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Sputum cytopathology: use and potential in monitoring the workplace environment by screening for biological effects of exposure.

Sputum cytopathologic monitoring detects squamous cell lung cancers at an extremely early stage (x-ray negative). It holds further potential for preventing disease by detecting epithelial alterations which reflect environmental hazards. The addition of sputum cytology screening to screening by chest x-ray film does not significantly reduce mortality from all types of lung cancer, but preliminary analysis of Johns Hopkins Lung Project data suggests that mortality from squamous cell carcinoma is reduced. Quantitative automated cytopathology systems and biochemical/immunological cell markers enhance understanding of these precursors and offer great promise for increasing capacity, accuracy, and usefulness in cytopathology screening of workers. Cytological specimens collected over years of screening workers considered at risk may be important to eventually understanding development and prevention of major occupational diseases.

Carcinoma, Squamous Cell↗

Clusters of galaxies: a cosmological probe.

The constraints on cosmological parameters presently obtained and those that can be obtained from X-ray cluster surveys are presented. Extremely strong bounds on the values of Omega, Lambda, sigma(8) and the power spectrum of fluctuations, as well as constraints on the equation of state of dark energy, can be determined. Recent Advanced Satellite for Cosmology and Astrophysics and XMM results on the chemical composition of clusters show that the Fe abundance is not universal, but is correlated with cluster mass and central gas density. The Si, S and Fe abundances do not resemble those seen in Milky Way Halo stars or those in the Lyman-limit galaxies. The XMM RGS abundances for gas in elliptical galaxies are subsolar and the abundance pattern is not alpha-element rich, in contradiction with all models of elliptical-galaxy gas abundances.

Journal Article↗

Plasma hydrodynamics of the intense laser-cluster interaction.

We present a one-dimensional hydrodynamic model of the intense laser-cluster interaction in which the laser field is treated self-consistently. We find that for clusters initially as small as approximately 25 A in radius nonuniform expansion of the heated material results in long-time resonance of the laser field at the critical density plasma layer. A significant result of this is that the ponderomotive force, which is enhanced at the critical density surface, can be large enough to strongly modify the plasma hydrodynamics, even at laser intensities as low as 10(15) W/cm(2) for 800 nm laser pulses. Simulations of our recent experiments in extreme ultraviolet and x-ray generation from clusters explain the dependence of generation efficiency on laser pulse width.

Journal Article↗

Epidemiological, clinical and therapeutic features of AIDS-related Mycobacterium kansasii infection during the HIV pandemic: an 11-year follow-up study.

OBJECTIVES: Optimal diagnosis and timely treatment of atypical mycobacteriosis, and especially Mycobacterium kansasii disease, remain a serious challenge for clinicians engaged in the management of the immunocompromised host. METHODS AND RESULTS: From more than 2700 hospitalizations (over 1800 patients) attributable to HIV-associated disorders over an 11-year period, 12 patients were found to have a confirmed M. kansasii infection. This reflects the recent reduction in the frequency of this HIV-related complication, which virtually disappeared after the introduction of potent antiretroviral combinations in 1996. In the early 1990s, the lack of effective antiretroviral regimens made frequent the association with AIDS, a mean CD4 lymphocyte count of nearly 20 cells/microL, and an extremely variable chest X-ray features. The recent detection of a further case was attributable to late recognition of very advanced HIV disease, complicated by multiple opportunistic disorders. CONCLUSIONS: Mycobacterium kansasii respiratory or disseminated infection continues to occur, and poses diagnostic problems in terms of late or missed identification as a result of slow culture and frequently concurrent opportunistic disease. Serious therapeutic difficulties also arise from the unpredictable in vitro antimicrobial susceptibility profile of these organisms, and from the need to start an effective combination therapy that does not interfere with other medications as soon as possible.

AIDS-Related Opportunistic Infections↗

Steering attosecond electron wave packets with light.

Photoelectrons excited by extreme ultraviolet or x-ray photons in the presence of a strong laser field generally suffer a spread of their energies due to the absorption and emission of laser photons. We demonstrate that if the emitted electron wave packet is temporally confined to a small fraction of the oscillation period of the interacting light wave, its energy spectrum can be up- or downshifted by many times the laser photon energy without substantial broadening. The light wave can accelerate or decelerate the electron's drift velocity, i.e., steer the electron wave packet like a classical particle. This capability strictly relies on a sub-femtosecond duration of the ionizing x-ray pulse and on its timing to the phase of the light wave with a similar accuracy, offering a simple and potentially single-shot diagnostic tool for attosecond pump-probe spectroscopy.

