home *** CD-ROM | disk | FTP | other *** search
/ Year Books 1991 / Year Books 1991.iso / dp / 11 / 110.pkg next >
Unknown  |  1992-06-06  |  472.1 KB

open in: MacOS 8.1     |     Win98     |     DOS

view JSON data     |     view as text

This file was not able to be converted.
This format is not currently supported by dexvert.

ConfidenceProgramDetectionMatch TypeSupport
66% dexvert OS/2 Installation Package (archive/os2InstallPackage) ext Supported
1% dexvert BeOS Installation Package (archive/beOSInstallPackage) ext Unsupported
1% dexvert Newton Package (archive/newtonPackage) ext Unsupported
1% dexvert Independence War 2 mod Package (other/independenceWar2ModPackage) ext Unsupported
100% file data default



hex view
+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 64 00 |.DP1.1..|......d.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 9c 05 00 00 |......00|........|
|00000020| af 0f 00 00 30 31 00 00 | 00 01 4b 15 00 00 a1 0d |....01..|..K.....|
|00000030| 00 00 30 32 00 00 00 01 | ec 22 00 00 32 11 00 00 |..02....|."..2...|
|00000040| 30 33 00 00 00 01 1e 34 | 00 00 01 0f 00 00 30 34 |03.....4|......04|
|00000050| 00 00 00 01 1f 43 00 00 | 17 0f 00 00 30 35 00 00 |.....C..|....05..|
|00000060| 00 01 36 52 00 00 d4 13 | 00 00 30 36 00 00 00 01 |..6R....|..06....|
|00000070| 0a 66 00 00 10 11 00 00 | 30 37 00 00 00 01 1a 77 |.f......|07.....w|
|00000080| 00 00 9c 0d 00 00 30 38 | 00 00 00 01 b6 84 00 00 |......08|........|
|00000090| 5b 10 00 00 30 39 00 00 | 00 01 11 95 00 00 26 16 |[...09..|......&.|
|000000a0| 00 00 31 30 00 00 00 01 | 37 ab 00 00 ed 16 00 00 |..10....|7.......|
|000000b0| 31 31 00 00 00 01 24 c2 | 00 00 fc 0e 00 00 31 32 |11....$.|......12|
|000000c0| 00 00 00 01 20 d1 00 00 | 2d 0c 00 00 31 33 00 00 |.... ...|-...13..|
|000000d0| 00 01 4d dd 00 00 e6 19 | 00 00 31 34 00 00 00 01 |..M.....|..14....|
|000000e0| 33 f7 00 00 1a 10 00 00 | 31 35 00 00 00 01 4d 07 |3.......|15....M.|
|000000f0| 01 00 28 10 00 00 31 36 | 00 00 00 01 75 17 01 00 |..(...16|....u...|
|00000100| be 13 00 00 31 37 00 00 | 00 01 33 2b 01 00 8a 0c |....17..|..3+....|
|00000110| 00 00 31 38 00 00 00 01 | bd 37 01 00 12 15 00 00 |..18....|.7......|
|00000120| 31 39 00 00 00 01 cf 4c | 01 00 46 15 00 00 32 30 |19.....L|..F...20|
|00000130| 00 00 00 01 15 62 01 00 | ba 14 00 00 32 31 00 00 |.....b..|....21..|
|00000140| 00 01 cf 76 01 00 4b 10 | 00 00 32 32 00 00 00 01 |...v..K.|..22....|
|00000150| 1a 87 01 00 27 11 00 00 | 32 33 00 00 00 01 41 98 |....'...|23....A.|
|00000160| 01 00 12 0f 00 00 32 34 | 00 00 00 01 53 a7 01 00 |......24|....S...|
|00000170| da 0f 00 00 32 35 00 00 | 00 01 2d b7 01 00 95 12 |....25..|..-.....|
|00000180| 00 00 32 36 00 00 00 01 | c2 c9 01 00 f2 17 00 00 |..26....|........|
|00000190| 32 37 00 00 00 01 b4 e1 | 01 00 b1 14 00 00 32 38 |27......|......28|
|000001a0| 00 00 00 01 65 f6 01 00 | d5 0e 00 00 32 39 00 00 |....e...|....29..|
|000001b0| 00 01 3a 05 02 00 35 10 | 00 00 33 30 00 00 00 01 |..:...5.|..30....|
|000001c0| 6f 15 02 00 78 10 00 00 | 33 31 00 00 00 01 e7 25 |o...x...|31.....%|
|000001d0| 02 00 4f 12 00 00 33 32 | 00 00 00 01 36 38 02 00 |..O...32|....68..|
|000001e0| 2f 12 00 00 33 33 00 00 | 00 01 65 4a 02 00 79 10 |/...33..|..eJ..y.|
|000001f0| 00 00 33 34 00 00 00 01 | de 5a 02 00 24 1a 00 00 |..34....|.Z..$...|
|00000200| 33 35 00 00 00 01 02 75 | 02 00 d1 15 00 00 33 36 |35.....u|......36|
|00000210| 00 00 00 01 d3 8a 02 00 | fb 0f 00 00 33 37 00 00 |........|....37..|
|00000220| 00 01 ce 9a 02 00 93 0c | 00 00 33 38 00 00 00 01 |........|..38....|
|00000230| 61 a7 02 00 45 16 00 00 | 33 39 00 00 00 01 a6 bd |a...E...|39......|
|00000240| 02 00 d2 13 00 00 34 30 | 00 00 00 01 78 d1 02 00 |......40|....x...|
|00000250| 3d 15 00 00 34 31 00 00 | 00 01 b5 e6 02 00 08 0c |=...41..|........|
|00000260| 00 00 34 32 00 00 00 01 | bd f2 02 00 49 1b 00 00 |..42....|....I...|
|00000270| 34 33 00 00 00 01 06 0e | 03 00 3e 0a 00 00 34 34 |43......|..>...44|
|00000280| 00 00 00 01 44 18 03 00 | ab 18 00 00 34 35 00 00 |....D...|....45..|
|00000290| 00 01 ef 30 03 00 78 19 | 00 00 34 36 00 00 00 01 |...0..x.|..46....|
|000002a0| 67 4a 03 00 8a 1d 00 00 | 34 37 00 00 00 01 f1 67 |gJ......|47.....g|
|000002b0| 03 00 7b 1d 00 00 34 38 | 00 00 00 01 6c 85 03 00 |..{...48|....l...|
|000002c0| f7 17 00 00 34 39 00 00 | 00 01 63 9d 03 00 f9 13 |....49..|..c.....|
|000002d0| 00 00 35 30 00 00 00 01 | 5c b1 03 00 dd 21 00 00 |..50....|\....!..|
|000002e0| 35 31 00 00 00 01 39 d3 | 03 00 f9 16 00 00 35 32 |51....9.|......52|
|000002f0| 00 00 00 01 32 ea 03 00 | 33 21 00 00 35 33 00 00 |....2...|3!..53..|
|00000300| 00 01 65 0b 04 00 db 14 | 00 00 35 34 00 00 00 01 |..e.....|..54....|
|00000310| 40 20 04 00 a6 17 00 00 | 35 35 00 00 00 01 e6 37 |@ ......|55.....7|
|00000320| 04 00 bf 15 00 00 35 36 | 00 00 00 01 a5 4d 04 00 |......56|.....M..|
|00000330| a5 0e 00 00 35 37 00 00 | 00 01 4a 5c 04 00 cf 0b |....57..|..J\....|
|00000340| 00 00 35 38 00 00 00 01 | 19 68 04 00 69 1c 00 00 |..58....|.h..i...|
|00000350| 35 39 00 00 00 01 82 84 | 04 00 1b 12 00 00 36 30 |59......|......60|
|00000360| 00 00 00 01 9d 96 04 00 | 27 19 00 00 36 31 00 00 |........|'...61..|
|00000370| 00 01 c4 af 04 00 bd 12 | 00 00 36 32 00 00 00 01 |........|..62....|
|00000380| 81 c2 04 00 1e 0e 00 00 | 36 33 00 00 00 01 9f d0 |........|63......|
|00000390| 04 00 44 13 00 00 36 34 | 00 00 00 01 e3 e3 04 00 |..D...64|........|
|000003a0| 83 14 00 00 36 35 00 00 | 00 01 66 f8 04 00 56 15 |....65..|..f...V.|
|000003b0| 00 00 36 36 00 00 00 01 | bc 0d 05 00 17 11 00 00 |..66....|........|
|000003c0| 36 37 00 00 00 01 d3 1e | 05 00 29 12 00 00 36 38 |67......|..)...68|
|000003d0| 00 00 00 01 fc 30 05 00 | fe 12 00 00 36 39 00 00 |.....0..|....69..|
|000003e0| 00 01 fa 43 05 00 f3 1b | 00 00 37 30 00 00 00 01 |...C....|..70....|
|000003f0| ed 5f 05 00 06 19 00 00 | 37 31 00 00 00 01 f3 78 |._......|71.....x|
|00000400| 05 00 18 16 00 00 37 32 | 00 00 00 01 0b 8f 05 00 |......72|........|
|00000410| 63 15 00 00 37 33 00 00 | 00 01 6e a4 05 00 08 10 |c...73..|..n.....|
|00000420| 00 00 37 34 00 00 00 01 | 76 b4 05 00 96 18 00 00 |..74....|v.......|
|00000430| 37 35 00 00 00 01 0c cd | 05 00 af 0f 00 00 37 36 |75......|......76|
|00000440| 00 00 00 01 bb dc 05 00 | 72 0f 00 00 37 37 00 00 |........|r...77..|
|00000450| 00 01 2d ec 05 00 40 11 | 00 00 37 38 00 00 00 01 |..-...@.|..78....|
|00000460| 6d fd 05 00 44 10 00 00 | 37 39 00 00 00 01 b1 0d |m...D...|79......|
|00000470| 06 00 0f 0e 00 00 38 30 | 00 00 00 01 c0 1b 06 00 |......80|........|
|00000480| ae 0e 00 00 38 31 00 00 | 00 01 6e 2a 06 00 a0 0e |....81..|..n*....|
|00000490| 00 00 38 32 00 00 00 01 | 0e 39 06 00 50 0f 00 00 |..82....|.9..P...|
|000004a0| 38 33 00 00 00 01 5e 48 | 06 00 63 0c 00 00 38 34 |83....^H|..c...84|
|000004b0| 00 00 00 01 c1 54 06 00 | 2a 11 00 00 38 35 00 00 |.....T..|*...85..|
|000004c0| 00 01 eb 65 06 00 14 0f | 00 00 38 36 00 00 00 01 |...e....|..86....|
|000004d0| ff 74 06 00 8d 12 00 00 | 38 37 00 00 00 01 8c 87 |.t......|87......|
|000004e0| 06 00 3e 13 00 00 38 38 | 00 00 00 01 ca 9a 06 00 |..>...88|........|
|000004f0| b8 0f 00 00 38 39 00 00 | 00 01 82 aa 06 00 ed 10 |....89..|........|
|00000500| 00 00 39 30 00 00 00 01 | 6f bb 06 00 fd 0e 00 00 |..90....|o.......|
|00000510| 39 31 00 00 00 01 6c ca | 06 00 b3 0e 00 00 39 32 |91....l.|......92|
|00000520| 00 00 00 01 1f d9 06 00 | a6 0c 00 00 39 33 00 00 |........|....93..|
|00000530| 00 01 c5 e5 06 00 a0 0b | 00 00 39 34 00 00 00 01 |........|..94....|
|00000540| 65 f1 06 00 45 15 00 00 | 39 35 00 00 00 01 aa 06 |e...E...|95......|
|00000550| 07 00 21 12 00 00 39 36 | 00 00 00 01 cb 18 07 00 |..!...96|........|
|00000560| 79 0f 00 00 39 37 00 00 | 00 01 44 28 07 00 ec 17 |y...97..|..D(....|
|00000570| 00 00 39 38 00 00 00 01 | 30 40 07 00 05 10 00 00 |..98....|0@......|
|00000580| 39 39 00 00 00 01 35 50 | 07 00 4b 10 00 00 00 00 |99....5P|..K.....|
|00000590| 00 00 00 00 80 60 07 00 | 00 00 00 00 24 55 6e 69 |.....`..|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 31 31 30 30 30 7d |que_ID{Y|RB11000}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 43 68 72 6f 6e 69 63 |..$Title|{Chronic|
|000005c0| 20 4f 73 74 65 6f 6d 79 | 65 6c 69 74 69 73 3a 20 | Osteomy|elitis: |
|000005d0| 20 54 68 65 20 52 65 6c | 61 74 69 76 65 20 52 6f | The Rel|ative Ro|
|000005e0| 6c 65 73 20 6f 66 20 53 | 63 69 6e 74 69 67 72 61 |les of S|cintigra|
|000005f0| 6d 73 2c 20 50 6c 61 69 | 6e 20 52 61 64 69 6f 67 |ms, Plai|n Radiog|
|00000600| 72 61 70 68 73 2c 20 61 | 6e 64 20 54 72 61 6e 73 |raphs, a|nd Trans|
|00000610| 6d 69 73 73 69 6f 6e 20 | 43 6f 6d 70 75 74 65 64 |mission |Computed|
|00000620| 20 54 6f 6d 6f 67 72 61 | 70 68 79 7d 0d 0a 24 41 | Tomogra|phy}..$A|
|00000630| 75 74 68 6f 72 7b 54 75 | 6d 65 68 2c 20 53 53 0d |uthor{Tu|meh, SS.|
|00000640| 0a 41 6c 69 61 62 61 64 | 69 2c 20 50 0d 0a 53 65 |.Aliabad|i, P..Se|
|00000650| 6c 74 7a 65 72 2c 20 53 | 45 0d 0a 57 65 69 73 73 |ltzer, S|E..Weiss|
|00000660| 6d 61 6e 2c 20 42 4e 0d | 0a 4d 63 4e 65 69 6c 2c |man, BN.|.McNeil,|
|00000670| 20 42 4a 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 | BJ}..$A|ffiliati|
|00000680| 6f 6e 7b 48 61 72 76 61 | 72 64 20 4d 65 64 20 53 |on{Harva|rd Med S|
|00000690| 63 68 6f 6f 6c 3b 20 42 | 72 69 67 68 61 6d 20 61 |chool; B|righam a|
|000006a0| 6e 64 20 57 6f 6d 65 6e | 27 73 20 48 6f 73 70 2c |nd Women|'s Hosp,|
|000006b0| 20 42 6f 73 74 6f 6e 7d | 0d 0a 24 4a 6f 75 72 6e | Boston}|..$Journ|
|000006c0| 61 6c 7b 43 6c 69 6e 20 | 4e 75 63 6c 20 4d 65 64 |al{Clin |Nucl Med|
|000006d0| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 31 33 7d 0d 0a |}..$Volu|me{13}..|
