Aspiration Of Mucus Research Articles

Characterization of Encephalitozoon (Septata) intestinalis isolates cultured from nasal mucosa and bronchoalveolar lavage fluids of two AIDS patients.

Microsporidia are obligate intracellular protozoan parasites that can cause opportunistic infections in AIDS patients. Species from five genera of microsporidia are presently known to infect man. One species, Septata intestinalis originally was detected in stool specimens of individuals with chronic diarrhea and subsequently was found to disseminate to the kidneys, lungs, and nasal sinuses. This organism has since been reclassified as Encephalitozoon and in this study, we report the culture of Encephalitozoon intestinalis from a bronchoalveolar lavage specimen and a nasal mucus aspirate of two AIDS patients living in the USA. The bronchoalveolar and nasal microsporidian isolates grew in several continuous cell lines including RK-13, MDCK, HT-29, Caco-2, Vero, and I047. Transmission electron microscopy of the clinical and cell culture specimens revealed that the new isolates appeared to be E. intestinalis based on morphology and growth of organisms in septated membrane-bound parasitophorous vacuoles. The new E. intestinalis isolates were characterized and compared with the first isolated E. intestinalis that was cultured from stool to confirm their identity and to determine if there existed any minor differences, as seen in the closely related Encephalitozoon cuniculi strains. By the methods of sodium dodecyl sulfate-polyacrylamide gel electrophoresis staining for proteins and carbohydrates, Western blot immunodetection, and polymerase chain reaction-based methods with restriction endonuclease digestion, double-stranded DNA heteroduplex mobility shift analysis, and DNA sequencing of the ribosomal DNA intergenic spacer region, the new isolates were identical to each other and to the reference isolate of E. intestinalis. In addition, with any of these methods, the E. intestinalis organisms could be distinguished from the three E. cuniculi strains, Encephalitozoon hellem, and Vittaforma corneae, which is important for diagnostics, therapeutic strategies, and epidemiology.

Isolation of fetal cells from transcervical samples by micromanipulation: Molecular confirmation of their fetal origin and diagnosis of fetal aneuploidy

Transcervical cell (TCC) samples have been shown to contain fetal cells amenable to molecular analysis. However, the presence of 'contaminating' maternal cells limits their use for prenatal diagnoses. In this report we show that clumps of fetal cells can be isolated from transcervical samples by micromanipulation and tested by fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR). Out of 129 clumps, isolated from mucus aspirates and transcervical lavages from 29 patients, 29 clumps from 11 patients were found to be exclusively of fetal origin as judged by the detection of chromosome 21-specific polymorphic DNA markers and Y-derived DNA sequences by PCR and FISH. One case of a male triploid fetus, diagnosed by the analysis of TCC samples obtained by mucus aspiration and lavage, was confirmed by testing clumps of cells isolated by micromanipulation.

Methods for the transcervical collection of fetal cells during the first trimester of pregnancy

Before termination of pregnancy, four techniques for retrieving fetal cells transcervically were investigated: uterine lavage, endocervical lavage, cytobrush and mucus aspiration. The yield of fetal cells in these samples was studied and found to be somewhat better after uterine lavage. A preliminary assessment of the safety of mucus aspiration was carried out before transcervical chorionic villus sampling (CVS) in continuing pregnancies. No difference in outcome to a control group having only CVS was found.

Umbilical vessel oxytocin administration for retained placenta: In vitro study of various infusion techniques

The aim of our study was to investigate whether the discrepancies in results between various studies of umbilical vein administration of oxytocin for retained placenta may be related to differences in the infusion techniques used. An in vitro, descriptive study was performed. Contrast medium was injected into the umbilical vessels of 25 freshly delivered placentas and sequential x-ray films were taken. Capillary filling was inconsistent after injection of 20 ml of solution into the umbilical vein without or with "milking" of the cord (1/5 and 2/5, respectively). These are the techniques most commonly used in reported controlled clinical studies. Injection via an infant mucus aspiration catheter introduced along the umbilical vein to 5 cm from the placental insertion demonstrated a cotyledonary pattern in three of five cases after 20 ml and in all 5 after 30 ml. The latter method (use of increased infusion volumes) is recommended in future studies to determine the effectiveness of umbilical vein administration of oxytocin for retained placenta.

