Goal-setting program improves nutrition and physical activity among Supplemental Nutrition Assistance Program eligible adults.

OBJECTIVE: To examine the impact of Nutrition for Life (NFL), a goal-setting nutrition education program, on the knowledge, self-efficacy and behaviour of adults eligible for Supplemental Nutrition Assistance Program-Education. DESIGN: NFL was developed using a 4-week goal-setting behavioural strategy focused on nutrition, physical activity and meal planning techniques. A quantitative repeated-measures design using self-reported data was collected at pre- and post-interventions and at 1-week and 1-month follow-ups. SETTING: Two Federally Qualified Health Centers in Philadelphia, PA, USA. PARTICIPANTS: A total of ninety-eight participants enrolled in the intervention; the majority were women (80·2 %), Black/Non-Hispanic (75·0 %) and 45-54 year old (39·6 %). RESULTS: Participants showed significant improvement in knowledge, self-efficacy and behaviour. Specifically, mean daily intake for vegetables increased by 0·31 cup (P < 0·05) and for fruits by 0·39 cup (P < 0·01) at 1-week follow-up. Participants also showed healthier behaviour at 1-month follow-up. Planning at least seven meals per week increased from 14·8 to 50 % (P < 0·01), completing at least 30 min of physical activity every day in the last week increased from 16·7 to 36 % (P < 0·01) and consuming water with all meals increased from 39 to 70·6 % (P < 0·01). CONCLUSIONS: The implementation of a goal-oriented nutrition education program offers a promising approach at achieving positive behaviour change among SNAP-eligible adults.

Treatment of malignant pleural effusion: pleurodesis using a small percutaneous catheter. A prospective randomized study.

The aim of this prospective, randomized study was to investigate the possibility of performing pleurodesis using a small percutaneous catheter (Cystofix catheter, CH10, 65 cm) inserted at bedside in patients with recurrent malignant pleural effusion and to compare this catheter with a conventional large bore chest tube (CH24) placed in connection with diagnostic thoracoscopy. After drainage pleurodesis was performed with tetracycline as sclerosing agent. Of 18 evaluable consecutive patients (mean age 67.8 years) nine were randomized for pleurodesis with the small and nine for the large catheter. In the former group, the majority (seven of nine) did not find insertion of the catheter more unpleasant than thoracentesis. In the latter group only a few (two of nine) found insertion comparable with thoracentesis (P < 0.05). All patients found the presence of the large catheter very or somewhat unpleasant (two and seven patients), whereas this was only the case for a few (no and two patients) treated with the small catheter (P < 0.05). In the former group three patients required new thoracentesis, whereas this was only the case for two patients in the latter group (P > 0.05). No complications were seen. We conclude that pleurodesis in patients with recurrent malignant pleural effusion can be performed with a small percutaneous catheter (Cystofix) with an effect similar to that obtained with a large-bore chest tube and with less discomfort for the patient.

Ethical reasoning in mixed nurse-physician groups.

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning.

[Percutaneous transthoracic needle aspiration biopsy. Diagnostic yield after negative fiberoptic bronchoscopy in patients with peripheral pulmonary infiltrations]. / Perkutan transtorakal nåleaspirationsbiopsi. Diagnostisk udbytte efter negativ fiberbronkoskopi hos patienter med perifert beliggende lungeinfiltrater.

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB performed over a five-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytological classification of the tumour type in 72.2% (39 of 54 patients). Five of the 54 patients (9.3%) presented with small cell anaplastic bronchogenic carcinoma, diagnosed by TNB, and were treated with chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, three benign tumour, two infection, and three sequelae after pulmonary infarction. The remaining 22 patients with undiagnosed lesions were followed long term, five showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable in the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore a definitive benign diagnosis was not made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral, malignant pulmonary lesions.

Hyaluronan and procollagen type III aminoterminal peptide in serum and bronchoalveolar lavage fluid in patients with pulmonary sarcoidosis.

