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At least 19 recordsLinked to original sources
PubMed1991

The Washington University-Barnes Hospital experience with lung transplantation. Washington University Lung Transplantation Group.

OBJECTIVE: --To review our experience with lung transplantation, emphasizing recipient selection, choice of procedure, functional results, and outcome. DESIGN: --Retrospective review of patients who received lung transplants at Barnes Hospital, St Louis, Mo, between July 1, 1988, and January 31, 1991. SETTING: --Washington University School of Medicine, St Louis, Mo, and Barnes Hospital, a medical school and its affiliated referral hospital, respectively. PATIENTS: --Sixty-nine lung transplant procedures were performed in 66 recipients. Patients with clinically and physiologically severe lung disease were selected according to predetermined guidelines. Underlying diseases in the recipients included chronic obstructive pulmonary disease, alpha 1-antitrypsin deficiency emphysema, cystic fibrosis, pulmonary fibrosis, primary pulmonary hypertension, Eisenmenger's syndrome associated with an atrial septal defect, bronchiectasis, eosinophilic granuloma, and lymphangiomyomatosis. INTERVENTION: --Double-lung, bilateral sequential, and single-lung transplantations were performed. Eight patients underwent en bloc double-lung transplantations or a modification of this procedure with separate bronchial anastomoses. Thereafter, the bilateral sequential approach to replacement of both lungs was performed in 26 patients. Thirty-two patients underwent single-lung transplantations. MAIN OUTCOME MEASURES: --Pulmonary function tests, arterial blood gas levels, pulmonary artery pressure, pulmonary vascular resistance, and actuarial survival. RESULTS: --Actuarial survival at 1 year for the 66 lung transplant recipients was 79%. Actuarial survival at 1 year was 82% for the bilateral lung transplant recipients and was 90% for the single-lung transplant recipients. In patients with either restrictive or obstructive lung disease, pulmonary function tests and arterial blood gas levels improved markedly after lung transplantation. In patients with primary pulmonary hypertension or Eisenmenger's syndrome, the pulmonary artery pressure decreased and the cardiac index increased into the normal range after single-lung transplantation. CONCLUSIONS: --In carefully selected patients with end-stage lung disease, single-lung and bilateral lung transplantations can significantly improve functional capacity, with promising early actuarial survival statistics after 1 year.

Actuarial Analysis↗
PubMed1989

Blastomycosis in Washington Parish, Louisiana, 1976-1985.

For the period 1976-1985, the authors attempted to identify all cases of blastomycosis in Louisiana and studied in detail one county (Washington Parish) suspected by local physicians of having an unusually high incidence of the disease. The mean annual incidence rates for Louisiana and for Washington Parish were 0.23 and 6.8 cases per 100,000 population, respectively. To the authors' knowledge, the rate for Washington Parish is the highest annual incidence rate documented for a population in a nonoutbreak setting. Among the 30 cases detected in Washington Parish, the age range was 3 weeks to 81 years. Five cases died; of these, one was an infant who may have been infected in utero, and another developed clinical symptoms compatible with adult respiratory distress syndrome. There was no geographic clustering among cases the authors investigated, and a case-control study failed to identify specific activities or host factors which may have predispose to infection. Washington Parish is probably a hyperendemic area for blastomycosis because environmental conditions are especially conducive to Blastomyces dermatitidis growth. The study suggests that most cases in Washington Parish were sporadically infected, and common-source exposures to B. dermatitidis with resultant clinical illness are rare even in hyperendemic settings.

Adolescent↗
PubMed1991

Serological survey for heartworm (Dirofilaria immitis) in dogs in Washington.

The serologic prevalence of Dirofilaria immitis infection in 601 dogs in Washington was investigated in 1989-1990. Blood samples for serum were obtained from dogs approximately 2 yr of age or older in humane society shelters (n = 392) or veterinary clinics (n = 209). Serum samples were tested for heartworm infection using an enzyme-linked immunosorbent assay antigen test. Three (0.5%) dogs were positive for D. immitis infection, all of which were born and lived several years in states other than Washington. Heartworms have not been detected during the last 9 yr in the 1,203 dogs examined at the Washington Animal Disease Diagnostic Laboratory, Pullman, Washington. Consequently, the likelihood of indigenous heartworm infections in dogs in Washington remains low at this time.

Animals↗
PubMed1977

Isolation and characterization of epizootic hemorrhagic disease virus from white-tailed deer (Odocoileus virginianus) in eastern Washington.

