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Biomedical subjects

S L Wiener

Publications and source records attributed to S L Wiener.

At least 19 recordsLinked to original sources
PubMed1996

Strategies for the prevention of a successful biological warfare aerosol attack.

Biological warfare (BW) aerosol attacks are different from chemical attacks in that they may provide no warning/all clear signals that allow the soldier to put on or remove his M17/M40 protective mask. Methods are now being perfected to detect a BW aerosol cloud using an airborne (helicopter) pulsed laser system to scan the lower altitudes upwind from a troop concentration of corps size, and to sample and analyze the nature of the aerosol within a brief time interval. This system has certain limitations and vulnerabilities, since it is designed specifically to detect a line-type aerosol attack. Provision of, training with, and field use of a lightweight dust mist or HEPA filter respirator for each soldier is proposed for protection against undetected aerosol attacks. This particulate filter respirator would be issued in addition to the M17/M40 mask. Such a BW respirator will be able to purify the soldier's air by removing particles in the 0.3- to 15-micro m-diameter range with an efficiency of 98 to 100%. Particle size of BW aerosols is in the same range, with an optimum size for high-efficiency casualty production of 1 to 5 micro m mass median diameter. The proposed BW respirator will be lightweight; will require low inhalation pressures; will be comfortable to wear for prolonged periods; will not interfere with vision, hearing, and communication; and will not degrade overall effectiveness and performance to the degree observed with the M17/M40 masks. Such respirators would be worn as part of a contingency defense against an enemy likely to use BW agents. This respirator could be worn for prolonged periods when under threat of an undetectable BW attack during weather conditions favorable to the success of such an attack (i.e., low wind velocity and temperature inversion in the target area). In addition, tactically important assets such as command and control centers and missile batteries can also be protected continuously by air filtration systems powered by electricity (modular collective protection equipment). Vaccinations against anthrax, botulism, Q fever, plague, and tularemia are now available and immune protection against ricin and staphylococcal toxins appears feasible in the near future. Chemotherapy can also be provided for prophylaxis of infectious agents released on the battlefield. The vaccines and antibiotics can provide back-up protection against an unexpected BW attack during a period when the BW respirator is not in use or malfunctions due to a poor seal or filter leak. Enemy sites of biological weapon production, assembly, testing, and storage, and delivery vehicles can be targeted for destruction by bombs and/or missiles. An integrated, well-planned, BW defense with multiple components can decrease the likelihood of a successful enemy BW aerosol attack.

Aerosols↗
PubMed1993

Accuracy and reproducibility of precordial percussion and palpation for detecting increased left ventricular end-diastolic volume and mass. A comparison of physical findings and ultrafast computed tomography of the heart.

OBJECTIVE: To assess the accuracy and reproducibility of indirect definitive precordial percussion in detecting increased left ventricular end-diastolic volume (LVEDV), left ventricular mass (LVM), and left ventricular end-diastolic wall thickness (LVEDWT), and to compare it with palpation of the apical impulse. DESIGN: Descriptive study. SETTING: Hospitals and clinics of a university medical center. PATIENTS: Convenience sample of 103 patients (62 men and 41 women) referred for ultrafast computed tomography (CT) of the heart. INTERVENTIONS: Percussion dullness distance from the midsternal line in the left fourth through sixth intercostal spaces, distance of the apical impulse from the midsternal line, and apical impulse diameter in the left lateral decubitus position were measured on all patients. Measurements of LVEDV, LVM, and LVEDWT were taken using ultrafast CT of the heart. Investigators performing the physical diagnostic maneuvers were blinded to the clinical history and CT results, and investigators performing the CT scans were blinded to physical findings. RESULTS: Percussion dullness distance in the left fifth intercostal space was the best discriminator of LVEDV (receiver operating characteristic [ROC] area, 0.680; 95% confidence interval [CI], 0.547 to 0.813), and dullness distance in the left sixth intercostal space was the best discriminator of LVM and LVEDWT (ROC areas, 0.831, 95% CI, 0.674 to 0.988; and 0.849, 95% CI, 0.651 to 0.999, respectively). A percussion dullness distance of greater than 10.5 cm in the left fifth intercostal space detected increased LVEDV or LVM with a sensitivity of 91.3% (95% CI, 70.5% to 98.5%) and a specificity of 30.3% (95% CI, 19.9% to 43.0%). There was moderate concordance between investigators for percussion dullness distance (kappa, 0.57; 95% CI, 0.18 to 0.96). In patients in whom an impulse was palpated, an apical impulse diameter of greater than 3.0 cm in the left lateral decubitus detected increased LVEDV or LVM with a sensitivity of 100% (95% CI, 77.1% to 100%) and a specificity of 40% (95% CI, 23.2% to 59.3%). However, an impulse was palpable in only 53% of cases and showed only slight interobserver reproducibility (kappa, 0.18; 95% CI, 0.0 to 0.58). CONCLUSION: Indirect definitive percussion of the precordium is a sensitive and moderately reproducible maneuver for excluding cardiomegaly due to increased LVEDV or LVM. Although measurement of apical impulse diameter was also sensitive in excluding cardiomegaly, lack of a palpable impulse in many patients and low precision between physicians may limit its utility in clinical practice.