Alterations in rat intestinal mucin patterns following luminal infusion of acetylsalicylic acid and prostaglandin derivatives

The secretion of gastrointestinal mucin and/or the formation of mucoid caps have been implicated in cytoprotective or repair mechanisms related to mucosal injury models. In this study, rats were treated with acetylsalicylic acid (ASA) or prostaglandins (PG), and their effects on the synthesis and secretion of small intestinal mucin were examined. A newly developed polyclonal antibody to rat intestinal mucin was used for immunoassay of rat intestinal luminal and tissue mucin. The mucin antigen source was obtained by vacuum aspiration of luminal mucus. A high-molecular-weight glycoprotein (2 x 10(6) Da) fraction injected into rabbits produced a primary mucin antibody. A sensitive and quantitative enzyme-linked immunosorbent assay (ELISA) was developed that yielded a highly reproducible and linear response with mucin aliquots containing 0-20 ng of protein/ml. Incorporation of the plasma tracers ([3H]glucose and [35S]sodium sulfate) into mucin derived from hexadecyltrimethylammonium bromide precipitation after treatment with ASA (100 mg/kg body wt) decreased, although administration of dimethylprostaglandin E2 (100 micrograms/kg body wt) significantly increased the specific tracer incorporation values for the sialomucin and sulfomucin indices in luminal mucin fractions. The immunoassay data pattern for the ELISA technique was virtually identical to the results of the radiolabeled tracer method obtained for the same pharmacologic treatments. These experiments demonstrate that the estimation of synthesized mucin (tissue source) or secreted mucin (luminal source) as determined by the ELISA technique is similar to that obtained by the time-consuming and labor-intensive tracer incorporation methodology.

Detection of adenovirus in nasopharyngeal specimens by radioactive and nonradioactive DNA probes.

The presence of adenovirus DNA in clinical specimens was analyzed by nucleic acid hybridization assays by both radioactive and enzymatic detection systems. The sensitivity of the hybridization tests was in the range of 10 to 100 pg of homologous adenovirus DNA. Minimal background was noticed with unrelated viral and nonviral DNA. Twenty-four nasopharyngeal mucus aspirate specimens, collected from children with acute respiratory infection, were assayed in the hybridization tests and also by an enzyme immunoassay for adenovirus hexon antigen which was used as a reference test. Sixteen specimens positive by the enzyme immunoassay also were positive in the two nucleic acid hybridization tests, and the remaining eight specimens were negative in all of the tests. The results indicate that nucleid acid hybridization tests with both radioactive and nonradioactive probes can be used for diagnosis of microbial infections.

Esophageal atresia: embryogenesis and management.

AbstractThe embryogenesis of esophageal atresia is reviewed. Esophageal atresia is frequently associated with other predictable anomalies and prematurity. The management of esophageal atresia will vary according to the size and vigor of the baby, the severity of complicating anomalies, and the distance between the 2 esophageal ends. Surgical repair is not urgent, since the infant can be maintained by sump suction of the proximal esophagus to prevent aspiration of mucus and by gastrostomy or jejunal feedings. When associated anomalies or pulmonary complications have been resolved, the definitive repair is performed. If there is a long distance between the esophageal ends, it is usually possible over a period of time to bring the 2 ends close together by bougie stretching and by performing a series of esophageal myotomies. Complications that should be anticipated following repair include anastomotic stricture, recurrent tracheoesophageal fistula, esophageal dysmotility, tracheomalacia, and gastroesophageal reflux with aspiration, impaired caloric intake, and esophagitis.

Epidemiological and bacteriological investigation of Serratia marcescens epidemic in a nursery and in a neonatal intensive care unit.

An epidemic caused by Serratia marcescens that involved 26 infants admitted to the Neonatal Intensive Care Unit (NICU) and 82 infants admitted to the Nursery of the 2nd Medical School of Naples is reported. Two different biotypes of S. marcescens with two completely different epidemiological patterns were identified. The prevalent biotype (A8b trigonelline-) was isolated in the delivery room, in the operating room, in the Nursery and in the NICU from items, healthy infant excreters and affected infants; the second biotype (A3a) was isolated only in the NICU from staff, two healthy infant excreters and two affected infants. Colonization of the throat and the gastrointestinal tract was frequent. Infected and colonized infants were the most important reservoir for serratia in the Nursery and in the NICU particularly for the type strain A3a. A mucus aspiration apparatus contaminated in the delivery room and the contamination of several instruments and items probably had a major role in the initiation and maintenance of the spread of the A8b strain. Mass contamination of the nursery has been related to overcrowding and a lack of the control measures; the transfer of high-risk colonized infants caused spread in the NICU. In the NICU the attack rate 26%; 69% of infants became ill; the case fatality ratio was 19%. Epidemiological investigation of the infants at risk showed some factors predisposing to infection with serratia. The hygienic measures failed to control the spread of serratia and it was necessary to refuse new admissions to pregnant women in order to decontaminate and re-organize the wards.

