Effects of a coccidiosis challenge on dietary methionine recommendations in broilers.

Broilers are commonly exposed to coccidiosis infections, and the use of dietary strategies to reduce losses in growth performance has practical implications for the poultry industry. Methionine (Met) is typically the first limiting amino acid for broilers and is involved in metabolic and immunological pathways; however, literature is conflicting on how dietary Met requirements are affected by environmental stressors. Our objective was to assess how the Met requirement changes during coccidiosis based on results of growth performance, carcass traits, and health outcomes. Two trials were conducted using 780 male Ross 308 broiler chicks in floor pens randomly assigned to 1 of 12 experimental treatments. All birds received common starter (d 0-10) and finisher (d 24-35, Trial 2 only) diets, and only differed based on their assigned experimental grower diet (d 10-24). Trial 1 experimental grower diets ranged from 2.61 to 6.21 g/kg digestible Met. Trial 2 experimental grower diets were formulated to contain 15% below, at, or 15% above the Met requirement determined in Trial 1. Birds were exposed to a coccidiosis challenge on d 11, with blood and tissue collection (1 bird/pen) on d 18 and carcass processing on d 35 (2 birds/pen) in Trial 2. Data were analyzed using a 1- or 2-way ANOVA. A non-linear regression analysis was conducted in Trial 1 to determine the Met requirement of 4.32 g of digestible Met/kg of diet using BW gain. Coccidiosis infection reduced (P < 0.05) growth performance during the experimental grower and overall study periods in Trial 2. Increasing dietary Met from below requirement to meeting requirement during the grower period improved (P < 0.001) BW gain and feed conversion ratio (FCR), but this effect was only significant between treatments below and above the requirement for the overall study period. There was an interactive effect (P = 0.038) on FCR for the overall study period. These findings provide evidence that the Met requirement is likely increased during coccidiosis based on growth performance outcomes.

Psychological science and the use of anatomically detailed dolls in child sexual-abuse assessments.

Many devices are used in child assessment and treatment as communication aids, projective tools, and symbolic means of interaction. None are as hotly debated in their application among mental health professionals as dolls with genital details. Anatomically detailed (AD) dolls are often used in sexual-abuse evaluation and treatment with children, but such applications are controversial. This article is the product of a working group formed to review AD doll research and practice. This article reviews historical use of dolls in clinical inquiry and research on sexual behaviors in children, normative use of AD dolls in nonreferred children, differences in children's play behavior and emotional reactions to AD dolls, and memory and suggestibility issues relating to AD-doll use. Recommendations for future research are provided.

Pulmonary sequestration receiving arterial supply from the left circumflex coronary artery.

Pulmonary sequestration is an uncommon anomaly for which the arterial supply is usually derived from the aorta or its major branches. A 66-year-old man is described with a pulmonary sequestration that received its arterial supply from a coronary artery.

Transbronchial needle aspiration: guidance with CT fluoroscopy.

BACKGROUND: Bronchoscopy with transbronchial needle aspiration (TBNA) is valuable to diagnose lesions in the mediastinum and lung, but conventional fluoroscopic guidance may be suboptimal. We describe the use of CT fluoroscopy to provide real-time, transaxial TBNA localization, thus facilitating biopsy. METHODS: Patients were selected because of prior unsuccessful bronchoscopy or anticipated difficulty owing to small size or inaccessibility of the lesion. CT fluoroscopy consists of a spiral CT scanner adapted using a rapid-reconstruction algorithm and hardware that permits real-time in-room imaging. The bronchoscope was inserted on the CT scanner, which was used to guide TBNA instruments into the target lesion. RESULTS: Of 27 patients who underwent TBNA with CT fluoroscopic assistance, 15 had mediastinal nodes, and 12 had lung nodules or focal infiltrates. Mean lesion size was 1.7 cm in the mediastinum, 2. 2 cm in the lung. A correct diagnosis was established in 10 of 12 mediastinal lesions (83%) for which follow-up was available and in 8 lung lesions (67%). Diagnoses included small cell and non-small cell lung cancer and invasive aspergillosis. False-negative results were caused by sampling errors or inability to reach the lesion as documented by CT fluoroscopy. Postprocedure CT fluoroscopy revealed no complications. CONCLUSION: CT fluoroscopy provides effective, real-time guidance for TBNA and may be particularly valuable in patients with small or less accessible mediastinal or lung lesions.

