Biomedical subjects

H Durant

Publications and source records attributed to H Durant.

10 recordsLinked to original sources

PubMed1993

Digital subtraction in multi-compartment arthrography of the wrist.

In a series of 23 patients with chronic and unexplained painful wrist, three-compartment arthrography was carried out using digital subtraction. Pathologic conditions were disclosed in 19 patients. Digital subtraction both allowed for a stronger diluting of the dye and for the demonstration of a larger amount of lesions of smaller size than conventional wrist-arthrography, as long as motion artefacts had been avoided. Obtaining successive views without having to wait for complete contrast resorption in the injected compartments represents a significant advantage. The importance of three-compartment injection is stressed and the best way to perform the technique is discussed. As it proved to be a fast and reliable examination procedure the authors advocate using digital subtraction arthrography of the wrist whenever the method is available. However, this relatively new technique does not rule out careful correlation between arthrographic findings and clinical complaints.

Adolescent↗

PubMed1988

Cell-mediated immunity of healthy adult Nova Scotians in various age groups compared with nursing home and hospitalized senior citizens.

We used the Multitest CMI to define the delayed-type hypersensitivity response (DTH) of 149 healthy adult Nova Scotians (49 male and 100 female subjects, ranging in age from 25 to 82 years) and to define and compare the response of the healthy senior citizens (66 to 82 years old) with 79 self-sufficient senior citizens in a nursing home, 25 senior citizens in a nursing home but not self-sufficient, and 15 senior citizens hospitalized in an acute care hospital. The DTH response decreased with increasing age and with increasing dependency in a nursing home. Thus, 1.5%, 9.5%, 17.9%, 41.8%, 60%, and 40%, respectively, of the subjects in the groups listed above were anergic. For the healthy subjects, age and sex were significant factors in predicting a positive response to the skin test antigens. Use of a logistic model revealed that for male subjects, the probability of a positive response was Ln (p/1 - p) = 1.72 - 0.038 (age), whereas for female subjects, it was Ln (p/1 - p) 0.59 - 0.0213 (age). When this model was applied to the responses of senior citizens, those living at home had a significantly greater response than did those in nursing homes. Furthermore, those self-sufficient while they were living in a nursing home had a significantly greater response than those who were not self-sufficient.

Adult↗

PubMed1988

Exposure to parturient cats: a risk factor for acquisition of Q fever in Maritime Canada.

Over a 34-mo period we studied 51 patients with Q fever and 102 control subjects (with various lower-respiratory-tract infections) who were matched for age, sex, and time of onset of infection. By univariate analysis (not adjusted for multiple comparisons), cases differed significantly from controls in the following activities: working on a farm; slaughtering or dressing animals; and contact with cats, cattle, and sheep. The strongest association was with exposure to stillborn kittens--11 of 51 cases vs. none of 102 controls (P less than .00000)--and with exposure to parturient cats (odds ratio, 10.3; 95% confidence interval, 3.5-31.8). Exposures to newborn animals (chiefly kittens) and stillborn kittens were significant risk factors by multivariate analysis, as were rural residence and slaughtering or dressing animals. In 13 Q fever incidents following exposure to parturient cats, 80 people became ill, 52 of whom had serological evidence of recent Coxiella burnetii infection (most of the others were not tested).

Animals↗

PubMed1988

An outbreak of Q fever probably due to contact with a parturient cat.

Thirty-three cases (24 definite, nine probable) of Q fever were diagnosed in Victoria County, Cape Breton, Nova Scotia from May to August, 1985. Twenty-six of the cases occurred in residents of Baddeck (population 900, attack rate 2.8 percent), and 21 of the cases occurred during the month of June. There was geographic clustering of the cases: 14 of the 33 (42 percent) lived or worked in four buildings located side by side in the center of town. A case control study revealed that 25 of 29 cases were exposed to a cat that gave birth to stillborn kittens on June 8, 1985 and had bled per vaginum for three weeks prior to delivery. The cat lived in one of the buildings where geographic clustering occurred and frequently visited the other buildings. None of the 40 control subjects was so exposed (p less than 0.001). This cat had an antibody titer of 1:512 to Coxiella burnetii phase 1 antigen and a titer of 1:1024 to phase 2 antigen. Exposure to cattle, sheep and goats, the traditional reservoirs of Q fever, was uncommon among patients and control subjects and none of eight cattle tested had antibodies to C burnetii phase I antigen. We conclude that the infected parturient cat was probably responsible for this outbreak of Q fever affecting 2.8 percent of the population of the town of Baddeck.