Post-coital testing of peritoneal fluid aspirate

SummaryEighteen patients who had previously had negative or poor post-coital tests were examined for the presence of spermatozoa in the cervical mucus and peritoneal fluid aspirate. In four cases in which there was either a negative or a poor post-coital test, spermatozoa were isolated from the peritoneal cavity. The use of a specific fluorescent antibody to detect the presence of spermatozoa is described.

Management of Status Epilepticus

Status epilepticus is one of the few neurologic emergencies in the practice of pediatrics. A patient is considered to be in status when seizures occur so frequently as to prevent emergence from the postictal phase induced by one attack before the occurrence of the next. There are four sequential aspects to the management of the patient in status: maintenance of vital functions, drug therapy to control the convulsions, assigning a cause for the condition, and lastly, prevention of further convulsions. MAINTENANCE OF VITAL FUNCTIONS A significant percentage of patients die in the course of status epilepticus, or shortly thereafter. Fatalities have ranged from 23% in all ages to 4% in an exclusively pediatric series. The physician treating the child in status should act promptly to maintain an adequate airway, prevent aspiration of mucus, and secure the child from injury induced by the violence of the convulsions. Hyperthermia and hypotension should be vigorously corrected. Whenever there is cyanosis, oxygen should be administered. From experimental work we have learned that convulsions lasting longer than 20 to 30 minutes may induce brain damage. Several systemic factors acting singly or in concert are believed to be responsible. Hyperpyrexia and arterial hypotension have been singled out as inducing damage to nerve cells, particularly within the cerebellum.

Management of Status Epilepticus

Status epilepticus is one of the few neurologic emergencies in the practice of pediatrics. A patient is considered to be in status when seizures occur so frequently as to prevent emergence from the postictal phase induced by one attack before the occurrence of the next. There are four sequential aspects to the management of the patient in status: maintenance of vital functions, drug therapy to control the convulsions, assigning a cause for the condition, and lastly, prevention of further convulsions. MAINTENANCE OF VITAL FUNCTIONS A significant percentage of patients die in the course of status epilepticus, or shortly thereafter. Fatalities have ranged from 23% in all ages to 4% in an exclusively pediatric series. The physician treating the child in status should act promptly to maintain an adequate airway, prevent aspiration of mucus, and secure the child from injury induced by the violence of the convulsions. Hyperthermia and hypotension should be vigorously corrected. Whenever there is cyanosis, oxygen should be administered. From experimental work we have learned that convulsions lasting longer than 20 to 30 minutes may induce brain damage. Several systemic factors acting singly or in concert are believed to be responsible. Hyperpyrexia and arterial hypotension have been singled out as inducing damage to nerve cells, particularly within the cerebellum.

Two stage Asai laryngectomy utilizing a modified Tucker valve

1. 1. The Asai technic has been modified into a two stage operation. The results were excellent in three patients in whom this revised approach was employed, and they have speech that is far superior to that of patients with esophageal voices. 2. 2. The Tucker valve can be modified so that finger control of the tracheal stoma is unnecessary for speech control. 3. 3. There are inherent problems with the Asai technic. The most annoying is the aspiration of mucus into the tracheopulmonary system and the occasional need to block off the dermal channel when food or liquids are swallowed.

