Shortage of psychiatrists plaguing northern Ontario.
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Adolescent↗
Biomedical subjects
K Nugent
Publications and source records attributed to K Nugent.
Spectrum of invasive pulmonary aspergillosis in immunocompetent patients with chronic obstructive pulmonary disease.
Invasive pulmonary aspergillosis is a well-recognized complication in immunocompromised patients, especially those with neutropenia. We report four cases of invasive pulmonary aspergillosis in patients whose main underlying disease was chronic obstructive pulmonary disease (COPD). Two patients had an acute fatal course, one had chronic necrotizing pulmonary aspergillosis ending in an acute fatal course, and the other had a semiacute disease that responded to amphotericin B. Autopsy on three patients showed invasive pulmonary aspergillosis in both lungs, and tissue invasion was documented by transbronchial biopsy in the patient who survived. Retrospective review of all cultures that grew Aspergillus species from bronchoscopic specimens showed no false-positive results, and this procedure proved to be the most useful maneuver in making the diagnosis. Invasive pulmonary aspergillosis should be in the differential diagnosis in patients with COPD and unexplained pulmonary infiltrates.
Acute Disease↗
Psychiatric consultation with children in underserviced areas: lessons from experiences in northern Ontario.
There are only 350 child psychiatrists in Canada. It is therefore unrealistic to expect them to be able to provide sufficient direct treatment, even in small densely populated communities with abundant resources. Such expectations are even more unrealistic in underserviced, sparsely populated areas. A review of the literature on psychiatric consultation in underserviced areas is presented along with a description of the consultation process, taking advantage of the "multiplier effect." Some of the realities of mental health consultation in underserviced areas are discussed, stressing the importance of consultation as a way of professional life. Some guidelines for the psychiatric consultant are outlined which would enhance the "multiplier effect". It is maintained that the training of psychiatric residents should include a supervised experience consulting in underserviced areas. Finally, it is hoped that psychiatric training programs, funding bodies, hospitals, and agencies, will recognize the value of this use of psychiatric expertise.
Child↗
Termination of central sleep apnea episodes by upper airway stimulation using intermittent positive pressure ventilation.
A 52-year-old man presented with pure central sleep apnea syndrome that failed to respond to nasal continuous positive airway pressure (NCPAP) therapy. Intermittent positive pressure stimulation via a nasal mask was instituted using a portable positive pressure ventilator. We found marked reduction in the respiratory disturbance index, number of desaturations, and the number of arousals with this mode of therapy.
Electrocardiography↗
Clinical results of bony fixation methods in digital replantation.
Clinical results comparing different techniques of fixation in replanted digits have not been described in detail, and bony deformities after replantation have been documented only in limited series. We retrospectively analyzed our population of phalangeal replants over a 5-year period to assess the outcome of different fixation methods with regard to frequency of angulation, fracture instability, nonunion, and need for corrective osteotomy. Techniques evaluated included: single and crossed Kirschner wires, intraosseous wires with and without Kirschner wire support, and the tetrahedral (Cassel) wire. Initial results show similar early angulation deformities in all groups. Intraosseous wires alone were found to have the lowest nonunion and complication rate. The Cassel wire was found to have the highest number of digits with fixation problems. Overall, bony problems were seen in nearly 50% of replants in our series.
Bone Wires↗
A cluster of silicosis in sandblasters.
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Cluster Analysis↗
Neonatal behavior of prenatally stressed Lebanese infants.
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Adolescent↗
Interferon and growth factor activity for human lung fibroblasts. Release from bronchoalveolar cells from patients with active sarcoidosis.
Pulmonary sarcoidosis is a granulomatous disorder of unknown etiology characterized by both an active cellular immune process and interstitial fibrosis. It has recently been demonstrated that gamma-interferon (the type of interferon associated with an active cellular immune process) is also a potent growth factor for human lung fibroblasts. To evaluate the hypothesis that there is an association between the release of immune interferon and the release of growth factor activity for fibroblasts, bronchoalveolar cells from patients with sarcoidosis were studied for the spontaneous release of both immune interferon and growth factor activity for fibroblasts. Bronchoalveolar cells from 11 of the 24 patients spontaneously released gamma-interferon in vitro. Supernatants from sarcoidosis patients whose bronchoalveolar cells released interferon contained a significantly higher percentage of lymphocytes than those whose bronchoalveolar cell supernatants did not contain interferon (p less than 0.01). Fibroblast growth was also significantly augmented by supernatants from sarcoidosis patients whose bronchoalveolar cells released gamma-interferon compared to supernatants which did not contain interferon (p less than 0.05). In patients with focal abnormalities on chest x-ray films, there was significantly more interferon released by bronchoalveolar cells from the areas that were most abnormal compared to more normal areas of the lung. These studies suggest that there is an association between the release of immune interferon and release of growth factor activity for fibroblasts by bronchoalveolar cells from patients with active pulmonary sarcoidosis.
