A single-season prospective study of respiratory viral infections in lung transplant recipients.

The frequency and complications of respiratory viral infections (RVI) were studied in 50 ambulatory lung transplant patients during a single winter season, using viral antigens, viral cultures and PCR of nasal washes or bronchoalveolar lavages. Patients' survival, episodes of acute rejection and occurrence of bronchiolitis obliterans (BO) or BO syndrome (BOS) were monitored for 1 yr after the study. Overall, 32 (64%) patients had 49 symptomatic episodes. Documented infections included eight due to respiratory syncytial virus (RSV), one due to parainfluenza virus (PIV) and 10 due to influenza (FLU). Four of the FLU infections were serological rises without symptoms. Overall, 17 (34%) patients had documented viral infection; four patients had lower respiratory involvement and two (one RSV, one PIV) were hospitalised for aerosolised ribavirin treatment. After 1 yr there were three (6%) deaths unrelated to RVI. BO or BOS had occurred in one (6%) out of 17 patients with and three (12%) out of 33 without RVI. Respiratory viruses infected one-third of ambulatory lung transplant recipients in a single season. In conclusion, respiratory viral infection was not associated with subsequent graft dysfunction. Larger prospective studies are required to better define the acute and long-term morbidity of these infections.     

An alternative method for Ra determinations in water

Concentrations of 226Ra and 224Ra in 13 wells distributed throughout McCulloch and Mason counties in the Hickory Aquifer of the Llano Uplift Region of West-Central Texas are reported. Measurable alpha-particle activity is present in all wells, with seven wells having 226Ra radioactivity concentrations greater than 185 Bq m-3 (5 pCi L-1). An alternative methodology for measuring 226Ra, 224Ra and 228Ra is described. The EPA-approved methodology for estimating total Ra is shown to be invalid for aquifers containing significant levels of 224Ra. Alpha-particle activity measurements made in the interval of 12 to 300 h after Ra isolation lead to self-consistent solutions for radioactivity concentrations of 226Ra and 224Ra, with negligible contributions from 228Ra. Radioactivity concentrations of 228Ra can be calculated from grow-in terms for this isotope used with alpha-particle activity measurements at post-isolation times significantly longer than 800 h. Comparison of the 226Ra radioactivity concentration with that reported previously by the Texas Department of Health for a single well indicates acceptable agreement. However, the radioactivity concentration attributable to 228Ra for the same well was found to be in significant disagreement with the Texas Department of Health value.     

Thermoforming plastic in lead shield construction

Radiation treatments using low energy X-rays or electrons frequently require a final field defining shield to be placed on the patient's skin. A custom made lead cut-out is used to provide a close fit to a particular patient's surface contours. We have developed a procedure which utilizes POLYFORM thermoplastic to obtain a negative mold of the patient instead of the traditional plaster bandage or dental impression gel. The Polyform is softened in warm water, molded carefully over the patient's surface, and is removed when "set" or hardened, usually within five minutes. Then lead sheet cut-outs can be formed within this negative. For shielding cut-outs requiring thicker lead sheet, a positive is made from dental stone using this Polyform negative. We have found this procedure to be neat, fast and comfortable for both patient and the dosimetrist.     

Long term variation in beam symmetry as a function of gantry angle for a computer-controlled linear accelerator

Testing computer-controlled linear accelerators for patient safety and proper patient dose delivery requires that certain beam characteristics be monitored over an extended period of time. Computer-controlled conformal radiation therapy using asymmetric collimator jaw settings necessitates stable symmetric treatment beams. Long term beam symmetry measurements have been performed on a Philips SL20 dual energy computer-controlled linear accelerator. Symmetry in both the radial and transverse axis of each x-ray beam was monitored for eight gantry positions. These measurements were undertaken to determine the effectiveness of the SL20 beam steering system during dose delivery of 50 monitor units (MU) per field. Evaluation of the data shows that careful beam steering setup procedures result in x-ray beams in which fluctuations in symmetry as a function of gantry angle are within +/- 1.5%. Day to day instabilities produce a total overall variation in beam symmetry on the order of +/- 2.0%. Results suggest the measurement of symmetry as a function of gantry position become a routine quality assurance procedure for this accelerator.     