|000006e0| 24 50 61 67 65 7b 37 31 | 30 2d 37 31 35 7d 0d 0a |$Page{71|0-715}..|
|000006f0| 24 44 61 74 65 7b 4f 63 | 74 6f 62 65 72 20 31 39 |$Date{Oc|tober 19|
|00000700| 38 38 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 30 |88}..$YB|Vol{1990|
|00000710| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4d 65 | Year Bo|ok of Me|
|00000720| 64 69 63 69 6e 65 7d 0d | 0a 24 43 68 61 70 74 65 |dicine}.|.$Chapte|
|00000730| 72 7b 32 2d 34 7d 0d 0a | 24 59 42 45 64 69 74 6f |r{2-4}..|$YBEdito|
|00000740| 72 7b 44 72 73 2e 20 52 | 6f 67 65 72 73 2c 20 44 |r{Drs. R|ogers, D|
|00000750| 65 73 20 50 72 65 7a 2c | 20 43 6c 69 6e 65 2c 20 |es Prez,| Cline, |
|00000760| 42 72 61 75 6e 77 61 6c | 64 2c 20 47 72 65 65 6e |Braunwal|d, Green|
|00000770| 62 65 72 67 65 72 2c 20 | 57 69 6c 73 6f 6e 2c 20 |berger, |Wilson, |
|00000780| 45 70 73 74 65 69 6e 2c | 20 61 6e 64 20 4d 61 6c |Epstein,| and Mal|
|00000790| 61 77 69 73 74 61 7d 0d | 0a 24 54 61 62 6c 65 7b |awista}.|.$Table{|
|000007a0| 54 61 62 6c 65 20 4f 6d | 69 74 74 65 64 7d 0d 0a |Table Om|itted}..|
|000007b0| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 44 2e 45 |$Comment|ator{D.E|
|000007c0| 2e 20 52 6f 67 65 72 73 | 2c 20 4d 2e 44 2e 7d 0d |. Rogers|, M.D.}.|
|000007d0| 0a 0d 0a 43 6f 70 79 72 | 69 67 68 74 20 28 63 29 |...Copyr|ight (c)|
|000007e0| 20 59 65 61 72 62 6f 6f | 6b 20 4d 65 64 69 63 61 | Yearboo|k Medica|
|000007f0| 6c 20 50 75 62 6c 69 73 | 68 65 72 73 2c 20 49 6e |l Publis|hers, In|
|00000800| 63 2e 2c 20 31 39 39 30 | 0d 0a 0d 0a 31 39 39 30 |c., 1990|....1990|
|00000810| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 4d 65 | Year Bo|ok of Me|
|00000820| 64 69 63 69 6e 65 20 28 | 52 29 0d 0a 0d 0a 50 61 |dicine (|R)....Pa|
|00000830| 72 74 20 4f 6e 65 2d 2d | 49 6e 66 65 63 74 69 6f |rt One--|Infectio|
|00000840| 75 73 20 44 69 73 65 61 | 73 65 73 0d 0a 0d 0a 43 |us Disea|ses....C|
|00000850| 68 61 70 74 65 72 20 32 | 2d 2d 41 20 4e 65 77 20 |hapter 2|--A New |
|00000860| 6c 6f 6f 6b 20 61 74 20 | 4f 6c 64 20 50 72 6f 62 |look at |Old Prob|
|00000870| 6c 65 6d 73 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |lems....|--------|
|00000880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000008c0| 2d 2d 2d 2d 2d 2d 0d 0a | 43 68 72 6f 6e 69 63 20 |------..|Chronic |
|000008d0| 4f 73 74 65 6f 6d 79 65 | 6c 69 74 69 73 3a 20 20 |Osteomye|litis: |
|000008e0| 54 68 65 20 52 65 6c 61 | 74 69 76 65 20 52 6f 6c |The Rela|tive Rol|
|000008f0| 65 73 20 6f 66 20 53 63 | 69 6e 74 69 67 72 61 6d |es of Sc|intigram|
|00000900| 73 2c 20 50 6c 61 69 6e | 20 52 61 64 69 6f 67 72 |s, Plain| Radiogr|
|00000910| 61 70 68 73 2c 0d 0a 61 | 6e 64 20 54 72 61 6e 73 |aphs,..a|nd Trans|
|00000920| 6d 69 73 73 69 6f 6e 20 | 43 6f 6d 70 75 74 65 64 |mission |Computed|
|00000930| 20 54 6f 6d 6f 67 72 61 | 70 68 79 0d 0a 0d 0a 54 | Tomogra|phy....T|
|00000940| 75 6d 65 68 20 53 53 3b | 20 41 6c 69 61 62 61 64 |umeh SS;| Aliabad|
|00000950| 69 20 50 3b 20 53 65 6c | 74 7a 65 72 20 53 45 3b |i P; Sel|tzer SE;|
|00000960| 20 57 65 69 73 73 6d 61 | 6e 20 42 4e 3b 20 4d 63 | Weissma|n BN; Mc|
|00000970| 4e 65 69 6c 20 42 4a 0d | 0a 28 48 61 72 76 61 72 |Neil BJ.|.(Harvar|
|00000980| 64 20 4d 65 64 20 53 63 | 68 6f 6f 6c 3b 20 42 72 |d Med Sc|hool; Br|
|00000990| 69 67 68 61 6d 20 61 6e | 64 20 57 6f 6d 65 6e 27 |igham an|d Women'|
|000009a0| 73 20 48 6f 73 70 2c 20 | 42 6f 73 74 6f 6e 29 0d |s Hosp, |Boston).|
|000009b0| 0a 43 6c 69 6e 20 4e 75 | 63 6c 20 4d 65 64 20 31 |.Clin Nu|cl Med 1|
|000009c0| 33 3a 37 31 30 2d 37 31 | 35 2c 20 4f 63 74 6f 62 |3:710-71|5, Octob|
|000009d0| 65 72 20 31 39 38 38 0d | 0a 2d 2d 2d 2d 2d 2d 2d |er 1988.|.-------|
|000009e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000009f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a00| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a10| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000a20| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|00000a30| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 49 74 20 6d |act.... | It m|
|00000a40| 61 79 20 62 65 20 64 69 | 66 66 69 63 75 6c 74 20 |ay be di|fficult |
|00000a50| 74 6f 20 64 69 61 67 6e | 6f 73 65 20 61 6e 20 61 |to diagn|ose an a|
|00000a60| 63 75 74 65 20 66 6c 61 | 72 65 20 6f 66 20 63 68 |cute fla|re of ch|
|00000a70| 72 6f 6e 69 63 20 6f 73 | 74 65 6f 6d 79 65 6c 69 |ronic os|teomyeli|
|00000a80| 74 69 73 2c 0d 0a 62 75 | 74 20 69 74 20 69 73 20 |tis,..bu|t it is |
|00000a90| 69 6d 70 6f 72 74 61 6e | 74 20 74 6f 20 64 65 6c |importan|t to del|
|00000aa0| 69 6e 65 61 74 65 20 61 | 20 73 65 71 75 65 73 74 |ineate a| sequest|
|00000ab0| 72 75 6d 20 73 6f 20 74 | 68 61 74 20 69 74 20 6d |rum so t|hat it m|
|00000ac0| 61 79 20 62 65 20 72 65 | 6d 6f 76 65 64 0d 0a 73 |ay be re|moved..s|
|00000ad0| 75 72 67 69 63 61 6c 6c | 79 2e 20 20 46 61 6c 73 |urgicall|y. Fals|
|00000ae0| 65 20 70 6f 73 69 74 69 | 76 65 20 43 54 20 73 63 |e positi|ve CT sc|
|00000af0| 61 6e 73 20 68 61 76 65 | 20 62 65 65 6e 20 72 65 |ans have| been re|
|00000b00| 63 6f 72 64 65 64 2e 20 | 20 49 6e 20 61 64 64 69 |corded. | In addi|
|00000b10| 74 69 6f 6e 20 74 6f 20 | 43 54 2c 0d 0a 70 6c 61 |tion to |CT,..pla|
|00000b20| 69 6e 20 72 61 64 69 6f | 67 72 61 70 68 79 20 61 |in radio|graphy a|
|00000b30| 6e 64 20 73 63 69 6e 74 | 69 67 72 61 70 68 79 20 |nd scint|igraphy |
|00000b40| 77 65 72 65 20 65 76 61 | 6c 75 61 74 65 64 20 69 |were eva|luated i|
|00000b50| 6e 20 32 37 20 70 61 74 | 69 65 6e 74 73 20 77 69 |n 27 pat|ients wi|
|00000b60| 74 68 20 73 75 72 67 69 | 63 61 6c 0d 0a 70 72 6f |th surgi|cal..pro|
|00000b70| 6f 66 20 6f 66 20 61 63 | 74 69 76 65 20 6f 72 20 |of of ac|tive or |
|00000b80| 69 6e 61 63 74 69 76 65 | 20 64 69 73 65 61 73 65 |inactive| disease|
|00000b90| 2e 20 20 42 6f 6e 65 20 | 73 63 61 6e 73 20 77 65 |. Bone |scans we|
|00000ba0| 72 65 20 6d 61 64 65 20 | 77 69 74 68 20 74 65 63 |re made |with tec|
|00000bb0| 68 6e 65 74 69 75 6d 2d | 39 39 6d 0d 0a 6d 65 74 |hnetium-|99m..met|
|00000bc0| 68 79 6c 65 6e 65 20 64 | 69 70 68 61 73 70 68 6f |hylene d|iphaspho|
|00000bd0| 6e 61 74 65 20 72 61 64 | 69 6f 67 61 6c 6c 69 75 |nate rad|iogalliu|
|00000be0| 6d 2e 0d 0a 20 20 20 20 | 20 4f 6e 6c 79 20 35 20 |m... | Only 5 |
|00000bf0| 6f 66 20 31 35 20 73 65 | 71 75 65 73 74 72 61 20 |of 15 se|questra |
|00000c00| 77 65 72 65 20 64 65 74 | 65 63 74 65 64 20 62 79 |were det|ected by|
|00000c10| 20 70 6c 61 69 6e 20 72 | 61 64 69 6f 67 72 61 70 | plain r|adiograp|
|00000c20| 68 79 2c 20 62 75 74 20 | 74 68 65 20 73 74 75 64 |hy, but |the stud|
|00000c30| 79 0d 0a 77 61 73 20 74 | 6f 74 61 6c 6c 79 20 73 |y..was t|otally s|
|00000c40| 70 65 63 69 66 69 63 2e | 20 20 54 72 61 6e 73 6d |pecific.| Transm|
|00000c50| 69 73 73 69 6f 6e 20 43 | 54 20 64 65 74 65 63 74 |ission C|T detect|
|00000c60| 65 64 20 61 6c 6c 20 73 | 65 71 75 65 73 74 72 61 |ed all s|equestra|
|00000c70| 3b 20 68 6f 77 65 76 65 | 72 2c 20 33 0d 0a 66 61 |; howeve|r, 3..fa|
|00000c80| 6c 73 65 20 70 6f 73 69 | 74 69 76 65 20 73 74 75 |lse posi|tive stu|
|00000c90| 64 69 65 73 20 77 65 72 | 65 20 6f 62 74 61 69 6e |dies wer|e obtain|
|00000ca0| 65 64 2c 20 61 6c 6c 20 | 69 6e 20 70 61 74 69 65 |ed, all |in patie|
|00000cb0| 6e 74 73 20 77 69 74 68 | 20 62 6f 6e 65 20 72 65 |nts with| bone re|
|00000cc0| 6d 6f 64 65 6c 69 6e 67 | 20 61 6e 64 0d 0a 73 63 |modeling| and..sc|
|00000cd0| 6c 65 72 6f 73 69 73 20 | 66 72 6f 6d 20 70 61 73 |lerosis |from pas|
|00000ce0| 74 20 69 6e 66 65 63 74 | 69 6f 6e 2e 20 20 42 6f |t infect|ion. Bo|
|00000cf0| 6e 65 20 73 63 61 6e 73 | 20 77 65 72 65 20 61 62 |ne scans| were ab|
|00000d00| 6e 6f 72 6d 61 6c 20 69 | 6e 20 61 6c 6c 20 70 61 |normal i|n all pa|
|00000d10| 74 69 65 6e 74 73 2e 20 | 20 54 68 65 0d 0a 73 63 |tients. | The..sc|
|00000d20| 61 6e 73 20 69 6e 20 61 | 6c 6c 20 33 20 70 61 74 |ans in a|ll 3 pat|
|00000d30| 69 65 6e 74 73 20 77 69 | 74 68 20 66 61 6c 73 65 |ients wi|th false|
|00000d40| 20 70 6f 73 69 74 69 76 | 65 20 43 54 20 73 74 75 | positiv|e CT stu|
|00000d50| 64 69 65 73 20 73 68 6f | 77 65 64 20 61 20 70 61 |dies sho|wed a pa|
|00000d60| 74 74 65 72 6e 0d 0a 69 | 6e 63 6f 6e 73 69 73 74 |ttern..i|nconsist|
|00000d70| 65 6e 74 20 77 69 74 68 | 20 61 63 74 69 76 65 20 |ent with| active |
|00000d80| 64 69 73 65 61 73 65 2e | 0d 0a 20 20 20 20 20 43 |disease.|.. C|
|00000d90| 6f 6d 70 75 74 65 64 20 | 74 6f 6d 6f 67 72 61 70 |omputed |tomograp|
|00000da0| 68 79 20 43 54 20 69 73 | 20 61 20 73 65 6e 73 69 |hy CT is| a sensi|
|00000db0| 74 69 76 65 20 6d 65 61 | 6e 73 20 6f 66 20 64 65 |tive mea|ns of de|
|00000dc0| 74 65 63 74 69 6e 67 20 | 73 65 71 75 65 73 74 72 |tecting |sequestr|
|00000dd0| 61 20 69 6e 0d 0a 70 61 | 74 69 65 6e 74 73 20 77 |a in..pa|tients w|
|00000de0| 69 74 68 20 63 68 72 6f | 6e 69 63 20 6f 73 74 65 |ith chro|nic oste|
|00000df0| 6f 6d 79 65 6c 69 74 69 | 73 20 62 75 74 20 73 68 |omyeliti|s but sh|
|00000e00| 6f 75 6c 64 20 62 65 20 | 70 65 72 66 6f 72 6d 65 |ould be |performe|
|00000e10| 64 20 61 66 74 65 72 20 | 74 68 65 0d 0a 64 69 61 |d after |the..dia|
|00000e20| 67 6e 6f 73 69 73 20 69 | 73 20 63 6f 6e 66 69 72 |gnosis i|s confir|
|00000e30| 6d 65 64 2e 20 20 42 6f | 6e 65 2f 67 61 6c 6c 69 |med. Bo|ne/galli|
|00000e40| 75 6d 20 73 63 61 6e 6e | 69 6e 67 20 63 61 6e 20 |um scann|ing can |
|00000e50| 68 65 6c 70 20 74 6f 20 | 65 78 63 6c 75 64 65 20 |help to |exclude |
|00000e60| 61 63 74 69 76 65 0d 0a | 64 69 73 65 61 73 65 20 |active..|disease |
|00000e70| 69 6e 20 70 61 74 69 65 | 6e 74 73 20 77 69 74 68 |in patie|nts with|
|00000e80| 20 66 61 6c 73 65 20 70 | 6f 73 69 74 69 76 65 20 | false p|ositive |
