[Dying and death in the hospital. Very few are dying alone].
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Hospital Mortality↗
Biomedical subjects
C Bucher
Publications and source records attributed to C Bucher.
[Dying and death in an acute-care medical hospital].
Nowadays, more people seem to die in hospitals or other establishments than in their own homes. The following paper reports on 50 consecutive cases of death that occurred in a clinic of internal medicine. The analysis concentrated on the circumstances, the symptoms and the treatment of the patients during the 12 h. preceding and immediately before death as well as on the opinion of the relatives and the attending staff. A questionnaire registered the different opinions. Nearly a third of these deaths occurred after a fairly short hospitalization time. Death was not always the result of a long illness and it involved also young people. Most of the patients died in their hospital room, in the presence of their relatives and/or of the attending staff. They were mostly unconscious during the moments preceding their death. Terminal symptoms such as pain, anxiety, shortness of breath or thirst were largely kept under control. The relatives and concerned people were, as far as possible, informed about the grievance and the fatal issue of the patient's illness. Their reactions were diverse. Most relatives were satisfied with the treatment and care given to the hospitalized patient. The doctors and nursing staff considered their working together as being better than usually expected. Clear therapeutical concepts, appropriate palliative care as much as optimal communication are important requirements for a good treatment of the dying. The following results allow us to question many a prejudice concerning death in a hospital surrounding, but also show us possibilities of improvement. So we should sometimes question ourselves about the sense and the need of certain nursing interventions. We should spend more time during our medical training on the question of palliative care and on the problem of the relationship of doctors to death and to the dying. We feel that establishing a "science of death" or a segregation of the dying in specialized institutions makes no sense.
Adult↗
[New concept of the posture of premature infants].
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Humans↗
Inhibition of intracellular growth of Histoplasma capsulatum yeast cells by cytokine-activated human monocytes and macrophages.
Human monocytes/macrophages (M psi) were infected with Histoplasma capsulatum yeast cells, and intracellular growth was quantified after 24 h of incubation in medium alone or in medium containing cytokines. Yeast cells multiplied within freshly isolated monocytes, cultured M psi, and alveolar M psi with intracellular generation times of 14.2 +/- 1.4, 18.5 +/- 2.1, and 19.9 +/- 1.9 h (mean +/- standard error of the mean), respectively. Monocytes and M psi inhibited the intracellular growth of yeast cells in response to cytokine supernatant; maximum inhibition was obtained when cytokines were added to cell monolayers immediately after infection. Opsonization of yeast cells in normal serum or in H. capsulatum-immune serum did not affect the intracellular generation time of yeast cells in either control M psi or cytokine-activated M psi.
Cytokines↗
[Total cholesterol, HDL-cholesterol and blood pressure in relation to life style: results of the first population screening of the Swiss MONIKA Project].
To evaluate the association of individual health habits with levels of cardiovascular risk factors such as serum cholesterol and blood pressure, data from a representative population sample of 860 men and 788 women, aged 25 to 64 years and residing in Western Switzerland, were analyzed cross-sectionally. The data had been collected during 1984/85 as a part of the WHO MONICA project, an international research project on the epidemiology of cardiovascular diseases. In age-adjusted analysis, a score of prudent diet was a reasonably strong inverse correlate of total cholesterol in men (p less than 0.001) but less so in women (p = 0.11); the diet score was unrelated to HDL cholesterol. In both genders, alcohol consumption was associated with elevated levels of systolic and diastolic blood pressure (men: both p less than 0.001; women: p = 0.05 and 0.01 respectively) and of HDL cholesterol (men and women: p less than 0.001). Coffee consumption was unrelated to either blood lipids or blood pressure. In both men and women, leisure-time exercise was a predictor of a low-risk lipid profile, i.e. a low total cholesterol/HDL ratio (both p less than 0.001). Better educated persons, especially women, revealed consistently lower levels of cardiovascular risk factors. The independent character of these lifestyle-risk factor-associations was largely confirmed in a multivariate analysis, with cigarette smoking emerging as another significant predictor of a deteriorated lipid profile, while education was not an independent determinant of biological risk factors. Lifestyle variables, including body mass index, explained 9 to 19% of variance in cardiovascular risk factors, with relative weight being the strongest of the predictors related to behaviour. Entering age and sex into the regression models enhanced the predictive power of the equations to 16 to 26% explained risk factor variance. We conclude from this population-based, cross-sectional study that personal health habits such as diet, exercise, alcohol consumption and smoking, as well as body weight are significantly and independently related to blood lipid and blood pressure levels; the apparent size of effect of these behavioural traits on biological risk factors for cardiovascular diseases was only modest, but it may nevertheless be relevant to prevention.
Adult↗
[Diagnostic and therapeutic aspects of the initial epileptic seizure].
We present the concept of an 'epileptic syndrome' which is important for prognostic statements and the application of appropriate therapeutic measures. We then discuss the epileptic seizure and the assessment of suspected seizure, indications for admission to a hospital, diagnostic measures (EEG, CT scan, laboratory tests, lumbal puncture, MRI scan, PET scan, angiography), therapy and procedures for imminent status epilepticus. Finally, we try to answer the question whether anticonvulsant medication should be instituted after a first epileptic seizure.
