Latino beliefs about diabetes.

OBJECTIVE: To describe Latino beliefs about diabetes and assess heterogeneity in beliefs across different groups. RESEARCH DESIGN AND METHODS: This study comprised a survey of 161 representative Latino adults from four diverse communities: Hartford, Connecticut; Edinburg, Texas; Guadalajara, Mexico; and rural Guatemala. A 130-item questionnaire covered causes symptoms, and treatments for diabetes. Information on demographics and acquaintanceship with someone with diabetes was also collected. The cultural consensus model was used to analyze the variation in responses to determine whether the degree of consistency within and between samples was sufficient to warrant aggregation and description as a single set of beliefs. RESULTS: Homogeneous beliefs were present within each of the four samples. Although variability in responses increased significantly from Connecticut to Guatemala (P < 0.00005), there was significant agreement between samples on the answers (P < 0.0005). Answers tended to be concordant with the biomedical description of diabetes. Greater acculturation, higher educational attainment, and higher diabetes prevalence were associated with greater cultural knowledge about diabetes. In Connecticut, greater knowledge correlated with longer mainland U.S. residency (P < 0.05). In Mexico, those with average educational attainment knew more (P < 0.05). Finally, average knowledge levels were higher in communities with greater diabetes prevalence. CONCLUSIONS: The cultural consensus model facilitated assessment of cultural beliefs regarding diabetes and diabetes management. Overall, Latino cultural beliefs about diabetes were concordant with the biomedical model. Variation in responses tended to characterize less knowledge or experience with diabetes and not different beliefs.

Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion.

BACKGROUND: Chemical pleurodesis is an effective treatment for malignant pleural effusion and pneumothorax. This mode of therapy is, however, less widely accepted in the treatment of patients with refractory benign or undiagnosed pleural effusion. STUDY OBJECTIVES: To analyze the outcome of talc slurry pleurodesis in patients with nonmalignant pleural effusions. DESIGN: Retrospective and partly prospective analysis of clinical outcome. SETTING: Hadassah University Hospital, Jerusalem, Israel. PATIENTS AND PARTICIPANTS: Between 1992 and 1997, we treated 16 patients with nonmalignant pleural effusion using talc slurry pleurodesis. The cause of effusion was congestive heart failure in 6 patients, liver cirrhosis in 4 patients, yellow nail syndrome in 1 patient, systemic lupus erythematosus in 1 patient, chylothorax in 1 patient, and undiagnosed in 3 patients. INTERVENTIONS: Nine patients were hospitalized, and seven patients received treatment in a day-care setting. Follow-up ranged from 2 months to 3 years. RESULTS: Complete success was observed in 12 cases (75%), partial success in 3 cases (19%), and pleurodesis was ineffectual in 1 case (6%). There were no significant complications after the procedure in any of our patients. A review of the English-language medical literature revealed an additional 110 reported cases of nonmalignant pleural effusion that were treated with chemical pleurodesis. Of these cases, talc was used in 65% with a success rate of nearly 100%. CONCLUSIONS: Chemical pleurodesis, and specifically talc slurry, is an effective treatment for recurrent benign or undiagnosed pleural effusion. This procedure is safe and easily performed and, in selected cases, can be performed in an outpatient day-care setting.

Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital.

OBJECTIVES: Hemoptysis, an important and alarming symptom, often indicates serious disease. This study was designed to assess the different causes of hemoptysis, the relative importance of the different diagnostic modalities employed, and the outcome in an Israeli population cohort. DESIGN: A retrospective analysis of 208 patients with hemoptysis at the Hadassah University Hospital, Jerusalem, Israel between January 1980 and August 1995. RESULTS: Bronchiectasis (20%), lung cancer (19%), bronchitis (18%), and pneumonia (16%) accounted for most causes of hemoptysis. In contrast to older studies, active tuberculosis was a rare finding (1.4%). Bronchiectasis and bleeding diathesis were major causes of moderate to severe hemoptysis while bronchitis and lung cancer were commonly associated with milder degrees of bleeding. CT scan was the most sensitive diagnostic test when employed alone, with a positive yield of 67%. However, it failed to locate at least three cases of lung cancer. When combining a CT study together with a bronchoscopy, the positive yield increased to 93%. The mortality rate for patients with mild to moderate hemoptysis was low (2.5% and 6%, respectively), while patients with massive hemoptysis had high mortality rates (38%). Patients with lung cancer or bleeding diathesis had higher mortality rates compared with the rest of the cohort. CONCLUSIONS: Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with lung malignancy and patients with bleeding diathesis had a poorer prognosis. Patients older than 50 years with a positive smoking history need an extensive evaluation and follow-up to exclude lung carcinoma. The combined use of bronchoscopy and chest CT has the best yield in evaluating hemoptysis.

