The nurse outcomes and patient outcomes following the High-Quality Care Project.

BACKGROUND: There have been many single cross-sectional studies on nurse or patient outcomes. However, long-term evidence on improving nurse and patient outcomes is still limited. The High-Quality Care Project is a national project in China for improving nurse and patient outcomes by implementing primary nursing. AIM: (1) To assess the long-term changes in nurse and patient outcomes in the context of the High-Quality Care Project. (2) To explore the potential influences of primary nursing on nurse and patient outcomes based on this study and broader existing evidence. METHODS: The data of two cross-sectional studies were used for analysis. The two cross-sectional studies were conducted before (2009) and after (2016) the High-Quality Care Project. A total of 1376 nurses and 904 patients from 40 units of 10 tertiary hospitals were surveyed. Reliable and validated instruments were used to measure nurse and patient outcomes. Multilevel modelling was the main method for data analysis. RESULTS: Nurses in 2016 were more satisfied than nurses in 2009 with most dimensions of nurse work environment and job satisfaction. However, they were not more satisfied with burnout, global job satisfaction or intention to leave their job. Nurses in 2016 also reported better quality of patient care and patient safety while their patients reported higher patient satisfaction. CONCLUSION: The analysis of our results based on existing evidence indicates that primary nursing could be considered as a potentially effective way to improve nurse work environment and patient outcomes. More studies with rigorous study design from micro perspectives would be useful to further explore the direct effects of primary nursing on nurse or/and patient outcomes. IMPLICATIONS FOR NURSING AND NURSING POLICY: Policymakers, healthcare service leaders and nurse managers should make efforts to provide multi-level supports to cultivate an encouraging environment for nurses to practice primary nursing, because the implementation of primary nursing may improve the nurse work environment and patient outcomes. Furthermore, improving nurse participation in hospital affairs and developing nursing discipline and education for increasing nursing staff resource and nurses' capacity - which all need policy and management supports - are crucial to further improve nurse and patient outcomes.

Liver and vascularized posterior rectus sheath fascia composite tissue allotransplantation.

Abdominal wall closure in pediatric solid organ recipients may be confounded by donor size discrepancy and structural insults from previous surgery. Here we describe the novel use of vascularized donor abdominal wall posterior rectus sheath fascia, as a composite tissue allotransplant (CTA), to achieve abdominal wall closure in a liver and double kidney pediatric recipient who could not be closed primarily due to donor/recipient size mismatch. The posterior rectus sheath fascia was procured in continuity with the liver and falciform ligament. Blood supply was achieved using the single hepatic artery anastomosis as part of the standard liver transplantation procedure. Specimens of posterior rectus sheath fascia taken on postoperative days 3 and 30 showed no signs of acute rejection. The patient succumbed to an overwhelming fungal infection on day 51, with no signs of intraabdominal involvement. The patient received no additional immunosuppression in conjunction with the posterior rectus sheath fascia allotransplant.

Conservation and duplication of isozymes in plants.

Many enzymes in plants have isozymes because the same catalytic reaction is often present in several subcellular compartments, most frequently the plastids and the cytosol. The number and subcellular locations of the isozymes appear to be highly conserved in plant evolution. However, gene duplication in diploid species and the addition of genomes in polyploid species have increased the number of isozymes.

Cholestasis and hepatic metastases: a factor contributing to extreme elevations of carcinoembryonic antigen.

Records of 19 autopsied patients with metastatic carcinoma were studied to elucidate the contribution to the elevation of antemortem plasma carcinoembryonic antigen (CEA) levels (range, 5.9--136,000 ng/ml) of 1) liver pathology and dysfunction, 2) tumor morphology and CEA content, and 3) tumor spread and location. Liver function tests and plasma CEA recorded within 8 weeks of death, autopsy records of tumor spread, liver weight (as an index of liver tumor mass), and histologic sections were reviewed. Tissue CEA was demonstrated in 15 patients by an immunoperoxidase method. Cholestasis was seen in histologic sections of tissue from 8 of 10 patients, and elevated bilirubin was seen in 7 of 10 patients with hepatic metastases and CEA levels greater than 1,000 ng/ml In contrast, histologically observed cholestasis and elevated bilirubin were seen in only 1 of 8 patients with CEA less than 500 ng/ml. A significant correlation was found between the plasma CEA level and histologically observed cholestasis (P less than 0.01). Serum bilirubin also correlated significantly (P less than 0.01), but alkaline phosphatase did not. Liver weight (tumor mass) showed a positive correlation with cholestasis (P less than 0.01) but not with circulating CEA. Markedly elevated plasma CEA levels (greater than 1,000 ng/ml) seen preterminally may partially reflect impaired excretion of CEA by the hepatobiliary system rather than, or in addition to, preterminal increase in CEA-producing tumor.

