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O Hnatiuk

Publications and source records attributed to O Hnatiuk.

3 recordsLinked to original sources
PubMed1996

Evaluation of internists' spirometric interpretations.

BACKGROUND: Correct interpretation of screening spirometry results is essential in making accurate clinical diagnoses and directing subsequent pulmonary evaluation. The general internist is largely responsible for interpreting screening spirometric tests at community hospitals. However, reports of new guidelines for screening spirometry are infrequently published in the general internal medicine literature. This can lead to incorrect interpretations. We sought to evaluate whether spirometric interpretations by a group of practicing general internists differed from those of two board-certified pulmonologists using guidelines published by the American Thoracic Society (ATS). METHODS: As part of a Continuous Quality Improvement project, all available screening spirometric tests over a 3-month period at two area community hospitals were reviewed. Only those performed on individuals age 18 or older were included in the analysis. Comparison was made between the interpretations of staff internists and those of two pulmonologists, who were blinded to the results of all other interpretations. We analyzed 110 screening spirometric tests from 84 males and 26 females. The patients ranged in age from 18 to 77 (mean 41 +/- 13 years of age). RESULTS: There was 97% concordance between the two pulmonologists' interpretations. In three cases, interpretations of only one pulmonologist agreed with those of the internists. The internists and both pulmonologists agreed in 73 cases. The majority of spirometric results in this subgroup were normal (n = 54). Both pulmonologists disagreed with internists' nomenclature in five cases. There was complete disagreement between the pulmonologists and the internists in the other 29 cases. Using the pulmonologists' interpretations as the "gold standard," the sensitivity (the internists' ability to correctly identify abnormal spirometric results) was 58.8% (95% confidence interval [CI] 42.2%, 73.3%), the specificity was 81.8% (95% CI 70.0%, 89.8%), the positive predictive value was 66.7% (95% CI 49.0%, 80.9%), and the negative predictive value was 76.1% (95% CI 64.3%, 85.0%). The most common inaccurate interpretations made by internists were "small airways disease" when spirometric results were normal (n = 8); "normal" when a restrictive pattern was present (n = 6), and "normal" when an abnormal flow-volume loop suggesting possible upper airway obstruction was present (n = 5). CONCLUSIONS: The spirometric interpretations of a group of general internists differed significantly from those of two board-certified pulmonologists using published guidelines in approximately one third of cases. This may be because subspecialty guidelines are infrequently published in the general internal medicine literature. We believe that wider dissemination of these interpretative guidelines and ongoing physician education would improve general internists' ability to identify patients who require further pulmonary evaluation.

Adolescent↗
PubMed1992

Churg-Strauss syndrome.

A 62-year-old woman who had a history of asthma and allergic rhinitis developed bilateral pulmonary infiltrates and marked eosinophilia. A transbronchial biopsy specimen did not help clarify the diagnosis. She later developed erythematous nodules on her feet; results of a biopsy specimen revealed necrotizing extravascular granulomas and marked infiltration of the dermis with eosinophils consistent with a diagnosis of Churg-Strauss syndrome. Skin manifestations are often nonspecific in this syndrome and occur in approximately two thirds of cases.

Churg-Strauss Syndrome↗
PubMed1981

Hepatic and intestinal contribution of two forms of apolipoprotein B to plasma lipoprotein fractions in the rat.

The in vivo incorporation of labeled amino acids into two forms of apolipoprotein B of nascent hepatic, nascent intestinal, and plasma lipoproteins was studied. Using SDS-gel filtration column chromatography rat apolipoprotein B was separated into two proteins of higher (apo Bh) and of lower (apo Bl) molecular size and the incorporation of label into each was measured. When livers isolated from fed rats were perfused with 3H-labeled amino acids, radioactivity was incorporated into both forms of apo B of the d less than 1.060 fractions (very low (VLDL), intermediate (IDL), and low (LDL) density lipoproteins) with a labeling ratio of apo Bl to apo Bh of 0.8. When mesenteric lymph was collected from corn oil fed rats intraduodenally injected with 3H-labeled amino acids, radioactivity was mainly incorporated into apo Bl of chylomicrons and VLDL with apo Bl to apo Bh labeling ratios of 14 and 44, respectively. Plasma was isolated 2 h after intraperitoneal injection of 3H-labeled amino acids into chow fed rats and lipoproteins were isolated by sequential density ultracentrifugation. The labeling ratio of apo Bl and apo Bh decreased from 4.2 in VLDL to 0.5 in LDL indicating a progressive enrichment of apo Bh in the LDL fraction. High density lipoproteins (HDL) contained less than 4% of the total labeled apo B and was enriched in apo Bl. The results of this study indicate that the liver synthesizes both forms of apo B while the intestine synthesizes almost entirely apo Bl. Since both apo B proteins are secreted primarily by the liver into VLDL, the results are consistent with preferential removal of apo Bl during triglyceride-rich lipoprotein catabolism and entry of hepatically derived apo Bh into LDL.

Animals↗