The role of radiologic imaging in diagnosing complications of video-assisted thoracoscopic surgery.

STUDY OBJECTIVE: To examine the role of radiologic imaging in evaluating complications of video-assisted thoracoscopic surgery. DESIGN: Retrospective review of radiographic and clinical data. SETTING: Tertiary referral hospital. PATIENTS: All patients who underwent thoracoscopy at the University of Maryland Hospital between July 1990 and June 1994. A total of 260 procedures were performed on 239 patients. MEASUREMENTS AND RESULTS: Imaging studies performed before, during, and after surgery in cases in which complications occurred were reviewed by two thoracic radiologists. A randomly selected group of 22 CT scans from uncomplicated cases were used as control subjects. Complications occurred in 24 (9.2%) of the 260 thoracoscopic procedures. Intraoperative complications developed in 14 (5.4%) patients. Ten of the 14 patients had an obliterated pleural space that prevented access of the trocars and videoscope. Preoperative imaging showed significant pleural thickening or calcifications in seven of these ten patients. Other intraoperative complications were malposition of the double-lumen endotracheal tube (n=2) and dislodgement of a localizing needle-wire (n=2). In 8 (3.1%) patients, radiographically evident postoperative complications developed; these complications included prolonged air leak, empyema, recurrent pneumothorax, pulmonary edema, and pneumonia. CONCLUSION: Pleural calcification or thickening that is found on preoperative studies may help predict difficulty in inserting the thoracoscopic instruments but also can be seen on preoperative CT scans in uncomplicated cases. Thoracic CT scans may fail to predict complete pleural symphysis.

Acute asthma. Admission chest radiography in hospitalized adult patients.

The utility of admission chest radiography has been controversial in the management of adult patients admitted to the hospital with acute asthma. We reviewed the impact of admission chest radiography on in-hospital management of 54 adult patients with acute asthma. Each patient was admitted after a failed 12-h course of bronchodilator therapy in the emergency ward. Major radiographic abnormalities were found in 20 (34 percent) of 58 occasions. These abnormalities included focal parenchymal opacities, IIM, enlarged cardiac silhouette, pulmonary vascular congestion, new solitary pulmonary nodule and pneumothorax. Subsequent antibiotic use correlated with radiographic focal opacities or IIM, even in afebrile patients, but did not correlate with elevated blood leukocyte count. Based on the evidence of in-hospital alteration of management independent of elevated blood leukocyte count and body temperature, we recommend that chest radiographs be obtained for all adult patients admitted because of acute asthma.

Accuracy of CT for the detection of pleural adhesions: correlation with video-assisted thoracoscopic surgery.

STUDY OBJECTIVE: The presence of pleural adhesions may render video-assisted thoracoscopic surgery (VATS) difficult or impossible. The aim of this study was to assess the value of chest CT in the detection of pleural adhesions prior to VATS. DESIGN: Prospective study of the accuracy of chest CT in detecting pleural adhesions prior to VATS. SETTING: Tertiary-referra; teaching hospital and Veterans Administration hospital. PATIENTS: Between July 1994 and March 1995, 63 consecutive patients undergoing 64 VATS procedures were evaluated with chest CT prior to surgery. MEASUREMENTS AND RESULTS: Preoperative scans were interpreted by consensus of two pulmonary radiologists prior to surgery. Suspected pleural adhesions and other findings related to the pleura were recorded on a form given to the surgeon prior to VATS. The surgeon confirmed or excluded each suspected adhesion during VATS, and documented any other lesions not identified preoperatively. Patient-by-patient and lesion-by-lesion analyses were performed. Pleural adhesions were correctly identified by CT in 28 of 39 cases (sensitivity, 71%) and excluded in 18 of 25 cases (specificity, 72%). On a lesion-by-lesion basis, 73 adhesions were identified during VATS, of which only 28 were identified prospectively at CT. There were 45 missed adhesions and 20 adhesions that were suggested falsely (sensitivity, 38%; specificity, 46%). Eighteen pleural spaces were correctly identified as being free of pleural adhesions. CONCLUSIONS: CT is moderately sensitive and specific for preoperative identification of pleural adhesions in patients undergoing VATS but its accuracy is poorer for individual lesions.

The impact of routine chest radiography on the management of patients admitted from an emergency service.

