Lethal factor and anti-protective antigen IgG levels associated with inhalation anthrax, Minnesota, USA.

Bacillus anthracis was identified in a 61-year-old man hospitalized in Minnesota, USA. Cooperation between the hospital and the state health agency enhanced prompt identification of the pathogen. Treatment comprising antimicrobial drugs, anthrax immune globulin, and pleural drainage led to full recovery; however, the role of passive immunization in anthrax treatment requires further evaluation.

Imaging sensor constellation for tomographic chemical cloud mapping.

A sensor constellation capable of determining the location and detailed concentration distribution of chemical warfare agent simulant clouds has been developed and demonstrated on government test ranges. The constellation is based on the use of standoff passive multispectral infrared imaging sensors to make column density measurements through the chemical cloud from two or more locations around its periphery. A computed tomography inversion method is employed to produce a 3D concentration profile of the cloud from the 2D line density measurements. We discuss the theoretical basis of the approach and present results of recent field experiments where controlled releases of chemical warfare agent simulants were simultaneously viewed by three chemical imaging sensors. Systematic investigations of the algorithm using synthetic data indicate that for complex functions, 3D reconstruction errors are less than 20% even in the case of a limited three-sensor measurement network. Field data results demonstrate the capability of the constellation to determine 3D concentration profiles that account for ~?86%? of the total known mass of material released.

Neuromuscular disorders in the intensive care unit.

Neuromuscular disorders encountered in the ICU can be categorized as muscular diseases that lead to ICU admission and those that are acquired in the ICU. This article discusses three neuromuscular disorders can lead to ICU admission and have a putative immune-mediated pathogenesis: the Guillian-Barré syndrome, myasthenia gravis, and dermatomyositis/polymyositis. It also reviews critical care polyneuropathy and ICU acquired myopathy, two disorders that, alone or in combination, are responsible for nearly all cases of severe ICU acquired muscle weakness.

Impact of randomized trial results on acute lung injury ventilator therapy in teaching hospitals.

Reducing tidal volumes administered to patients with acute lung injury is the only intervention reported to decrease mortality resulting from this life-threatening condition. Whereas many medical advances are slowly brought into practice, clinicians in teaching hospitals are often assumed to be early adopters of new medical advances. Our objective was to examine trends in the ventilatory prescription for 398 patients with acute lung injury treated in three teaching hospitals from 1994 to 2001. There was no change in tidal volumes until mid to late 1998, when volumes started to slowly decline at the rate of 48.0 (95% confidence interval, 21.0 to 74.4) ml/year. In the 2 years after the results were released from a large trial that demonstrated the superiority of 6 ml/kg tidal volume therapy over 12 ml/kg, clinicians prescribed tidal volumes of 651 +/- 128 ml or 10.1 +/- 1.9 ml/kg. Tidal volumes after intubation were minimally reduced over the subsequent 2 days of mechanical ventilation (mean reduction, 33 ml). Hospital category, male sex, and disease onset before May 1999 were associated with higher volumes whereas lung injury severity was inversely associated. We conclude that clinicians practicing at these teaching hospitals have not rapidly adopted low tidal volume ventilation that may reduce mortality.