A virus was isolated from the spleen of a white-tailed deer (Odocoileus virginianus) that had died during an epizootic in Washington state in 1967. Inoculation of a 10% spleen suspension from the deer caused hemorrhagic disease in normal white-tailed deer. Studies were conducted on the biological, physicochemical, and serologic properties of the Washington isolate. An in vitro assay system, utilizing a cultured primary of white-tailed deer fetal cells from an entire fetus, was employed for isolation and propagation of the virus. Cytopathic effect was characterized by focal development of rounded and clumped cells. Propagation was unsuccessful in suckling mice, BHK-21, and Vero cell cultures. The virus was resistant to treatment with ether, sodium deoxycholate, trypsin, oxytetracycline hydrochloride, and was sensitive to chloroform. Virus yield was not affected when infected cultures were treated with 5-iodo-2'-deoxyuridine, but dactinomycin (actinomycin D) treatment of infected cultures reduced virus yield. The virus was inactivated when heated at 70 C for 5 minutes or when exposed to pH 5 for 18 hours at 4 C. The virus was completely excluded from the filtrate by a 0.10- micronm (APD) membrane filter. Staining of infected cells with acridine orange indicated the presence of double-standard nucleic acid in the cytoplasm. Serum-neutralization tests with antiserums against the homologous virus and the New Jersey and Alberta strains of epizootic hemorrhagic disease virus resulted in neutralization of the Washington isolate. The Washington virus was not neutralized by bluetongue virus antiserum. Cells infected with the Washington isolate exhibited intracytoplasmic fluorescence by the indirect fluorescent antibody method with New Jersey and Alberta epizootic hemorrhagic disease antiserums but not with bluetongue antiserum.

Animals↗
PubMed1992

Barnes Hospital and the Washington University Medical Center.

The author documents the development of the Medical School at Washington University since 1891, when the St. Louis Medical College was first included as part of the University. In 1909, Robert Brookings, President of the Corporation of Washington University, acquired a large endowment and moved the clinical and hospital facilities to a new location, enabled by the estate of Robert Barnes. Harvey Cushing was offered the chair of surgery but eventually decided in favor of Harvard University in 1910. Dr. Ernest Sachs was recruited to Washington University by Dr. Fred Murphy, and in 1919 became the first ever Professor of Neurological Surgery. The history of neurosurgery and those who served it at the Washington University Medical Center and Barnes Hospital is recounted.

History, 19th Century↗
PubMed1990

Trends in teenage smoking during pregnancy. Washington State: 1984 through 1988.

Smoking rates in the United States have decreased since 1963, but this trend is less apparent in adolescents, especially girls. Using data on birth certificates from 1984 through 1988, we analyzed smoking trends during pregnancy in teenagers in Washington State. There was a small but significant increase in the overall smoking prevalence during pregnancy between 1984 (32%) and 1988 (37%). Smoking rates varied by mother's age, race and ethnicity, marital status, and prenatal care. Whites had the highest smoking prevalence, and native Americans showed the largest increase in smoking prevalence over time. In the 5 years studied, unmarried pregnant teenagers had a smoking prevalence of 42.8%, compared with a rate of 31.7% in married teenagers. Compared with other studies of smoking rates in nonpregnant teenagers, pregnant teenagers in Washington State had a much higher smoking prevalence than their nonpregnant peers, and the differences between these two groups did not appear to diminish over time. This study suggests that there is little movement toward meeting the 1990 Health Objectives for the Nation regarding smoking in Washington State teenagers who become pregnant.

Adolescent↗
PubMed1992

Trends in the utilization of mammography in Washington state and British Columbia: relation to stage of diagnosis and mortality.

To compare the utilization of an imaging technology in the United States and Canada and its effect on clinical outcomes, trends in the utilization of mammography among women aged 50 to 75 years from 1984 through 1988 in Washington State and British Columbia were examined. Also compared were trends in the stage at time of diagnosis of invasive breast cancer and mortality due to breast cancer in the two regions. Annual mammography use increased in both regions, but the proportion of women examined was consistently two to three times higher in Washington than in British Columbia (43% vs 16% in 1988). Although there was no difference in mortality trends, the proportion of women diagnosed with localized disease in Washington increased each year (from 52% to 64%, P less than .001), while in British Columbia it remained unchanged at approximately 56%. Results of this study suggest that differences in utilization were influenced by clinical policies, the degree to which these policies were promoted, reimbursement, and the organization of radiology services.

Aged↗
PubMed1992

Immunization practices of Washington State pediatricians--1989.

Administration of immunizations has become complicated by issues about consent, cost, and liability. To determine if these issues have changed the immunization practices of pediatricians, we surveyed pediatricians in private practice in Washington State. The survey results show that about one half of vaccines administered in pediatricians' offices are provided by the Washington State Health Department. The mean charge for administration of each parenteral vaccine was $7.02. Respondents strongly agreed that they would administer vaccine supplied by the Washington State Health Department if it was available. They also agreed that they referred patients to Health Department clinics for vaccination because of inability to pay and not because of concern about liability.

