A computerized mass spectrometer and flowmeter system for respiratory gas measurements

Instrumentation systems for breath-to-breath analysis of respiratory gas exchange have been faulted by phase lags between various flow and composition signals and by difficulties in gathering and processing large amounts of data. The system described here represents an attempt to overcome these problems. Phase delays have been minimized by using a direct, piezoelectrically operated mass spectrometer inlet rather than an inlet capillary, by locating the mass spectrometer inlet and flow sensors in the same plane, and by incorporating design features which enhance the mass spectrometer response. Convenience in system operation and data analysis has been enhanced by integrating a computer into the system design so that the computer performs on-line data analysis and control functions and provides the primary interface between the experimenter and the instruments. Miniaturization of the instruments permits close coupling to an exercising subject.     

The effect of intravenous pyelography and cystoscopy on the staging of cervical cancer.

Intravenous pyelography and cystoscopy were performed in 583 patients with invasive cervical cancer at the University of Kentucky Medical Center. Eighty-six patients were found to have ureteral obstruction, which occurred most commonly at or near the ureterovesical junction. The incidence of ureteral obstruction varied from 2.2% in patients with pelvic findings consistent with Stage I disease to 36% in patients with Stage IV disease. No patient with Stage I or II disease on pelvic examination was found to have invasive cervical cancer in the bladder. However, bladder invasion occurred in 27 patients initially thought to have Stage IIIB disease.Intravenous pyelography should be performed as part of staging in all patients with cervical cancer, whereas cystoscopy can be reserved for those initially thought to have Stage III or IV disease.     

Impact of urinary incontinence on self-concept in children with spina bifida

PURPOSE: Low self-concept and self-esteem are thought to be the main predictors of psychological problems in children and adolescents. Children with spina bifida are thought to be at an increased risk for low self-concept and self-esteem given their disabilities. We examined the impact of urinary continence on self-concept in children with myelomeningocele. MATERIALS AND METHODS: A total of 50 patients 7 to 19 years old with spina bifida were evaluated using the Hartner self-perception profile. Each patient was asked to self-rate on a scale of 1 to 4 using specific domains of self-concept, including scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct and global self-worth. Continence and several other factors, namely ambulatory status, family situation and insurance status, were reviewed simultaneously. RESULTS: There were no statistically significant differences between continent patients with spina bifida and controls. Overall children with spina bifida rated lower in scholastic competence, social acceptance and behavioral conduct than controls. Girls with spina bifida scored lower in perceived athleticism, physical appearance and global self-worth than boys with spina bifida. Continent girls were self-rated higher in social acceptance and global self-worth than incontinent girls. Continent boys were self-rated higher in scholastic competence, social acceptance, physical appearance and behavior compared to incontinent boys. CONCLUSIONS: Continence is associated with better self-concept in children with spina bifida and incontinent girls are at particularly high risk for poor self-esteem. Urologists' efforts to promote continence are likely to have a positive effect on self-concept in boys and girls with spina bifida.     

Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study

BACKGROUND: Although Weber type B ankle fractures are often considered benign with a good prognosis, evidence from observational studies suggests that 17% to 24% of such patients may have less satisfactory outcomes. Although the explanation for variability in outcomes remains unclear, previous studies of other surgical procedures have suggested nonsurgery-related causes account for much of the variability in outcomes. METHODS: We conducted a prospective observational cohort study to evaluate health-related quality of life in 30 patients with unstable ankle fractures who were otherwise healthy. Only patients from 2 university-affiliated hospitals sustaining unstable type B Weber injury patterns requiring surgery were eligible. Patients provided detailed baseline information regarding alcohol consumption, smoking habits, and educational level. Patients completed the short form 36 questionnaire and a visual analogue pain scale at regular follow-up intervals. RESULTS: The average patient age was 51.6 years (SD 15.2 years), and 57% (17 out of 30) were male. The majority of fractures were the result of a fall (67%, 20 out of 30), and all were closed injuries. Almost half of all patients were smokers (47%, 14 out of 30), whereas 43% consumed alcohol on a weekly basis (13 out of 30). Forty-three percent of patients (13 out of 30) had obtained an elementary or high school level of education. Patients experienced significant improvements in all domains of the SF-36 questionnaire (P < 0.001), except general health, which remained essentially normal over the 24-month period. Study patients achieved scores similar to age-matched U.S. normative data across 6 of the 8 domains (Role Emotional, Social Function, Mental Health, Bodily Pain, Vitality, and General Health). However, patients' physical function and role physical scores remained significantly lower than US norms at 24 months (21.8 and 20.7 points lower on a 100-point scale, respectively; P < 0.001). Smoking history (P = 0.02), presence of a medial malleolar fracture (P = 0.02), and lower levels of education (P = 0.01) were significant independent predictors of lower physical function up to 3 months postoperation. Lower mental health domain scores were significantly associated with alcohol use (P = 0.02) and increasing age (P = 0.04). CONCLUSIONS: As is the case in many other areas, social factors may be important determinants of outcome in patients with traumatic fractures. Optimal orthopedic care may involve attention to modifiable risk factors, including smoking and alcohol consumption.     

