A retrospective study was done on 38 patients with atypical mycobacterial lymphadenitis who underwent surgical intervention at The Children's Hospital, Denver, between the years 1953 and 1983. One group consisting of 18 patients had incision and drainage of the abscess or biopsy only. Sixteen of these patients developed a draining sinus or recurrent disease within a few months despite the use of antituberculous drugs or antibiotics. The other group, consisting of 20 patients, were treated initially by total excision of the inflammatory mass with no persistence or recurrence. The groups were found to be comparable with respect to age, sex, race, duration of disease and size and site of the lymph node involved. We recommend total excision of the lesion without antituberculous medications as the first choice of treatment.

Antitubercular Agents↗

PubMedDate not supplied

Subjective symptomatology of asthma in an outpatient population.

Characteristics of subjective symptomatology of asthma were examined within a group of 132 adult asthma patients receiving medical care in a university-based, ambulatory clinic setting. Patients responded to 36 symptom descriptions or adjectives associated with asthma which were included in a modified version of the Asthma Symptoms Checklist (ASC). A principal components exploratory factor analysis was conducted and five factors were identified. The five factors measured 1) panic-fear, 2) airways obstruction, 3) hyperventilation, 4) fatigue, and 5) irritability. Psychometric properties of the factor scores were satisfactory. The reliabilities were high, standard deviations were large, and differences in factor mean scores conformed to clinical experience. Correlational analyses support the construct validity of the ASC, especially the panic-fear factor. An important outcome of this study was to verify the ASC factor structure in an outpatient setting. The ASC was confirmed as a valuable instrument for use in self-management programs for adults with asthma. The five ASC factors represent highly stable components of subjective symptomatology of asthma among diverse adult patient populations and geographical settings.

Adaptation, Psychological↗

PubMedDate not supplied

Advance directives in cardiac and pulmonary rehabilitation patients.

PURPOSE: Advance directives have been available in parts of the United States for more than 20 years, but research shows that only a small percentage of adults (5-25%) have some form of written advance directive. The purose of this study was to examine the presence of advance directives among persons entering cardiac and pulmonary rehabilitation, and identify characteristics of persons most likely to have advance directives. METHODS: The sample consisted of 336 cardiac patients and 181 pulmonary patients who enrolled in the University of Alabama at Birmingham's Cardiopulmonary Rehabilitation Program between January 1996 and December 1999. As part of the initial program assessment, patients were asked two questions: (1) Do you have a living will? (2) Do you have any advance directives? For the purposes of this study, the two questions were combined to examine the presence of either a living will or other type of advance directive. RESULTS: Results indicate that 25% of both subgroups (cardiac and pulmonary patients) report having written advance directives. Logistic regression analysis indicates that among cardiac patients whites and older persons were more likely to have advance directives. Among pulmonary patients, females and whites were more likely to have advance directives. CONCLUSIONS: These results indicate that only a minority of cardiopulmonary rehabilitation patients have advance directives upon entry into the program, and that the prevalence differs among gender, racial, and age groups. Cardiac and pulmonary rehabilitation programs may be valuable sites for educating patients about advance directives and efforts by rehabilitation personnel may increase the prevalence of advance directives among patients.

Adult↗

PubMedDate not supplied

Chronic obstructive pulmonary disease stage and 6-minute walk outcome.

PURPOSE: Although physicians generally reserve pulmonary rehabilitation (PR) referral for patients in later stages of chronic obstructive pulmonary disease (COPD), there is no evidence to suggest that PR programs are more effective for these persons than for those in earlier stages of the disease. This study examined the relationship between 6-minute walk change and COPD stage in patients completing PR. METHODS: The sample consisted of 76 patients who enrolled in the University of Alabama at Birmingham's Cardiopulmonary Rehabilitation Program with a primary diagnosis of COPD between January 1996 and June 2000. Data was collected on 6-minute walk upon entry into the program and upon program completion. Patients were stratified according to COPD stage using the American Thoracic Society staging system. RESULTS: There were significant differences among the three stages with regard to initial and ending 6-minute walk distances such that persons in later stages of the disease have shorter initial and ending 6-minute walk distances. However, all three stages show significant improvements in the 6-minute walk after PR. There were no significant differences in the median change among groups indicating that the median change was not better (or worse) for patients in any particular COPD stage. CONCLUSIONS: This study suggests that PR is equally effective in increasing physical performance for all patients regardless of COPD stage. This type of information can be used to support the recommendation of PR for patients early in the disease process.

Aged↗

PubMedDate not supplied

A simple "step-test" protocol for identifying suspected unrecognized exercise-induced asthma (EIA) in children.

The purpose of this study was to demonstrate that a simple submaximal "step-test" could be used as an exercise challenge to identify elementary school students with suspected but undiagnosed asthma. This article also describes a protocol for exercise testing that can be used in epidemiological evaluations. School age children grades 1-4 with suspected but undiagnosed asthma were identified by a 12-item questionnaire completed by a parent or guardian. Only students identified with suspected asthma by questionnaire were exercise challenged on a step-test it baseline spirometry was normal and there was no contraindication for intense aerobic activity. Possible asthma was defined as a 15% or greater decrease in FEV1 or a 25% or greater decrease in FEF25-75 from baseline at either 3 or 10 minutes. The exercise protocol included spirometry before and after stepping continuously for 5 minutes at an exercise intensity sufficient to maintain a heart rate between 150 and 200 beats per minute. Heart rate was continuously monitored throughout the exercise period. Testing was completed at school. No complications occurred during the exercise testing. Exercise testing was completed on 548 students with suspected undiagnosed asthma. Thirty students (6%) had exercise test changes in pulmonary function that met established criteria for suspecting asthma. A board-certified pediatric allergist/immunologist or private physician examined 26 of the 30 students with positive exercise testing. Asthma was diagnosed in 23 (88.89%) of these students. All students with impaired pulmonary function after exercise were able to return to class after a short period of observation. In conclusion, a simple, reproducible school-based exercise protocol can be used to identify students with suspected undiagnosed asthma.

Asthma, Exercise-Induced↗

PubMedDate not supplied

A technique for standardizing the jet injector and Mantoux tuberculin skin tests.

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Adolescent↗