|00000e90| 43 54 20 66 69 6e 64 69 | 6e 67 73 2e 0d 0a 0d 0a |CT findi|ngs.....|
|00000ea0| 50 6f 73 74 2d 43 6f 6d | 6d 65 6e 74 0d 0a 0d 0a |Post-Com|ment....|
|00000eb0| 20 20 20 20 20 43 68 72 | 6f 6e 69 63 20 6f 73 74 | Chr|onic ost|
|00000ec0| 65 6f 6d 79 65 6c 69 74 | 69 73 20 72 65 6d 61 69 |eomyelit|is remai|
|00000ed0| 6e 73 20 61 20 64 69 66 | 66 69 63 75 6c 74 20 70 |ns a dif|ficult p|
|00000ee0| 72 6f 62 6c 65 6d 2e 20 | 20 49 6e 20 74 68 65 20 |roblem. | In the |
|00000ef0| 65 61 72 6c 79 0d 0a 61 | 6e 74 69 62 69 6f 74 69 |early..a|ntibioti|
|00000f00| 63 20 65 72 61 20 61 74 | 74 65 6d 70 74 73 20 77 |c era at|tempts w|
|00000f10| 65 72 65 20 6d 61 64 65 | 20 74 6f 20 65 72 61 64 |ere made| to erad|
|00000f20| 69 63 61 74 65 20 6c 6f | 6e 67 2d 73 74 61 6e 64 |icate lo|ng-stand|
|00000f30| 69 6e 67 20 63 68 72 6f | 6e 69 63 0d 0a 6f 73 74 |ing chro|nic..ost|
|00000f40| 65 6f 6d 79 65 6c 69 74 | 69 73 20 77 69 74 68 20 |eomyelit|is with |
|00000f50| 70 72 6f 6c 6f 6e 67 65 | 64 20 63 6f 75 72 73 65 |prolonge|d course|
|00000f60| 73 20 6f 66 20 69 6e 74 | 72 61 76 65 6e 6f 75 73 |s of int|ravenous|
|00000f70| 20 61 6e 74 69 73 74 61 | 70 68 79 6c 6f 63 6f 63 | antista|phylococ|
|00000f80| 63 61 6c 0d 0a 61 6e 74 | 69 62 69 6f 74 69 63 73 |cal..ant|ibiotics|
|00000f90| 2e 20 20 53 75 63 63 65 | 73 73 65 73 20 77 65 72 |. Succe|sses wer|
|00000fa0| 65 20 6c 69 6d 69 74 65 | 64 2c 20 69 6e 20 6c 61 |e limite|d, in la|
|00000fb0| 72 67 65 20 70 61 72 74 | 20 62 65 63 61 75 73 65 |rge part| because|
|00000fc0| 20 6f 66 20 74 68 65 20 | 64 69 66 66 69 63 75 6c | of the |difficul|
|00000fd0| 74 79 0d 0a 61 6e 64 20 | 65 78 70 65 6e 73 65 20 |ty..and |expense |
|00000fe0| 6f 66 20 70 72 6f 76 69 | 64 69 6e 67 20 6d 6f 6e |of provi|ding mon|
|00000ff0| 74 68 73 20 6f 66 20 69 | 6e 74 72 61 76 65 6e 6f |ths of i|ntraveno|
|00001000| 75 73 20 61 6e 74 69 62 | 69 6f 74 69 63 20 74 68 |us antib|iotic th|
|00001010| 65 72 61 70 79 2e 20 20 | 4d 6f 72 65 0d 0a 72 65 |erapy. |More..re|
|00001020| 63 65 6e 74 6c 79 2c 20 | 63 6c 69 6e 69 63 69 61 |cently, |clinicia|
|00001030| 6e 73 20 68 61 76 65 20 | 61 64 6f 70 74 65 64 20 |ns have |adopted |
|00001040| 74 68 65 20 63 6f 6e 63 | 65 70 74 20 6f 66 20 22 |the conc|ept of "|
|00001050| 73 75 70 70 72 65 73 73 | 69 76 65 20 63 75 72 65 |suppress|ive cure|
|00001060| 22 20 61 6e 64 0d 0a 70 | 72 6f 76 69 64 65 64 20 |" and..p|rovided |
|00001070| 64 61 69 6c 79 20 64 6f | 73 65 73 20 6f 66 20 6f |daily do|ses of o|
|00001080| 72 61 6c 20 61 6e 74 69 | 62 69 6f 74 69 63 20 74 |ral anti|biotic t|
|00001090| 68 65 72 61 70 79 20 66 | 6f 72 20 6d 6f 6e 74 68 |herapy f|or month|
|000010a0| 73 20 6f 72 20 65 76 65 | 6e 20 79 65 61 72 73 2e |s or eve|n years.|
|000010b0| 0d 0a 52 65 73 75 6c 74 | 73 20 68 61 76 65 20 62 |..Result|s have b|
|000010c0| 65 65 6e 20 65 6e 63 6f | 75 72 61 67 69 6e 67 2c |een enco|uraging,|
|000010d0| 20 61 6e 64 20 73 6f 6d | 65 20 70 61 74 69 65 6e | and som|e patien|
|000010e0| 74 73 20 68 61 76 65 20 | 72 65 6d 61 69 6e 65 64 |ts have |remained|
|000010f0| 20 69 6e 66 65 63 74 69 | 6f 6e 20 66 72 65 65 0d | infecti|on free.|
|00001100| 0a 61 66 74 65 72 20 6d | 6f 6e 74 68 73 20 6f 66 |.after m|onths of|
|00001110| 20 61 6e 74 69 62 69 6f | 74 69 63 20 74 68 65 72 | antibio|tic ther|
|00001120| 61 70 79 2c 20 6f 72 20 | 68 61 76 65 20 72 65 6d |apy, or |have rem|
|00001130| 61 69 6e 65 64 20 73 79 | 6d 70 74 6f 6d 20 66 72 |ained sy|mptom fr|
|00001140| 65 65 20 77 69 74 68 0d | 0a 63 6f 6e 74 69 6e 75 |ee with.|.continu|
|00001150| 61 74 69 6f 6e 20 6f 66 | 20 73 75 70 70 72 65 73 |ation of| suppres|
|00001160| 73 69 76 65 20 74 68 65 | 72 61 70 79 2e 20 20 49 |sive the|rapy. I|
|00001170| 74 20 69 73 20 65 73 73 | 65 6e 74 69 61 6c 2c 20 |t is ess|ential, |
|00001180| 68 6f 77 65 76 65 72 2c | 20 77 68 61 74 65 76 65 |however,| whateve|
|00001190| 72 0d 0a 61 6e 74 69 62 | 69 6f 74 69 63 20 73 74 |r..antib|iotic st|
|000011a0| 72 61 74 65 67 79 20 69 | 73 20 65 6d 70 6c 6f 79 |rategy i|s employ|
|000011b0| 65 64 2c 20 74 68 61 74 | 20 61 6e 79 20 64 65 61 |ed, that| any dea|
|000011c0| 64 20 62 6f 6e 65 20 6f | 72 20 73 65 71 75 65 73 |d bone o|r seques|
|000011d0| 74 72 75 6d 20 62 65 20 | 72 65 6d 6f 76 65 64 2e |trum be |removed.|
|000011e0| 0d 0a 50 72 6f 70 65 72 | 20 72 65 6d 6f 64 65 6c |..Proper| remodel|
|000011f0| 69 6e 67 20 6f 66 20 62 | 6f 6e 65 20 63 61 6e 6e |ing of b|one cann|
|00001200| 6f 74 20 6f 63 63 75 72 | 20 75 6e 74 69 6c 20 73 |ot occur| until s|
|00001210| 75 63 68 20 61 72 65 61 | 73 20 61 72 65 20 64 65 |uch area|s are de|
|00001220| 62 72 69 64 65 64 2c 20 | 61 6e 64 20 64 65 61 64 |brided, |and dead|
|00001230| 0d 0a 62 6f 6e 65 20 73 | 65 72 76 65 73 20 61 73 |..bone s|erves as|
|00001240| 20 61 20 73 6f 75 72 63 | 65 20 6f 66 20 68 69 67 | a sourc|e of hig|
|00001250| 68 2d 6c 65 76 65 6c 20 | 62 61 63 74 65 72 69 61 |h-level |bacteria|
|00001260| 6c 20 63 6f 6e 74 61 6d | 69 6e 61 74 69 6f 6e 2e |l contam|ination.|
|00001270| 0d 0a 20 20 20 20 20 54 | 68 69 73 20 61 72 74 69 |.. T|his arti|
|00001280| 63 6c 65 20 65 6d 70 68 | 61 73 69 7a 65 73 20 74 |cle emph|asizes t|
|00001290| 68 65 20 64 69 66 66 69 | 63 75 6c 74 79 20 69 6e |he diffi|culty in|
|000012a0| 20 61 73 63 65 72 74 61 | 69 6e 69 6e 67 20 74 68 | ascerta|ining th|
|000012b0| 65 20 70 72 65 73 65 6e | 63 65 20 6f 66 20 61 0d |e presen|ce of a.|
|000012c0| 0a 73 65 71 75 65 73 74 | 72 75 6d 20 69 6e 20 63 |.sequest|rum in c|
|000012d0| 68 72 6f 6e 69 63 61 6c | 6c 79 20 69 6e 66 65 63 |hronical|ly infec|
|000012e0| 74 65 64 20 62 6f 6e 65 | 2e 20 20 4d 6f 73 74 20 |ted bone|. Most |
|000012f0| 63 6c 69 6e 69 63 69 61 | 6e 73 20 68 61 76 65 20 |clinicia|ns have |
|00001300| 6c 6f 6e 67 20 73 69 6e | 63 65 0d 0a 67 69 76 65 |long sin|ce..give|
|00001310| 6e 20 75 70 20 6f 6e 20 | 74 68 65 20 72 65 6c 69 |n up on |the reli|
|00001320| 61 62 69 6c 69 74 79 20 | 6f 66 20 70 6c 61 69 6e |ability |of plain|
|00001330| 20 78 2d 72 61 79 20 66 | 69 6e 64 69 6e 67 73 20 | x-ray f|indings |
|00001340| 69 6e 20 61 66 66 65 63 | 74 65 64 20 62 6f 6e 65 |in affec|ted bone|
|00001350| 2c 20 61 6e 64 20 74 68 | 69 73 0d 0a 72 65 70 6f |, and th|is..repo|
|00001360| 72 74 20 63 6f 6e 66 69 | 72 6d 73 20 74 68 61 74 |rt confi|rms that|
|00001370| 20 65 78 70 65 72 69 65 | 6e 63 65 2e 20 20 54 68 | experie|nce. Th|
|00001380| 72 65 65 20 6f 74 68 65 | 72 20 77 61 79 73 20 6f |ree othe|r ways o|
|00001390| 66 20 65 76 61 6c 75 61 | 74 69 6e 67 20 62 6f 6e |f evalua|ting bon|
|000013a0| 65 20 76 69 61 0d 0a 69 | 6d 61 67 69 6e 67 20 74 |e via..i|maging t|
|000013b0| 65 63 68 6e 6f 6c 6f 67 | 79 20 77 65 72 65 20 61 |echnolog|y were a|
|000013c0| 73 73 65 73 73 65 64 2d | 2d 67 61 6c 6c 69 75 6d |ssessed-|-gallium|
|000013d0| 20 73 63 61 6e 2c 20 62 | 6f 6e 65 20 73 63 61 6e | scan, b|one scan|
|000013e0| 2c 20 61 6e 64 20 43 54 | 20 73 63 61 6e 2e 20 20 |, and CT| scan. |
|000013f0| 54 68 65 0d 0a 62 6f 74 | 74 6f 6d 20 6c 69 6e 65 |The..bot|tom line|
|00001400| 3a 20 20 41 6c 6c 20 33 | 20 74 65 63 68 6e 6f 6c |: All 3| technol|
|00001410| 6f 67 69 65 73 20 73 68 | 6f 75 6c 64 20 62 65 20 |ogies sh|ould be |
|00001420| 75 73 65 64 20 74 6f 20 | 64 65 74 65 72 6d 69 6e |used to |determin|
|00001430| 65 20 74 68 65 20 70 72 | 65 73 65 6e 63 65 20 6f |e the pr|esence o|
|00001440| 72 0d 0a 61 62 73 65 6e | 63 65 20 6f 66 20 73 65 |r..absen|ce of se|
|00001450| 71 75 65 73 74 72 75 6d | 20 69 6e 20 63 68 72 6f |questrum| in chro|
|00001460| 6e 69 63 61 6c 6c 79 20 | 69 6e 66 65 63 74 65 64 |nically |infected|
|00001470| 20 62 6f 6e 65 2e 20 28 | 41 6c 61 73 2c 20 79 6f | bone. (|Alas, yo|
|00001480| 75 20 6e 65 65 64 20 61 | 6c 6c 20 33 2e 29 0d 0a |u need a|ll 3.)..|
|00001490| 45 76 65 6e 20 68 65 72 | 65 20 61 6e 20 6f 63 63 |Even her|e an occ|
|000014a0| 61 73 69 6f 6e 61 6c 20 | 66 61 6c 73 65 20 70 6f |asional |false po|
|000014b0| 73 69 74 69 76 65 20 72 | 65 73 75 6c 74 20 77 69 |sitive r|esult wi|
|000014c0| 6c 6c 20 62 65 20 72 65 | 70 6f 72 74 65 64 2c 20 |ll be re|ported, |
|000014d0| 62 75 74 20 74 68 65 0d | 0a 63 6f 6d 62 69 6e 61 |but the.|.combina|
|000014e0| 74 69 6f 6e 20 6f 66 20 | 74 65 73 74 73 20 73 68 |tion of |tests sh|
|000014f0| 6f 75 6c 64 20 67 72 65 | 61 74 6c 79 20 61 69 64 |ould gre|atly aid|
|00001500| 20 74 68 65 20 6d 61 6e | 61 67 65 6d 65 6e 74 20 | the man|agement |
|00001510| 6f 66 20 74 68 69 73 0d | 0a 64 69 66 66 69 63 75 |of this.|.difficu|
|00001520| 6c 74 2d 74 6f 2d 74 72 | 65 61 74 20 69 6e 66 65 |lt-to-tr|eat infe|
|00001530| 63 74 69 6f 6e 2e 2d 2d | 44 2e 45 2e 20 52 6f 67 |ction.--|D.E. Rog|
|00001540| 65 72 73 2c 20 4d 2e 44 | 2e 0d 0a 24 55 6e 69 71 |ers, M.D|...$Uniq|
|00001550| 75 65 5f 49 44 7b 59 52 | 42 31 31 30 30 31 7d 0d |ue_ID{YR|B11001}.|
|00001560| 0a 24 54 69 74 6c 65 7b | 42 72 6f 6e 63 68 6f 70 |.$Title{|Bronchop|
|00001570| 75 6c 6d 6f 6e 61 72 79 | 20 43 72 6f 73 73 2d 43 |ulmonary| Cross-C|
|00001580| 6f 6c 6f 6e 69 7a 61 74 | 69 6f 6e 20 61 6e 64 20 |olonizat|ion and |
|00001590| 49 6e 66 65 63 74 69 6f | 6e 20 52 65 6c 61 74 65 |Infectio|n Relate|
|000015a0| 64 20 74 6f 20 4d 79 63 | 6f 62 61 63 74 65 72 69 |d to Myc|obacteri|
|000015b0| 61 6c 20 43 6f 6e 74 61 | 6d 69 6e 61 74 69 6f 6e |al Conta|mination|
|000015c0| 20 6f 66 20 53 75 63 74 | 69 6f 6e 20 56 61 6c 76 | of Suct|ion Valv|
|000015d0| 65 73 20 6f 66 20 42 72 | 6f 6e 63 68 6f 73 63 6f |es of Br|onchosco|
|000015e0| 70 65 73 7d 0d 0a 24 41 | 75 74 68 6f 72 7b 57 68 |pes}..$A|uthor{Wh|
|000015f0| 65 65 6c 65 72 2c 20 50 | 57 0d 0a 4c 61 6e 63 61 |eeler, P|W..Lanca|
|00001600| 73 74 65 72 2c 20 44 0d | 0a 4b 61 69 73 65 72 2c |ster, D.|.Kaiser,|