Detection of the tumor-associated glycoprotein antigen (TAG-72) in premalignant lesions of the colon.

We used monoclonal antibody B72.3 to study the expression of the colorectal carcinoma-associated antigen TAG-72 in premalignant colonic lesions with the immunoperoxidase technique. This antigen, which is rarely detectable in the normal colonic epithelium, was expressed in 13 of 19 adenomas with moderate to severe dysplasia and nine of nine cases of inflammatory bowel disease. The antibody reacted with the normal-appearing mucosa adjacent to a carcinoma in 10 of 12 cases, although only eight of the tumors expressed the antigen. The expression of the TAG-72 antigen in the colonic epithelium may be an early marker of malignant transformation.

Tissue localization of zinc glycinate marker and carcinoembryonic antigen by immunofluorescence. II. Immunofluorescence microscopy.

Preliminary indirect immunofluorescence studies on the zinc glycinate marker (ZGM) were compared with carcinoembryonic antigen (CEA) immunofluorescence, ZGM, detected in 26 of 29 human colon adenocarcinomas, was associated with the epithelial component of the malignant glands. Fluorescence was generally less strong and more granular for ZGM than for CEA and was found in intraglandular spaces, luminal border areas, and cytoplasm. ZGM concentration and tissue localization appeared to be related to tumor differentiation. ZGM was also detected in benign colon mucosae (adjacent to and distant from the carcinomas) from patients with colon carcinoma, but differed from CEA in that it was present in the deep crypt portion only. Gastric, pancreatic, esophageal, and anal adenocarcinomas, as well as benign gastric pyloric and small bowel mucosae had detectable ZGM. CEA, but not ZGM, was observed in 20 nongastrointestinal carcinomas to date. Studies are under way to determine whether ZGM is a marker associated with colon and gastrointestinal adenocarcinoma specifically or undifferentiated crypt cells of the colon and digestive tract in general.

A Comparison of the Diabetes Risk Score in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) and HAART-Naïve Patients at the Limbe Regional Hospital, Cameroon.

BACKGROUND: Highly active antiretroviral therapy (HAART) has been associated with dysglycaemia. However, there is scarce data on the risk of developing diabetes mellitus (DM) in HIV/AIDS patients in Africa. OBJECTIVES: Primarily to quantify and compare the risk of having diabetes mellitus in HIV/AIDS patients on HAART and HAART-naïve patients in Limbe, Cameroon; and secondarily to determine if there is an association between HAART and increased DM risk. METHODS: A cross-sectional study was conducted at the Limbe Regional Hospital HIV treatment center between April and June 2013, involving 200 HIV/AIDS patients (100 on first-line HAART regimens for at least 12 months matched by age and gender to 100 HAART-naïve patients). The Diabetes Risk Score (DRS) was calculated using a clinically validated model based on routinely recorded primary care parameters. A DRS ≥ 7% was considered as indicative of an increased risk of developing DM. RESULTS: The median DRS was significantly higher in patients on HAART (2.30%) than in HAART-naïve patients (1.62%), p = 0.002. The prevalence of the increased DM risk (DRS ≥ 7%) was significantly higher in patients on HAART, 31% (95% CI: 22.13-41.03) than in HAART-naïve patients, 17% (95% CI: 10.23-25.82), p = 0.020. HAART was significantly associated with an increased DM risk, the odds ratio of the HAART group compared to the HAART-naïve group was 2.19 (95% CI: 1.12-4.30, p = 0.020). However, no association was found after adjusting for BMI-defined overweight, hypertension, age, sex, family history of DM and smoking (Odds ratio = 1.22, 95% CI: 0.42-3.59, p = 0.708). Higher BMI and hypertension accounted for the increased risk of DM in patients on HAART. Also, more than 82% of the participants were receiving or had ever used Zidovudine based HAART regimens. CONCLUSION: HIV/AIDS patients on HAART could be at a greater risk of having DM than HAART-naïve patients as a result of the effect of HAART on risk factors of DM such as BMI and blood pressure.