The role of BAL in the diagnosis of pulmonary mucormycosis.

Five patients with pulmonary mucormycosis diagnosed during life are described. All had underlying predisposing conditions: either posttransplant or hematologic malignancies. In all cases, the diagnosis was made using fiberoptic bronchoscopy. In three patients, BAL was diagnostic. In two of these patients, the diagnosis was made by identifying the typical hyphae of mucormycosis in the BAL fluid alone. Transbronchial biopsy was diagnostic in three patients. Treatment was based on IV antifungal chemotherapy together with surgical removal of involved lung tissue whenever feasible. The clinical outcome of these patients was dismal and was determined primarily by the underlying condition.

Rehabilitation of hypoxemic patients with COPD at low altitude at the Dead Sea, the lowest place on earth.

BACKGROUND: In patients with COPD, oxygen therapy has been shown to improve exercise capacity and survival. Increase in barometric pressure at low altitude can serve as a simple way to improve arterial oxygenation in hypoxemic patients. We have tried to evaluate the effect of staying at low altitude on arterial oxygenation and exercise performance in patients with COPD. PATIENTS AND METHOD: Eleven patients with COPD (9 male, 2 female) aged 38 to 79 years (mean FEV1, 0.96 L; 36% predicted) with hypoxemia (mean PaO2, 54.2+/-8.9 mm Hg) at Jerusalem (altitude 800 m above sea level) were taken down to the Dead Sea area (altitude 402 m below sea level) for 3 weeks. At both locations we tested arterial blood gases, spirometry, progressive exercise, 6-minute walking distance, and sleep oximetry. The study was repeated 2 weeks after returning to Jerusalem. RESULTS: Spirometry results were unchanged. Mean arterial PaO2 rose from 54.2+/-8.9 mm Hg to 69.5+/-11 at the first week and to 66.6+/-11 at the third week of stay (p<0.001). PaCO2 rose from 43.5+/-9.8 mm Hg to 47.7+/-9 and 49.5+/-8.4 (p<0.006). Six-minute walking distance rose from 337+/-107 m to 449+/-73 and 507+/-91 in the third week (p<0.005). Maximum oxygen consumption (VO2max) rose from 901+/-257 mL/min to 1,099+/-255 and 1,063+/-250 mL/min (p=0.01). Sleep oximetry showed an increase in mean sleep arterial oxygen saturation from 86.0+/-4.3% to 89.9+/-4.2% and 88.3+/-3.0 at 1 and 3 weeks, respectively (p<0.05). Following the return to Jerusalem, arterial gases returned to their baseline levels (PaO2, 52.9+/-9.4 mm Hg) but 6-min walking distance remained significantly high, 453+/-47 (p<0.02), and VO2max remained high as well (1,102+/-357 mL/min), although it did not reach statistical significance. CONCLUSIONS: Decline to low altitude or staving at high oxygen environment improves arterial oxygenation and exercise capacity in hypoxemic patients residing in moderate or high altitude. Low altitude (or pressurized wards) can improve pulmonary rehabilitation of hypoxemic patients with COPD.

Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature.

OBJECTIVE: To determine the characteristic features and outcome of pulmonary carcinoid tumors in Israel. METHODS: Retrospective analysis of the clinicopathologic data and outcome of patients from four major hospitals in Israel in the last 20 years. RESULTS: There were 142 cases of pulmonary carcinoid tumors: typical (n = 128) and atypical (n = 14). We calculated an annual incidence of about 2.3 to 2.8 cases per 1 million population. The ratio of female to male patients was 1.6:1. The prevalence of smoking was similar to the general population in patients with typical carcinoids and twice as high in the atypical group. Bronchial obstruction was the cause of most of the presenting symptoms and signs and included obstructive pneumonitis, pleuritic pain, atelectasis, and dyspnea (41%). Carcinoid syndrome was extremely rare and occurred in only one patient with metastatic disease. Most of the tumors (68%) arose in the major bronchi. Diagnosis was made using fiberoptic bronchoscopy in 52% of patients without evidence of endobronchial hemorrhage. Nodal involvement and distant metastases occurred in 57% and 21%, respectively, in the atypical group, and 10% and 3%, respectively, in the typical group. The treatment of choice was surgical: lobectomy (56%) or pneumonectomy (16%). The respective 5-year survival rates for patients with typical and atypical tumors were 89% and 75% (not significant), and the 10-year survival rates were 82% and 56% (p < 0.05). A review of large series from the literature is presented. CONCLUSION: Pulmonary carcinoid is an uncommon tumor in the Israeli population. With early diagnosis and aggressive surgical therapy, long-term prognosis is excellent.