|00001610| 20 41 42 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 | AB}..$A|ffiliati|
|00001620| 6f 6e 7b 53 74 20 54 68 | 6f 6d 61 73 20 48 6f 73 |on{St Th|omas Hos|
|00001630| 70 2c 20 4e 61 73 68 76 | 69 6c 6c 65 3b 20 56 61 |p, Nashv|ille; Va|
|00001640| 6e 64 65 72 62 69 6c 74 | 20 55 6e 69 76 7d 0d 0a |nderbilt| Univ}..|
|00001650| 24 4a 6f 75 72 6e 61 6c | 7b 4a 20 49 6e 66 65 63 |$Journal|{J Infec|
|00001660| 74 20 44 69 73 7d 0d 0a | 24 56 6f 6c 75 6d 65 7b |t Dis}..|$Volume{|
|00001670| 31 35 39 7d 0d 0a 24 50 | 61 67 65 7b 39 35 34 2d |159}..$P|age{954-|
|00001680| 39 35 38 7d 0d 0a 24 44 | 61 74 65 7b 4d 61 79 20 |958}..$D|ate{May |
|00001690| 31 39 38 39 7d 0d 0a 24 | 59 42 56 6f 6c 7b 31 39 |1989}..$|YBVol{19|
|000016a0| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|000016b0| 4d 65 64 69 63 69 6e 65 | 7d 0d 0a 24 43 68 61 70 |Medicine|}..$Chap|
|000016c0| 74 65 72 7b 33 2d 31 7d | 0d 0a 24 59 42 45 64 69 |ter{3-1}|..$YBEdi|
|000016d0| 74 6f 72 7b 44 72 73 2e | 20 52 6f 67 65 72 73 2c |tor{Drs.| Rogers,|
|000016e0| 20 44 65 73 20 50 72 65 | 7a 2c 20 43 6c 69 6e 65 | Des Pre|z, Cline|
|000016f0| 2c 20 42 72 61 75 6e 77 | 61 6c 64 2c 20 47 72 65 |, Braunw|ald, Gre|
|00001700| 65 6e 62 65 72 67 65 72 | 2c 20 57 69 6c 73 6f 6e |enberger|, Wilson|
|00001710| 2c 20 45 70 73 74 65 69 | 6e 2c 20 61 6e 64 20 4d |, Epstei|n, and M|
|00001720| 61 6c 61 77 69 73 74 61 | 7d 0d 0a 24 54 61 62 6c |alawista|}..$Tabl|
|00001730| 65 7b 54 61 62 6c 65 20 | 4f 6d 69 74 74 65 64 7d |e{Table |Omitted}|
|00001740| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 44 |..$Comme|ntator{D|
|00001750| 2e 45 2e 20 52 6f 67 65 | 72 73 2c 20 4d 2e 44 2e |.E. Roge|rs, M.D.|
|00001760| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00001770| 63 29 20 59 65 61 72 62 | 6f 6f 6b 20 4d 65 64 69 |c) Yearb|ook Medi|
|00001780| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00001790| 49 6e 63 2e 2c 20 31 39 | 39 30 0d 0a 0d 0a 31 39 |Inc., 19|90....19|
|000017a0| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|000017b0| 4d 65 64 69 63 69 6e 65 | 20 28 52 29 0d 0a 0d 0a |Medicine| (R)....|
|000017c0| 50 61 72 74 20 4f 6e 65 | 2d 2d 49 6e 66 65 63 74 |Part One|--Infect|
|000017d0| 69 6f 75 73 20 44 69 73 | 65 61 73 65 73 0d 0a 0d |ious Dis|eases...|
|000017e0| 0a 43 68 61 70 74 65 72 | 20 33 2d 2d 4e 6f 73 6f |.Chapter| 3--Noso|
|000017f0| 63 6f 6d 69 61 6c 20 49 | 6e 66 65 63 74 69 6f 6e |comial I|nfection|
|00001800| 73 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |s....---|--------|
|00001810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001850| 2d 2d 2d 0d 0a 42 72 6f | 6e 63 68 6f 70 75 6c 6d |---..Bro|nchopulm|
|00001860| 6f 6e 61 72 79 20 43 72 | 6f 73 73 2d 43 6f 6c 6f |onary Cr|oss-Colo|
|00001870| 6e 69 7a 61 74 69 6f 6e | 20 61 6e 64 20 49 6e 66 |nization| and Inf|
|00001880| 65 63 74 69 6f 6e 20 52 | 65 6c 61 74 65 64 20 74 |ection R|elated t|
|00001890| 6f 20 4d 79 63 6f 62 61 | 63 74 65 72 69 61 6c 0d |o Mycoba|cterial.|
|000018a0| 0a 43 6f 6e 74 61 6d 69 | 6e 61 74 69 6f 6e 20 6f |.Contami|nation o|
|000018b0| 66 20 53 75 63 74 69 6f | 6e 20 56 61 6c 76 65 73 |f Suctio|n Valves|
|000018c0| 20 6f 66 20 42 72 6f 6e | 63 68 6f 73 63 6f 70 65 | of Bron|choscope|
|000018d0| 73 0d 0a 0d 0a 57 68 65 | 65 6c 65 72 20 50 57 3b |s....Whe|eler PW;|
|000018e0| 20 4c 61 6e 63 61 73 74 | 65 72 20 44 3b 20 4b 61 | Lancast|er D; Ka|
|000018f0| 69 73 65 72 20 41 42 0d | 0a 28 53 74 20 54 68 6f |iser AB.|.(St Tho|
|00001900| 6d 61 73 20 48 6f 73 70 | 2c 20 4e 61 73 68 76 69 |mas Hosp|, Nashvi|
|00001910| 6c 6c 65 3b 20 56 61 6e | 64 65 72 62 69 6c 74 20 |lle; Van|derbilt |
|00001920| 55 6e 69 76 29 0d 0a 4a | 20 49 6e 66 65 63 74 20 |Univ)..J| Infect |
|00001930| 44 69 73 20 31 35 39 3a | 39 35 34 2d 39 35 38 2c |Dis 159:|954-958,|
|00001940| 20 4d 61 79 20 31 39 38 | 39 0d 0a 2d 2d 2d 2d 2d | May 198|9..-----|
|00001950| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001960| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 0d 0a 41 62 73 |--------|-....Abs|
|000019a0| 74 72 61 63 74 0d 0a 0d | 0a 20 20 20 20 20 41 6c |tract...|. Al|
|000019b0| 74 68 6f 75 67 68 20 67 | 6c 75 74 61 72 61 6c 64 |though g|lutarald|
|000019c0| 65 68 79 64 65 20 73 65 | 65 6d 73 20 74 6f 20 62 |ehyde se|ems to b|
|000019d0| 65 20 61 6e 20 65 66 66 | 65 63 74 69 76 65 20 62 |e an eff|ective b|
|000019e0| 61 63 74 65 72 69 63 69 | 64 61 6c 20 61 6e 64 0d |acterici|dal and.|
|000019f0| 0a 6d 79 63 6f 62 61 63 | 74 65 72 69 63 69 64 61 |.mycobac|tericida|
|00001a00| 6c 20 61 67 65 6e 74 20 | 69 6e 20 62 72 6f 6e 63 |l agent |in bronc|
|00001a10| 68 6f 73 63 6f 70 79 2c | 20 64 69 72 65 63 74 20 |hoscopy,| direct |
|00001a20| 65 78 70 6f 73 75 72 65 | 20 6f 66 20 6f 72 67 61 |exposure| of orga|
|00001a30| 6e 69 73 6d 73 20 66 6f | 72 20 61 6e 0d 0a 61 64 |nisms fo|r an..ad|
|00001a40| 65 71 75 61 74 65 20 70 | 65 72 69 6f 64 20 69 73 |equate p|eriod is|
|00001a50| 20 63 72 69 74 69 63 61 | 6c 2e 20 20 4d 79 63 6f | critica|l. Myco|
|00001a60| 62 61 63 74 65 72 69 61 | 6c 20 63 6f 6e 74 61 6d |bacteria|l contam|
|00001a70| 69 6e 61 74 69 6f 6e 20 | 6f 66 20 62 72 6f 6e 63 |ination |of bronc|
|00001a80| 68 6f 73 63 6f 70 79 0d | 0a 73 70 65 63 69 6d 65 |hoscopy.|.specime|
|00001a90| 6e 73 20 69 6e 20 32 20 | 69 6e 73 74 61 6e 63 65 |ns in 2 |instance|
|00001aa0| 73 20 61 6e 64 20 70 75 | 6c 6d 6f 6e 61 72 79 20 |s and pu|lmonary |
|00001ab0| 69 6e 66 65 63 74 69 6f | 6e 20 69 6e 20 31 20 77 |infectio|n in 1 w|
|00001ac0| 65 72 65 20 72 65 6c 61 | 74 65 64 20 74 6f 0d 0a |ere rela|ted to..|
|00001ad0| 69 6e 61 64 65 71 75 61 | 74 65 20 64 69 73 69 6e |inadequa|te disin|
|00001ae0| 66 65 63 74 69 6f 6e 20 | 6f 66 20 74 68 65 20 62 |fection |of the b|
|00001af0| 72 6f 6e 63 68 6f 73 63 | 6f 70 65 20 73 75 63 74 |ronchosc|ope suct|
|00001b00| 69 6f 6e 20 76 61 6c 76 | 65 2e 20 20 50 72 65 70 |ion valv|e. Prep|
|00001b10| 61 72 61 74 69 6f 6e 20 | 6f 66 20 74 68 65 0d 0a |aration |of the..|
|00001b20| 69 6e 73 74 72 75 6d 65 | 6e 74 73 20 69 6e 63 6c |instrume|nts incl|
|00001b30| 75 64 65 64 20 63 6c 65 | 61 6e 69 6e 67 20 77 69 |uded cle|aning wi|
|00001b40| 74 68 20 62 6f 74 68 20 | 70 6f 76 69 64 6f 6e 65 |th both |povidone|
|00001b50| 2d 69 6f 64 69 6e 65 20 | 61 6e 64 20 32 25 20 67 |-iodine |and 2% g|
|00001b60| 6c 75 74 61 72 61 6c 64 | 65 68 79 64 65 0d 0a 73 |lutarald|ehyde..s|
|00001b70| 6f 6c 75 74 69 6f 6e 2c | 20 74 68 65 20 6c 61 74 |olution,| the lat|
|00001b80| 74 65 72 20 62 65 69 6e | 67 20 66 6f 72 63 65 64 |ter bein|g forced|
|00001b90| 20 72 65 70 65 61 74 65 | 64 6c 79 20 74 68 72 6f | repeate|dly thro|
|00001ba0| 75 67 68 20 74 68 65 20 | 76 61 6c 76 65 2e 0d 0a |ugh the |valve...|
|00001bb0| 20 20 20 20 20 4d 79 63 | 6f 62 61 63 74 65 72 69 | Myc|obacteri|
|00001bc0| 75 6d 20 61 76 69 75 6d | 20 77 61 73 20 69 73 6f |um avium| was iso|
|00001bd0| 6c 61 74 65 64 20 66 72 | 6f 6d 20 62 72 6f 6e 63 |lated fr|om bronc|
|00001be0| 68 69 61 6c 20 77 61 73 | 68 69 6e 67 73 20 6f 66 |hial was|hings of|
|00001bf0| 20 32 20 70 61 74 69 65 | 6e 74 73 20 6f 6e 0d 0a | 2 patie|nts on..|
|00001c00| 74 68 65 20 73 61 6d 65 | 20 64 61 79 2e 20 20 53 |the same| day. S|
|00001c10| 65 76 65 72 61 6c 20 77 | 65 65 6b 73 20 6c 61 74 |everal w|eeks lat|
|00001c20| 65 72 2c 20 34 20 70 61 | 74 69 65 6e 74 73 20 68 |er, 4 pa|tients h|
|00001c30| 61 64 20 4d 79 63 6f 62 | 61 63 74 65 72 69 75 6d |ad Mycob|acterium|
|00001c40| 20 74 75 62 65 72 63 75 | 6c 6f 73 69 73 0d 0a 63 | tubercu|losis..c|
|00001c50| 75 6c 74 75 72 65 64 20 | 66 72 6f 6d 20 62 72 6f |ultured |from bro|
|00001c60| 6e 63 68 69 61 6c 20 77 | 61 73 68 69 6e 67 73 20 |nchial w|ashings |
|00001c70| 61 6e 64 20 31 20 6f 66 | 20 74 68 65 6d 20 62 65 |and 1 of| them be|
|00001c80| 63 61 6d 65 20 69 6e 66 | 65 63 74 65 64 2e 20 20 |came inf|ected. |
|00001c90| 44 65 73 70 69 74 65 0d | 0a 61 64 6f 70 74 69 6f |Despite.|.adoptio|
|00001ca0| 6e 20 6f 66 20 61 20 63 | 6f 6d 6d 65 72 63 69 61 |n of a c|ommercia|
|00001cb0| 6c 20 65 6e 64 6f 73 63 | 6f 70 65 20 77 61 73 68 |l endosc|ope wash|
|00001cc0| 65 72 2c 20 61 20 74 68 | 69 72 64 20 65 70 69 73 |er, a th|ird epis|
|00001cd0| 6f 64 65 20 6f 66 0d 0a | 63 72 6f 73 73 2d 63 6f |ode of..|cross-co|
|00001ce0| 6e 74 61 6d 69 6e 61 74 | 69 6f 6e 20 65 6e 73 75 |ntaminat|ion ensu|
|00001cf0| 65 64 2e 20 20 54 68 65 | 20 73 75 63 74 69 6f 6e |ed. The| suction|
|00001d00| 20 76 61 6c 76 65 20 6f | 6e 20 74 68 65 20 70 72 | valve o|n the pr|
|00001d10| 6f 78 69 6d 61 6c 20 65 | 6e 64 20 6f 66 20 74 68 |oximal e|nd of th|
|00001d20| 65 0d 0a 73 63 6f 70 65 | 20 28 46 69 67 20 33 2d |e..scope| (Fig 3-|
|00001d30| 31 29 20 73 65 65 6d 65 | 64 20 61 20 6c 69 6b 65 |1) seeme|d a like|
|00001d40| 6c 79 20 73 6f 75 72 63 | 65 20 6f 66 20 63 6f 6e |ly sourc|e of con|
|00001d50| 74 61 6d 69 6e 61 74 69 | 6f 6e 2e 20 20 54 68 65 |taminati|on. The|
|00001d60| 20 76 61 6c 76 65 73 20 | 6f 66 20 69 6e 74 61 63 | valves |of intac|
|00001d70| 74 0d 0a 62 72 6f 6e 63 | 68 6f 73 63 6f 70 65 73 |t..bronc|hoscopes|
|00001d80| 20 77 65 72 65 20 70 72 | 65 66 65 72 65 6e 74 69 | were pr|eferenti|
|00001d90| 61 6c 6c 79 20 63 6f 6e | 74 61 6d 69 6e 61 74 65 |ally con|taminate|
|00001da0| 64 20 62 79 20 4d 79 63 | 6f 62 61 63 74 65 72 69 |d by Myc|obacteri|
|00001db0| 75 6d 20 66 6f 72 74 75 | 69 74 75 6d 2c 0d 0a 61 |um fortu|itum,..a|
|00001dc0| 6e 64 20 69 73 6f 6c 61 | 74 65 64 20 76 61 6c 76 |nd isola|ted valv|
|00001dd0| 65 73 20 72 65 6d 61 69 | 6e 65 64 20 63 6f 6e 74 |es remai|ned cont|
|00001de0| 61 6d 69 6e 61 74 65 64 | 20 64 65 73 70 69 74 65 |aminated| despite|
