cancer patients

Several important aspects of the history of psychotherapeutic interventions in cancer patients, such as the historical role of the cancer personality, the change in the conceptualization of the mind-body relationship and the influence of medical progress and social developments, are discussed.Presented at the Symposium Psychotherapeutic Interventions in Cancer Patients, Flims, Switzerland, 12–14 January 1995     

Similarities between cognitive and humanistic approaches to psychotherapy

It is suggested that humanistic and cognitive therapies share some similar goals. Both see the employment of rigid absolutistic shoulds as generative of dysfunctional behavior. Both value self-acceptance, in the form of discouraging the client from forming negative overgeneralized trait-like self-judgements. Both value viewing one's failures and mistakes as part of a process of exploration and coping. Hypothesis-testing and holding constructs tentatively is also valued. At the level of practice some of Beck's cognitive strategies appear to help the client learn to stick to his/her moment to moment experiencing, and to be more phenomenological. Similarly Rogers' client-centered interventions appear to lay bare the client's negative self-statement process, and to counter and correct overgeneralized negative cognitions.     

Which is the abnormal lung?

A case of acute respiratory failure with congestive heart failure is described. Unilateral pulmonary edema with left ventricular failure was demonstrated by hemodynamic data, excluding the initial diagnosis of right-sided pneumonia. Controlateral pulmonary hyperlucency was due to a pulmonary embolism confirmed by a cut off on the angiographic X-ray. At autopsy total lung infarction was the confirmatory finding.     

Does psychological characteristic influence physicians’ communication styles? Impact of physicians’ locus of control on interviews with a cancer patient and a relative

Context Physicians psychological characteristics may influence their communication styles and may thus interfere with patient-centred communication.Objective Our aim was to test the hypothesis that, in interviews with a cancer patient and a relative, physicians with an external locus of control (LOC; who believe that life outcomes are controlled by external forces such as luck, fate or others) have a communication style different from that of physicians with an internal LOC (who believe that life outcomes are controlled by their own characteristics or actions).Design, setting, participants and intervention Eighty-one voluntary physicians practising in the field of oncology were recorded while performing an actual and a simulated interview with a cancer patient and a relative.Main outcome measures Physicians communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians LOC was assessed using the Rotter I–E scale. The communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Students t test.Results In actual interviews, physicians with an external LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an internal LOC. In simulated interviews, physicians with an external LOC used less utterances that give premature information (P=0.031) and used more utterances with a supportive function, such as empathy and reassurance (P=0.029), than physicians with an internal LOC.Conclusion These results provide evidence that physicians LOC can influence their communication styles. Physicians awareness of this influence constitutes a step towards a tailoring of their communication skills to every patients and relatives concerns and needs and thus towards a patient-centred communication.This research program was supported by the Fonds National de la Recherche Scientifique—Section Télévie of Belgium, the Fonds dEncouragement à la Recherche de lUniversité Libre de Bruxelles (Brussels, Belgium) and the CAM Training and Research Group (Brussels, Belgium).     

The effects of PEEP on arterial oxygenation

The effect of positive end expiratory pressure (PEEP) on arterial oxygenation depends on many factors. Two of the most important are the quality and the quantity of the physiological shunt. The quality depends on the mixed venous oxygen tension, and the quantity on the shunt fraction. Each of these factors may rise or fall with PEEP, depending on the pulmonary and circulatory state of the patient. Their ultimate balance influences the change in arterial oxygen tension.     

Non-invasive ventilation for cancer patients with life-support techniques limitation

Goals of work The study was conducted to determine the usefulness and efficacy of non-invasive ventilation (NIV) in cancer patients with life-support techniques limitation admitted for an acute respiratory distress, in terms of intensive care unit (ICU) and hospital discharges.Patients and methods A total of 18 consecutive cancer patients (17 with solid tumours and one with haematological malignancy) with life-support techniques limitation in acute respiratory failure and who benefited from NIV were included. NIV was provided with a standard face mask by the BiPAP Vision ventilator (Respironics Inc.). Variables related to the demographic parameters, SAPS II score, cancer characteristics, intensive care data and hospital discharge were recorded.Main results Complications leading to NIV were hypoxemic respiratory failure in 11 patients and hypercapnic respiratory failure in seven. Total median duration of NIV was 29 h. NIV was applied during a median of 2.5 days with a median of 16 h per day. Total median ICU stay was 7 days (range 1–21). Fourteen and ten patients were discharged from ICU and from hospital, respectively.Conclusion NIV appears to be an effective ventilation support for cancer patients with life-support techniques limitation.     