Child↗
PubMedDate not supplied

Smoking prevalence of pregnant women compared to women in the general population of Washington State.

We used two readily available sources of information to identify subgroups of pregnant Washington State women with high smoking rates. We compared smoking rates in pregnant women and women in general using information from the Washington State birth certificate collection system and the Washington State Behavioral Risk Factor Surveillance System. Smoking rates are substantially higher in young mothers 18-24 years of age than in comparable age cohorts in the general population of women in the state. In contrast, mothers 25 years of age and older smoke at lower rates than their age cohort in the general population. For multiparous women of all ages, smoking prevalence is related to age at first birth. Married women, whether pregnant or not, smoked less than unmarried women.

Adolescent↗
PubMedDate not supplied

Cervical cytology quality assurance in Washington State.

The objectives of this study were to establish a profile of cervical cytology laboratories in Washington State, identify quality assurance problems amenable to correction through education or legislation, and describe differences between large and small cytology laboratories. All 43 Washington laboratories that perform cervical cytology were surveyed by mail during 1989. Completed surveys were returned by 37 (86%) of the laboratories. Nearly half (43%) of the respondents reported processing less than 10,000 Papanicolaou smears annually. Only one-third (35%) of the respondents reported participating in relevant proficiency programs. A proportion of smaller cytology laboratories were compensating their cytotechnologists on the basis of the number of slides read and allowing Papanicolaou smears to be read outside the confines of the laboratory. The results of this study suggest that cytotechnologists in some larger Washington laboratories have been exceeding work load limits recommended by professional associations. Recent legislation includes regulations that address cervical cytology quality assurance. However, continued efforts will need to be made to encourage voluntary adoption of quality control measures not addressed by this legislation.

Female↗
PubMed1991

Lower extremity amputations among persons with diabetes mellitus--Washington, 1988.

Diabetes mellitus is the leading cause of lower extremity amputations (LEAs) in the United States, accounting for approximately 50% of all nontraumatic LEAs. To assist public health programs in preventing diabetes-related LEAs in Washington state, the diabetes-control program of the Washington Department of Health characterizes LEAs. This report summarizes an analysis of the incidence of LEAs during 1988 among Washington residents with and without diabetes.

Adult↗
PubMed1991

Differences in the obstetric practices of obstetricians and family physicians in Washington State.

In response to the obstetric malpractice crisis, both obstetrician-gynecologists and family physicians have raised their fees and preferentially selected lower risk patients. In addition, large numbers of general and family physicians have left obstetric practice altogether. The impact of these responses was explored by examining the differences in the demographic and clinical profile of patients served by these two disciplines in the State of Washington. Eighty-five percent (45,540) of all complete records from 1983 births attended by physicians in the State of Washington were matched to physician specialty information. These births represent 67% of the total deliveries in Washington State in 1983. Although twice as many general and family physicians as obstetricians were practicing obstetrics, obstetricians delivered 2.5 times as many infants as did general and family physicians. Obstetricians served an older patient population with more low-birthweight infants, multiple births, and complications of pregnancy than family physicians. General and family physicians were more likely to care for minorities, teenagers, and unmarried and rural mothers. Obstetricians cared for patients with higher medical risks, whereas general and family physicians provided care to more socially vulnerable and geographically isolated populations. To the extent that general and family physicians are differentially abandoning obstetric practice because of the current malpractice crisis, access to care for rural and socially vulnerable groups may deteriorate rapidly.

Adolescent↗
PubMed1990

A separate department of health in Washington State: four years before the mast.

This paper reviews the recent experience in Washington State which resulted in creation of a separate state Department of Health. Until the 1989 legislation was passed, Washington was one of 19 states in which public health was organizationally housed in a superagency. The Institute of Medicine, in its 1988 report on The Future of Public Health, recommended that states organize core functions under a separate department of health. The effort in Washington State was led by local public health officials. Success followed four years of hard work during which mistakes were made, coalitions were built, and legislative process was learned.

Forecasting↗
PubMed1989

A brief history of graduate medical education in Washington, Alaska, Montana, and Idaho.

Internships and hospital-based medical education preceded by more than 40 years the beginnings of a medical school in Washington State. Just after the turn of the 20th century, a few internships were begun by hospitals in Seattle and Spokane to help with the care of their sicker patients in the tradition of Eastern teaching hospitals. In the 1920s and 1930s, the number of hospitals with internship programs grew steadily as part of a nationwide effort at hospital standardization. Experiences in developing these programs and problems with intern recruitment contributed to the beginning of the University of Washington School of Medicine after World War II. Since the 1960s, intern and resident training has progressively become a cooperative effort of the school with many hospitals and clinics in Washington, Alaska, Montana, and Idaho contributing to the development of graduate medical education in this region.

Alaska↗