|00001df0| 20 61 20 33 30 2d 6d 69 | 6e 75 74 65 20 65 78 70 | a 30-mi|nute exp|
|00001e00| 6f 73 75 72 65 20 74 6f | 20 32 25 0d 0a 67 6c 75 |osure to| 2%..glu|
|00001e10| 74 61 72 61 6c 64 65 68 | 79 64 65 20 73 6f 6c 75 |taraldeh|yde solu|
|00001e20| 74 69 6f 6e 2e 20 20 4d | 6f 73 74 20 6f 66 20 74 |tion. M|ost of t|
|00001e30| 68 65 20 31 34 20 68 6f | 73 70 69 74 61 6c 73 20 |he 14 ho|spitals |
|00001e40| 73 75 72 76 65 79 65 64 | 20 64 69 64 20 6e 6f 74 |surveyed| did not|
|00001e50| 20 75 73 65 20 61 20 6d | 6f 72 65 0d 0a 69 6e 74 | use a m|ore..int|
|00001e60| 65 6e 73 69 76 65 20 64 | 69 73 69 6e 66 65 63 74 |ensive d|isinfect|
|00001e70| 69 6f 6e 20 72 65 67 69 | 6d 65 6e 20 74 68 61 6e |ion regi|men than|
|00001e80| 20 77 61 73 20 69 6e 20 | 75 73 65 20 61 74 20 74 | was in |use at t|
|00001e90| 68 65 20 70 72 65 73 65 | 6e 74 20 68 6f 73 70 69 |he prese|nt hospi|
|00001ea0| 74 61 6c 2e 0d 0a 20 20 | 20 20 20 42 65 63 61 75 |tal... | Becau|
|00001eb0| 73 65 20 6f 66 20 74 68 | 65 20 74 69 6d 65 20 6e |se of th|e time n|
|00001ec0| 65 65 64 65 64 20 74 6f | 20 69 73 6f 6c 61 74 65 |eeded to| isolate|
|00001ed0| 20 6d 79 63 6f 62 61 63 | 74 65 72 69 61 6c 20 6f | mycobac|terial o|
|00001ee0| 72 67 61 6e 69 73 6d 73 | 20 74 68 65 72 65 20 69 |rganisms| there i|
|00001ef0| 73 20 61 0d 0a 63 6f 6e | 73 69 64 65 72 61 62 6c |s a..con|siderabl|
|00001f00| 65 20 63 68 61 6e 63 65 | 20 6f 66 20 6f 76 65 72 |e chance| of over|
|00001f10| 6c 6f 6f 6b 69 6e 67 20 | 6f 75 74 62 72 65 61 6b |looking |outbreak|
|00001f20| 73 20 6f 66 20 63 72 6f | 73 73 2d 63 6f 6e 74 61 |s of cro|ss-conta|
|00001f30| 6d 69 6e 61 74 69 6f 6e | 20 6f 72 20 65 76 65 6e |mination| or even|
|00001f40| 0d 0a 69 6e 66 65 63 74 | 69 6f 6e 2e 20 20 41 74 |..infect|ion. At|
|00001f50| 20 70 72 65 73 65 6e 74 | 2c 20 76 61 6c 76 65 73 | present|, valves|
|00001f60| 20 61 72 65 20 73 74 65 | 61 6d 2d 61 75 74 6f 63 | are ste|am-autoc|
|00001f70| 6c 61 76 65 64 20 61 66 | 74 65 72 20 63 6c 65 61 |laved af|ter clea|
|00001f80| 6e 69 6e 67 2c 20 61 6e | 64 0d 0a 64 69 73 69 6e |ning, an|d..disin|
|00001f90| 66 65 63 74 69 6f 6e 20 | 77 69 74 68 20 67 6c 75 |fection |with glu|
|00001fa0| 74 61 72 61 6c 64 65 68 | 79 64 65 20 63 6f 6e 74 |taraldeh|yde cont|
|00001fb0| 69 6e 75 65 73 20 66 6f | 72 20 61 74 20 6c 65 61 |inues fo|r at lea|
|00001fc0| 73 74 20 33 30 20 6d 69 | 6e 75 74 65 73 20 61 74 |st 30 mi|nutes at|
|00001fd0| 20 72 6f 6f 6d 0d 0a 74 | 65 6d 70 65 72 61 74 75 | room..t|emperatu|
|00001fe0| 72 65 2e 20 20 4e 6f 20 | 66 75 72 74 68 65 72 20 |re. No |further |
|00001ff0| 65 70 69 73 6f 64 65 73 | 20 68 61 76 65 20 6f 63 |episodes| have oc|
|00002000| 63 75 72 72 65 64 20 69 | 6e 20 74 68 65 20 70 61 |curred i|n the pa|
|00002010| 73 74 20 32 20 79 65 61 | 72 73 2c 20 61 6e 64 20 |st 2 yea|rs, and |
|00002020| 74 68 65 0d 0a 73 75 63 | 74 69 6f 6e 20 76 61 6c |the..suc|tion val|
|00002030| 76 65 73 20 68 61 76 65 | 20 63 6f 6e 74 69 6e 75 |ves have| continu|
|00002040| 65 64 20 74 6f 20 66 75 | 6e 63 74 69 6f 6e 20 77 |ed to fu|nction w|
|00002050| 65 6c 6c 2e 0d 0a 0d 0a | 50 6f 73 74 2d 43 6f 6d |ell.....|Post-Com|
|00002060| 6d 65 6e 74 0d 0a 0d 0a | 20 20 20 20 20 57 6f 77 |ment....| Wow|
|00002070| 21 20 20 54 68 69 73 20 | 77 61 73 20 61 6e 64 20 |! This |was and |
|00002080| 69 73 20 6d 6f 73 74 20 | 77 6f 72 72 69 73 6f 6d |is most |worrisom|
|00002090| 65 2e 20 20 46 75 72 74 | 68 65 72 2c 20 69 74 20 |e. Furt|her, it |
|000020a0| 61 70 70 65 61 72 73 20 | 64 65 66 69 6e 69 74 65 |appears |definite|
|000020b0| 20 74 68 61 74 0d 0a 31 | 20 70 61 74 69 65 6e 74 | that..1| patient|
|000020c0| 20 77 68 6f 20 68 61 64 | 20 75 6e 64 65 72 67 6f | who had| undergo|
|000020d0| 6e 65 20 6c 75 6e 67 20 | 62 69 6f 70 73 79 20 61 |ne lung |biopsy a|
|000020e0| 6e 64 20 77 61 73 20 72 | 65 63 65 69 76 69 6e 67 |nd was r|eceiving|
|000020f0| 20 70 72 65 64 6e 69 73 | 6f 6e 65 20 66 6f 72 20 | prednis|one for |
|00002100| 77 68 61 74 0d 0a 61 70 | 70 65 61 72 65 64 20 74 |what..ap|peared t|
|00002110| 6f 20 62 65 20 63 6c 65 | 61 72 2d 63 75 74 20 70 |o be cle|ar-cut p|
|00002120| 75 6c 6d 6f 6e 61 72 79 | 20 73 61 72 63 6f 69 64 |ulmonary| sarcoid|
|00002130| 20 77 61 73 20 61 63 74 | 75 61 6c 6c 79 20 69 6e | was act|ually in|
|00002140| 66 65 63 74 65 64 20 77 | 69 74 68 20 4d 2e 0d 0a |fected w|ith M...|
|00002150| 74 75 62 65 72 63 75 6c | 6f 73 69 73 20 76 69 61 |tubercul|osis via|
|00002160| 20 74 68 65 20 63 6f 6e | 74 61 6d 69 6e 61 74 65 | the con|taminate|
|00002170| 64 20 62 72 6f 6e 63 68 | 6f 73 63 6f 70 65 2e 0d |d bronch|oscope..|
|00002180| 0a 20 20 20 20 20 54 68 | 65 20 66 6c 65 78 69 62 |. Th|e flexib|
|00002190| 6c 65 20 66 69 62 65 72 | 6f 70 74 69 63 20 62 72 |le fiber|optic br|
|000021a0| 6f 6e 63 68 6f 73 63 6f | 70 65 20 68 61 73 20 63 |onchosco|pe has c|
|000021b0| 6c 65 61 72 6c 79 20 62 | 65 65 6e 20 61 20 6d 61 |learly b|een a ma|
|000021c0| 6a 6f 72 20 61 64 76 61 | 6e 63 65 2c 0d 0a 70 65 |jor adva|nce,..pe|
|000021d0| 72 6d 69 74 74 69 6e 67 | 20 62 65 74 74 65 72 20 |rmitting| better |
|000021e0| 64 69 61 67 6e 6f 73 69 | 73 20 61 6e 64 20 74 72 |diagnosi|s and tr|
|000021f0| 65 61 74 6d 65 6e 74 20 | 6f 66 20 70 75 6c 6d 6f |eatment |of pulmo|
|00002200| 6e 61 72 79 20 70 72 6f | 62 6c 65 6d 73 2e 20 20 |nary pro|blems. |
|00002210| 42 75 74 2c 20 61 73 20 | 77 69 74 68 0d 0a 73 6f |But, as |with..so|
|00002220| 20 6d 61 6e 79 20 61 64 | 76 61 6e 63 65 73 2c 20 | many ad|vances, |
|00002230| 69 74 20 63 61 72 72 69 | 65 73 20 77 69 74 68 20 |it carri|es with |
|00002240| 69 74 20 70 6f 74 65 6e | 74 69 61 6c 20 68 61 7a |it poten|tial haz|
|00002250| 61 72 64 73 2e 20 20 49 | 20 68 6f 70 65 20 74 68 |ards. I| hope th|
|00002260| 65 0d 0a 6d 61 6e 75 66 | 61 63 74 75 72 65 72 73 |e..manuf|acturers|
|00002270| 20 61 72 65 20 77 69 64 | 65 6c 79 20 70 75 62 6c | are wid|ely publ|
|00002280| 69 63 69 7a 69 6e 67 20 | 74 68 69 73 20 63 6f 6e |icizing |this con|
|00002290| 74 61 6d 69 6e 61 74 69 | 6f 6e 20 70 72 6f 62 6c |taminati|on probl|
|000022a0| 65 6d 20 61 6e 64 20 74 | 68 65 20 6e 65 65 64 0d |em and t|he need.|
|000022b0| 0a 74 6f 20 73 74 65 61 | 6d 20 73 74 65 72 69 6c |.to stea|m steril|
|000022c0| 69 7a 65 20 74 68 65 20 | 73 75 63 74 69 6f 6e 20 |ize the |suction |
|000022d0| 67 61 64 67 65 74 2e 2d | 2d 44 2e 45 2e 20 52 6f |gadget.-|-D.E. Ro|
|000022e0| 67 65 72 73 2c 20 4d 2e | 44 2e 0d 0a 24 55 6e 69 |gers, M.|D...$Uni|
|000022f0| 71 75 65 5f 49 44 7b 59 | 52 42 31 31 30 30 32 7d |que_ID{Y|RB11002}|
|00002300| 0d 0a 24 54 69 74 6c 65 | 7b 41 6e 61 6c 79 73 69 |..$Title|{Analysi|
|00002310| 73 20 6f 66 20 41 6d 69 | 6b 61 63 69 6e 2d 52 65 |s of Ami|kacin-Re|
|00002320| 73 69 73 74 61 6e 74 20 | 50 73 65 75 64 6f 6d 6f |sistant |Pseudomo|
|00002330| 6e 61 73 20 61 65 72 75 | 67 69 6e 6f 73 61 20 44 |nas aeru|ginosa D|
|00002340| 65 76 65 6c 6f 70 69 6e | 67 20 69 6e 20 50 61 74 |evelopin|g in Pat|
|00002350| 69 65 6e 74 73 20 52 65 | 63 65 69 76 69 6e 67 20 |ients Re|ceiving |
|00002360| 41 6d 69 6b 61 63 69 6e | 7d 0d 0a 24 41 75 74 68 |Amikacin|}..$Auth|
|00002370| 6f 72 7b 4d 61 6c 6f 6e | 65 79 2c 20 4a 0d 0a 52 |or{Malon|ey, J..R|
|00002380| 69 6d 6c 61 6e 64 2c 20 | 44 0d 0a 53 74 65 70 68 |imland, |D..Steph|
|00002390| 65 6e 73 2c 20 44 53 0d | 0a 54 65 72 72 79 2c 20 |ens, DS.|.Terry, |
|000023a0| 50 0d 0a 57 68 69 74 6e | 65 79 2c 20 41 4d 7d 0d |P..Whitn|ey, AM}.|
|000023b0| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 45 6d |.$Affili|ation{Em|
|000023c0| 6f 72 79 20 55 6e 69 76 | 7d 0d 0a 24 4a 6f 75 72 |ory Univ|}..$Jour|
|000023d0| 6e 61 6c 7b 41 72 63 68 | 20 49 6e 74 65 72 6e 20 |nal{Arch| Intern |
|000023e0| 4d 65 64 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 31 34 |Med}..$V|olume{14|
|000023f0| 39 7d 0d 0a 24 50 61 67 | 65 7b 36 33 30 2d 36 33 |9}..$Pag|e{630-63|
|00002400| 34 7d 0d 0a 24 44 61 74 | 65 7b 4d 61 72 63 68 20 |4}..$Dat|e{March |
|00002410| 31 39 38 39 7d 0d 0a 24 | 59 42 56 6f 6c 7b 31 39 |1989}..$|YBVol{19|
|00002420| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|00002430| 4d 65 64 69 63 69 6e 65 | 7d 0d 0a 24 43 68 61 70 |Medicine|}..$Chap|
|00002440| 74 65 72 7b 33 2d 32 7d | 0d 0a 24 59 42 45 64 69 |ter{3-2}|..$YBEdi|
|00002450| 74 6f 72 7b 44 72 73 2e | 20 52 6f 67 65 72 73 2c |tor{Drs.| Rogers,|
|00002460| 20 44 65 73 20 50 72 65 | 7a 2c 20 43 6c 69 6e 65 | Des Pre|z, Cline|
|00002470| 2c 20 42 72 61 75 6e 77 | 61 6c 64 2c 20 47 72 65 |, Braunw|ald, Gre|
|00002480| 65 6e 62 65 72 67 65 72 | 2c 20 57 69 6c 73 6f 6e |enberger|, Wilson|
|00002490| 2c 20 45 70 73 74 65 69 | 6e 2c 20 61 6e 64 20 4d |, Epstei|n, and M|
|000024a0| 61 6c 61 77 69 73 74 61 | 7d 0d 0a 24 54 61 62 6c |alawista|}..$Tabl|
|000024b0| 65 7b 54 61 62 6c 65 20 | 4f 6d 69 74 74 65 64 7d |e{Table |Omitted}|
|000024c0| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 44 |..$Comme|ntator{D|
|000024d0| 2e 45 2e 20 52 6f 67 65 | 72 73 2c 20 4d 2e 44 2e |.E. Roge|rs, M.D.|
|000024e0| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|000024f0| 63 29 20 59 65 61 72 62 | 6f 6f 6b 20 4d 65 64 69 |c) Yearb|ook Medi|
|00002500| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00002510| 49 6e 63 2e 2c 20 31 39 | 39 30 0d 0a 0d 0a 31 39 |Inc., 19|90....19|
|00002520| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|00002530| 4d 65 64 69 63 69 6e 65 | 20 28 52 29 0d 0a 0d 0a |Medicine| (R)....|
|00002540| 50 61 72 74 20 4f 6e 65 | 2d 2d 49 6e 66 65 63 74 |Part One|--Infect|
|00002550| 69 6f 75 73 20 44 69 73 | 65 61 73 65 73 0d 0a 0d |ious Dis|eases...|
|00002560| 0a 43 68 61 70 74 65 72 | 20 33 2d 2d 4e 6f 73 6f |.Chapter| 3--Noso|
|00002570| 63 6f 6d 69 61 6c 20 49 | 6e 66 65 63 74 69 6f 6e |comial I|nfection|