The aim of this study was to evaluate whether markers of collagen synthesis, hyaluronan (HA) and procollagen type III aminoterminal peptide (PIIINP) in bronchoalveolar lavage fluid (BALF) and serum (S) were correlated to paraclinical markers of disease activity (S-ACE, S-IgG S-IgA S-calcium, chest X-ray (CXR) profusion score, pulmonary function tests (FEV1, FVC, TLC, DLCO)) in pulmonary sarcoidosis. The material comprised 48 patients with biopsy proven sarcoidosis (35 male, 13 female, median age 31 years) and 24 controls (16 male, 8 female, median age 60 years). BAL was performed in the right middle lobe with 250 ml saline. Patients had higher BALF-HA, mean 88 +/- 13 (SEM) micrograms/l, than controls, 39 +/- 2 micrograms/l (p < 0.01), higher BALF-albumin, 121 +/- 13 mg/l, than controls 58 +/- 4 mg/l (p < 0.01), and higher BALF/S-HA ratio, 3.35 +/- 0.51, than controls, 1.23 +/- 0.60 (p < 0.01). There were no significant differences for S-HA, BALF-PIIINP, or S-PIIINP. In patients significant correlations were found between BALF-HA, S-HA, and BALF-albumin; between S-HA and S-ACE; between BALF/S-HA and BALF-albumin; between CXR profusion score and S-HA, S-ACE, S-IgG, S-IgA, FEV1, FVC, TLC and DLCO. The results indicate that measurement of S-HA, BALF-HA, and BALF-albumin may be of value in the monitoring of disease in pulmonary sarcoidosis.

Diagnostic yield of transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in 103 patients with peripheral circumscribed pulmonary lesions.

The diagnostic potential of secondary transthoracic needle biopsy (TNB) following negative fiberoptic bronchoscopy (FOB) in patients with peripheral circumscribed pulmonary lesions was evaluated in a retrospective study. The records from 224 patients who had TNB over a 5-year period were reviewed. Of these, 103 patients met the criteria for inclusion in this series. The overall diagnostic yield of TNB in malignancy was 73.8% (54 of 73 patients). TNB allowed cytologic classification of the tumor type in 72.2% (39 of the 54 patients). Five of the 54 patients (9.3%) presented with small-cell anaplastic bronchogenic carcinoma, diagnosed at TNB, and were referred to chemotherapy. Of the 49 patients with a negative TNB, 27 went on to diagnostic surgical procedures; 19 had malignancy, 3 benign tumor, 2 infection, and 3 sequelae after pulmonary infarction. The remaining 22 undiagnosed patients were followed up over a long period of time, 5 showed progression of the pulmonary lesion suggesting malignancy. TNB appeared unsuitable for the diagnosis of benign lesions. Unspecific inflammation was not considered evidence of benignity, and therefore no definitive benign diagnosis was made by TNB in this series. There were no serious complications to TNB. In 18.1% of the procedures a pneumothorax developed, indicating a chest tube in 8.6% of the procedures. TNB is a suitable diagnostic procedure with a high diagnostic yield in patients with peripheral localized malignant pulmonary lesions.

Transbronchial lung biopsy through the fibre optic bronchoscope. Results and complications in 452 examinations.

During 1986-1989, diagnostic fibre optic bronchoscopy (FOB) was performed in local anaesthesia in 1144 consecutive patients. Of these, 405 (35%) patients, median age 59 years, had transbronchial lung biopsy (TBB) performed under fluoroscopic guidance; 47 patients had a rebronchoscopy, i.e. in total 452 FOB were evaluated. The indication for TBB was localized pulmonary lesions in 279 (69%) patients, and diffuse pulmonary lesions in 126 (31%) patients. Localized lesions: TBB yielded a clinically relevant diagnosis in 55.2% of the patients. Of the 110 patients with malignancy, the overall diagnostic strength was 45.5%. Of the 159 patients with non-malignant lesions, 65.4% were diagnosed by TBB. The diagnostic yield increased with the number of biopsy specimens (< or = 4 biopsies, 52%; > 4 biopsies, 70%. P < 0.05). In 155 patients with well defined, circumscribed lesions, the diagnostic yield of TBB increased with the size of the lesion (< 31 mm, 47%; 31-60 mm, 54%; > 60 mm, 60%, P = 0.09), and decreased with the distance of the lesion from the main carina < 61 mm, 70%; 61-100 mm, 52%; > 100 mm, 40% P < 0.02). Diffuse lesions: TBB yielded a clinically relevant diagnosis in 66.7% of the patients. Of the 15 patients with malignancy, 73.3% were diagnosed by TBB. Of the 93 patients with non-malignant lesions, 78.5% were diagnosed by TBB. The diagnostic yield showed a trend to increase with the number of biopsy specimens (< or = 4 biopsies, 65%; > 4 biopsies, 71%, P = 0.11).(ABSTRACT TRUNCATED AT 250 WORDS)

No effect of high-dose inhaled steroids in pulmonary sarcoidosis: a double-blind, placebo-controlled study.