Enquête ethnobotanique: screening chimique et efficacité thérapeutique de quelques plantes utilisées contre le paludisme en médecine traditionnelle à Brazzaville

Résumé: Les effets antipaludiques des extraits de trois plantes de la pharmacopée traditionnelle congolaise, Cassia siamea, Cassia spectabilis, Tetracera alnifolia (sélectionnées à partir dune enquête ethnobotanique), ont été étudiés chez des malades (20 pour chaque extrait) présentant une goutte épaisse positive et une hyperthermie. Les grandes familles chimiques de lextrait le plus efficace ont été recherchées en utilisant les méthodes phytochimiques classiques. Lextrait aqueux de Cassia siamea a présenté leffet antipaludique le plus important (sur la parasitémie et lhyperthermie); cette intéressante activité du Cassia siamea pourrait sexpliquer par la présence des alcaloïdes et des quinones.     

In vitro activity of β-lactams and quinolones against AmpC β-lactamase-producing Escherichia coli

We studied the antimicrobial susceptibility of AmpC -lactamase-producing Escherichia coli isolates collected at ten medical institutions in the Kinki area of Japan during a 6-month period (November 2002 through April 2003). Of 2845 E. coli isolates tested, 29 (1.0%) showed a minimum inhibitory concentration (MIC) for cefazolin of more than 8µg/ml and were three-dimensional extract test positive. In standard inoculum susceptibility tests against these 29 strains, the MIC90s for the four carbapenems tested ranged from 0.06µg/ml to 0.5µg/ml, and these compounds were more active than the other -lactams, with meropenem being the most active. The MIC90s for -lactams, except carbapenems, ranged from 4µg/ml to 32µg/ml, with cefepime being the most active. In high inoculum susceptibility tests against these strains, the MIC90s for the four carbapenems and cefepime were 8µg/ml or less, and these compounds were more active than other -lactams. The MIC90s for -lactams, except carbapenems and cefepime, were 32µg/ml or more. The MIC90s for the five quinolones tested ranged from 4µg/ml to 16µg/ml, and the order of increasing susceptibility was ciprofloxacin > levofloxacin, gatifloxacin and pazufloxacin > prulifloxacin.     

Optimization of dose and dose regimen of biapenem based on pharmacokinetic and pharmacodynamic analysis

Pharmacokinetic and pharmacodynamic (PK/PD) parameters, which are important indices of the therapeutic efficacy of antimicrobials, and the minimum inhibitory concentration (MIC) predictive of clinical efficacy at common clinical doses, were examined for biapenem (BIPM; 300mg b.i.d.), imipenem/cilastatin (IPM/CS; 500mg/500mg b.i.d.), meropenem (MEPM; 500mg b.i.d.), and ceftazidime (CAZ; 1000mg b.i.d.), using a mouse model of thigh infection caused by Pseudomonas aeruginosa. The PK/PD parameter that most closely correlated with the therapeutic efficacy of all these antimicrobials was time above MIC (T MIC). The values of T MIC predictive of clinical efficacy against P. aeruginosa infection varied among antimicrobials and were 17%, 17%, 23%, and 33% for BIPM, IPM/CS, MEPM, and CAZ, respectively. From these values and the known plasma concentrations of the antimicrobials in humans after administration at the common clinical doses, the MIC for bacterial strains at which clinical efficacy can be expected was estimated to be 4.4µg/ml for BIPM, 6.1µg/ml for IPM/CS, 2.2µg/ml for MEPM, and 13.6µg/ml for CAZ. These MICs nearly coincided with the MIC₈₀ of the antimicrobials for 104 clinical isolates of P. aeruginosa strains. These results indicate that, even at a low dose, of 300mg b.i.d., the clinical efficacy of BIPM against P. aeruginosa infection can be expected to be comparable to that of IPM/CS, MEPM, and CAZ.     

Studies on the ultrastructure of blood cells and the microaggregate fraction in stored human blood

Electron microscopy of citrate-phosphatedextrose (CPD) buffered bank blood performed over 21 days shows that the normal architecture of erythrocytes, platelets and leucocytes disappears and that deformed organelles, leucocyte ghosts, cell fragments and microaggregates accumulate. Leucocytes and platelets emerge as the most sensitive indicators of blood deterioration showing profound morphological changes from the first day. Microaggregates which passed through a 20-m high capacity transfusion filter were identified as platelet conglomerates, leucocyte ghost and platelet-leucocyte ghost coaggregates with diameters of 6–20, 20–30 and 30–40 m respectively. of these aggregates present in the filtrate, 62% fell into the size range of 20–40 m. The composition of microaggregates varies with storage time, the platelet conglomerates appear first during or after Day 1, leucocyte ghosts after Day 5 followed by platelet-leucocyte ghost coaggregate formation. At this stage the number of intact leucocytes and platelets is reduced and the filtrate shows an abundance of leucocyte debris. Microfiltration would thus appear to reduce but not eliminate the danger of microembolism and damage to capillary endothelium.     