Cardiomegaly↗
PubMed1991

Accuracy of precordial percussion in detecting cardiomegaly.

STUDY OBJECTIVE: To assess the value of precordial percussion in detecting cardiomegaly, and to compare it with palpation of the apical impulse. DESIGN: Descriptive study. SETTING: Hospitals and clinics of a university medical center. PATIENTS: Light indirect percussion of the precordium was performed on 72 inpatients and 28 outpatients. All patients had a posteroanterior radiograph of the chest. Percussors were unaware of the clinical history and of chest roentgenogram results. MEASUREMENTS AND MAIN RESULTS: Thirty-six patients (36%) had cardiomegaly, defined as a cardiothoracic ratio of greater than 0.5 on chest roentgenogram. The cardiothoracic ratio was significantly correlated with percussion distance from the midsternal line in the left fourth (r = 0.35, p less than 0.0006), fifth (r = 0.65, p less than 0.00001), and sixth (r = 0.40, p less than 0.0001) intercostal spaces. After adjustment for clinical symptoms and systolic and diastolic blood pressures, percussion distance in the left fifth intercostal space remained a significant independent predictor of the cardiothoracic ratio. Percussion distance in the left fifth interspace discriminated cardiomegaly with a receiver-operating characteristic (ROC) area of 0.95. Percussion dullness more than 10.5 cm from the midsternal line in the left fifth interspace had a sensitivity of 94.4% (95% confidence interval [CI], 79.9% to 99.0%) and a specificity of 67.2% (CI, 54.2% to 78.1%). Distance of the apical impulse from the midsternal line discriminated with an ROC area of 0.95, but an impulse was palpated in only 40% of cases. CONCLUSIONS: Percussion in the left fifth intercostal space accurately discriminates patients with and without cardiomegaly, and adds information beyond that obtainable from the history and other parts of the physical examination.

Adolescent↗
PubMed1982

Nontypeable Haemophilus influenzae in the elderly.

Nontypeable Haemophilus influenzae pneumonia occurred in 12 patients older than 60 years in a 15-month period. These patients represented approximately 11% of the 104 elderly patients with bacterial pneumonia in whom transtracheal aspiration was performed. Eighty-five percent of H influenzae isolates (12/14) recovered from elderly patients with pneumonia were nontypeable. Nontypeable H influenzae pneumonia occurred in the community, in nursing homes, and in the hospital. Patterns of both bilateral patchy bronchopneumonia and dense lobar consolidation were seen on chest roentgenograms.

Age Factors↗
PubMed1981

Outbreak of acute pulmonary histoplasmosis in members of a wagon train.

In August 1980, an outbreak of acute pulmonary histoplasmosis occurred among participants in a wagon train as it traveled through eastern Tennessee. Of the 85 people on the train 69 (81 percent) had evidence of infection with Histoplasma capsulatum. Fifty-four people had symptomatic disease. The source of infection was traced to the site of a former winter blackbird roost in Charleston, Tennessee, that had been partially cleared five years earlier to make a park. Fourteen of 25 soil samples from this site were culture-positive for H. capsulatum. This is the first reported outbreak to involve a large migrant group. The outbreak is unusual in that exposure occurred without excavation, construction or tree-cutting at the site.

Adult↗
PubMed1981

Mixed Streptococcus pneumoniae and gram-negative bacillary pneumonia in the elderly.

Of 24 elderly patients with Streptococcus pneumoniae pneumonia confirmed by transtracheal aspiration, six had concomitant infection with gram-negative aerobic bacilli. All six patients were elderly men with underlying cardiopulmonary disease. Three had had recent prior episodes of gram-negative pneumonia and four had previously received antibiotics. The clinical, laboratory, and epidemiologic characteristics of these six patients with mixed bacterial pneumonia are reported.

Aged↗
PubMed1981

Campylobacter fetus ssp jejuni: isolation from patients with gastroenteritis.

Within a seven-month period, Campylobacter fetus ssp jejuni was isolated in East Tennessee from 18 patients with gastroenteritis; 83% of these patients had bloody diarrhea. Absence of other enteric organisms such as Salmonella, Shigella, and Yersinia implicated C fetus ssp jejuni as the causative agent. A fourfold increase in titer by tube agglutination from four of eight patients studied supported the pathogenicity of this organism. Treatment with erythromycin alleviated gastroenteritis symptoms within 24 to 48 hours, with concurrent disappearance of the organism from the feces. An isolation rate of 8% in our patients indicates that C fetus ssp jejuni is more common as a cause of human diarrhea than Salmonella or Shigella. The severity of the C fetus ssp jejuni gastroenteritis poses a possible reclassification from diarrhea or gastroenteritis to acute dysentery syndrome.

Adult↗