Prevalence of Hypertension in HIV/AIDS Patients on Highly Active Antiretroviral Therapy (HAART) Compared with HAART-Naïve Patients at the Limbe Regional Hospital, Cameroon.

BACKGROUND: Highly active antiretroviral therapy (HAART) has greatly reduced the morbidity and mortality of HIV/AIDS patients but has also been associated with increased metabolic complications and cardiovascular diseases. Data on the association between HAART and hypertension (HTN) in Africa are scarce. OBJECTIVES: Primarily to compare the prevalence of HTN in HIV/AIDS patients on HAART and HAART-naïve patients in Limbe, Cameroon; and secondarily to assess other socio-demographic and clinical factors associated with HTN in this population. METHODS: A cross-sectional study was conducted at the Limbe Regional Hospital HIV treatment center between April and June 2013, involving 200 HIV/AIDS patients (100 on first-line HAART regimens for at least 12 months matched by age and sex to 100 HAART-naïve patients). HTN was defined as a systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. RESULTS: The prevalence of HTN in patients on HAART was twice (38%; 95% CI: 28.5-48.3) that of the HAART-naïve patients (19%; 95% CI, 11.8-28.1), p = 0.003. In multivariate analyses adjusted for age, gender, smoking, family history of HTN, and BMI-defined overweight, HAART was associated with HTN, the adjusted odds ratio of the HAART-treated versus HAART-naïve group was 2.20 (95% CI: 1.07-4.52), p = 0.032. HTN was associated with older age and male gender, in the HAART group and with BMI-defined overweight in the HAART-naïve group. CONCLUSION: The prevalence of hypertension in HIV/AIDS patients in Limbe stands out to be elevated, higher in patients on HAART compared to those not on treatment. Blood pressure and cardiovascular risk factors should be routinely monitored. Other factors such as diet, weight control and physical exercise should also be considered.

Evidence for duplication and divergence of the structural gene for phosphoglucoisomerase in diploid species of clarkia.

Formal genetic analysis of the mode of inheritance of the electrophoretic phenotypes for phosphoglucoisomerase (PGI) in the annual plants Clarkia rubicunda and C. xantiana showed that these diploid species have two and three genes, respectively, that specify PGI subunits. Electrophoretic examination of seven other diploid species of Clarkia revealed that species assigned to ancestral sections in the current taxonomy have two PGI genes, whereas more specialized species have three PGI genes. Together with evidence that diploid species in two closely related genera have two PGI genes, this suggests the third PGI gene arose within Clarkia. Intergenic heterodimers are formed between polypeptides specified by the third gene and one of the other PGI genes, indicating they have a high degree of structural similarity. The combined genetic, biochemical, and phylogenetic evidence suggests that the third PGI gene resulted from a process of gene duplication. The apparent Michaelis constants (F6P to G6P) of the most common electrophoretic variants of the ancestral gene in C. xantiana and in C. rubicunda are closely similar, but that of the duplicate enzyme is much higher. The intergenic heteromer has an intermediate value. Four alleles have been identified for the duplicate PGI gene in C. xantiana, including a null allele which eliminates the activity of its product. This allele is one of the few examples of a "silenced" duplicate gene. The ancestral and duplicate genes assort independently in C. xantiana. In conjunction with the substantial chromosomal rearrangements that characterize species of Clarkia, this may mean that the duplicate PGI marks a duplicated chromosomal segment that originated from a cross between partially overlapping reciprocal translocations rather than from unequal crossing over.

Genetic Stability in a Peripheral Isolate of STEPHANOMERIA EXIGUA Ssp. CORONARIA That Fluctuates in Population Size.

Allelic frequencies did not change at five polymorphic loci in seedlings grown from seeds collected in four consecutive years in a geographically peripheral population of the annual plant Stephanomeria exigua ssp. coronaria (Compositae), even though the population number fluctuated during this period by 50:1. Genetic stability is attributed to buffering effects provided by seed storage in the ground. Evidence described elsewhere suggests that this population was the recent progenitor of a new diploid species. The present result indicates that fluctuations in number of individuals in the parental population were probably not involved in the origin of the new species.