Anticonvulsants↗
[Allergic reaction form of middle ear mucosa. An animal experiment study].
The middle ear is not a body site at which anaphylactic reactions (type I in the classification of Coombs and Gell) predominate. Non-IgE-mediated reactions preferentially occur in response to an allergen. Out of 64 guinea pigs, 48 were sensitized and provoked with an allergen (p-toluene-diamine, hair dye). Sixteen nonsensitized animals were treated in order to rule out toxic reactions. A mainly lymphomonocytic infiltration (without eosinophilia) is proof of allergic origin. In addition there is a more or less pronounced edema. This may also be absent, as the present study shows. A differential diagnosis of inflammatory reactions is not feasible with conventional histologic techniques alone. This is doubtless due to the fact that immune mechanisms (tuberculin reaction type) are also present in chronic infections. In the animal experimental model, a definitive separation between toxic and allergic reactions is possible. Sporadic clinical observations of this allergic reaction form of the middle-ear mucosa are thus confirmed.
Animals↗
Phagocytosis of Histoplasma capsulatum yeasts and microconidia by human cultured macrophages and alveolar macrophages. Cellular cytoskeleton requirement for attachment and ingestion.
Phagocytosis of Histoplasma capsulatum (Hc) yeasts and microconidia by human macrophages (M phi) was quantified by a fluorescence quenching technique. Phagocytosis of unopsonized Hc yeasts by monocyte-derived M phi and human alveolar M phi (AM) was rapid. After 60 min, 79% of cultured M phi and 59% of AM had ingested an average of 9.8 and 11 yeasts/M phi, respectively. In contrast, only 26% of monocytes ingested 4.5 yeasts/cell after 60 min. Phagocytosis of unopsonized microconidia by cultured M phi and by AM was equivalent. Monoclonal antibodies specific for the alpha-chains and beta-chain of the CD18 family of adhesion receptors inhibited the binding of Hc yeasts and microconidia to cultured M phi and AM. Thus, the M phi CD18 complex mediates recognition of both phases of this dimorphic fungus. Disruption of actin microfilaments with cytochalasin D inhibited both attachment and ingestion of yeasts by M phi. In contrast, nocodazole, which prevents polymerization of microtubules, did not inhibit binding or ingestion. Both drugs inhibited ingestion, but neither drug inhibited binding of C3b- and C3bi-coated sheep erythrocytes to complement receptors type one (CR1) or type three (CR3), respectively. Therefore, different signal transducing mechanisms for phagocytosis appear to be triggered by the binding of Hc yeasts to CD18, and by the binding of EC3bi to CD11b/CD18, respectively.
Antibodies, Monoclonal↗
Differentiation in throat cultures of group C and G streptococci from Streptococcus milleri with identical antigens.
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Antigens, Bacterial↗
Evaluation of differential and selective media for isolation of Aeromonas and Plesiomonas spp. from human feces.
We studied nine solid and two liquid media for their suitability to select Aeromonas and Plesiomonas spp. from human stools, using artificially contaminated samples as well as 254 samples from outpatients with and without diarrhea. Media with optimal sensitivity and specificity for Aeromonas spp. were alkaline peptone-water, Trypticase soy broth with ampicillin, inositol-brilliant green-bile salts agar, dextrin-fuchsin-sulfite agar, xylose-sodium desoxycholate-citrate agar, and Pril-xylose-ampicillin agar. For Plesiomonas sp., alkaline peptone-water and inositol-brilliant green-bile salts agar were optimal. Four strains of Aeromonas spp. were detected in patient samples with these media.
Aeromonas↗
Accuracy of the KOH and vancomycin tests in determining the Gram reaction of non-enterobacterial rods.
Two nonstaining tests for the Gram reaction, the KOH and vancomycin disk (5 micrograms) tests, were employed on 488 strains of aerobic gram-negative and gram-positive rods. Since each test may yield false results with certain species, the use of a combination is suggested.
Bacteriological Techniques↗
O serotyping scheme for Enterobacter cloacae.
A serotyping scheme for Enterobacter cloacae based on heat-stable somatic antigens is described. A total of 28 antisera were prepared in rabbits, and titers of agglutinins were high (greater than 640). Some cross-reactions were observed, and 11 sera required absorption before routine use. Of 300 clinical isolates from 66 hospitals, 77.6% were typable, 11.4% were not agglutinated by any of the sera, and 11.0% were autoagglutinable in saline. The eight most frequent serotypes were O3 (21.3%), O8 (13.3%), O1 (7.6%), O13 (5.0%), O9 (4.7%), O10 (3.0%), O16 (3.0%), and O25 (3.0%).
Agglutination Tests↗
Isolation of Pseudomonas maltophilia from human stools with thienamycin.
P. maltophilia, a thienamycin-resistant species, was isolated by means of thienamycin-blood agar (10 mg/l) from 14 out of 218 stools. MacConkey agar with thienamycin was inhibitory for part of the strains.