Journal Article↗

Emergency department management of mild traumatic brain injury in the USA.

OBJECTIVE: To describe the emergency department (ED) management of isolated mild traumatic brain injury (TBI) in the USA and to examine variation in care across age and insurance types. METHODS: A secondary analysis of ED visits for isolated mild TBI in the National Hospital Ambulatory Medical Care Survey 1998-2000 was performed. Mild TBI was defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9) codes for skull fracture, concussion, intracranial injury (unspecified), and head injury (unspecified). Available ED care variables were analysed by patient age and insurance categories using multivariate logistic regression. RESULTS: The incidence of isolated mild TBI cases attending ED was 153,296 per year, or 56.4/100,000 people. Of the patients with isolated mild TBI, 44.3% underwent computed tomography, 23.9% underwent other non-extremity, non-chest x rays, 17.1% received wound care and 14.1% received intravenous fluids. However, only 43.8% had an assessment of pain. Of those with documented pain, only 45.5% received analgesics in the ED. Nearly 38% were discharged without recommendations for specific follow up. Several aspects of ED care varied by age but not by insurance type. CONCLUSION: Substantial ED resources are devoted to the care of isolated mild TBI. The present study identified deficiencies in and variation around several important aspects of ED care. The development of guidelines specific for mild TBI could reduce variation and improve emergency care for this injury.

Adolescent↗

Uneven epidural analgesia-early diagnosis and correction: case reports.

Lateral displacement of the epidural catheter can cause uneven epidural analgesia. Early determination can be made by pulse-wave monitoring of sympathetic blockade of the lower extremities and by x-ray determination of the placement of the catheter tip. Withdrawal of the catheter tip to near the midline may correct uneven epidural analgesia.

Anesthesia, Epidural↗

Charcot's spine with neurological deficit: computed tomography as an aid to treatment.

A patient with Charcot's disease of the lumbar spine presented with weakness of one extremity. Myelographic and x-ray film studies indicated stenosis and compression due to degenerative changes. Although decompression and fusion were considered, computed tomographic scans indicated the wide extent and location of the destructive changes. Nonoperative treatment was elected because of the high risk of fusion failure and instability.

Arthropathy, Neurogenic↗

Procedure for simulating divergent-light halos.

Divergent-light halos are halos produced by light from nearby light sources, like street lamps being scattered by small crystals of ice floating in the air. The use of "brute-force" Monte Carlo methods to simulate such halos is extremely inefficient, as most scattered rays will not hit the eye of the observer. I present a new procedure for Monte Carlo simulations of divergent-light halos. This procedure uses rotational symmetries to make a selected sampling of events that greatly improves the computational efficiency of the algorithm. We can typically generate a simulated halo display in minutes using a personal computer, several orders of magnitude more rapid than a simple brute-force method. The algorithm can also optionally generate three-dimensional pictures of divergent-light halo displays.

Journal Article↗

SiC/Tb and Si/Tb multilayer coatings for extreme ultraviolet solar imaging.

Narrowband SiC/Tb and Si/Tb multilayers are fabricated with as much as a 23% normal-incidence reflectance near a 60 nm wavelength and spectral bandpass (FWHM) values of 9.4 and 6.5 nm, respectively. The structural properties of the films are investigated using extreme ultraviolet and x-ray reflectometry and transmission electron microscopy. Thermal stability is investigated in films annealed to as high as 300 degrees C. Because of their superior thermal stability, relatively high reflectance, and narrower spectral bandpass, Si/Tb multilayers are identified as optimal candidates for solar physics imaging applications, where the peak response can be tuned to important emission lines such as O v near 63.0 nm and Mg x near 61.0 nm. We describe our experimental procedures and results, discuss the implications of our findings, and outline prospects for improved performance.

Journal Article↗

Cervical flexion myelopathy associated with cervical spina bifida occulta--case report.