Adolescent↗

PubMed1988

A positive response to any of seven intradermal antigens predicts favorable outcome in patients hospitalized with community-acquired pneumonia.

We used the commercially available Multitest (R) CMI to assess the response of 100 adults hospitalized with community-acquired pneumonia to the following seven antigens: tetanus toxoid, diphtheria toxoid, Streptococcus, Proteus, tuberculin, Candida, and trichophyton. Thirty-one of the patients responded to one or more of these antigens and survived their acute illness. Of the Multitest (R) CMI negative patients, 49 lived and 20 died. A comparison of the three groups revealed that the 31 patients with positive tests were significantly younger and had a higher mean serum albumin than did those with negative tests who died. Multivariate analysis revealed that a positive Multitest (R) CMI and the albumin level were independent predictors of survival. A positive Multitest (R) CMI identified a less seriously ill group of patients as evidenced by 100% survival, by a very low rate of complications (0.18/patient), and by less utilization of resources (fewer hemograms and chest radiographs). Thus a positive Multitest (R) CMI may identify patients who could be discharged earlier, and a negative test should target its patients for more aggressive therapy.

Adult↗

PubMed1987

Pneumonia--the quality of medical records data.

The quality of medical records data for patients who were hospitalized with community-acquired pneumonia was assessed by comparing medical records data with data obtained in a prospective study of pneumonia for the period April 1, 1984, to December 31, 1984. One hundred five patients fulfilled the case definition of pneumonia for entry into the prospective study. One hundred twenty-seven patients were identified by medical records data. Seventy-three of the patients appeared in both studies. The positive predictive accuracy of the medical records data was 57%. When the etiologic diagnoses for the 73 patients identified by both studies were compared, there was agreement only 52.6% of the time. Streptococcus pneumoniae was overdiagnosed, and Mycoplasma, specific viral causes, and Haemophilus influenzae were not recorded by the medical records data. The quality of medical records data regarding pneumonia can be improved by changing the current ICD-9-CM coding system for pneumonia and by providing instruction and an algorithm for abstractors to follow in assigning a diagnosis of pneumonia.

Humans↗

PubMed1986

Nursing home-acquired pneumonia. A case-control study.

To determine if there are any unique features of nursing home-acquired pneumonia we carried out a case-control study wherein each patient admitted with nursing home-acquired pneumonia was age- and sex-matched with a patient with community-acquired pneumonia. There were 36 men and 38 women in the nursing home group. The mean age of both groups was 74 years. The mortality rate for nursing home-acquired pneumonia it was 40.5%, whereas for community-acquired pneumonia it was 28% (P = NS). Patients with nursing home-acquired pneumonia had a significantly higher incidence of dementia and cerebrovascular accidents, and patients with community-acquired pneumonia were more likely to be smokers and to have chronic obstructive pulmonary disease. Aspiration pneumonia was more common among patients with nursing home-acquired pneumonia (P less than .001), and Hemophilus influenza pneumonia more common among the patients with community-acquired infection (P less than .01). Sputum for culture could be obtained in only 31 and 39% of the patients--contributory to the high rates of pneumonia of unknown etiology 63.5 and 56.1% for the nursing home group and the control subjects, respectively. Patients with nursing home-acquired pneumonia received cloxacillin and aminoglycosides more frequently than patients with community-acquired pneumonia (P less than .05), and patients with community-acquired pneumonia received erythromycin more frequently than patients with nursing home-acquired pneumonia (P less than .05). Complications were common during the hospital stay of these patients--the most frequent being congestive heart failure, urinary tract infection, renal failure, and respiratory failure.

Age Factors↗

PubMed1985

Community-acquired pneumonia requiring hospitalization. Is it different in the elderly?