OBJECTIVE: To evaluate whether inhaled steroids in high doses might be of therapeutic value in pulmonary sarcoidosis. DESIGN: Randomized, double blind and placebo controlled parallel study. SETTING: The out-patient clinic of the Department of Pulmonary Medicine, Gentofte Hospital, Copenhagen, Denmark. SUBJECTS: Twenty-one untreated patients (17 males, 4 females, median age 33 years, range 21-65) and eight patients treated with systemic prednisolone. All patients had biopsy proven pulmonary sarcoidosis radiological stage I-III. INTERVENTIONS: Treatment with either inhaled budesonide 1.2 mg day-1-2.0 mg day-1 (n = 9) or placebo (n = 12) for 12 months. MAIN OUTCOME MEASURES: Clinical (cough, chest pain, dyspnoea) and paraclinical variables (chest X-ray, gallium scintigraphy, pulmonary function tests, and biochemical markers of disease activity: blood leukocytes, lymphocytes, serum (S-) angiotensin converting enzyme (ACE), S-1,25-OH-cholecalciferol, plasma (P-) calcium, P-immunoglobulins) were recorded before treatment, every three months during treatment, and 6 months after treatment had been discontinued. RESULTS: There were no significant differences between the recorded variables in the budesonide and placebo groups. In general, a regression of disease activity was observed in both groups. Two patients in the treatment group, treated with 2.0 mg budesonide/day, and two in the placebo group had progression in disease and were put on systemic steroids. CONCLUSION: Inhaled budesonide in doses of 1.2-2.0 mg day-1 had no recognizable therapeutic effect on pulmonary sarcoidosis.

[Should the presence of Mycobacterium tuberculosis be demonstrated before the treatment of patients with suspected pulmonary tuberculosis?]. / Skal Mycobacterium tuberculosis påvises inden behandling af patienter mistaenkt for lungetuberkulose?

In Denmark, treatment of tuberculosis is generally only recommended if the diagnosis is confirmed bacteriologically, which may cause a delay in treatment. We investigated the duration of the treatment delay, and if the delay would cause any serious health problems for the individual or risk of contact infections by a retrospective examination of 324 cases of pulmonary tuberculosis. The mean treatment delay was longer in older age groups. Regarding death due to delay, we found no risk for the patients who are not weakened by old age or another disease. Only 11 (3.6%) above the age of ten years were treated without bacteriological confirmation (1% for Danes). The infection risk from the smear negative, but culture positive patients was minimal, as only one subject was definitely infected from a smear negative subject. In conclusion, we find the epidemiologic and individual risk sufficiently low to continue our rather restrictive treatment policy.

[Primary lung cancer in patients under 40 years of age]. / Primaer lungekraeft hos patienter under 40 år.

There seems to be a resistance of patients and physicians towards aggressive diagnostic evaluation of the symptoms of lung cancer in young people. We here review nine series of young patients with primary lung cancer. Patients below 40 years of age represent between 1.2 and 5% of the total lung cancer population. The distribution of sex and histopathologic findings is different, there being more women, fewer cases of squamous cell and more cases of small anaplastic and adenocarcinoma in the young group. Between 87 and 96% are smokers. There is a delay from the debut of symptoms to the first contact with a general physician of 2.4 to 10.8 months. There is a wide variation concerning tendency to operate with a frequency of curative resection of between 15 and 57%. Based on the survival of young patients who are treated by curative surgical resection, the outcome of surgical treatment for young patients does not differ from the general experience concerning resection in patients of all ages. Young patients who are found inoperable have worse survival than the older patients. Seventy to 90%, more than in the group of patients of all ages, have stadium II or III at the time of diagnosis. In conclusion, physicians should be aggressive with respect to the diagnostic evaluation even of young patients with symptoms suggestive of lung cancer.

[Disseminated primary bronchogenic carcinoma in 3 young patients]. / Dissemineret primaert bronkogent karcinom hos tre unge patienter.

Primary lung cancer in young patients is rare, patients under 40 years of age constituting between 1.2 and five percent of all cases. Three cases of primary lung cancer in young patients are presented, and the typical manifestations of primary lung cancer in young patients are discussed.

Pulse oximetry during fibreoptic bronchoscopy in local anaesthesia: frequency of hypoxaemia and effect of oxygen supplementation.