Increased Sensitivity of a New Coagglutination Test for Rapid Identification of Haemophilus influenzae Type b

A newly developed rapid coagglutination test for identifying Haemophilus influenzae type b organisms isolated from clinical specimens correlated 100% with the slide agglutination test but was 100- to 200-fold more sensitive.     

Clinical and molecular genetic features of pulmonary hypertension in patients with hereditary hemorrhagic telangiectasia

BACKGROUND: Most patients with familial primary pulmonary hypertension have defects in the gene for bone morphogenetic protein receptor II (BMPR2), a member of the transforming growth factor beta (TGF-beta) superfamily of receptors. Because patients with hereditary hemorrhagic telangiectasia may have lung disease that is indistinguishable from primary pulmonary hypertension, we investigated the genetic basis of lung disease in these patients. METHODS: We evaluated members of five kindreds plus one individual patient with hereditary hemorrhagic telangiectasia and identified 10 cases of pulmonary hypertension. In the two largest families, we used microsatellite markers to test for linkage to genes encoding TGF-beta-receptor proteins, including endoglin and activin-receptor-like kinase 1 (ALK1), and BMPR2. In subjects with hereditary hemorrhagic telangiectasia and pulmonary hypertension, we also scanned ALK1 and BMPR2 for mutations. RESULTS: We identified suggestive linkage of pulmonary hypertension with hereditary hemorrhagic telangiectasia on chromosome 12q13, a region that includes ALK1. We identified amino acid changes in activin-receptor-like kinase 1 that were inherited in subjects who had a disorder with clinical and histologic features indistinguishable from those of primary pulmonary hypertension. Immunohistochemical analysis in four subjects and one control showed pulmonary vascular endothelial expression of activin-receptor-like kinase 1 in normal and diseased pulmonary arteries. CONCLUSIONS: Pulmonary hypertension in association with hereditary hemorrhagic telangiectasia can involve mutations in ALK1. These mutations are associated with diverse effects, including the vascular dilatation characteristic of hereditary hemorrhagic telangiectasia and the occlusion of small pulmonary arteries that is typical of primary pulmonary hypertension.     

Market model addresses hospitals' need for decision support

A Decision Support System should be approached, not as “starting over,” but as a natural extension of the design and development of a hospital's current HIS. Integrated, real-time HISs generate reams of information that, when combined with relevant external data, provide the essential information base for a hospital DDS. The Travenol Market Model is discussed as an example of a DSS specific to hospital needs.     

Revision of the Parenting Stress Index

To facilitate early identification of children at risk for developmentof behavioral or emotional disturbance, the Parenting StressIndex (PSI) is designed as a screening and diagnostic instrumentthat measures the relative magnitude of stress in the parent-childsystem. For this study, the most re cent revision of the PSI,Form 6, was evaluated for reliability and factorial validityusing a sample of 534 parents. Form 6 of the PSI was found tohave even higher reliability than previous forms, supportingits continued usefulness both for preliminary screening andfor pretesl/posttest measure ment of the effectiveness of counselingprograms and intervention tech niques. Form 6 of the PSI wasalso found to have high factorial validity, suggesting thatthe domain scores and subscale scores may be confidently utilizedto provide information about specific sources of stress in theparent-child system which should be the focus of further attentionand professional assistance.     

Anesthesia, preoperative, and postoperative medications

Retrobulbar and peribulbar anesthesia remain the principle means of ophthalmic anesthesia. Methods, needles, and medications continue to vary in the search for what works best, and that is a very individual preference as is seen by the literature over the past year. The increased role of nonsteroidal anti-inflammatory drugs is discussed, along with prophylactic antibiotic use.