Nitric oxide inhibits ATP release from erythrocytes

Erythrocytes have been reported to release ATP from intracellular stores into the surrounding environment in response to decreased oxygen tension and mechanical deformation. This erythrocyte-derived ATP can then act on purinergic receptors present on vascular endothelial cells, resulting in the synthesis and bidirectional release of nitric oxide (NO). NO released abluminally produces relaxation of vascular smooth muscle, thereby increasing vascular caliber, leading to a decrease in deformation-induced ATP release from erythrocytes. In contrast, NO released into the vascular lumen could interact directly with formed elements in the blood, including the erythrocyte. Here, we investigate the hypothesis that NO functions in a negative-feedback manner to inhibit ATP release from the erythrocyte. The NO donor N-(2-aminoethyl)- N-(2-hydroxy-2-nitrosohydrazino)-1,2-ethylenediamine (spermine NONOate) decreased total pulmonary resistance in a dose-dependent manner when administered to isolated perfused rabbit lungs. ATP release from rabbit erythrocytes in response to decreased oxygen tension or mechanical deformation was inhibited by preincubation with spermine NONOate (100 nM, 20 min). Importantly, incubating rabbit erythrocytes with spermine (100 nM, 20 min), the polyamine remaining after the liberation of NO from spermine NONOate, did not affect decreased oxygen tension-induced ATP release. Mechanical deformation-induced ATP release was also inhibited when erythrocytes were preincubated with spermine NONOate. However, NO-depleted spermine NONOate had no effect on mechanical deformation-induced ATP release from rabbit erythrocytes. These data provide support for the hypothesis that NO inhibits ATP release from erythrocytes, thereby identifying an additional role of NO in the regulation of vascular resistance.     

Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness

OBJECTIVES: This study examined Medicaid claims forms to determine the prevalence, severity, and co-occurrence of physical illness within a representative sample of persons with serious mental illness (N=147). METHODS: Representativeness of health problems in the study sample was established through comparison with a larger sample of persons with serious mental illness enrolled in Medicaid within the same state. Standardized annual costs were then assigned to Medicaid claims diagnoses, and individual health problem severity was measured as the sum of estimated treatment costs for diagnosed conditions. RESULTS: Seventy-four percent of the study sample (N=109) had been given a diagnosis of at least one chronic health problem, and 50 percent (N=73) had been given a diagnosis of two or more chronic health problems. Of the 14 chronic health conditions surveyed, chronic pulmonary illness was the most prevalent (31 percent incidence) and the most comorbid. Persons with chronic pulmonary illness were second only to those with infectious diseases in average annual cost of treatment ($8,277). Also, 50 percent or more of participants in eight other diagnostic categories had chronic pulmonary illness. A regression analysis identified age, obesity, and substance use disorders as significant predictors of individual health problem severity. CONCLUSIONS: Risk adjustment for physical health is essential when setting performance standards or cost expectations for mental health treatment. Excluding persons with chronic health problems from mental health service evaluations restricts generalizability of research findings and may promote interventions that are inappropriate for many persons with serious mental illness.