Assessment of pleiotropic effects of a gene substitution in pea by two-dimensional polyacrylamide gel electrophoresis.

We examined, by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), near-isogenic lines of the r-gene in pea (Pisum sativum) which determines round (RR) vs. wrinkled (rr) seed. The study was undertaken to assess the number of protein changes resulting from a single gene substitution as a means of quantifying pleiotropic effects. A total of 636 to 770 resolvable polypeptides were identical in all respects between RR and rr for roots, shoots, leaflets, stipules, young ovaries, and young embryos. A single difference between the lines became evident about 21-23 days after anthesis in the embryos. Mature seeds of the two lines showed 62 spot differences in addition to differences in four clusters of spots, representing about 10% of the total number of spots visible on the gels. The protein differences are presumably involved in the many known physiological differences of the two seed types. 2-D PAGE analyses of near-isogenic lines are likely to be valuable in a number of quantitative and developmental genetic contexts.

Phosphoglucose Isomerase Expression in Species of Clarkia with and without a Duplication of the Coding Gene.

The duplication of the nuclear gene specifying the cytosolic isozyme of phosphoglucose isomerase (PGI; EC 5.3.1.9) arose within Clarkia, a genus of annual plants native to California, and now characterizes about half of the diploid species of this genus. Evidence obtained by immunological inhibition and titration of crude leaf extracts demonstrated that species with and without the duplication have the same levels of cytosolic to total PGI (the sum of the cytosolic and plastid PGI activities). The immunological studies were carried out with a specific anticytosolic PGI antiserum and were fully supported by a densitometric analysis of the electrophoretically separated isozymes. Densitometric examination of electrophoretically separated PGIs in 11 vegetable species revealed only two levels of cytosolic to total PGI activities, one of which was the same as in Clarkia. This suggests that only certain levels of the cytosolic isozyme are compatible with proper operation of the cytosolic PGI reaction and make it likely that some form of genic or metabolic regulation has evolved that compensates for the PGI duplication.

Alcohol Dehydrogenase in the Diploid Plant STEPHANOMERIA EXIGUA (Compositae): Gene Duplication, Mode of Inheritance and Linkage.

Study of the biochemical genetics of alcohol dehydrogenase (ADH) in the annual plant Stephanomeria exigua (Compositae) revealed that the isozymes are specified by a small family of tightly linked structural genes. One set of ADH isozymes (ADH-1) was induced in roots by flooding, and was also expressed in thickened unflooded tap roots, stems, ovaries and seeds. As in other plants, the enzymes are dimeric and form homo- and heterodimers. An electrophoretic survey of ADH-1 phenotypes in two natural populations revealed seven different ADH-1 homodimers in various phenotypes having one to eight enzyme bands. Genetic analysis of segregations from crosses involving 59 plants showed that the ADH-1 isozymes are inherited as a single Mendelian unit, Adh1. Adh1 is polymorphic for forms that specify one, two, or three different ADH-1 subunits (which combine to form homo- and heterodimers), and are expressed co-dominantly in all genotypic combinations. Staining intensity of enzymes extracted from various homozygous and heterozygous plants indicated that the different subunit types specified by Adh1 are produced in approximately equal amounts. These observations suggest that Adh1 is a compound locus consisting of one to several tightly linked (0 recombinants among 579 testcross progeny), coordinately expressed structural genes. The genes in the two triplications also occur in various duplicate complexes and thus could have originated via unequal crossing over. The ADH-2 isozyme found in pollen and seeds is apparently specified by a different gene, Adh2. Adh1 and Adh2 are tightly linked (0 recombinants among 81 testcross progeny).

Evidence for duplication of the structural genes coding plastid and cytosolic isozymes of triose phosphate isomerase in diploid species of clarkia.

Formal genetic analyses of the mode of inheritance of the multiple plastid and cytosolic isozymes of triose phosphate isomerase (TPI, EC 5.3.1.1) in annual diploid species of Clarkia (Onagraceae), native to California, suggest that each set of isozymes is specified by duplicate structural genes. In contrast, most diploid plant species possess one plastid and one cytosolic TPI isozyme each coded by a single locus. Linkage tests revealed that the two genes coding the plastid TPIs assort independently. Although the number of individuals sampled per species was small, the plastid isozymes were electrophoretically more variable than the cytosolic isozymes. The two gene duplications are the first reported that characterize an entire plant genus. Initial electrophoretic surveys of TPI in other genera of Onagraceae revealed that the duplication of the gene coding the plastid isozyme is apparently restricted to Clarkia, whereas that of the gene coding the cytosolic isozyme is present in most genera of the family. The separate phylogenetic distributions of the two duplications suggest that the processes that gave rise to them were unrelated.