The Perceived Adjustment to Chronic Illness Scale (PACIS): a global indicator of coping for operable breast cancer patients in clinical trials

Subjective well-being is a major aspect of quality of life and is therefore increasingly used as an endpoint in clinical trials. It is influenced to a great extent by the complex process of coping with the disease and its treatment. Assessment of coping is methodologically demanding, especially in large clinical trials. We therefore developed a single-item measure, the Perceived Adjustment to Chronic Illness Scale (PACIS), as an indicator of coping, complementary to other scales related to quality of life. We sought to validate this instrument in a subgroup of 121 Swiss patients participating in the International Breast Cancer Study Group (IBCSG) adjuvant trials. At months 3 and 6 of adjuvant treatment PACIS showed a distinct pattern of highly significant rank correlations with several disease-and treatment-related problem areas from the Herschbach coping inventory (FBBK); 42% of the variance of PACIS at month 3 was explained by the FBBK (P=0.0001). The portion of explained variance was considerably higher for the Italian-(70%) than for the German-speaking (30%) subgroups. Patients who rated more effort to cope with their disease on PACIS indicated more frequent use of 3 of 15 coping strategies in relation to psychological distress. These were crying and becoming desperate, taking tranquillizers and alcohol and other people are far worse off. These three coping strategies may define a high-risk group for poor psychosocial outcome. Patients whose PACIS scores showed that it required less effort to cope tended to use the strategy seeing a positive side of the problem. We conclude that PACIS can be used as a global indicator of the coping process in large multicultural clinical trials of adjuvant therapy for breast cancer.Some of these data were presented at the postgraduate course: Current Concepts in Psycho-oncology IV, Memorial Sloan-Kettering Cancer Center New York, October 1991 [11]     

Discrepant views of oncologists and cancer patients on complementary/alternative medicine

Goals Complementary/alternative medicine (CAM) is widely used by patients but rarely discussed with oncologists. To understand reasons for the communication gap, this study compares physicians and patients on perceived reasons for CAM use and nondisclosure of use, reactions of physicians to disclosure, and expectations for CAM.Patients and methods Cross-sectional studies assessed 82 physicians (response 68.3%) and 244 of 374 outpatients (response 65.2%) identified as CAM users at the MD Anderson Cancer Center. Data were summarized by frequency and compared using chi-square tests.Main results Physicians were more likely (p<0.001) than patients to attribute CAM use to hope (²=17.7), control (²=17.5), incurable disease (²=42.8), or a nontoxic approach (²=50.9). Both physicians and patients agreed CAM could relieve symptoms/side effects, but physicians were less likely (p<0.001) than patients to expect that CAM improved immunity (²=72.2) or quality of life (²=17.1), cured disease (²=42.5), or prolonged life (²=58.4). Physicians and patients responded differently (p<0.005) on reasons for nondisclosure. Physicians believed patients felt CAM discussions were unimportant (²=7.9) and physicians would not understand (²=48.1), discontinue treatment (²=26.4), discourage or disapprove of the use (²=131.7); patients attributed nondisclosure to their uncertainty of its benefit (²=10.4) and never being asked about CAM (²=9.9) by physicians. Physicians were more likely (²=9.5, p<0.002) to warn of risks and less likely (²=23.5, p<0.001) to encourage use than patients perceived.Conclusion Oncologists and cancer patients hold discrepant views on CAM that may contribute to a communication gap. Nevertheless, physicians should ask patients about CAM use, discuss possible benefits, and advise of potential risks.     

Augmented inhibition of <Emphasis Type="Italic">Candida albicans</Emphasis> growth by murine neutrophils in the presence of a tryptophan metabolite,picolinic acid

The effects of picolinic acid (PLA), a product of tryptophan catabolism, on anti-Candida activity of neutrophils were studied. Casein-induced peritoneal neutrophils of C3H/He mice partially inhibited mycelial growth of Candida albicans when cultured with C. albicans for 16h in vitro. The growth inhibition of Candida was augmented by a combination of neutrophils and more than 4mM picolinic acid. Especially in the presence of 200U/ml murine interferon- (IFN-), 2mM picolinic acid augmented the anti-Candida activity of neutrophils. The physiological significance of the augmenting effects of picolinic acid is discussed.     