The indication for oxygen supplementation during diagnostic fibreoptic bronchoscopy (FOB) in local anaesthesia was evaluated by means of pulse oximetry in 160 patients (108 men, 52 women), median age 62 years. The patients were allocated at random into four groups of each 40 persons, which were comparable concerning pulmonary function and the dose of benzodiazepine used for premedication. The oxygen saturation of the haemoglobin (SpO2) in the tip of the index finger and the pulse rate were continuously recorded. Group 1 was examined without O2 supplement. Group 2a received O2 2 litres/min through a catheter placed in the vestibulum nasi. Group 2b received O2 2 litres/min through a pharyngeal catheter. Group 3 received O2 3 litres/min through a pharyngeal catheter. SpO2 mean values during FOB were 92 +/- (SD) 3% in group 1 and 96 +/- 2% in groups 2a, 2b and 3 (p < 0.001). SpO2 trough levels were mean 87 +/- 4% in group 1 vs. 93 +/- 2% in groups 2a and 2b, and 94 +/- 3% in group 3 (p < 0.001). Transient hypoxaemia, i.e., SpO2 < 85%, occurred with a frequency of 35% in group 1, 2.5% in group 2a, 0% in group 2b, and 2.5% in group 3. Tachycardia and bradycardia during FOB occurred with a frequency of 20% in group 1, 25% in group 2a, 18% in group 2b, and 10% in group 3. Pulse oximetry increases the safety of FOB, and is recommended for routine use. During FOB, oxygen supplement 2-3 litres/min should be administered to all patients, preferably through a pharyngeal catheter, as a preventive measure against hypoxaemia.

[Pulmonary coccidioidomycosis]. / Pulmonal coccidioidomycosis.

Coccidioidomycosis is an acute, generally mild, respiratory disease that rarely becomes chronic or disseminated and fatal. The aetiologic agent is Coccidioides immitis, a dimorphic fungus growing in soil. The fungus is endemic in hot semi-arid areas in the USA and South America. Human beings and animals become infected by inhaling dust with arthroconidia. The fungus gives rise to either a purulent or a granulomatous inflammation or both. Clinically and radiologically, it can be confused with neoplasms and tuberculosis. The disease may be fatal in immuno-deprived persons who are also at risk of reactivation of a latent infection. Coccidioidomycosis can be detected serologically. The standard treatment of severe illness is Amphotericin B. The authors present the first histologically and serologically verified case of pulmonary coccidioidomycosis in Denmark. An increased number of coccidioidomycosis can be expected with increased travelling and an increased number of immuno-deprived persons.

[Idiopathic bilateral paralysis of the diaphragm]. / Idiopatisk bilateral diaphragmaparalyse.

The case of a 38-year old Caucasian man with acute irreversible idiopathic bilateral paralysis of the diaphragm is presented. The relevant diagnostic procedures are discussed. Paralysis of diaphragm during fluoroscopy in the supine position, observation of paradoxical movement of the anterior abdominal wall and upright position during sleep are the major characteristics of this condition. Elevation of both hemidiaphragms on thoracic X-ray during maximal inspiration, lack of phrenic nerve conduction, gradually increasing dyspnoea without ongoing infection or simultaneous vaccination and decreased functional status may further confirm the diagnosis.

Percutaneous transthoracic fine-needle lung biopsy with 3 different needles. A retrospective study of results and complications in 224 patients.

During 1986-1990, 307 percutaneous transthoracic fine-needle biopsies (PTNB) were performed on 224 patients (mean age 63 years, range 27-83) with three types of needles (Nordenström, Vacu-Cut and Franzén). The overall sensitivity regarding malignant disease in central and peripheral pulmonary lesions was 67.0%. In 71 patients with suspected malignancy and a negative PTNB, the examination was repeated and the sensitivity was increased to 79.5%. Each needle had the following sensitivity: Nordenström 67.4%, Vacu-Cut 75.7%, Franzén 75.9%. The overall pneumothorax frequency was 24.7%, being highest with the Nordenström needle. Hemoptysis was seen in 5 examinations. In conclusion, the Franzén and Vacu-Cut needles have a significantly higher sensitivity and a lower complication frequency compared to the Nordenström needle.

Restrictive treatment policy for pulmonary tuberculosis in a low prevalence country.

