Pulmonary infection with Mycobacterium chelonei: successful treatment with one drug based on disk diffusion susceptibility data.
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Anti-Bacterial Agents↗
Biomedical subjects
M R Pratter
Publications and source records attributed to M R Pratter.
Stability of stored methacholine chloride solutions: clinically useful information.
Methacholine inhalation challenge (MIC) has been shown to be an extremely useful diagnostic test. Because a decrease in the time and expense involved in the preparation of methacholine chloride solutions might encourage more laboratories to perform MIC, we assessed the stability of several different concentrations of methacholine chloride in solution over a period of 4 months. We used and compared 2 different assay techniques: a high pressure liquid chromatography assay and a colorimetric assay. Comparable results were obtained by both assays and demonstrated that methacholine solutions stored either at room temperature or at 4 degrees C showed no significant decomposition over a period of 4 months. From our results, we conclude that: (1) methacholine chloride solutions are much more stable than stated in the Merck Manual, (2) the original data of MacDonald and coworkers on the stability of methacholine chloride solution are accurate, (3) our high pressure liquid chromatography method is an accurate and highly specific technique for measuring methacholine chloride solutions. The major clinical implication of our results is that the time and cost necessary to prepare methacholine chloride solutions is much less than previously thought. This should encourage a more widespread use of this important diagnostic technique for the demonstration of bronchial hyperreactivity.
Chromatography, High Pressure Liquid↗
The transiency of oropharyngeal colonization with gram-negative bacilli in residents of a skilled nursing facility.
To determine the duration and persistence of gram-negative bacillary (GNB) oropharyngeal colonization over a specified period and the risk of subsequent GNB pneumonia developing in nursing home patients, we prospectively cultured for 31 weeks the oropharynges of patients in a skilled nursing facility. Over a 31-week period, an average of 13.8 percent of the patients showed colonization (weekly prevalence rates ranged from 0 to 29 percent). No patient had pneumonia during the study period. We concluded that the presence of GNB in the oropharynx of our patients is transient, continually changing over an extended period, and that GNB colonization as a transient occurrence is not directly associated with an increased risk of GNB pneumonia. Our data also emphasize the limitations of previously described single-culture survey studies in predicting the importance of GNB oropharyngeal colonization.
Adult↗
Chronic persistent cough: an uncommon presenting complaint of thyroiditis.
We report two patients with non-conventional thyroiditis whose chief complaint was chronic persistent cough. Cough was attributed to thyroiditis only after extensive diagnostic evaluations failed to uncover another cause and only after cough and thyroiditis disappeared simultaneously with suppressive therapy for the latter. Although thyroiditis is a rare cause of persistently troublesome cough, the diagnosis can be made by systematic evaluation of the sites of receptors and afferent nerves subserving the cough reflex.
Adult↗
Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy.
Using a diagnostic protocol based on the anatomy and distribution of cough receptors and afferent nerves, we sought to determine the causes and outcome of specific therapy of chronic persistent cough in 49 consecutive and unselected patients. A specific diagnosis was made in all. Cough was due to chronic postnasal dip from a variety of conditions in 29%, asthma in 25%, postnasal drip plus asthma in 18%, chronic bronchitis in 12%, gastroesophageal reflux in 10%, and miscellaneous disorders in 6%. History, physical examination, and methacholine inhalational challenge diagnosed disease in 86% of all patients. Adjusted success rates for specific therapy, and average of 4.4 and 18.9 months after therapy had been prescribed, were 98% and 97%, respectively. We concluded the following about chronic persistent cough; using an anatomic, diagnostic protocol, the cause can be consistently determined; postnasal drip and/or bronchial asthma are very common causes of cough; the outcome of specific therapy, almost without exception, is successful and sustained.
Adolescent↗
The effect of transtracheal aspiration on cardiac rate and rhythm. A prospective study.
To determine the effect of transtracheal aspiration (TTA) on cardiac rate and rhythm, we prospectively monitored by electrocardiography 14 cases before, during, and after the procedure. No serious or life-threatening arrhythmias occurred; sinus tachycardia was virtually a routine occurrence. Cardiac rate increased significantly from an average of 96 beats/min before the procedure to an average of 121/min during the procedure (P less than 0.001). The incidence of premature ventricular or atrial contractions did not change significantly before, during, or after the procedure. Before TTA, all patients had PaO2 measurements equal to or greater than 70 mm Hg; none had CO2 retention or an unstable cardiac status. Patients with significant COPD (mean FEV1/FVC% = 48) were not at increased risk for cardiac arrhythmias during or immediately after TTA. Our results imply the following: (1) routine ECG monitoring in patients such as ours undergoing TTA does not appear to be necessary; and (2) premedication with narcotics, sedatives, or atropine does not appear to be warranted.
Adult↗
Viridans streptococcal pulmonary parenchymal infections.
