Endemic and epidemic aspergillosis associated with in-hospital replication of Aspergillus organisms

When a new hospital opened in 1983, environmental culturing for Aspergillus organisms and surveillance for nosocomial aspergillosis cases were begun to characterize the relationship between environmental contamination and infection. Monthly air sampling demonstrated increasing concentrations of Aspergillus flavus and Aspergillus fumigatus to mean levels greater than 1 cfu/m3 during 1986-1987, accompanied by a progressive increase in incidence of aspergillosis to 1.2% in immunocompromised patients. This prompted an inspection that revealed heavy growth of Aspergillus organisms on air filters. Subsequent inspections of hospital wards showed small foci of A. flavus growth on other materials. Removal of the contaminated filters and improved environmental maintenance were associated with reduction in A. flavus and A. fumigatus to 0.01 cfu/m3 and a fourfold decline in aspergillosis incidence during the next 2 years. These findings, together with laboratory studies that showed aspergilli could proliferate on common hospital materials when moistened, indicate a need for careful environmental maintenance.     

End-tidal carbon dioxide tension as a monitor of native blood flow during resuscitation by extracorporeal circulation

In a porcine model of cardiac arrest, we investigated end-tidal carbon dioxide tension as a monitor of native blood flow during resuscitation by extracorporeal circulation. After 15 minutes of cardiac arrest and after precordial compression and transthoracic countershocks had failed, extracorporeal circulation consistently restored spontaneous circulation. Native end-tidal carbon dioxide tension, which averaged 29.8 +/- 1.0 mm Hg before arrest, was only 5.2 +/- 0.8 mm Hg during precordial compression. After the start of extracorporeal circulation, native end-tidal carbon dioxide tension was measured during 15-second interruptions of pump flow. End-tidal carbon dioxide tension progressively increased with a corresponding increase in native cardiac index. The correlation coefficients between end-tidal carbon dioxide tension and native cardiac index averaged 0.92 +/- 0.03 (mean +/- standard error of the mean). When end-tidal carbon dioxide tension exceeded 15 mm Hg, mean aortic pressure in each instance was 60 mm Hg or greater, and the animal was successfully weaned from extracorporeal support. We conclude that end-tidal carbon dioxide tension serves as a reliable monitor of blood flow through the lung and therefore of native cardiac output during weaning from extracorporeal circulation. It therefore indicates when native cardiac output is likely to be adequate to sustain spontaneous circulation.     

Treatment of circulatory shock with dopamine. Studies on survival.

Therapeutic effects of dopamine hydrochloride on the peripheral and metabolic defects of shock were investigated in 34 patients with circulatory shock associated with myocardial infarction, bacteremia, or hypovolemia. Severity of the circulatory defect characterized by hypotension, reduced cardiac output, oliguria, and notably reduced skin (toe) temperature before treatment with dopamine was not directly related to survival. However, the arterial blood concentration of lactate before treatment with dopamine indicated the likelihood of survival. Patients who ultimately survived following treatment with dopamine had normal or only mildly elevated levels of arterial blood lactate before therapy. No patients with established shock states in whom perfusion failure was associated with substantial increases in the level of arterial blood lactate survived regardless of treatment with dopamine. Increases in toe temperature during dopamine treatment also emerged as a uniquely good indicator of favorable outcome during therapy.     

Elective postoperative radiotherapy for locally advanced colorectal cancer. A preliminary report.

Preoperative radiotherapy in colorectal carcinoma invalidates surgical staging and delays performing the surgical resection. Postoperative radiotherapy does neither. From October 1972, to December 1975, 40 patients at high risk for local recurrence (B2 and C) received postoperative radiotherapy. Lesions that were located in the rectum, rectosigmoid and low sigmoid colon were given 4600 rads in four and a half weeks through an inverted T-shaped field which encompassed the pelvic and paraortic nodes. Patients with tumors located above mid-sigmoid were treated to the entire abdominal cavity by the moving strip technique. Of 19 patients with rectal and rectosigmoid lesions, 14 (74%) are alive without evidence of disease. Two had local recurrence in the treated area. Of 21 patients with lesions above the mid-sigmoid, four have failed locally, while 11 (52%) are alive without evidence of disease. One of these 40 patients died to radiation enteritis. Although the follow up period is short, the results suggest that a moderate dose of radiation may prevent local recurrence in patients with locally advanced colorectal cancer.     

Circulatory arrest pressure as a prognostic indicator of cardiopulmonary resuscitation

In a porcine model of cardiac arrest, the intravascular pressure measured during circulatory standstill was positively correlated with the success of cardiopulmonary resuscitation. When volume was expanded before cardiac arrest, circulatory arrest pressure increased and the success of resuscitation increased. After volume expansion, the hematocrit was reduced and colloid osmotic pressure was decreased. However, neither hematocrit nor colloid osmotic pressure changes were directly related to survival.