In Denmark, treatment of tuberculosis is generally recommended only if the diagnosis is confirmed bacteriologically. This policy may cause a delay in treatment, if the patients are smear negative. We investigated the duration of the treatment delay, and whether the delay would cause any serious health problems for the individual, or risk of contact infections, in a retrospective examination of 324 cases of pulmonary tuberculosis. The mean treatment delay was longer in the oldest age group. Concerning death due to delay, we found no risk for those patients who were not weakened by other disease or old age. Only 11 patients (3.6%) over the age 10 yrs were treated without bacteriological confirmation (1% for Danes). The infection risk from the smear negative but culture positive patients was minimal, as only one subject was definitely infected from a smear negative patient. However, a risk of transmission exists from patients who are initially culture negative but later become smear positive. In conclusion, we find the epidemiological and individual risks sufficiently low to continue our rather restrictive treatment policy.

Five-day storage of platelets in a non-diethylhexyl phthalate-plasticized container.

A non-diethylhexyl phthalate (DEHP)-plasticized blood bag for 5-day storage of random-donor platelet concentrates has been developed. The plastic bag is composed of polyvinylchloride plastic with a butyryl trihexyl citrate plasticizer. The suitability of this plastic for the storage of platelet concentrates for use in clinical transfusion practice was evaluated. In vitro storage studies showed no significant differences at Day 5 for a series of in vitro assays (test plastic vs. control plastic) including pH (7.31 vs. 7.44), lactate dehydrogenase discharge (21.8 vs. 17.1%), pO2 (103 vs. 120 torr), osmotic recovery (52 vs. 57%), and morphology score (527 vs. 516). For paired radiolabeled recovery and survival data from autologous blood donors, results showed equivalence between the test plastic and two control plastics. A small but significant difference between test and control plastics in regard to survival was found by using a linear computer model, but not with a gamma function (multiple-hit) model. For paired transfusions to thrombocytopenic patients, the corrected count increments at 1 to 4 hours (test vs. control) were 13,534 versus 15,494 (p > 0.05, NS). Similar results were seen for corrected count increments determined at 12 to 24 hours. It can be concluded that platelets stored in the test plastic are acceptable for use in clinical practice.

[Thoracic Ewing's sarcoma]. / Torakalt Ewing's sarkom.

The case history of a girl aged 16 years with Ewing's sarcoma of a rib is presented. The symptomatology was typical and consisted mostly of moderate and intermittent pain in the thorax. The time elapsing between the first symptoms and the diagnosis was about 18 months and the consequent therapeutic delay was obvious. The importance of early diagnosis in cases of this type is emphasized.

[Pulmonary sarcoidosis or intrathoracic malignant lymphoma--the significance of a histological diagnosis]. / Pulmonal sarkoidose kontra intratorakalt malignt lymfom--betydningen af en histologisk diagnose.

The clinical appearance of sarcoidosis and the changes seen on x-ray of the thorax are often typical. However, several other conditions may present the same symptoms and identical x-ray findings. The present case report emphasizes the importance of an invasive approach and of histological investigation in patients in whom carcoidosis is suspected. For almost one year, a man aged 29 years was considered to be suffering from sarcoidosis on account of the clinical symptoms and bilateral hilar adenitis on x-ray op the thorax. He was treated with steroid for several months with clinical and radiological response. After the illness has lasted for one year, bronchoscopy was performed and bronchial biopsies revealed the diagnosis of malignant lymphoma.

Platelet storage in synthetic media lacking glucose and bicarbonate.

The goal of these studies was to develop a cost-effective medium for the storage at 22 +/- 2 degrees C of platelets for transfusion. Platelet concentrates were prepared from platelet-rich plasma in a standard fashion and resuspended in 55 mL of medium. Residual plasma was 14.4 +/- 4.3 percent of the final suspending solution. The use of a simple solution containing electrolytes and citrate, but no glucose or bicarbonate, was associated with a drop in pH to the range of 6.0 to 6.6, as a result of the production of lactic acid from the platelet glycogen and glucose present in residual plasma. When 25 mM (25 mmol/L) sodium phosphate was included as a buffer, the drop in pH was retarded, but the range throughout storage was still 6.5 to 6.8. Nonetheless, platelets stored for 5 days in this phosphate-containing medium showed satisfactory maintenance of many in vitro variables. However, there was a 10 to 35 percent reduction of in vivo recovery after isotopic labeling. There was no significant reduction in subsequent mean cell life. Because of the in vivo abnormalities, these media are not recommended for use at the present time. However, the results are encouraging and suggest that further research may lead to a satisfactory, cost-effective medium.