New aspects of pulmonary mechanics: ‘slowly” distensible compartments of the respiratory system,identified by a PEEP step maneuver

Objective The aims of the present study were 1) to evaluate a method for identification of slowly distensible compartments of the respiratory system (rs), which are characterized by long mechanical time constants (RC) and 2) to identify slowly distensible rs-compartments in mechanically ventilated patients.Design Prospective studyon a physical lung model.Setting Intensive Care Unit, University Hospital, Tübingen.Patients and participants 19 patients with severe lung injury (acute respiratory distress syndrome, ARDS) and on 10 patients with mild lung injury.Measurements and results Positive end-expiratory pressure (PEEP)-increasing and-decreasing steps of about 5 cmH₂O were applied and the breath-by-breath differences of inspiratory and expiratory volumes (V) were measured. The sequence of Vs were analyzed in terms of volume change in the fast compartment (V_fast), the slow compartment (V_slow), total change in lung volume (VL) and mechanical time constant of the slow compartment (RC_slow). Thirty-eight measurements in a lung model revealed a good correlation between the preset V_slow/VL and V_slow/VL measured: r²=0.91 The V_slow/VL measured amounted to 0.94±0.15 of V_slow/VL in the lung model. RC_slow measured was 0.92±0.43 of the RC_slow reference. Starting from a PEEP level of 11 cmH₂O PEEP-increasing and PEEP-decreasing steps were applied to the mechanically ventilated patients. Three out of ten patients with mild lung injury (30%) and 7/19 patients with ARDS (36.8%) revealed slowly distensible rscompartments in a PEEP-increasing step, whereas 15/19 ARDS patients and 1/10 patients with mild lung injury showed slowly distensible rs-compartments in a PEEP-decreasing step (78.9% vs 10%,P<0.002, chi-square test).Conclusions The gas distribution properties of the respiratory system can be easily studied by a PEEP-step maneuver. The relative contribution of the slow units to the total increase of lung volume following a PEEP step could be adequately assessed. Slowly distensible rs-compartments could be detected in patients with severe and mild lung injury, however significantly more ARDS patients revealed slow rs-compartments in PEEP-decreasing steps. The influence of slowly distensible rs-compartments on pulmonary gas exchange is unknown and has yet to be studied.The work was performed at the Klinik für Anaesthesiologie und Transfusionsmedizin der Universität Tübingen     

Early evaluation of coagulase negative staphylococcus in blood samples of intensive care unit patients

Of 2160 intensive care unit patients, 36 patients with positive blood cultures had coagulasenegative staphylococcus in one blood bottle, whereas the organism was present in two or more bottles in 38 cases. The groups were not significantly different in 27 clinical variables, obtained at the time of their first positive blood culture. There was also no significant difference in the antimicrobial sensitivities. No initial clinical data supported the classification of coagulase-negative staphylococcus as either pathogen or contaminant.When the 74 patients with blood culture positive coagulase-negative staphylococcus were compared with three control groups (absent septicemia, probable septicemia and proven septicemia) they were not different from those with probable septicemia. A discriminant analysis was performed comparing patients with absent septicemia and with proven septicemia in an attempt to classify patients with isolates of coagulase-negative staphylococcus in one of these groups at an early stage. Patients with two or more positive blood cultures were not statistically classified more frequently as septicemic than patients with one blood bottle positive for this organism. However, patients categorized as septicemic had a significantly higher mortality (59%) than those classified as non-septicemic (35%) (p<0.05).     

The “lung pulse”: an early ultrasound sign of complete atelectasis

Objective Complete atelectasis can be immediately generated by selective intubation. A dynamic lung ultrasound sign can be described as the association of absent lung sliding with the perception of heart activity at the pleural line, a sign which was called lung pulse. We examined whether this sign be used promptly to confirm complete atelectasis due to selective intubation.Design and setting Prospective study in the medical intensive care unit of a university-affiliated teaching hospital.Patients Consecutive patients with no history of respiratory disorders and needing intubation were enrolled. Fifteen patients with selective intubation of the right lung were compared with 30 patients with nonselective intubation and 15 healthy volunteers.Interventions The lung pulse was sought at the left anterolateral chest wall in intubated patients. Healthy subjects were studied during breathing and apnea.Results A left lung pulse was immediately present in 14 of 15 patients with right selective intubation, and absent, with normal lung sliding, in all 30 correctly intubated patients and in all 15 healthy subjects during breathing. All healthy subjects exhibited a lung pulse in apnea. The lung pulse had a sensitivity of 93% and a specificity of 100% for the diagnosis of complete atelectasis following selective intubation in patients without previous respiratory disorders.Conclusions The lung pulse is a sign of complete atelectasis which is observable immediately before radiological changes. Its absence which is correlated with the absence of selective intubation and of conserved lung inflation can eliminate the need for confirmation radiography.Electronic Supplementary Supplementary material is available in the online version of this article at .