Biomedical subjects

R L Sopher

Publications and source records attributed to R L Sopher.

12 recordsLinked to original sources

PubMed1984

Reducing tuberculosis detection costs.

Use of sputum culture for diagnosis of tuberculosis is an inefficient detection technique in a disease of declining prevalence. We found such testing at our 400 bed acute care hospital resulted in less than 2 percent positive when done with prior patient screening. In an effort to minimize detection costs, restrictions requiring that a tuberculin skin test and chest roentgenogram be performed prior to processing the MTB culture were instituted. This resulted in 672 fewer cultures being processed in the trial year, a significant (44 percent) reduction compared to the prior year. At $50.00 per culture, this represents an annual savings of more than $30,000.

Cytological Techniques↗

PubMed1981

Clinical determinants of tuberculosis screening.

Because of declining prevalence of tuberculosis in the United States, standard laboratory tests detect fewer actively infected patients. Of 6,884 cultures for Mycobacterium tuberculosis (MTB) in three years at our hospital, only 2% were positive. To select other effective screening variables, we retrospectively reviewed patients in whom cultures were ordered. Charts of 79 patients with active tuberculosis and 226 patients whose cultures were negative were reviewed for 45 signs, symptoms, and laboratory tests determined at the time of initial contact. Those variables which distinguished the MTB-active from the nonactive were: history of weight loss, prior exposure, night sweats, fever, abnormal chest roentgenogram, positive skin test (PPD) (at P less than .001), and cough and abnormal pulmonary examination (at P less than .05). An algorithmic analysis suggests that weight loss and/or cough, followed by abnormal chest x-ray film and/or positive PPD, would detect 77% of the MTB-infected persons in whom these tests were done. The classic signs and symptoms of pulmonary tuberculosis continue to be excellent screening variables. When combined with the chest x-ray film and PPD, they may allow use of the culture as a confirmatory test, rather than its current inappropriate use as a screening test, for a disease of low prevalence.

Body Weight↗

PubMed1981

Pneumococcus-induced granulocytopenia and pulmonary leukostasis in rabbits.

Mortality associated with pneumococcal disease often remains unexplained. Intraperitoneal inoculation of live PNCs into rabbits induced significant granulocytopenia compared with broth-injected controls (p < 0.001). Lung sections from the infected rabbits had significantly increased mean alveolar septal wall granulocytes compared with controls (p < 0.01). Granulocytopenia and pulmonary leukostasis occurred only in those animals with high levels of bacteremia. Intravenous challenge of rabbits with sonified, nonviable PNCs induced a mean change of blood granulocytes of -64% compared with +124% for saline-injected controls, a difference significant at p < 0.001. Mean lung granulocytes from the PNC sonicate-challenged animals were 10.7 +/- 1.7 cells/HPF compared with 4.0 +/- 1.4 for controls, a difference significant at p < 0.001. Pulmonary vascular granulocyte plugging was found in five of six experimental animals but in none of six controls. complement-depleted animals displayed significantly less granulocytopenia (p < 0.005) and pulmonary leukostasis (p < 0.005). Therefore PNC constituents induce profound, possibly complement-mediated granulocytopenia and pulmonary leukostasis. Similar phenomena may contribute to the pulmonary dysfunction and even death associated with human pneumococcal disease.

Agranulocytosis↗

PubMed1974