Pulmonary parenchymal infections were caused by viridans streptococci in two patients. Pleural empyema and lung abscess occurred in a previously healthy adult; an uncomplicated pneumonia developed in an immunocompromised host. In the first case, the diagnosis was ascertained by percutaneous lung abscess aspiration, transtracheal aspiration, and thoracentesis culture findings. In the second case, the diagnosis was established by transtracheal aspiration culture results.
Bacteriological Techniques↗
Evaluation of methylene blue and squamous epithelial cells as oropharyngeal markers: a means of identifying oropharyngeal contamination during transtracheal aspiration.
The usefulness of 1% methylene blue (MB) and squamous epithelial cells as oropharyngeal markers in transtracheal aspiration was prospectively evaluated. In vitro studies showed that failure to detect MB by spectrophotometry ruled out contamination by greater than 0.05 microliters of oropharyngeal secretions and that visual inspection was almost as sensitive as spectrophotometry. Even minute contamination could be ruled out if greater than 5 x 10(4) organisms were found by culture of Gram-stained smear in a specimen that was MB-negative by spectrophotometry. In specimens of transtracheal aspirate obtained from 10 bronchitic patients, quantitative bacteriology ruled out even minute contamination in nine. Cytologic-morphometric examination revealed that 70% of both sterile and colonized specimens of transtracheal aspirate contained squamous epithelial cells that were indistinguishable, except by electron microscopy, from buccal mucosal cells. MB is a useful marker for identification of oropharyngeal contamination during transtracheal aspiration, and traditional cytologic screening is misleading in conditions associated with tracheobronchial squamous metaplasia.
Biopsy, Needle↗
An outbreak of acinetobacter infection associated with the use of a ventilator spirometer.
Although respiratory therapy equipment is a well-known source of nosocomial infection, ventilator spirometers have not been previously implicated. We report 17 Acinetobacter calcoaceticus variety anitratus infections traced to contaminated spirometers. Isolates from infected patients were recovered from urine, sputum, wounds, and blood. A review of attack rates for Acinetobacter was prompted by a dramatic increase in blood culture isolates. Prospective surveillance of intensive care environment, personnel, and patients established that Bennett MA-1 spirometers constituted the major reservoir of infecting organisms. Despite daily sterilization, 30% of spirometers in use were found to be contaminated. The hands of 12% of intensive care nurses and 10% of respiratory therapists cultured were found to be colonized. In addition to the infected patients, 28 other patients on spirometer-equipped ventilators were judged to be colonized by Acinetobacter following examination of sputa and/or mouthwashings. Following discontinuation of spirometer use and following increased emphasis on proper handwashing, the incidence of Acinetobacter infections dropped dramatically. Antibiosis in the intensive care environment and a deterioration in aseptic awareness serve to make Acinetobacter an environmental opportunist of increasing importance.
Acinetobacter Infections↗
Bloody pleural effusion associated with an intralobar pulmonary sequestration.
A 50-year-old male cigarette smoker with a posterior parenchymal lung mass developed a bloody, exudative pleural effusion. Pathologic examination of the resected lung confirmed the preoperative diagnosis of an intralobar pulmonary sequestration.
Bronchopulmonary Sequestration↗
Transtracheal aspiration. Guidelines for safety.
A four-year experience with transtracheal aspiration was reviewed in order to determine those patients at risk for developing life-threatening complications. One hundred procedures were performed by at least 20 different physicians trained according to an established protocol. Complications were limited to minimal subcutaneous emphysema in 19 percent (10/52), pneumomediastinum in 3 percent (3/93), and gross but self-limited hemoptysis in 1 percent (one patient); occasional unifocal premature ventricular contractions were noted in one patient. We conclude that patients not at risk of developing life-threatening complications from transtracheal aspiration can be identified. They (1) are able to cooperate and have a clearly identifiable and normal cricothyroid membrane, (2) have the procedure performed only by well-trained or supervised physicians, (3) have an arterial oxygen pressure of at least 70 mm Hg with administration of supplemental oxygen, and (4) have a prothrombin activity of at least 65 percent of the control value or a normal bleeding time or a platelet count of at least 100,000/cu mm. To minimize subcutaneous emphysema or pneumomediastinum, no patient should have therapy with intermittent positive-pressure breathing or any other procedure that might induce coughing for the subsequent 24 hours.
Exudates and Transudates↗
Is the demonstration of bronchial hyperreactivity the sine qua non for diagnosing symptomatic bronchial asthma?
Bronchial hyperreactivity, a fundamental feature of bronchial asthma, is universally present in patients with symptomatic asthma. It can be reliably and safely demonstrated in the pulmonary function laboratory through pharmacological bronchoprovocation challenge testing. Furthermore, in the patient suspected of having symptomatic asthma, the laboratory determination of the presence of bronchial hyperreactivity is diagnostically of greater predictive value than findings on history, physical examination, routine spirometry, or the measurement of the total blood eosinophil count.
Adolescent↗