The authors studied 138 patients, 57 of whom were younger than 65 years of age and 81 who were 65 years of age and older, with community-acquired pneumonia to determine whether or not such pneumonia is different in the elderly and to define how such patients are investigated and treated. Pneumonia in the elderly was characterized by a higher mortality, 30 v 10%; more likely to be of unknown etiology, 54 v 30%; and more likely to show radiographic progression after the patient had been admitted to the hospital, 48 v 11%. In addition, elderly patients were more likely to be afebrile when admitted, 57 v 26%. Twenty-seven etiologic categories were present in 77 patients in whom a cause for the pneumonia was established. Streptococcus pneumoniae accounted for 9.4% of the pneumonia overall and for 27% of the pneumonia among patients who had sputum cultures performed before antibiotic therapy. The diagnostic yield was 11.6% for blood cultures, 38.2% for sputum cultures, 2.3% for throat washing, and 22.1% for serological studies. Twenty-seven percent of patients were receiving antibiotics of the time of admission to the hospital. Most (79%) received more than one antibiotic after admission. This study indicates that community-acquired pneumonia is a serious illness and that an algorithm approach to diagnosis and treatment of such pneumonia is necessary.

Aged↗

PubMed1985

Does cytomegalovirus play a role in community-acquired pneumonia?

Cytomegalovirus (CMV) is recognized as an important pathogen in the immuno-suppressed patient. Sporadic case reports of cytomegalovirus community-acquired pneumonia have appeared. We studied 443 patients with community-acquired pneumonia requiring hospitalization to define the role of cytomegalovirus in this illness. Four patients (0.9%) had good evidence that cytomegalovirus caused their pneumonia: 2 had the virus isolated from pulmonary tissue and 2 had cytomegalovirus inclusion bodies visualized in this tissue. An additional 14 patients had serologic evidence (a fourfold rise in the complement fixation tests) of cytomegalovirus infection. Analysis of these 18 patients suggest, that cytomegalovirus plays a role in community-acquired pneumonia. Six (33%) of the patients were immunosuppressed. Six others had concomitant infections: Chlamydia trachomatis (3); Epstein-Barr virus and M. pneumoniae (1); and bacteremia with Group B streptococcus and Bacteroides fragilis plus Eubacterium lentum (1 each). Seven patients (39%) required assisted ventilation, four of whom developed secondary bacterial pneumonia. Five (28%) died. Only two patients had a clinical and radiographic picture suggestive of a viral illness as a cause of the pneumonia. Three patients had atypical lymphocytes in their peripheral blood film. We found that the prevalence of complement fixing antibody to cytomegalovirus increased with age. Such antibody was lacking among those in the 16-20 year group while it peaked at 65% for males and at 78% for females ages 91-100 years. Despite the fact that 42.2% of the adults lacked antibody to cytomegalovirus, community-acquired pneumonia due to this virus is uncommon and does not justify routine serological testing for such infection among patients with community-acquired pneumonia.

Adult↗

PubMedDate not supplied

Community-acquired pneumonia requiring hospitalization: 5-year prospective study.

We studied all patients with community-acquired pneumonia who were admitted to our 800-bed adult acute care hospital from 1 November 1981 to 15 March 1987. The 719 patients had a mean age of 63.2 years; 18% were admitted from nursing homes, and 18% required ventilatory assistance as part of the therapy for pneumonia. Patients with nursing home-acquired pneumonia were significantly older; had a higher mortality (40% vs. 17%); were more likely to be admitted in January; were less likely to complain of cough, fever, anorexia, chills, headache, nausea, sore throat, myalgia, or arthralgia; and were more likely to be confused than those admitted from the community. Pneumonia of unknown etiology and aspiration pneumonia were more common and Mycoplasma pneumoniae infection less common among those with nursing home-acquired pneumonia. Streptococcus pneumoniae accounted for 58% of the 48 cases of bacteremia. None of the bacteremic patients received antibiotics before admission, compared with 34% of the nonbacteremic patients. Aerobic gram-negative rod bacteremia was not more frequent among nursing home patients than among those from the community. The overall mortality was 21% (8.5% for those less than 60 years of age and 28.6% for those greater than 60 years old). By multivariate analysis the following variables were significant predictors of mortality: number of lobes involved by the pneumonic process, number of antibiotics used to treat the pneumonia, age, admission from a nursing home, ventilatory support, and the number of complications that occurred while the patient was in the hospital.

Aged↗