A 16-year-old boy presented with segmental muscular atrophy of the bilateral distal upper extremities. Cervical spine x-ray films showed occult spina bifida from C-1 to T-1 associated with an abnormal long club-like bone located parallel to the epidural space between C-5 and C-7. In neck flexion, the cervical spinal cord was stretched and compressed to the posterior aspect of the vertebral body. Moreover, the dorsally placed abnormal bone migrated ventrally, indenting the dorsal portion of the spinal cord. This is quite an unusual case of so-called "flexion myelopathy," aggravated by the abnormal bone located dorsally.

Adolescent↗

Computer-assisted optimization of correction osteotomies on lower extremities.

Automated methods are presented for the planning of correction osteotomies and osteosynthesis on lower extremities. Intraoperative calibrated X-ray images and kinematic measurements using optical tracking systems are the basis for the identification of the individual anatomy of the patient. The correction input of the surgeon, together with optimization algorithms, allows the calculation of the position and orientation of the osteotomies and the repositioning of the bone fragments. A navigation module supports the surgeon during the execution of osteotomies and repositioning, as well as osteosynthesis. So far, the approach has been evaluated in laboratory trials and ex vivo tests.

Cadaver↗

Non-Hodgkin's tumor and Pancoast's syndrome.

A 60-year old man presented with Horner's syndrome, and acute right hand and lower extremity weakness. Chest X-ray and MRI revealed a right apical lung tumor (presumed to be a primary lung cancer), with brachial plexus infiltration and spinal cord compression. Emergent radiotherapy was initiated for spinal cord compression and a biopsy was obtained 24 h later. A careful review of pathology demonstrated a non-Hodgkin's lymphoma. The patient subsequently received chemotherapy, and is now in remission. This case illustrates the importance of a tissue diagnosis before initiating therapy for a Pancoast's tumor.

Carcinoma↗

[Experimental erysipelas in different species as a model for systemic connective tissue disease. I. Systemic vascular processes during organ manifestation (author's transl)].

INTRODUCTION: The similarities between erysipelas in animals and rheumatic diseases in man have been discussed since the work of Nieberle (1931). The present work sets out to investigate the course of organ manifestations in pigs, rats, and mice using germ-free or specific pathogen-free experimental animals. Particular consideration will be given to the initial systemic vascular processes as well as to the significance of the erysipelas antigen. MATERIAL AND METHODS: In several experiments, a total of 166 pigs--partly gnotobiotic or specific pathogen-free animals--37 specific pathogen free Wistar rats and 57 albino mice were orally and/or parenterally infected with standardized erysipelas strains of serotype B. Clinical examination post infection were carried out with the EKG and by x-raying the joints of the extremities. All large parenchymatous organs, as well as heart valves, aorta and synovia were examined histologically in paraffin sections. In mice and rats, joints of the extremities were embedded in toto in metracrylate. Besides various histological staining methods, histochemical reactions were used to demonstrate mucopolysaccharides and fibrin. The myocardium, central nervous system and synovia of several joints were examined with the electron microscope. In the pig, immunohistological methods demonstrating the presence of fibrin, complement and IgG, as described by Seidler et al. (1971) and Trautwein et al. (1972), were used. RESULTS: The most important changes in joints, heart valves heart musculature and blood vessels occur during the early bacteriemic phase. A distinct sticking effect develops in the mouse 3.5 hours p.i., in the rat 24 hours p.i., and in the pig 36 hours p.i. Simultaneously, hyaline thrombi occur in capillaries and venules; these are seen as parallel, loosely-packed fibrin fibers in the electron microscope. With the aid of immunofluorescence fibrin, IgG and complement C3 can also be demonstrated here. Exudates rich in fibrin develop parallel to the microthrombosis. In pigs and rats vascular and myocardial necroses develop to 3 days p.i. The mice do not survive the 3rd p.i. 39% of the pigs showed edema and mesenchymal activation of varying intensity in the heart valves between the 3rd and 8th day p.i. Besides the insudation of the valves, endocardial thromboses developed in 80% of the mice. Endocarditis, aand in addition large aortic thromboses were recognized in more than 50% of the rats. As early as the 4th day p.i., coagulopathy, angionecrosis and exudation led to acute arthritic symptoms..

Animals↗

A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis.