Agar↗
Radioimmunometric assay for a monoclonal antibody-defined tumor marker, CA 19-9.
We describe a solid-phase radioimmunometric sandwich assay for a new tumor marker defined by a monoclonal antibody (19-9). This antibody reacts with a carbohydrate antigenic determinant (CA 19-9) found at low concentrations in sera from healthy individuals but frequently increased in sera from patients with adenocarcinomas. The assay is sensitive and simple to perform. It requires duplicate 100-microL samples and may be performed in 6 h. The concentration of CA 19-9 in samples is determined by reference to a standard curve, which is essentially linear from 0 to 120 arbitrary units/mL. The average CV is approximately 10% in the range of 5.8 to 120 units/mL. The minimum detectable dose is 1.4 units/mL and analytical recovery of CA 19-9 is 97.6 to 100.6%. The average concentration of CA 19-9 in sera from 1020 healthy individuals was 8.4 (SD 7.4) units/mL; only 0.6% of such sera had concentrations greater than 37 units/mL. The assay has high specificity (98.5%), even among patients with benign diseases, and has high sensitivity (up to 79%) for patients with gastrointestinal adenocarcinomas, especially those of the pancreas.
Adenocarcinoma↗
Differential production of acid by Enterobacteriaceae in OF media and in fermentation broth.
Several species of Enterobacteriaceae were checked for acid formation from some carbohydrates or alcohols in OF medium [OF Basal Medium, Baltimore Biological Laboratories] and in a traditional "fermentation broth". After selection of those species that formed acid only oxidatively or fermentatively in OF, it was found that acid formation in the fermentation broth could reflect fermentation or oxidation, but that it was not necessarily related to either. In oxidative species, it occurred less frequently than oxidation in OF and was usually delayed. Fermentative species (in OF) either yielded acid in fermentation broth or did not, depending on the species. Thus, OF media cannot be substituted for traditional broths, although they may be of value in differentiating certain species.
Culture Media↗
Evaluation of three differential media for detection of Enterobacter agglomerans (Erwinia herbicola).
Dextrin-fuchsine-sulfite medium (DFS), Rimler-Shotts agar (RS), and a new lysine-ornithine-mannitol agar (LOM) were tested for detection of Enterobacter agglomerans. In human stools, LOM and DFS were most sensitive at coliform-to-E. agglomerans ratios of less than or equal to 10(2) and E. agglomerans inocula of greater than 10(2) per plate. Both LOM and DFS detected one strain in 254 stools, but RS proved to be inhibitory.
Culture Media↗
The epidemiological type identification of Serratia marcescens from outbreaks of infection in hospitals.
A study of serological, bacteriocine and phage typing of Serratia marcescens was made. Specific O-antisera of adequate titre were relatively simple to prepare but H-antisera exhibited many heterologous agglutination reactions amongst the type strains. Most of these cross-reactions were not reproduced when immobilization tests with H-sera were performed. Direct haemagglutination tests were used to establish the presence of fimbriae amongst the H-type strains and the results of agglutination tests with non-fimbriate variants of strains indicated that fimbrial antibody in high titre was present in some sera. Replicate typing of 100 pairs of cultures by the phage-typing method indicated that small variations in pattern were common and that larger variations occurred occasionally. Therefore differences in pattern of less than two strong reactions should not be taken as evidence that strains can be distinguished. Cultures of S. marcescens, 273 in total, from six outbreaks of infection in British and European hospitals were typed by O-serology, H agglutination and immobilization tests, phage typing and bacteriocine susceptibility by a cross-streaking method. The typability of strains by each method was high but the results suggested that no single method was sufficiently discriminating to be used alone for typing. Comparison of the H-type and typing patterns of members of the same O serogroup from incidents of infection showed that reliable results were obtained by H-typing or by phage and bacteriocine typing after the application of the appropriate 'difference' rule. The greatest discrimination between strains of the same O-group was obtained by the use of H-typing or phage typing.
Aged↗
The effect of N-formimidoyl thienamycin, ceftazidime, cefotiam, ceftriaxone and cefotaxime on non-fermentative Gram-negative rods, Aeromonas, Plesiomonas and Enterobacter agglomerans.
Thirty-one species (185 strains) of non-fermentative gram-negative rods (excluding Pseudomonas aeruginosa) as well as 45 strains of Aeromonas spp., 15 strains of Plesiomonas shigelloides and 68 strains of Enterobacter agglomerans were tested in microdilution procedures against N-formimidoyl thienamycin, ceftazidime, cefotiam, ceftriaxone and cefotaxime. N-formimidoyl thienamycin was the most effective drug as far as the spectrum of these bacterial groups and potency is concerned; ceftazidime was the second most effective agent. Ceftriaxone and cefotaxime were similar in their activity (against a smaller spectrum), while cefotiam showed little effect. There were occasional differences between MBC and MIC values which were most notable with ceftazidime, cefotiam, ceftriaxone and cefotaxime against E. agglomerans.
Aeromonas↗