Detection of bronchial abnormalities: comparison of CT and bronchoscopy

We evaluated the usefulness of CT as compared with both visual and pathologic findings from fiberoptic bronchoscopy (FOB) in detecting bronchial lesions in 100 consecutive patients undergoing both procedures. There was agreement between CT and visual FOB in 83% of cases and CT and pathologic FOB in 68%. In the malignant disease category CT detected bronchial abnormalities in 59% (27 of 46) as compared with 57% (26 of 46) by visual FOB; both agreed in 81% of the cases (37 of 46). On the basis of CT findings alone, we retrospectively divided the cases into those for which we expected FOB to have high diagnostic yield (peribronchial abnormalities, n = 49) and a low diagnostic yield (i.e., no bronchial abnormality, n = 51). For the malignant disease category, selection by CT findings resulted in successful diagnosis by FOB in 69% for the high yield group as compared with 29% for the low yield group. We conclude that CT has excellent correlation with visual and pathologic results of FOB in detecting bronchial abnormalities and that CT, when used as an initial screening test, can enhance the yield by allowing appropriate selection of patients.     

Transthoracic needle biopsy of the hilum and mediastinum

TNB of hilar and mediastinal masses is both safe and useful. It has a high diagnostic yield, can be performed in practically all areas of the mediastinum, and appears to be no more hazardous than needle biopsy of the lung. In healthy patients, it can be performed as an outpatient procedure. TNB makes it possible to avoid surgery and mediastinoscopy in patients with unresectable malignant neoplasms and in many patients with innocuous benign mediastinal lesions. The ease and safety of TNB may make it the preferred initial procedure for diagnosing and staging patients with mediastinal masses of unknown etiology.     

High spatial resolution automated perimetry in glaucoma

BACKGROUND—Automated perimetry is of fundamental importance in assessing visual function in glaucoma. A technique was evaluated to perform high spatial resolution automated perimetry to allow a more detailed assessment of the luminance sensitivity in selected regions of the visual field than is possible with conventional perimetry.
METHOD—High spatial resolution perimetry was performed using a Humphrey automated perimeter by measuring luminance sensitivity across a 9 by 9 degree custom grid of 100 test locations with a separation between adjacent locations of 1 degree. Quantitative analysis of the raw and Gaussian filtered thresholds was performed to assess the repeatability of the technique in normals, glaucoma suspects, and glaucoma patients.
RESULTS—The testing protocol was well tolerated by all subjects. High spatial resolution perimetry in glaucomatous eyes demonstrated fine luminance sensitivity loss not suspected with conventional perimetry. High spatial resolution perimetry also demonstrated reproducible areas of sensitivity loss in some glaucomatous eyes in areas of the visual field which appear normal with conventional programmes. The repeatability of the technique correlated with mean threshold sensitivity and was substantially improved to clinically acceptable levels by Gaussian filtering the thresholds.
CONCLUSION—This technique of high spatial resolution perimetry allows the practical assessment of selected regions of the visual field at higher resolution than conventional perimetry, and may be clinically useful in glaucoma.

     

Strategy for urinary protein analysis

SUMMARY: Recent studies have highlighted the intrinsic toxicity of filtered proteins and their contribution to deterioration of renal function. In-depth analysis of proteinuria may assess the degree of glomerular and/or tubular involvement and help in the prognostication of an individual patient. One should consider not only the quantity but also the quality of the urinary protein. Apart from quantitating the total urinary protein, assessment of the quality of the protein may be achieved by performing sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) for an overview assessment follow by automated nephelometry or simple radial immunodiffusion measurement of specific proteins for calculating the selectivity index and detecting tubular dysfunction.     

Zinc absorption and exchangeable zinc pool sizes in breast-fed infants fed meat or cereal as first complementary food.

BACKGROUND: The aims of this study were to compare the absorption efficiency of zinc from rice cereal and meat, with and without human milk, in 7-month-old breast-fed infants and to compare the size of exchangeable zinc pools in the infants according to the assigned complementary food. METHODS: Fractional absorption of zinc was measured in male infants using extrinsic labeling with a stable isotope of zinc in a test meal of either pureed beef (n = 9) or iron-fortified infant rice cereal (n = 9). The effect on fractional absorption of the addition of human milk to each complementary food was measured in each infant with a second oral zinc isotope. Fractional absorption was measured using fecal monitoring of isotope excretion, and exchangeable zinc pool size was calculated from isotopic enrichment in urine. RESULTS: Fractional absorption of zinc did not statistically differ between the beef (0.41 +/- 0.11) and cereal (0.36 +/- 0.05) test meals, although the trend showed that beef had higher fractional absorption than cereal. The higher intake of zinc from the beef versus cereal test meal resulted in a 16-fold greater amount of absorbed zinc ( P = 0.0002). The addition of human milk caused significant decreases in fractional absorption of zinc (0.07 +/- 0.02, P = 0.01) and absorbed zinc (0.04 +/- 0.01 mg, P < 0.0001). The size of the exchangeable zinc pool did not differ according to group but was strongly correlated with mean daily zinc intake ( r = 0.72, P = 0.003). CONCLUSIONS: These results confirm that meat as a complementary food for breast-fed infants can provide a rich source of dietary zinc that is well absorbed. The significant positive correlation between zinc intake and exchangeable zinc pool size suggests that increasing zinc intake positively affects metabolically available zinc.     

A comparison of the nursing competence of graduates and diplomates from UK nursing programmes

This paper reviews the literature on nursing competence measurement and reports the results of a comparative quantitative study of the competencies of Project 2000 diplomates and BA (Hons) Adult Nursing graduates from two UK nursing programmes. The findings reveal that graduates appear to overcome any initial limitations and become more competent than the diplomates in certain areas. Attention to social awareness and participation is necessary in both pre-registration programmes, whilst greater attention could be given to graduates' leadership and management development. Diplomates need support in their professional development if they are to achieve the same level of competence as graduates during the first post-qualifying year. There are implications for the level of support afforded to qualifying nurses in their first staff positions; preceptorship programmes could be an important means of assisting newly qualified staff to gain confidence. More research on nurse competencies with larger samples drawn from programmes across the UK is needed.