|00002580| 73 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |s....---|--------|
|00002590| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000025a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000025b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000025c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000025d0| 2d 2d 2d 0d 0a 41 6e 61 | 6c 79 73 69 73 20 6f 66 |---..Ana|lysis of|
|000025e0| 20 41 6d 69 6b 61 63 69 | 6e 2d 52 65 73 69 73 74 | Amikaci|n-Resist|
|000025f0| 61 6e 74 20 50 73 65 75 | 64 6f 6d 6f 6e 61 73 20 |ant Pseu|domonas |
|00002600| 61 65 72 75 67 69 6e 6f | 73 61 20 44 65 76 65 6c |aerugino|sa Devel|
|00002610| 6f 70 69 6e 67 20 69 6e | 20 50 61 74 69 65 6e 74 |oping in| Patient|
|00002620| 73 0d 0a 52 65 63 65 69 | 76 69 6e 67 20 41 6d 69 |s..Recei|ving Ami|
|00002630| 6b 61 63 69 6e 0d 0a 0d | 0a 4d 61 6c 6f 6e 65 79 |kacin...|.Maloney|
|00002640| 20 4a 3b 20 52 69 6d 6c | 61 6e 64 20 44 3b 20 53 | J; Riml|and D; S|
|00002650| 74 65 70 68 65 6e 73 20 | 44 53 3b 20 54 65 72 72 |tephens |DS; Terr|
|00002660| 79 20 50 3b 20 57 68 69 | 74 6e 65 79 20 41 4d 0d |y P; Whi|tney AM.|
|00002670| 0a 28 45 6d 6f 72 79 20 | 55 6e 69 76 29 0d 0a 41 |.(Emory |Univ)..A|
|00002680| 72 63 68 20 49 6e 74 65 | 72 6e 20 4d 65 64 20 31 |rch Inte|rn Med 1|
|00002690| 34 39 3a 36 33 30 2d 36 | 33 34 2c 20 4d 61 72 63 |49:630-6|34, Marc|
|000026a0| 68 20 31 39 38 39 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |h 1989..|--------|
|000026b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000026c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000026d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000026e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000026f0| 2d 2d 2d 2d 2d 2d 0d 0a | 0d 0a 41 62 73 74 72 61 |------..|..Abstra|
|00002700| 63 74 0d 0a 0d 0a 20 20 | 20 20 20 54 68 65 20 65 |ct.... | The e|
|00002710| 6d 65 72 67 65 6e 63 65 | 20 6f 66 20 50 73 65 75 |mergence| of Pseu|
|00002720| 64 6f 6d 6f 6e 61 73 20 | 61 65 72 75 67 69 6e 6f |domonas |aerugino|
|00002730| 73 61 20 72 65 73 69 73 | 74 61 6e 74 20 74 6f 20 |sa resis|tant to |
|00002740| 61 6d 69 6e 6f 67 6c 79 | 63 6f 73 69 64 65 73 20 |aminogly|cosides |
|00002750| 6d 61 79 0d 0a 72 65 73 | 75 6c 74 20 66 72 6f 6d |may..res|ult from|
|00002760| 20 65 6e 7a 79 6d 61 74 | 69 63 20 69 6e 61 63 74 | enzymat|ic inact|
|00002770| 69 76 61 74 69 6f 6e 20 | 6f 66 20 61 6d 69 6e 6f |ivation |of amino|
|00002780| 67 6c 79 63 6f 73 69 64 | 65 73 20 6f 72 20 66 72 |glycosid|es or fr|
|00002790| 6f 6d 20 64 65 63 72 65 | 61 73 65 64 0d 0a 70 65 |om decre|ased..pe|
|000027a0| 72 6d 65 61 62 69 6c 69 | 74 79 20 6f 66 20 74 68 |rmeabili|ty of th|
|000027b0| 65 20 6f 72 67 61 6e 69 | 73 6d 20 74 6f 20 61 6d |e organi|sm to am|
|000027c0| 69 6e 6f 67 6c 79 63 6f | 73 69 64 65 73 20 70 61 |inoglyco|sides pa|
|000027d0| 72 74 6c 79 20 62 65 63 | 61 75 73 65 20 6f 66 20 |rtly bec|ause of |
|000027e0| 61 6c 74 65 72 61 74 69 | 6f 6e 73 0d 0a 69 6e 20 |alterati|ons..in |
|000027f0| 50 2e 20 61 65 72 75 67 | 69 6e 6f 73 61 20 6f 75 |P. aerug|inosa ou|
|00002800| 74 65 72 20 6d 65 6d 62 | 72 61 6e 65 20 70 72 6f |ter memb|rane pro|
|00002810| 74 65 69 6e 73 20 28 4f | 4d 50 73 29 20 6f 72 20 |teins (O|MPs) or |
|00002820| 6c 69 70 6f 70 6f 6c 79 | 73 61 63 63 68 61 72 69 |lipopoly|sacchari|
|00002830| 64 65 20 28 4c 50 53 29 | 0d 0a 22 4f 22 2d 73 70 |de (LPS)|.."O"-sp|
|00002840| 65 63 69 66 69 63 20 73 | 69 64 65 20 63 68 61 69 |ecific s|ide chai|
|00002850| 6e 73 2e 20 20 44 75 72 | 69 6e 67 20 61 20 33 36 |ns. Dur|ing a 36|
|00002860| 2d 6d 6f 6e 74 68 20 70 | 65 72 69 6f 64 2c 20 32 |-month p|eriod, 2|
|00002870| 38 20 70 61 74 69 65 6e | 74 73 20 74 72 65 61 74 |8 patien|ts treat|
|00002880| 65 64 20 66 6f 72 0d 0a | 69 6e 66 65 63 74 69 6f |ed for..|infectio|
|00002890| 6e 73 20 63 61 75 73 65 | 64 20 62 79 20 61 6d 69 |ns cause|d by ami|
|000028a0| 6b 61 63 69 6e 2d 73 75 | 73 63 65 70 74 69 62 6c |kacin-su|sceptibl|
|000028b0| 65 20 50 2e 20 61 65 72 | 75 67 69 6e 6f 73 61 20 |e P. aer|uginosa |
|000028c0| 73 75 62 73 65 71 75 65 | 6e 74 6c 79 20 61 63 71 |subseque|ntly acq|
|000028d0| 75 69 72 65 64 0d 0a 69 | 6e 66 65 63 74 69 6f 6e |uired..i|nfection|
|000028e0| 73 20 6f 72 20 63 6f 6c | 6f 6e 69 7a 61 74 69 6f |s or col|onizatio|
|000028f0| 6e 20 77 69 74 68 20 61 | 6d 69 6b 61 63 69 6e 2d |n with a|mikacin-|
|00002900| 72 65 73 69 73 74 61 6e | 74 20 50 2e 20 61 65 72 |resistan|t P. aer|
|00002910| 75 67 69 6e 6f 73 61 20 | 61 74 20 74 68 65 20 73 |uginosa |at the s|
|00002920| 61 6d 65 0d 0a 73 69 74 | 65 2e 20 20 45 6c 65 76 |ame..sit|e. Elev|
|00002930| 65 6e 20 73 65 6e 73 69 | 74 69 76 65 20 61 6e 64 |en sensi|tive and|
|00002940| 20 72 65 73 69 73 74 61 | 6e 74 20 70 61 69 72 73 | resista|nt pairs|
|00002950| 20 6f 66 20 69 73 6f 6c | 61 74 65 73 20 77 65 72 | of isol|ates wer|
|00002960| 65 20 61 6e 61 6c 79 7a | 65 64 20 66 6f 72 0d 0a |e analyz|ed for..|
|00002970| 61 6d 69 6e 6f 67 6c 79 | 63 6f 73 69 64 65 2d 69 |aminogly|coside-i|
|00002980| 6e 61 63 74 69 76 61 74 | 69 6e 67 20 65 6e 7a 79 |nactivat|ing enzy|
|00002990| 6d 65 73 2c 20 70 6c 61 | 73 6d 69 64 20 70 72 6f |mes, pla|smid pro|
|000029a0| 66 69 6c 65 73 2c 20 63 | 65 6c 6c 75 6c 61 72 20 |files, c|ellular |
|000029b0| 70 72 6f 74 65 69 6e 73 | 2c 0d 0a 4f 4d 50 73 2c |proteins|,..OMPs,|
|000029c0| 20 4c 50 53 20 70 72 6f | 66 69 6c 65 73 2c 20 61 | LPS pro|files, a|
|000029d0| 6e 64 20 61 6d 69 6b 61 | 63 69 6e 20 75 70 74 61 |nd amika|cin upta|
|000029e0| 6b 65 20 74 6f 20 65 76 | 61 6c 75 61 74 65 20 74 |ke to ev|aluate t|
|000029f0| 68 65 20 70 61 74 68 6f | 67 65 6e 65 74 69 63 0d |he patho|genetic.|
|00002a00| 0a 6d 65 63 68 61 6e 69 | 73 6d 73 20 6f 66 20 61 |.mechani|sms of a|
|00002a10| 6d 69 6b 61 63 69 6e 20 | 72 65 73 69 73 74 61 6e |mikacin |resistan|
|00002a20| 63 65 20 64 65 76 65 6c | 6f 70 69 6e 67 20 69 6e |ce devel|oping in|
|00002a30| 20 76 69 76 6f 2e 0d 0a | 20 20 20 20 20 41 6c 74 | vivo...| Alt|
|00002a40| 68 6f 75 67 68 20 74 68 | 65 72 65 20 77 61 73 20 |hough th|ere was |
|00002a50| 63 6f 6e 73 69 64 65 72 | 61 62 6c 65 20 76 61 72 |consider|able var|
|00002a60| 69 61 74 69 6f 6e 20 69 | 6e 20 70 6c 61 73 6d 69 |iation i|n plasmi|
|00002a70| 64 20 70 72 6f 66 69 6c | 65 73 2c 20 4f 4d 50 73 |d profil|es, OMPs|
|00002a80| 2c 20 61 6e 64 0d 0a 4c | 50 53 20 61 6d 6f 6e 67 |, and..L|PS among|
|00002a90| 20 50 2e 20 61 65 72 75 | 67 69 6e 6f 73 61 20 73 | P. aeru|ginosa s|
|00002aa0| 74 72 61 69 6e 73 20 69 | 73 6f 6c 61 74 65 64 20 |trains i|solated |
|00002ab0| 66 72 6f 6d 20 64 69 66 | 66 65 72 65 6e 74 20 70 |from dif|ferent p|
|00002ac0| 61 74 69 65 6e 74 73 2c | 20 73 65 6e 73 69 74 69 |atients,| sensiti|
|00002ad0| 76 65 0d 0a 61 6e 64 20 | 72 65 73 69 73 74 61 6e |ve..and |resistan|
|00002ae0| 74 20 69 73 6f 6c 61 74 | 65 73 20 66 72 6f 6d 20 |t isolat|es from |
|00002af0| 74 68 65 20 73 61 6d 65 | 20 70 61 74 69 65 6e 74 |the same| patient|
|00002b00| 73 20 73 68 6f 77 65 64 | 20 69 6e 64 69 73 74 69 |s showed| indisti|
|00002b10| 6e 67 75 73 68 61 62 6c | 65 20 63 65 6c 6c 75 6c |ngushabl|e cellul|
|00002b20| 61 72 0d 0a 70 72 6f 74 | 65 69 6e 73 2c 20 70 6c |ar..prot|eins, pl|
|00002b30| 61 73 6d 69 64 20 70 72 | 6f 66 69 6c 65 73 2c 20 |asmid pr|ofiles, |
|00002b40| 4f 4d 50 73 2c 20 61 6e | 64 20 4c 50 53 20 70 72 |OMPs, an|d LPS pr|
|00002b50| 6f 66 69 6c 65 73 20 28 | 74 61 62 6c 65 29 2e 20 |ofiles (|table). |
|00002b60| 20 4e 6f 6e 65 20 6f 66 | 20 74 68 65 0d 0a 72 65 | None of| the..re|
|00002b70| 73 69 73 74 61 6e 74 20 | 69 73 6f 6c 61 74 65 73 |sistant |isolates|
|00002b80| 20 70 72 6f 64 75 63 65 | 64 20 61 63 65 74 79 6c | produce|d acetyl|
|00002b90| 74 72 61 6e 73 66 65 72 | 61 73 65 20 28 36 29 2d |transfer|ase (6)-|
|00002ba0| 49 2c 20 74 68 65 20 6f | 6e 6c 79 20 65 6e 7a 79 |I, the o|nly enzy|
|00002bb0| 6d 65 20 6b 6e 6f 77 6e | 20 74 6f 0d 0a 69 6e 61 |me known| to..ina|
|00002bc0| 63 74 69 76 61 74 65 20 | 61 6d 69 6b 61 63 69 6e |ctivate |amikacin|
|00002bd0| 2e 20 20 53 65 76 65 6e | 20 6f 66 20 39 20 61 6d |. Seven| of 9 am|
|00002be0| 69 6b 61 63 69 6e 2d 72 | 65 73 69 73 74 61 6e 74 |ikacin-r|esistant|
|00002bf0| 20 69 73 6f 6c 61 74 65 | 73 20 77 69 74 68 20 72 | isolate|s with r|
|00002c00| 65 64 75 63 65 64 0d 0a | 61 6d 69 6b 61 63 69 6e |educed..|amikacin|
|00002c10| 20 75 70 74 61 6b 65 20 | 68 61 64 20 61 20 63 6c | uptake |had a cl|
|00002c20| 65 61 72 20 72 65 64 75 | 63 74 69 6f 6e 20 6f 66 |ear redu|ction of|
|00002c30| 20 61 74 20 6c 65 61 73 | 74 20 35 30 25 2e 0d 0a | at leas|t 50%...|
|00002c40| 20 20 20 20 20 54 68 65 | 73 65 20 64 61 74 61 20 | The|se data |
|00002c50| 73 68 6f 77 20 74 68 61 | 74 20 74 68 65 20 64 65 |show tha|t the de|
|00002c60| 76 65 6c 6f 70 6d 65 6e | 74 20 6f 66 20 61 6d 69 |velopmen|t of ami|
|00002c70| 6b 61 63 69 6e 20 72 65 | 73 69 73 74 61 6e 63 65 |kacin re|sistance|
|00002c80| 20 64 75 72 69 6e 67 0d | 0a 74 68 65 72 61 70 79 | during.|.therapy|
|00002c90| 20 6f 66 74 65 6e 20 72 | 65 73 75 6c 74 73 20 66 | often r|esults f|
|00002ca0| 72 6f 6d 20 65 6d 65 72 | 67 65 6e 63 65 20 6f 66 |rom emer|gence of|
|00002cb0| 20 72 65 73 69 73 74 61 | 6e 63 65 20 69 6e 20 70 | resista|nce in p|
|00002cc0| 72 65 76 69 6f 75 73 0d | 0a 61 6d 69 6b 61 63 69 |revious.|.amikaci|
|00002cd0| 6e 2d 73 65 6e 73 69 74 | 69 76 65 20 69 73 6f 6c |n-sensit|ive isol|
|00002ce0| 61 74 65 73 20 72 61 74 | 68 65 72 20 74 68 61 6e |ates rat|her than|
|00002cf0| 20 66 72 6f 6d 20 73 75 | 70 65 72 69 6e 66 65 63 | from su|perinfec|
|00002d00| 74 69 6f 6e 20 77 69 74 | 68 20 61 20 6e 65 77 0d |tion wit|h a new.|