Stab and gunshot wounds of the chest diagnosis and treatment

1. 1. Penetrating wounds of the chest in civilian practice are caused primarily by stabbing with knives or ice picks and gunshots with pistols. Because of depth of penetration, gunshot wounds are usually more serious than stab wounds. 2. 2. The physiologic effects of penetrating wounds of the chest are impairment of ventilation and reduction of cardiac output. Ventilation may be affected by pneumothorax, hemothorax, injury of pulmonary parenchyma, diaphragm, chest wall or phrenic nerves and retention of tracheobronchial secretions. Cardiac output is affected by a reduction in circulating blood volume secondary to hemorrhage and by cardiac tamponade. 3. 3. Thoracoabdominal injury, with involvement of intra-abdominal structures causing hemorrhage or peritonitis, greatly increases the physiologic affects of injury. 4. 4. Early diagnosis of injury is essential if treatment is to be instituted promptly. Initial examination should be made for presence of obstruction of the airway, tension pneumothorax, massive hemothorax and cardiac tamponade. Only after the presence of these conditions has been ruled out, or they have been corrected, if present, should one proceed with a general examination. Needle aspiration of the pleural or pericardial space may establish the diagnosis and afford an early opportunity to temporarily relieve these conditions. 5. 5. Roentgenographic examination is not usually necessary during resuscitation, and may be contraindicated. However, once resuscitation has been completed roentgenograms of the chest and abdomen will define the full extent of injury. 6. 6. When wounds of the trachea or major bronchi and esophagus are suspected, bronchoscopy and esophagoscopy may indicate the site and extent of injury. 7. 7. Objectives of treatment of penetrating wounds of the chest are restoration of normal ventilation and cardiac output. A patent airway should be established first, by insertion of an oral airway in the unconscious patient, and by aspiration of blood and mucus from the larynx and trachea. If associated injuries to the oropharynx are present or if other measures fail, tracheostomy should be performed. When the diagnosis of pneumothorax or hemothorax has been made, the patient is treated by insertion of a catheter through a lower intercostal space in the mid-axillary line. The catheter is connected to waterseal drainage. For a majority of injuries this is all that is needed for the evacuation of air and blood from the chest and expansion of the lung. 8. 8. Reduction in blood volume should be corrected by prompt replacement of whole blood. Measurement of central venous pressure is a reliable guide to blood replacement and, in addition, helps to differentiate between shock resulting from blood loss and cardiac tamponade. 9. 9. Patients with cardiac tamponade may be treated satisfactorily by aspiration of the pericardial space. Rarely is operative repair necessary. 10. 10. The loss of large amounts of air and blood from the chest suggests injury to the trachea and major bronchi or to the heart and great vessels and may necessitate thoracotomy. 11. 11. Thoracoabdominal wounds are managed by providing catheter drainage of the chest, if there is pneumothorax or hemothorax, and by exploring the abdomen. A combined thoraco-abdominal incision is to be avoided whenever possible.

Hypoventilation syndrome in bulbar poliomyelitis.

Because of the complex nature of respiratory inadequacy due to bulbar poliomyelitis and the severity of associated disturbances in acutely ill patients with this disease, there is little precise knowledge of the disturbed respiratory mechanism itself. In a patient whose muscles of respiration do not coordinate and whose respiratory air flow pattern is grossly irregular, it is sometimes difficult to tell whether the irregularity is caused by involvement of the respiratory center or by the airway difficulties engendered by cranial nerve involvement. Detailed attention to the maintenance of a clear airway, auscultation over the larynx, and visual observation of the character of the patient's respiratory effort often help to differentiate respiratory center involvement from the irregularity that arises as a result of the protective reflexes that are invoked to prevent the pulmonary aspiration of mucus and saliva. The gross irregularity of breathing and the ventilatory inadequacy which may be associated

The Patient with Bulbar-Respiratory Poliomyelitis

THE polio patient with bulbar and respiratory paralysis presents a number of serious nursing problems. Bulbar involvement with paralysis of the muscles of the palate, pharynx, and larynx makes it difficult or impossible for the patient to maintain an open airway. Partial or complete obstruction of the airway through the nose, pharynx, larynx, and trachea results in hypoxia (insufficient oxygen), aspiration of mucus into the trachea and lung, and pulmonary edema(1). When mucus or saliva is aspirated atelectasis and pneumonia result. Paralysis of the respiratory muscles makes assistance in ventilation imperative, or the patient will suffocate. At the present time adequate assistance to respiration can be obtained only by placing the patient in a tank-type respirator which immobilizes him almost com-

GASTROSTOMY IN POLIOMYELITIS

Pharyngeal paralysis associated with in swallowing is not unusual in bulbar poliomyelitis, but this condition seldom persists more than a few days. Wilson 1 states that difficulty in swallowing is transitory and the worst is usually over in one Physicians treating large numbers of poliomyelitis cases have, however, experienced situations on rare occasions when pharyngeal paralysis has persisted well over the week. It has been shown that if life can be sustained through the acute phase of the disease there is practically always a 100 per cent recovery of the pharyngeal muscles. As a rule tube feeding is not too difficult, but dangers associated with this procedure are always present and must be avoided whenever possible. The three main hazards are (1) aspiration of mucus or vomitus with resulting bronchial obstruction and sudden cessation of respiration, (2) choking attacks with temporary severe anoxemia and cyanosis and (3) excessive fatigue.

A method for the aspiration of mucus in asphyxia neonatorum

A method for the aspiration of mucus in asphyxia neonatorum