Adult patients entering a hospital usually undergo a routine admission chest radiographic examination (RACXR). Recently, this practice has been questioned. The clinical course of 188 patients admitted to an adult medical service from the emergency area of an inner city hospital was assessed prospectively. Each of these patients underwent RACXR, ie, the only indication for the examination was admission to the hospital. Four subpopulations considered to be at high risk for treatment-altering radiographic abnormalities were defined prospectively: age of 65 years or older, cigarette smokers, altered mental status, and human immunodeficiency virus (HIV) positivity. RACXR abnormalities were significantly more common in the subpopulations at high risk (104/127, 82%) than in the population at low risk (37/61, 61%) (P less than .01). Abnormalities on RACXR led to altered treatment in five (3%) of the 188 inpatients. Each of these five patients was a member of a subpopulation at high risk (5/127, 4%). Because results suggest that various clinical considerations may affect the yield of RACXR, it is proposed that a blanket recommendation to eliminate RACXR is premature.

Cholinergic sensitivity of the eccrine sweat gland in trained and untrained men.

The purpose of this study was to compare the cholinergic responsiveness of the human sweat gland in trained and untrained men. Eighteen healthy male volunteers (9 trained, 9 sedentary) served as subjects. Pilocarpine concentration vs. sweat rate dose-response curves were obtained from each subject using iontophoresis. From these measurements, maximal iontophoretic sweat rate (SRmax) was determined and correlated with each subject's maximal oxygen uptake (VO2max). The trained group had a significantly (P less than 0.05) greater mean SR max and their mean dose-response curve was shifted up and to the left, as compared to the sedentary controls. Furthermore, VO2max was significantly correlated with SRmax (r = 0.76). These findings suggest that the modification occurring in the human sweat gland after training may include improvements in both SRmax and cholinergic sensitivity, and support the hypothesis that the potentiation in sweating following training is achieved via a peripheral mechanism.

Subarachnoid-pleural fistula after resection of a pancoast tumor with hyponatremia.

Resection of superior sulcus neoplasms is associated with a number of complications resulting from the extensive nature of the resection and the necessity to sacrifice certain adjacent structures. One of the complications of resection is the development of subarachnoid-pleural fistula, with the subsequent appearance of air in the cerebrospinal fluid circulation. We report a case in which a subarachnoid-pleural fistula led to persistent pneumocephaly in a patient who exhibited postoperative hyponatremia, confusion, and gait disturbance.

Resection of primary brachial plexus tumor using a modified Dartevelle anterior approach.

We treated a patient with a large supraclavicular mass with associated parasthesia of the affected extremity. The mass was removed operatively using a supraclavicular Dartevelle approach.

The role of thoracoscopy in the diagnosis of interstitial lung disease.

A study was undertaken to evaluate the safety and efficacy of thoracoscopic lung biopsy for interstitial lung disease. The relation between operative findings, pathologic findings, and preoperative computed tomographic scan findings was examined. Twenty-six patients, 10 male and 16 female, underwent thoracoscopic lung resection to diagnose interstitial lung disease. Sixteen patients were outpatients for an elective procedure; 10 were inpatients including 2 who were ventilator dependent. The mean length of operation was 54 minutes and the mean length of chest tube duration, 1.3 days. There were no deaths. Staphylococcal pneumonia developed in 1 patient postoperatively. One patient with systemic pulmonary hypertension was ventilator dependent for 48 hours. A double-lumen endotracheal tube was used in all but 2 patients. Twelve-millimeter trocar ports were used to allow easy interchange of staplers and endoscopic instruments. Biopsy of at least two lobes was performed in each patient with resection of a piece of grossly abnormal lung. A single chest tube was left routinely. The pathologic diagnosis was usual interstitial pneumonitis in 7 patients. Four patients had interstitial fibrosis and 4, granulomas. Three patients had diffuse alveolar damage and 3, Wegener's granulomatosis. Two patients had bronchiolitis obliterans with organizing pneumonia. One patient each had lymphangioleiomyomatosis, eosinophilic granuloma, and cytomegalovirus. Sixteen patients underwent preoperative computed tomographic scanning. The scans were assessed by 2 radiologists who were blinded to the surgical results. Computed tomography accurately predicted the site of disease in most instances. Four patients had at least one lobe with no evidence of disease on computed tomography but with interstitial lung disease found thoracoscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative association between the in vitro human tumor stem cell assay and clinical response to cancer chemotherapy.