Enzyme activity in ems-induced null mutations of duplicated genes encoding phosphoglucose isomerases in clarkia.

The duplication of the nuclear gene encoding the cytosolic isozyme of phosphoglucose isomerase (PGI; EC 5.3.1.9) originated within Clarkia, a genus of annual plants native to California. Previous immunological studies showed that species with and without the duplication have the same levels of cytosolic PGI activity (relative to that of the plastid PGI isozyme), as well as similar levels of cytosolic PGI protein. In the present study, we characterized seven EMS-induced null activity mutations in both duplicate PGI genes. The mutations reduced PGI activity levels in direct proportion to the normal contribution of each gene. Homozygous mutants at Pgi-3 had 64% of wild-type activity, whereas those at Pgi-2 had only 36%. The effects of the mutations at the two loci were additive, as shown by further reductions in activity in certain progeny classes in F(2) progenies between them. The homozygous double null mutant class was not recovered and is presumably lethal. All of the mutants appear to be CRM+. The results account for the previously observed differences in in vivo accumulation of the duplicate isozymes in numerous Clarkia species. The results further show that PGI activity is not directly regulated by metabolic factors and suggest that the reduced PGI levels in Clarkias with the duplication probably evolved by regulatory changes in transcription or translation. The study also demonstrates a novel method to evaluate whether a particular enzyme activity is essential.

Molecular characterization of duplicate cytosolic phosphoglucose isomerase genes in Clarkia and comparison to the single gene in Arabidopsis.

The nucleotide sequence of PgiC1-a which encodes a cytosolic isozymes of phosphoglucose isomerase (PGIC; EC 5.3.1.9) in Clarkia lewisii, a wildflower native to California, is described and compared to the previously published sequence of the duplicate PgiC2-a from the same genome. Both genes have the same structure of 23 exons and 22 introns located in identical positions, and they encode proteins of 569 amino acids. Exon and inferred protein sequences of the two genes are 96.4% and 97.2% identical, respectively. Intron sequences are 88.2% identical. The high nucleotide similarity of the two genes is consistent with previous genetic and biosystematic findings that suggest the duplication arose within Clarkia. A partial sequence of PgiC2-b was also obtained. It is 99.5% identical to PgiC2-a in exons and 99.7% in introns. The nucleotide sequence of the single PgiC from Arabidopsis thaliana was also determined for comparison to the Clarkia genes. The A. thaliana PgiC has 21 introns located at positions identical to those in Clarkia PgiC1 and PgiC2, but lacks the intron that divides Clarkia exons 21 and 22. The A. thaliana PGIC protein is shorter, with 560 amino acids, and differs by about 17% from the Clarkia PGICs. The PgiC in A. thaliana was mapped to a site 20 cM from restriction fragment length polymorphism marker 331 on chromosome 5.

Two separable conformers of TATP and analogues exist at room temperature.

[reaction: see text] TATP gives rise to two separable conformations because the barrier for interconversion between them is relatively high at room temperature. This kind of behavior is rare in cyclic organic systems and is the result of poor overlap in the "flip-flop" transition state. The crystal structure of the analogous tricyclohexanone triperoxide also indicates the presence of two conformers.

Anticoagulation in atrial fibrillation. Does efficacy in clinical trials translate into effectiveness in practice?