Adult↗
Methods for bronchoalveolar lavage in asthmatic patients following bronchoprovocation and local antigen challenge.
We employed bronchoalveolar lavage (BAL) of subsegmental airways to study the local inflammatory effects of aeroallergen bronchoprovocation (BPC) and local instillation of allergen in allergic asthmatic patients, allergic rhinitis patients, and normal subjects. Two protocols were used: (1) BAL was performed in three subsegments following BPC or during spontaneous seasonal exposure, and (2) 5-ml aliquots of increasing doses of allergen were instilled into a single subsegment until there was at least 30 percent closure of the airway; the airway was then immediately lavaged. A subsegment in the opposite lung was lavaged as a control site. These same two segments were lavaged again two to 14 days later and the cells and fluid analyzed. Fifty-five lavages have been performed without complications. Pulmonary function tests (FEV1) were not significantly disturbed by either local challenge or lavage procedures. Cells were examined using light and electron microscopy and showed inflammatory cells in alveolar airways and dissolution of mast cell and eosinophil granules. Using selected criteria, we were able to use these methods in mildly, seasonally asthmatic patients to obtain safely cells and fluid for analysis. These techniques may permit studies which further our understanding of the mechanisms responsible for allergic asthma.
Adolescent↗
Site of airflow obstruction during early and late phase asthmatic responses to allergen bronchoprovocation.
Chronic asthma and late asthmatic responses (LAR) are associated with local inflammation which might be expected to produce airflow obstruction in small airways and to increase nonspecific airway reactivity. In contrast, early asthmatic responses (EAR) are primarily bronchospastic and probably involve more central airways. We challenged 17 nonsmoking, mildly asthmatic atopic subjects with allergen bronchoprovocation and measured changes in spirometry (FEV1) over the next 24 hours. Each subject also performed a helium-oxygen (He-O2) flow-volume loop before challenge (baseline), during the EAR, and six hours and 24 hours after challenge to measure the effect of gas density on flow rates at midvital capacity. Twelve subjects had both an EAR and a LAR; five subjects had only a LAR. Of these 17 subjects, 15 were initially density dependent, while only two were density independent. During the EAR, 13 percent of the density dependent population had significant decreases in delta Vmax 50 percent; 47 percent had significant decreases during LAR. The He-O2 flow data analyzed at specified time points after challenge revealed significant decreases in the mean delta Vmax 50 percent at six hours in those who had only a LAR (p less than 0.01). In those who had a dual airway response, density dependence increased during the EAR, but decreased at six and significantly at 24 hours (p less than 0.05) postchallenge. There was a strong trend for the severity of the LAR (measured by changes in FEV1) to be directly related to the total decrease in delta Vmax 50 percent during the LAR. We conclude that late asthmatic responses occur frequently after a single antigenic bronchial challenge and can be associated with persistent symptoms. The LAR were often associated with a decrease in density dependence of maximal expiratory airflow, and therefore, may involve small airways.
Adult↗
Polypeptide synthesis by extracts from Escherichia coli treated with T2 ghosts.
Infection of Escherichia coli B in inorganic salts-glycerol with a multiplicity of deoxyribonucleic acid-less T2 "ghosts" just sufficient to block all protein synthesis results in both viable and killed bacteria. We enriched for the viable cells by a combination of lysozyme treatment and filtration and measured the in vitro capacity of their extracts to synthesize polypeptides. Without added template ribonucleic acid (RNA), such "ghost extracts" incorporate amino acids (endogenous synthesis) at approximately one-half the rate as do extracts from uninfected bacteria. However, they are unable to use added synthetic or natural template RNAs for peptide synthesis. Some activity can be observed but only at high concentrations of Mg(2+). These results suggest that ghost infection may result in a blockage of ribosomes during translation. Mixing experiments show that the incapacity of ghost extracts to translate added template RNA is due to a defect in the ribosomes.
Amino Acids↗
A practice model for a parent support group.
Parent support groups in acute care settings can provide families of hospitalized children with opportunity to share emotions and concerns related to the crisis experience of hospitalization with others who are experiencing similar situations. The Nugent Model of Family Support combines several concepts of caring, empowerment and family efficacy into a practical framework that clinicians can use in providing and evaluating outcomes of an acute care based parent support program.
Adaptation, Psychological↗