Biomedical subjects
Publications and source records attributed to D P Nicholson.
Pulmonary involvement with non-Hodgkin's lymphoma, while well recognized, is less common than with Hodgkin's lymphoma. Endobronchial non-Hodgkin's lymphoma is even rarer and usually occurs in the presence of disseminated disease. We present a case of bilateral endobronchial non-Hodgkin's lymphoma.
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The use of glucocorticoids in high dosage for the prevention and treatment of sepsis, septic shock, and ARDS has been controversial. The state of our knowledge has been reviewed, particularly to include some recent critical contributions. It is possible that glucocorticoids have a place in the treatment of gram-negative bacteremia, because the evidence in this situation is equivocal. There is no evidence that such therapy is indicated in other septic states, nor is there evidence that glucocorticoids prevent ARDS or improve the outcome. There are inadequate data to state categorically that glucocorticoid therapy in sepsis is harmful.
Success in reviving victims of overdose may be achieved by careful attention to cardiovascular and respiratory support and a high urinary output. In addition to these general principles, special measures may be indicated in cases of specific drug overdose. Such measures are outlined for various drugs, including acetaminophen, aspirin, phencyclidine, barbiturates, and organophosphates.
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A man with chronic lymphocytic leukemia had a rapidly progressive five-lobe infiltrate of the lungs after treatment with 60 mg of bleomycin. He had previously been treated with adriamycin and cyclophosphamide. An open lung biopsy showed no evidence of an infection and was consistent with drug-induced injury. The patient improved dramatically with corticosteroid therapy.
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An evaluation of the Automicrobic System (AMS) for Urines (Vitek Systems, Inc.) was carried out under the auspices of the Product Evaluation Committee of the College of American Pathologists from the period June 1977 through October 1978. Data generated during this evaluation indicated that, when comparing the AMS methodology to our clinical microbiology laboratory methodology, a 37% time saving could be realized by utilizing the AMS. Quantitation with the AMS showed a 99% correlation with the clinical microbiology laboratory method except for yeast which correlated only 50% of the time. The average overall identification accuracy was 95%. Negative response accuracy was 99%. Other members of the Enterobacteriaceae which the instrument is not designed to identify may produce erroneous results if they occur in urine specimens. Specimens containing two organisms were identified with a 94% correlation when compared to our conventional methodology. The time when a well becomes positive may be used as a fairly reliable indicator of significance (count greater than 70,000 colony-forming units per ml) for Escherichia coli, Klebsiella-Enterobacter group, and group D Enterococcus, but not for Proteus sp., Pseudomonas aeruginosa, and yeast. Specimen collection must be performed properly since specimens considered as contaminated by conventional plating-out techniques may be reported out by the AMS as only one or two organisms and thus lead to an erroneous assumption as to significance. Cost per specimen was $1.83 more by utilizing the AMS method as compared to our conventional method. This is offset by a saving of 1.74 h daily of personnel time and a final report in 13 h. At least 30 urine specimens would be needed daily to pay for the instrument and specimen costs in 1 year. The AMS can provide significant aid to a clinical microbiology laboratory when all factors are considered.
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Acute isoniazid overdose and toxicity may be complicated by convulsions and death. Six patients are reported, one of whom ingested simultaneously 15 gm of isoniazid and 5 gm of pyridoxine hydrochloride (vitamin B6); no convulsions resulted. In the light of this and other experience, suggestions are made for the use of pyridoxine in the treatment and prevention of acute isoniazid poisoning.
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Chemotherapy of pulmonary disease due to Mycobacterium kansaii has not always been successful, and resectional surgery has been used frequently in the treatment of this infection. To ascertain the impact of new antimicrobial agents on the treatment of M. kansaii infection, we reviewed the clinical courses of 59 patients treated between 1971 and 1974. Over-all, 92 per cent of patients converted their sputum cultures while receiving drugs, with only one patient undergoing surgical resection. Regimens containing rifampin were universally effective in both initial and retreatment cases; however, they offered no significant advantage over monrifampin regimens in initial treatment cases. In vitro resistance to isoniazid and ethambutol did not adversely affect the results of treatment with these drugs. Owing to the effectiveness of current chemotherapy, parameters such as age, underlying lung disease, or extent of disease were not related to the outcome of therapy. Because 90 per cent of the conversions in successful regimens occur within 4 to 6 months of beginning therapy, patients whose cultures remain positive should be considered for alternate drugs. Because the frequency of relapse after current chemotherapy is not yet clear, and because rifampin appears to be particularly advantageous in retreatment programs, rifampin should be reserved for this role. The total course of treatment should probably span at least 18 months, or 6 months beyond any cultural or radiographic evidence of activity.
The repeatablilty of the measurement of closing volume (nitrogen method) in healthy, normal subjects was investigated. At least 7 consecutive measurements at 5-min intervals were made in each of 22 subjects. The mean coefficient of variation for the absolute volume of phase IV was 36.1 per cent and for the percentage ratio of phase IV to vital capacity, 36.1 per cent. Repeated measurements by the same observer of the same records on various days did not differ significantly (P greater than 0.5). There was a significant difference (P less than 0.05) between 2 observers measuring the same records, but there was no significant difference between the two observers in the variance of the closing variability in the same subject, it may be necessary to perform several closing volume maneuvers in each subject to establish his or her range before changes in the closing volume can be interpreted.
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