BACKGROUND: Several recent randomized clinical trials of anticoagulation in atrial fibrillation have demonstrated significant reduction in stroke rates with a small incidence of bleeding complications. The objective of this study was to determine whether the recommendations resulting from these trials have been implemented into routine practice, and if the anticoagulation control, therapeutic efficacy, and low complication rates achieved in the trials have been matched in community practice. METHODS: We analyzed the anticoagulation practices and outcomes obtained for patients in atrial fibrillation at a large staff model health maintenance organization (HMO). We reviewed the medical records of all patients in atrial fibrillation as of April 1990. We compared demographic characteristics and clinical risk factors between HMO patients and those in the clinical trials. We also compared anticoagulation monitoring, adequacy of anticoagulation control, and clinical outcomes at the HMO with those achieved in the clinical trials. RESULTS: Of 238 HMO patients in atrial fibrillation, 198 were without contraindications and therefore eligible for anticoagulation. Of these, 168 were offered anticoagulation (84.8%) and 156 were receiving anticoagulation therapy (78.8% of those eligible). The HMO patients had a greater prevalence of comorbidities than those in the clinical trials. The routine monitoring interval at the HMO was estimated at between 36.3 and 40.9 days (compared with 21 to 28 days reported in the clinical trials). The prothrombin time ratios at the HMO were in the target range on 50% of days compared with 68% of days in the clinical trials. The annual stroke and major bleeding rates in the HMO patients (1.3% and 0.6%, respectively) were not significantly different from the rates in the clinical trials (1.3% and 1.1%, respectively). The annual minor bleeding rate of 13.6% at the HMO was greater than the 7.8% to 8.4% rates in the two trials with better anticoagulation control (Boston Area Anticoagulation Trial for Atrial Fibrillation and Stroke Prevention in Atrial Fibrillation Study) but was not significantly different than the rates of 12.7% and 13.7% of the two trials with poorer anticoagulation control (Canadian Atrial Fibrillation Anticoagulation Study and Stroke Prevention in Nonrheumatic Atrial Fibrillation Study). CONCLUSIONS: Anticoagulation practices in this community setting appear to be good in that a large majority of patients were receiving anticoagulation therapy, and there were few major adverse outcomes. However, this study illustrates two common problems in attempting to apply the results of randomized clinical trials to routine practice: (1) differences between community patient populations and those on which the conclusions of clinical trials are based, and (2) less successful application of therapeutic interventions in settings other than that of a controlled clinical trial. The greater prevalence of comorbidities in the HMO patient population appears to convey a greater overall risk of thromboembolism and bleeding complications than in the clinical trials. In addition, the suboptimal anticoagulation control achieved at the HMO may increase the risks and decrease the potential benefits compared with those achieved in the clinical trials. Thus, the efficacy demonstrated in the clinical trials of anticoagulation in atrial fibrillation may not be directly translated into effectiveness in practice.

The efficacy of atenolol in the outpatient management of the alcohol withdrawal syndrome. Results of a randomized clinical trial.

We conducted a randomized, double-blind, clinical trial of atenolol compared with placebo in the outpatient management of patients with the alcohol withdrawal syndrome. In addition to receiving customary therapy, 88 patients were randomly assigned to receive atenolol and 92 to receive placebo. Outcome during the next 14 days was assessed using two main measures: the patient's clinical course as assessed by an alcohol withdrawal severity index; and the occurrence of treatment failure (composite measure including return to drinking, dropouts, and withdrawal lasting longer than 5 days). In addition, levels of craving for alcohol were assessed as an associated response variable. Overall, treatment failure occurred for 37% of the patients receiving atenolol and 52% of those receiving placebo. Among patients who had withdrawal symptoms at baseline, vital signs became normal more rapidly in the patients receiving atenolol, and their abnormal behavioral characteristics also resolved more rapidly. Levels of craving for alcohol were strongly associated with treatment failure; the group of patients who received atenolol included significantly fewer who reported high levels of craving 24 hours after treatment began (7% of patients receiving atenolol and 20% of those receiving placebo). We conclude that the outpatient management and treatment outcomes of the alcohol withdrawal syndrome are improved in patients who receive atenolol, and that the beneficial effects are associated with reduced levels of craving for alcohol. If these results are confirmed by other investigators, atenolol may prove to play an important role in the outpatient management of the alcohol withdrawal syndrome.

Pulmonary and rhinocerebral mucormycosis. Successful outcome with amphotericin B and griseofulvin therapy.

An ominous prognosis is associated with combined pulmonary and rhinocerebral mucormycosis (phycomycosis). We report the case of a diabetic patient with ketoacidosis who had extensive pulmonary and rhinocerebral mucormycosis that responded satisfactorily to amphotericin B and griseofulvin therapy. The affected lung is completely atelectatic and has remained so for 12 months without evidence of necrosis or abscess formation.