|00002d10| 0a 72 65 73 69 73 74 61 | 6e 74 20 73 74 72 61 69 |.resista|nt strai|
|00002d20| 6e 2e 20 20 41 20 6d 61 | 6a 6f 72 20 6d 65 63 68 |n. A ma|jor mech|
|00002d30| 61 6e 69 73 6d 20 6f 66 | 20 74 68 65 20 69 6e 20 |anism of| the in |
|00002d40| 76 69 76 6f 20 64 65 76 | 65 6c 6f 70 6d 65 6e 74 |vivo dev|elopment|
|00002d50| 20 6f 66 20 61 6d 69 6b | 61 63 69 6e 0d 0a 72 65 | of amik|acin..re|
|00002d60| 73 69 73 74 61 6e 63 65 | 20 62 79 20 50 2e 20 61 |sistance| by P. a|
|00002d70| 65 72 75 67 69 6e 6f 73 | 61 20 69 73 20 61 6c 74 |eruginos|a is alt|
|00002d80| 65 72 61 74 69 6f 6e 20 | 69 6e 20 70 65 72 6d 65 |eration |in perme|
|00002d90| 61 62 69 6c 69 74 79 20 | 74 6f 20 61 6d 69 6b 61 |ability |to amika|
|00002da0| 63 69 6e 2e 20 20 54 68 | 69 73 0d 0a 61 6c 74 65 |cin. Th|is..alte|
|00002db0| 72 61 74 69 6f 6e 20 6d | 61 79 20 6e 6f 74 20 62 |ration m|ay not b|
|00002dc0| 65 20 63 61 75 73 65 64 | 20 62 79 20 61 63 71 75 |e caused| by acqu|
|00002dd0| 69 73 69 74 69 6f 6e 20 | 6f 66 20 70 6c 61 73 6d |isition |of plasm|
|00002de0| 69 64 73 20 6f 72 20 63 | 68 61 6e 67 65 73 20 69 |ids or c|hanges i|
|00002df0| 6e 20 4f 4d 50 73 20 6f | 72 0d 0a 69 6e 20 74 68 |n OMPs o|r..in th|
|00002e00| 65 20 4c 50 53 20 70 72 | 6f 66 69 6c 65 2e 0d 0a |e LPS pr|ofile...|
|00002e10| 0d 0a 50 6f 73 74 2d 43 | 6f 6d 6d 65 6e 74 0d 0a |..Post-C|omment..|
|00002e20| 0d 0a 20 20 20 20 20 41 | 73 20 68 61 73 20 62 65 |.. A|s has be|
|00002e30| 65 6e 20 6e 6f 74 65 64 | 20 70 72 65 76 69 6f 75 |en noted| previou|
|00002e40| 73 6c 79 20 28 73 65 65 | 20 74 68 65 20 31 39 38 |sly (see| the 198|
|00002e50| 36 20 59 45 41 52 20 42 | 4f 4f 4b 20 4f 46 20 4d |6 YEAR B|OOK OF M|
|00002e60| 45 44 49 43 49 4e 45 2c | 20 70 20 33 39 29 2c 0d |EDICINE,| p 39),.|
|00002e70| 0a 74 68 65 20 64 65 76 | 65 6c 6f 70 6d 65 6e 74 |.the dev|elopment|
|00002e80| 20 6f 66 20 61 20 6e 6f | 73 6f 63 6f 6d 69 61 6c | of a no|socomial|
|00002e90| 6c 79 20 61 63 71 75 69 | 72 65 64 20 50 2e 20 61 |ly acqui|red P. a|
|00002ea0| 65 72 75 67 69 6e 6f 73 | 61 20 69 6e 66 65 63 74 |eruginos|a infect|
|00002eb0| 69 6f 6e 20 64 6f 65 73 | 20 6e 6f 74 0d 0a 6e 65 |ion does| not..ne|
|00002ec0| 63 65 73 73 61 72 69 6c | 79 20 72 65 70 72 65 73 |cessaril|y repres|
|00002ed0| 65 6e 74 20 61 20 62 72 | 65 61 6b 64 6f 77 6e 20 |ent a br|eakdown |
|00002ee0| 69 6e 20 69 6e 66 65 63 | 74 69 6f 6e 20 63 6f 6e |in infec|tion con|
|00002ef0| 74 72 6f 6c 20 70 72 61 | 63 74 69 63 65 73 2e 20 |trol pra|ctices. |
|00002f00| 20 50 72 6f 73 70 65 63 | 74 69 76 65 0d 0a 73 74 | Prospec|tive..st|
|00002f10| 75 64 69 65 73 20 68 61 | 76 65 20 69 6e 64 69 63 |udies ha|ve indic|
|00002f20| 61 74 65 64 20 74 68 61 | 74 2c 20 69 6e 20 74 68 |ated tha|t, in th|
|00002f30| 65 20 69 6e 74 65 6e 73 | 69 76 65 20 63 61 72 65 |e intens|ive care|
|00002f40| 20 73 65 74 74 69 6e 67 | 2c 20 74 68 65 20 6d 61 | setting|, the ma|
|00002f50| 6a 6f 72 69 74 79 20 6f | 66 0d 0a 70 61 74 69 65 |jority o|f..patie|
|00002f60| 6e 74 73 20 66 6f 75 6e | 64 20 74 6f 20 62 65 20 |nts foun|d to be |
|00002f70| 63 6f 6c 6f 6e 69 7a 65 | 64 20 77 69 74 68 20 67 |colonize|d with g|
|00002f80| 65 6e 74 61 6d 69 63 69 | 6e 2d 72 65 73 69 73 74 |entamici|n-resist|
|00002f90| 61 6e 74 20 50 2e 20 61 | 65 72 75 67 69 6e 6f 73 |ant P. a|eruginos|
|00002fa0| 61 20 77 65 72 65 0d 0a | 61 63 74 75 61 6c 6c 79 |a were..|actually|
|00002fb0| 20 63 61 72 72 79 69 6e | 67 20 74 68 65 73 65 20 | carryin|g these |
|00002fc0| 6f 72 67 61 6e 69 73 6d | 73 20 69 6e 20 6c 6f 77 |organism|s in low|
|00002fd0| 20 6e 75 6d 62 65 72 73 | 20 69 6e 20 74 68 65 69 | numbers| in thei|
|00002fe0| 72 20 63 6f 6c 6f 6e 20 | 6f 72 20 70 68 61 72 79 |r colon |or phary|
|00002ff0| 6e 78 20 61 74 0d 0a 74 | 68 65 20 74 69 6d 65 20 |nx at..t|he time |
|00003000| 6f 66 20 61 64 6d 69 73 | 73 69 6f 6e 20 28 31 29 |of admis|sion (1)|
|00003010| 2e 20 20 54 68 65 20 70 | 61 70 65 72 20 62 79 20 |. The p|aper by |
|00003020| 4d 61 6c 6f 6e 65 79 20 | 65 74 20 61 6c 2e 20 61 |Maloney |et al. a|
|00003030| 64 64 73 20 61 6e 6f 74 | 68 65 72 20 64 69 6d 65 |dds anot|her dime|
|00003040| 6e 73 69 6f 6e 0d 0a 74 | 6f 20 74 68 69 73 20 63 |nsion..t|o this c|
|00003050| 6f 6e 63 65 70 74 2e 20 | 20 41 6d 69 6b 61 63 69 |oncept. | Amikaci|
|00003060| 6e 2d 72 65 73 69 73 74 | 61 6e 74 20 50 73 65 75 |n-resist|ant Pseu|
|00003070| 64 6f 6d 6f 6e 61 73 20 | 69 73 20 72 61 72 65 6c |domonas |is rarel|
|00003080| 79 20 65 6e 63 6f 75 6e | 74 65 72 65 64 20 69 6e |y encoun|tered in|
|00003090| 20 74 68 65 0d 0a 63 6f | 6d 6d 75 6e 69 74 79 20 | the..co|mmunity |
|000030a0| 73 65 74 74 69 6e 67 2e | 20 20 53 75 63 68 20 69 |setting.| Such i|
|000030b0| 6e 66 65 63 74 69 6f 6e | 73 20 68 61 76 65 20 69 |nfection|s have i|
|000030c0| 6d 70 6c 69 65 64 20 64 | 65 20 66 61 63 74 6f 20 |mplied d|e facto |
|000030d0| 6e 6f 73 6f 63 6f 6d 69 | 61 6c 0d 0a 61 63 71 75 |nosocomi|al..acqu|
|000030e0| 69 73 69 74 69 6f 6e 2e | 20 20 49 6e 20 74 68 69 |isition.| In thi|
|000030f0| 73 20 76 65 72 79 20 6e | 69 63 65 20 73 74 75 64 |s very n|ice stud|
|00003100| 79 20 74 68 61 74 20 75 | 73 65 73 20 73 6f 70 68 |y that u|ses soph|
|00003110| 69 73 74 69 63 61 74 65 | 64 20 74 65 63 68 6e 69 |isticate|d techni|
|00003120| 71 75 65 73 20 74 6f 0d | 0a 69 64 65 6e 74 69 66 |ques to.|.identif|
|00003130| 79 20 22 73 61 6d 65 6e | 65 73 73 22 20 62 65 74 |y "samen|ess" bet|
|00003140| 77 65 65 6e 20 69 73 6f | 6c 61 74 65 73 2c 20 65 |ween iso|lates, e|
|00003150| 61 63 68 20 6f 66 20 31 | 31 20 61 6d 69 6b 61 63 |ach of 1|1 amikac|
|00003160| 69 6e 2d 72 65 73 69 73 | 74 61 6e 74 20 50 2e 0d |in-resis|tant P..|
|00003170| 0a 61 65 72 75 67 69 6e | 6f 73 61 20 69 73 6f 6c |.aerugin|osa isol|
|00003180| 61 74 65 73 20 77 61 73 | 20 73 68 6f 77 6e 20 74 |ates was| shown t|
|00003190| 6f 20 62 65 20 69 64 65 | 6e 74 69 63 61 6c 20 74 |o be ide|ntical t|
|000031a0| 6f 20 74 68 65 20 72 65 | 73 70 65 63 74 69 76 65 |o the re|spective|
|000031b0| 20 73 74 72 61 69 6e 20 | 74 68 61 74 0d 0a 68 61 | strain |that..ha|
|000031c0| 64 20 62 65 65 6e 20 69 | 73 6f 6c 61 74 65 64 20 |d been i|solated |
|000031d0| 62 65 66 6f 72 65 20 69 | 6e 69 74 69 61 74 69 6f |before i|nitiatio|
|000031e0| 6e 20 6f 66 20 61 6d 69 | 6b 61 63 69 6e 20 74 68 |n of ami|kacin th|
|000031f0| 65 72 61 70 79 2c 20 61 | 74 20 77 68 69 63 68 20 |erapy, a|t which |
|00003200| 74 69 6d 65 20 74 68 65 | 0d 0a 73 74 72 61 69 6e |time the|..strain|
|00003210| 20 77 61 73 20 61 6d 69 | 6b 61 63 69 6e 20 73 75 | was ami|kacin su|
|00003220| 73 63 65 70 74 69 62 6c | 65 2e 20 20 54 68 65 20 |sceptibl|e. The |
|00003230| 22 65 6d 65 72 67 65 6e | 63 65 22 20 6f 66 20 72 |"emergen|ce" of r|
|00003240| 65 73 69 73 74 61 6e 63 | 65 20 68 61 64 20 6f 63 |esistanc|e had oc|
|00003250| 63 75 72 72 65 64 2c 0d | 0a 61 73 20 6f 70 70 6f |curred,.|.as oppo|
|00003260| 73 65 64 20 74 6f 20 74 | 68 65 20 6e 6f 73 6f 63 |sed to t|he nosoc|
|00003270| 6f 6d 69 61 6c 20 61 63 | 71 75 69 73 69 74 69 6f |omial ac|quisitio|
|00003280| 6e 20 6f 66 20 61 20 72 | 65 73 69 73 74 61 6e 74 |n of a r|esistant|
|00003290| 20 69 73 6f 6c 61 74 65 | 2e 20 20 54 72 75 65 0d | isolate|. True.|
|000032a0| 0a 63 72 6f 73 73 2d 69 | 6e 66 65 63 74 69 6e 67 |.cross-i|nfecting|
|000032b0| 20 6f 75 74 62 72 65 61 | 6b 73 20 6f 66 20 72 65 | outbrea|ks of re|
|000032c0| 73 69 73 74 61 6e 74 20 | 50 73 65 75 64 6f 6d 6f |sistant |Pseudomo|
|000032d0| 6e 61 73 20 77 69 6c 6c | 20 63 6f 6e 74 69 6e 75 |nas will| continu|
|000032e0| 65 20 74 6f 20 6f 63 63 | 75 72 2c 20 61 6e 64 0d |e to occ|ur, and.|
|000032f0| 0a 63 61 72 65 66 75 6c | 20 68 61 6e 64 20 77 61 |.careful| hand wa|
|00003300| 73 68 69 6e 67 20 62 65 | 74 77 65 65 6e 20 65 78 |shing be|tween ex|
|00003310| 61 6d 69 6e 61 74 69 6f | 6e 73 20 72 65 6d 61 69 |aminatio|ns remai|
|00003320| 6e 73 20 61 6e 20 69 6d | 70 6f 72 74 61 6e 74 20 |ns an im|portant |
|00003330| 61 73 70 65 63 74 20 6f | 66 0d 0a 70 61 74 69 65 |aspect o|f..patie|
|00003340| 6e 74 20 63 61 72 65 2e | 20 20 42 75 74 2c 20 61 |nt care.| But, a|
|00003350| 73 20 6f 75 74 6c 69 6e | 65 64 20 69 6e 20 74 68 |s outlin|ed in th|
|00003360| 69 73 20 73 74 75 64 79 | 2c 20 73 75 63 68 20 6d |is study|, such m|
|00003370| 65 61 73 75 72 65 73 20 | 77 69 6c 6c 20 6e 6f 74 |easures |will not|
|00003380| 20 73 6f 6c 76 65 0d 0a | 74 68 65 20 70 72 6f 62 | solve..|the prob|
|00003390| 6c 65 6d 20 6f 66 20 69 | 6e 66 65 63 74 69 6f 6e |lem of i|nfection|
|000033a0| 20 63 61 75 73 65 64 20 | 62 79 20 6d 75 6c 74 69 | caused |by multi|
|000033b0| 70 6c 79 20 72 65 73 69 | 73 74 61 6e 74 20 50 2e |ply resi|stant P.|
|000033c0| 20 61 65 72 75 67 69 6e | 6f 73 61 2c 20 61 6e 64 | aerugin|osa, and|
|000033d0| 20 6e 65 77 0d 0a 73 74 | 72 61 74 65 67 69 65 73 | new..st|rategies|
|000033e0| 20 74 6f 20 64 65 61 6c | 20 77 69 74 68 20 74 68 | to deal| with th|
|000033f0| 69 73 20 6f 72 67 61 6e | 69 73 6d 20 61 72 65 20 |is organ|ism are |
|00003400| 6e 65 65 64 65 64 2e 2d | 2d 44 2e 45 2e 20 52 6f |needed.-|-D.E. Ro|
|00003410| 67 65 72 73 2c 20 4d 2e | 44 2e 0d 0a 0d 0a 24 55 |gers, M.|D.....$U|
|00003420| 6e 69 71 75 65 5f 49 44 | 7b 59 52 42 31 31 30 30 |nique_ID|{YRB1100|
|00003430| 33 7d 0d 0a 24 54 69 74 | 6c 65 7b 43 61 6e 64 69 |3}..$Tit|le{Candi|
|00003440| 64 61 20 41 6e 74 69 67 | 65 6e 20 4c 61 74 65 78 |da Antig|en Latex|
|00003450| 20 54 65 73 74 20 66 6f | 72 20 44 65 74 65 63 74 | Test fo|r Detect|
|00003460| 69 6f 6e 20 6f 66 20 49 | 6e 76 61 73 69 76 65 20 |ion of I|nvasive |
|00003470| 43 61 6e 64 69 64 69 61 | 73 69 73 20 69 6e 20 49 |Candidia|sis in I|
|00003480| 6d 6d 75 6e 6f 63 6f 6d | 70 72 6f 6d 69 73 65 64 |mmunocom|promised|