Isolated Castleman disease of the neck: MR findings.

Castleman disease in an 11-year-old girl appeared as a neck mass that grew despite antibiotic treatment. MR showed a well-defined solid mass, isointense with muscle on short-repetition-time/short-echo-time images, with a stellate area of central hypointensity on long-repetition-time/long-echo-time images, that did not enhance with gadolinium.

Consensus theory model of AIDS/SIDA beliefs in four Latino populations.

To describe Latino beliefs about AIDS (SIDA), Latino adults were sampled at two U.S. sites (Connecticut and Texas) and two international sites (Mexico and Guatemala). A 125-item questionnaire covered risk factors, symptoms, treatments, and sequellae of AIDS. The cultural consensus model was used to determine the cultural beliefs for each sample. Responses from 161 people indicated that a single set of beliefs was present at each site and that beliefs were shared across sites. Comparison of answers between samples indicated high agreement (p < .0007). The proportion of shared beliefs, however, decreased significantly between samples: .68 in Connecticut, .60 in Texas, .51 in Mexico, and .41 in Guatemala (p < .05). The proportion of positive answers similarly decreased from Connecticut to Guatemala (p < .001). Beliefs were stronger and more detailed in the higher prevalence areas. Furthermore, Latino beliefs tended to converge on biomedical beliefs about the disease.

Dissolution rate measurements of sparingly soluble compounds with the Coulter Counter model TAII.

A Coulter Counter, Model TAII was used to determine both solubility and dissolution rate from suspensions of griseofulvin and hydrocortisone acetate, where the initial particle size and shape had been characterized. The method assesses the weights and surface areas of particles remaining undissolved as a function of time. A comparison with a conventional method, assessing dissolved quantities of materials, showed that solubility data of the same order of magnitude can be obtained. The TAII data fitted a previously established equation that linearly relates log solubility and log of the intrinsic dissolution rate and indicated that the dissolution process was not diffusion controlled. The TAII method described is a rapid and convenient means of estimating the solubility and dissolution rate where no adequate technique for analysing the dissolved fraction exists.

Dx and Tx of the elderly patient with atherosclerotic coronary heart disease.

Complications of MI occur in patients of all ages, but are more common in the elderly. Prevalent are atrial and ventricular dysrhythmias, papillary muscle dysfunction, pericarditis, congestive heart failure, atrioventricular block, cardiogenic shock, and myocardial rupture. Improved surgical techniques and methods of myocardial protection have reduced the perioperative mortality of coronary artery bypass surgery in older persons to an acceptable level.

High capacity substrates as a platform for a DNA probe array genotyping assay.

Colloidal silica particles were deposited on a glass substrate to produce high-capacity porous supports for high-density DNA probe arrays. Porous surfaces were used to increase the addressable surface area and number of probes available for hybridization. Surfaces derived from 70-100 nm size particles deposited in films from 0.15 to 2 microns thick exhibited excellent performance in light-directed oligonucleotide synthesis. Evaluation of these substrates in a genotyping assay is reported.

Clinical applications of magnetic resonance angiography.

Recent technical advances in magnetic resonance imaging (MRI) now allow for the noninvasive study of blood flow in vessels, or magnetic resonance angiography (MRA). We describe several case reports involving the use of MRA and discuss its advantages in evaluating patients for carotid artery stenosis, intracerebral aneurysms, and arteriovenous malformations (AVMs).

Object-related vs. narcissistic depression: a theoretical and clinical study.

This paper has focused on the sense of helplessness as an essential component of a depressive reaction. By inference, a sense of mastery and ability to achieve goals seems essential for a sense of well-being. Both patients presented here revealed infantile fantasies that hampered their exercising this mastery, and the path to well-being was the analysis of these fantasies. The treatment plans differed, though, in the locus of the fantasies. In an object-related depression such as Mr. Janson's, the fantasy involved the inhbition of functioning--that is, the inability to express aggression--and the treatment aimed at removing the inhibition. In a narcissistic depression such as Miss Gaynor's, the helplessness was not due to inhibited functioning per se. Rather, her goals were unrealistic, unattainable, and based on unconscious fantasies. Here the aim of treatment was the development of more reality-adapted and attainable objectives and the concommitant internalization of a more realistic sense of her own worth. Thus the common denominator in both depressive reactions was a sense of helplessness, and the path toward increased self-esteem was by way of the development of a sense of mastery and competence.