OBJECTIVE: To determine, in subjects with knee pain but no radiographic changes of tibiofemoral or patellofemoral compartment osteoarthritis (OA), whether mean body weight, quadriceps and hamstring strength, lower extremity muscle mass, depression scores, and perceptions of their general health status differed from those of subjects with symptomatic knee OA. METHODS: Subjects were 25 women and 10 men with knee pain and radiographic evidence of OA at the baseline examination, and 21 women and 16 men who had knee pain at the baseline examination but no radiographic evidence of knee OA at either baseline examination or followup evaluation performed, on average, 31 months later. These individuals were a subset of a cohort of 462 independently living elderly individuals recruited by telephone interview after random selection through random digit dialing of households in central Indiana. Data from an additional 134 subjects who had neither knee pain nor radiographic changes of OA at either the baseline or followup examination were analyzed for comparison. Lower extremity muscle strength was measured by isokinetic dynamometry, lean tissue (i.e., muscle) mass in the lower extremities by dual x-ray absorptiometry, depression by Center for Epidemiology Depression (CES-D) scale. knee pain by Western Ontario McMaster University OA instrument, and perceived general health status by the Medical Outcome Survey Short Form-36. RESULTS: In contrast to those with symptomatic knee OA, those who had knee pain but no radiographic evidence of OA were less obese, had hamstring as well as quadriceps weakness, and had CES-D scores high enough to qualify for a diagnosis of clinical depression. CONCLUSION: Among subjects with knee pain but no OA--and among women in this subset, in particular--knee pain may be a manifestation of depression. rather than of joint disease.

Aged↗

Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results.

The Scarf osteotomy has proven to be a versatile and powerful procedure to correct various degrees of hallux valgus deformity. Through modifications of bone-cut lengths and in combination with a phalangeal osteotomy, most hallux valgus deformities can be addressed. In cases of extreme hypermobility of the first ray or arthrosis of the first metatarsocuneiform joint, the Lapidus operation may be more appropriate. Hallux valgus rigidus or hallux valgus with severe rheumatoid joint disease usually requires alternative procedures. The results of the Scarf osteotomy compare favorably with the results reported for other popular bunion surgeries. When choosing a procedure, the clinician should consider that the Scarf osteotomy allows the patient to ambulate postoperatively without a cast or the use of crutches, to return to bathing and a closed athletic shoe in one week, and to have bilateral surgery, which maintains cost-effectiveness and returns the patient to his or her desired lifestyle more quickly. It has been said that surgery is both a science and an art. The author often believes that bunion surgery is more art than science, hence the success of so many procedures in one surgeon's hands and the failure in another's hands. The Scarf bunionectomy is a technically demanding procedure that has a large learning curve. Once mastered, however, the Scarf bunionectomy can provide a predictable and satisfying outcome for both patient and foot surgeon.

Bone Screws↗

[Dislocation of the head of the fibula--diagnostic and therapeutic problems].

Luxation of the head of the fibula in the proximal tibiofibular joint is rare and is often overlooked. Pointers in this direction should be a swelling above the head of the fibula that is sensitive to pressure, an inexplicable pattern of signs involving the fibula, as well as an undefined insecurity of gait associated with the absence of other injuries in the genicular area. Diagnosis is best confirmed in the hospital by means of luxation or repositioning manoeuvres at the joint. The experienced physician can draw further conclusions from x-ray films of the forced extreme joint position. Therapy depends exclusively on the severity of complaints of the patient and must be determined individually for each patient.

Adult↗

[Results of surgical treatment of 248 lateral ligamentous lesions of the ankle joint (author's transl)].

From 1975 to 1980, 414 patients suffering from lateral ligamentous lesions of the ankle joint had undergone surgical treatment. 248 patients were seen in two follow-up examination; of these, 122 patients were examined by x-ray films taken in forced extreme joint position in two planes (a.p. and lateral) of both ankle joints, the uninjured ankle being examined for comparison. In 76.2% of the cases, both ankle joints were found to possess equal stability. Less than 10% of the follow-up patients examined showed slight restriction in mobility of the upper ankle joint. 97% of the patients questioned stated that the results of surgery were good. Only 3% expressed dissatisfaction. A severe complication was observed in 1 patient, who had an infection of the joint; cure was effected by means of arthrodesis of the upper ankle joint.

Ankle Injuries↗