Objective methods have been developed to quantitate results of the in vitro human tumor stem cell assay, the degree of the association between the in vitro assay and clinical response as well as the likelihood of response. Methods considered to quantitate in vitro assay data included first-order kinetics of percent survival with drug concentration, minimal percent of tumor colony-forming unit survival at low drug concentrations, and area under the in vitro percent survival-drug concentration curve. Based upon experimental data, the percent tumor colony survival and the area under the curve (i.e., in vitro sensitivity indices) were concluded to better account than other methods for the commonly observed nonlinear shape of the in vitro curves. The two methods also yielded equivalent quantitative descriptions of the in vitro data. A logistic regression model was used for explicit quantitation of the relationship between the in vitro sensitivity index and predicted probability of clinical response. Very high association was observed between the predicted in vivo and actual clinical response for the cytotoxic drugs considered. Incorporation of other pharmacologic and patient prognostic factors into the quantitative methods is discussed and shown to improve their effectiveness.

Chemical pneumonitis.

Many organic and nonorganic agents can cause chemical pneumonitis. The more soluble agents tend to involve the upper respiratory tract, whereas less soluble agents reach the distal airways, causing pulmonary edema. The initial chest radiograph can be normal for as long as 48 hours, therefore delayed radiographs are important in significant exposures. The most common radiographic pattern is pulmonary edema, although various radiographic opacities have been reported. Acute complications include secondary pneumonia. Long-term complications include bronchiectasis, bronchiolitis obliterans, and lung destruction.

CT fluoroscopy for thoracic interventional procedures.

In the past several years, CT fluoroscopy has proved a valuable new technique in guiding the performance of intrathoracic procedures. Several approaches to using CT fluoroscopy are discussed. We have found an interrupted, real-time technique optimal to facilitate biopsy of percutaneous lung nodules, particularly small lesions. The technique is also valuable in assisting thoracic drainage procedures. This article also discusses the use of CT fluoroscopy to guide transbronchial needle aspiration, which is another potentially important application.

Lung cancer: value of various imaging modalities.

Bronchogenic carcinoma is the leading cause of cancer death, and the overall prognosis remains poor. Imaging plays a critical role in the initial staging and follow-up of the disease. Bronchogenic carcinoma is typically detected first on chest radiography but computed tomography (CT) scan is the most important imaging technique, providing both staging information and assessment of recurrence. Magnetic resonance imaging (MRI) is most useful as a problem-solving tool. The increasing role of positron emission tomography (PET) scan in the evaluation is reviewed, and imaging guidelines of two national organizations are presented.

Radiologic manifestations of bronchogenic cancer.

Radiologic imaging provides crucial information about bronchogenic cancer and is complementary to more invasive diagnostic techniques. The diagnosis is often suspected initially from the chest radiograph. The CT scan permits the most complete analysis of the extent of the tumor, nodal metastasis, and distant metastasis and serves as a guide to further evaluation and surgery. MRI, at the current stage of development, is generally reserved for cases in which CT findings are inconclusive. Rapid technologic advances have the potential for altering this imaging hierarchy in the near future.

MR evaluation of the pericardium.

The pericardium is well visualized on magnetic resonance imaging (MRI) because of the superb contrast resolution and multiplanar capability of the technique. This article highlights some of the clinical uses of MRI in evaluating the pericardium and provides comparison with echocardiography and computed tomography (CT) scan. Specific pericardial diseases that are described include pericardial effusion, constrictive pericarditis, neoplastic pericardial disease, congenital abnormalities of the pericardium, and paracardiac masses. The value of MRI in differentiating constrictive pericarditis from restrictive cardiomyopathy is emphasized. The article discusses the impact of newer MRI techniques such as cine MRI on the assessment of pericardial disease.

MR imaging of slipped stacked breast implants: a potential pitfall in the diagnosis of intracapsular rupture.

The integrity of silicone-gel breast implants can be evaluated by MR imaging. The findings of intra- and extracapsular rupture have been described. Increasingly sophisticated breast reconstruction techniques such as stacking of prostheses have lead to a wider range of implant appearances. We report a case where intracapsular rupture was simulated by slippage of two retropectoral stacked implants in relation to each other. The MR and CT findings are described.