|00003490| 20 50 61 74 69 65 6e 74 | 73 7d 0d 0a 24 41 75 74 | Patient|s}..$Aut|
|000034a0| 68 6f 72 7b 4e 65 73 73 | 2c 20 4d 4a 0d 0a 56 61 |hor{Ness|, MJ..Va|
|000034b0| 75 67 68 61 6e 2c 20 57 | 50 0d 0a 57 6f 6f 64 73 |ughan, W|P..Woods|
|000034c0| 2c 20 47 4c 7d 0d 0a 24 | 41 66 66 69 6c 69 61 74 |, GL}..$|Affiliat|
|000034d0| 69 6f 6e 7b 55 6e 69 76 | 20 6f 66 20 4e 65 62 72 |ion{Univ| of Nebr|
|000034e0| 61 73 6b 61 7d 0d 0a 24 | 4a 6f 75 72 6e 61 6c 7b |aska}..$|Journal{|
|000034f0| 4a 20 49 6e 66 65 63 74 | 20 44 69 73 7d 0d 0a 24 |J Infect| Dis}..$|
|00003500| 56 6f 6c 75 6d 65 7b 31 | 35 39 7d 0d 0a 24 50 61 |Volume{1|59}..$Pa|
|00003510| 67 65 7b 34 39 35 2d 35 | 30 32 7d 0d 0a 24 44 61 |ge{495-5|02}..$Da|
|00003520| 74 65 7b 4d 61 72 63 68 | 20 31 39 38 39 7d 0d 0a |te{March| 1989}..|
|00003530| 24 59 42 56 6f 6c 7b 31 | 39 39 30 20 59 65 61 72 |$YBVol{1|990 Year|
|00003540| 20 42 6f 6f 6b 20 6f 66 | 20 4d 65 64 69 63 69 6e | Book of| Medicin|
|00003550| 65 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 33 2d 33 |e}..$Cha|pter{3-3|
|00003560| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|00003570| 2e 20 52 6f 67 65 72 73 | 2c 20 44 65 73 20 50 72 |. Rogers|, Des Pr|
|00003580| 65 7a 2c 20 43 6c 69 6e | 65 2c 20 42 72 61 75 6e |ez, Clin|e, Braun|
|00003590| 77 61 6c 64 2c 20 47 72 | 65 65 6e 62 65 72 67 65 |wald, Gr|eenberge|
|000035a0| 72 2c 20 57 69 6c 73 6f | 6e 2c 20 45 70 73 74 65 |r, Wilso|n, Epste|
|000035b0| 69 6e 2c 20 61 6e 64 20 | 4d 61 6c 61 77 69 73 74 |in, and |Malawist|
|000035c0| 61 7d 0d 0a 24 54 61 62 | 6c 65 7b 54 61 62 6c 65 |a}..$Tab|le{Table|
|000035d0| 20 4f 6d 69 74 74 65 64 | 7d 0d 0a 24 43 6f 6d 6d | Omitted|}..$Comm|
|000035e0| 65 6e 74 61 74 6f 72 7b | 44 2e 45 2e 20 52 6f 67 |entator{|D.E. Rog|
|000035f0| 65 72 73 2c 20 4d 2e 44 | 2e 7d 0d 0a 0d 0a 43 6f |ers, M.D|.}....Co|
|00003600| 70 79 72 69 67 68 74 20 | 28 63 29 20 59 65 61 72 |pyright |(c) Year|
|00003610| 62 6f 6f 6b 20 4d 65 64 | 69 63 61 6c 20 50 75 62 |book Med|ical Pub|
|00003620| 6c 69 73 68 65 72 73 2c | 20 49 6e 63 2e 2c 20 31 |lishers,| Inc., 1|
|00003630| 39 39 30 0d 0a 0d 0a 31 | 39 39 30 20 59 65 61 72 |990....1|990 Year|
|00003640| 20 42 6f 6f 6b 20 6f 66 | 20 4d 65 64 69 63 69 6e | Book of| Medicin|
|00003650| 65 20 28 52 29 0d 0a 0d | 0a 50 61 72 74 20 4f 6e |e (R)...|.Part On|
|00003660| 65 2d 2d 49 6e 66 65 63 | 74 69 6f 75 73 20 44 69 |e--Infec|tious Di|
|00003670| 73 65 61 73 65 73 0d 0a | 0d 0a 43 68 61 70 74 65 |seases..|..Chapte|
|00003680| 72 20 33 2d 2d 4e 6f 73 | 6f 63 6f 6d 69 61 6c 20 |r 3--Nos|ocomial |
|00003690| 49 6e 66 65 63 74 69 6f | 6e 73 0d 0a 0d 0a 2d 2d |Infectio|ns....--|
|000036a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000036b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000036c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000036d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000036e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 43 61 |--------|----..Ca|
|000036f0| 6e 64 69 64 61 20 41 6e | 74 69 67 65 6e 20 4c 61 |ndida An|tigen La|
|00003700| 74 65 78 20 54 65 73 74 | 20 66 6f 72 20 44 65 74 |tex Test| for Det|
|00003710| 65 63 74 69 6f 6e 20 6f | 66 20 49 6e 76 61 73 69 |ection o|f Invasi|
|00003720| 76 65 20 43 61 6e 64 69 | 64 69 61 73 69 73 20 69 |ve Candi|diasis i|
|00003730| 6e 0d 0a 49 6d 6d 75 6e | 6f 63 6f 6d 70 72 6f 6d |n..Immun|ocomprom|
|00003740| 69 73 65 64 20 50 61 74 | 69 65 6e 74 73 0d 0a 0d |ised Pat|ients...|
|00003750| 0a 4e 65 73 73 20 4d 4a | 3b 20 56 61 75 67 68 61 |.Ness MJ|; Vaugha|
|00003760| 6e 20 57 50 3b 20 57 6f | 6f 64 73 20 47 4c 0d 0a |n WP; Wo|ods GL..|
|00003770| 28 55 6e 69 76 20 6f 66 | 20 4e 65 62 72 61 73 6b |(Univ of| Nebrask|
|00003780| 61 29 0d 0a 4a 20 49 6e | 66 65 63 74 20 44 69 73 |a)..J In|fect Dis|
|00003790| 20 31 35 39 3a 34 39 35 | 2d 35 30 32 2c 20 4d 61 | 159:495|-502, Ma|
|000037a0| 72 63 68 20 31 39 38 39 | 0d 0a 2d 2d 2d 2d 2d 2d |rch 1989|..------|
|000037b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037f0| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 0d 0a 41 62 73 74 |--------|....Abst|
|00003800| 72 61 63 74 0d 0a 0d 0a | 20 20 20 20 20 41 20 6e |ract....| A n|
|00003810| 65 77 20 6c 61 74 65 78 | 20 61 67 67 6c 75 74 69 |ew latex| aggluti|
|00003820| 6e 61 74 69 6f 6e 20 74 | 65 73 74 20 66 6f 72 20 |nation t|est for |
|00003830| 74 68 65 20 64 65 74 65 | 63 74 69 6f 6e 20 6f 66 |the dete|ction of|
|00003840| 20 73 65 72 75 6d 20 43 | 61 6e 64 69 64 61 20 61 | serum C|andida a|
|00003850| 6e 74 69 67 65 6e 0d 0a | 68 61 73 20 72 65 63 65 |ntigen..|has rece|
|00003860| 6e 74 6c 79 20 62 65 63 | 6f 6d 65 20 61 76 61 69 |ntly bec|ome avai|
|00003870| 6c 61 62 6c 65 2e 20 20 | 54 6f 20 64 65 74 65 72 |lable. |To deter|
|00003880| 6d 69 6e 65 20 69 74 73 | 20 72 65 6c 69 61 62 69 |mine its| reliabi|
|00003890| 6c 69 74 79 20 69 6e 20 | 64 65 74 65 63 74 69 6e |lity in |detectin|
|000038a0| 67 0d 0a 69 6e 76 61 73 | 69 76 65 20 63 61 6e 64 |g..invas|ive cand|
|000038b0| 69 64 69 61 73 69 73 2c | 20 43 61 6e 64 69 64 61 |idiasis,| Candida|
|000038c0| 20 61 6e 74 69 67 65 6e | 20 6c 61 74 65 78 20 61 | antigen| latex a|
|000038d0| 67 67 6c 75 74 69 6e 61 | 74 69 6f 6e 20 74 65 73 |gglutina|tion tes|
|000038e0| 74 69 6e 67 20 77 61 73 | 0d 0a 70 65 72 66 6f 72 |ting was|..perfor|
|000038f0| 6d 65 64 20 74 77 69 63 | 65 20 77 65 65 6b 6c 79 |med twic|e weekly|
|00003900| 20 64 75 72 69 6e 67 20 | 32 37 31 20 61 64 6d 69 | during |271 admi|
|00003910| 73 73 69 6f 6e 73 20 6f | 66 20 32 30 30 20 70 61 |ssions o|f 200 pa|
|00003920| 74 69 65 6e 74 73 20 75 | 6e 64 65 72 67 6f 69 6e |tients u|ndergoin|
|00003930| 67 0d 0a 69 6e 74 65 6e | 73 69 76 65 20 63 68 65 |g..inten|sive che|
|00003940| 6d 6f 74 68 65 72 61 70 | 79 20 61 6c 6f 6e 65 20 |motherap|y alone |
|00003950| 6f 72 20 73 75 70 70 6f | 72 74 65 64 20 62 79 20 |or suppo|rted by |
|00003960| 61 75 74 6f 6c 6f 67 6f | 75 73 20 6f 72 20 61 6c |autologo|us or al|
|00003970| 6c 6f 67 65 6e 65 69 63 | 20 62 6f 6e 65 0d 0a 6d |logeneic| bone..m|
|00003980| 61 72 72 6f 77 20 74 72 | 61 6e 73 70 6c 61 6e 74 |arrow tr|ansplant|
|00003990| 61 74 69 6f 6e 2e 20 20 | 41 20 70 6f 73 69 74 69 |ation. |A positi|
|000039a0| 76 65 20 74 65 73 74 20 | 72 65 73 75 6c 74 20 77 |ve test |result w|
|000039b0| 61 73 20 64 65 66 69 6e | 65 64 20 61 73 20 61 20 |as defin|ed as a |
|000039c0| 74 69 74 65 72 20 6f 66 | 20 31 3a 34 0d 0a 6f 72 |titer of| 1:4..or|
|000039d0| 20 67 72 65 61 74 65 72 | 2e 0d 0a 20 20 20 20 20 | greater|... |
|000039e0| 49 6e 20 31 31 20 70 61 | 74 69 65 6e 74 73 20 69 |In 11 pa|tients i|
|000039f0| 6e 76 61 73 69 76 65 20 | 63 61 6e 64 69 64 69 61 |nvasive |candidia|
|00003a00| 73 69 73 20 64 65 76 65 | 6c 6f 70 65 64 3b 20 36 |sis deve|loped; 6|
|00003a10| 20 28 35 34 2e 35 25 29 | 20 6f 66 20 74 68 65 73 | (54.5%)| of thes|
|00003a20| 65 20 68 61 64 0d 0a 70 | 6f 73 69 74 69 76 65 20 |e had..p|ositive |
|00003a30| 43 61 6e 64 69 64 61 20 | 61 6e 74 69 67 65 6e 2e |Candida |antigen.|
|00003a40| 20 20 54 68 72 65 65 20 | 6f 66 20 74 68 65 73 65 | Three |of these|
|00003a50| 20 70 61 74 69 65 6e 74 | 73 20 73 75 72 76 69 76 | patient|s surviv|
|00003a60| 65 64 2c 20 62 75 74 20 | 6f 6e 6c 79 20 31 20 68 |ed, but |only 1 h|
|00003a70| 61 64 0d 0a 70 6f 73 69 | 74 69 76 65 20 43 61 6e |ad..posi|tive Can|
|00003a80| 64 69 64 61 20 61 6e 74 | 69 67 65 6e 2e 20 20 53 |dida ant|igen. S|
|00003a90| 65 76 65 6e 20 6f 66 20 | 74 68 6f 73 65 20 77 68 |even of |those wh|
|00003aa0| 6f 20 64 69 65 64 20 68 | 61 64 20 73 65 72 75 6d |o died h|ad serum|
|00003ab0| 20 63 72 65 61 74 69 6e | 69 6e 65 20 6c 65 76 65 | creatin|ine leve|
|00003ac0| 6c 73 0d 0a 6f 66 20 67 | 72 65 61 74 65 72 20 74 |ls..of g|reater t|
|00003ad0| 68 61 6e 20 32 20 6d 67 | 2f 64 6c 20 61 74 20 74 |han 2 mg|/dl at t|
|00003ae0| 68 65 20 74 69 6d 65 20 | 6f 66 20 64 65 61 74 68 |he time |of death|
|00003af0| 3b 20 35 20 6f 66 20 74 | 68 65 73 65 20 68 61 64 |; 5 of t|hese had|
|00003b00| 20 70 6f 73 69 74 69 76 | 65 20 43 61 6e 64 69 64 | positiv|e Candid|
|00003b10| 61 0d 0a 61 6e 74 69 67 | 65 6e 20 61 74 20 73 6f |a..antig|en at so|
|00003b20| 6d 65 20 74 69 6d 65 20 | 64 75 72 69 6e 67 20 61 |me time |during a|
|00003b30| 6e 20 61 76 65 72 61 67 | 65 20 68 6f 73 70 69 74 |n averag|e hospit|
|00003b40| 61 6c 69 7a 61 74 69 6f | 6e 20 6f 66 20 31 37 20 |alizatio|n of 17 |
|00003b50| 64 61 79 73 20 28 72 61 | 6e 67 65 2c 0d 0a 31 30 |days (ra|nge,..10|
|00003b60| 2d 33 36 20 64 61 79 73 | 29 2e 20 20 49 6e 76 61 |-36 days|). Inva|
|00003b70| 73 69 76 65 20 63 61 6e | 64 69 64 69 61 73 69 73 |sive can|didiasis|
|00003b80| 20 63 6f 75 6c 64 20 6e | 6f 74 20 62 65 20 64 6f | could n|ot be do|
|00003b90| 63 75 6d 65 6e 74 65 64 | 20 69 6e 20 32 30 36 20 |cumented| in 206 |
|00003ba0| 61 64 6d 69 73 73 69 6f | 6e 73 3b 0d 0a 36 30 20 |admissio|ns;..60 |
|00003bb0| 70 61 74 69 65 6e 74 73 | 20 64 69 65 64 2e 20 20 |patients| died. |
|00003bc0| 4f 66 20 74 68 65 20 34 | 31 20 61 75 74 6f 70 73 |Of the 4|1 autops|
|00003bd0| 69 65 64 20 70 61 74 69 | 65 6e 74 73 2c 20 32 39 |ied pati|ents, 29|
|00003be0| 20 28 37 31 25 29 20 68 | 61 64 20 70 6f 73 69 74 | (71%) h|ad posit|
|00003bf0| 69 76 65 20 43 61 6e 64 | 69 64 61 0d 0a 61 6e 74 |ive Cand|ida..ant|
|00003c00| 69 67 65 6e 20 64 75 72 | 69 6e 67 20 61 6e 20 61 |igen dur|ing an a|
|00003c10| 76 65 72 61 67 65 20 6f | 66 20 31 38 20 68 6f 73 |verage o|f 18 hos|
|00003c20| 70 69 74 61 6c 20 64 61 | 79 73 2e 20 20 54 68 65 |pital da|ys. The|
|00003c30| 20 6c 61 74 65 78 20 74 | 65 73 74 20 77 61 73 20 | latex t|est was |
|00003c40| 61 6c 73 6f 0d 0a 70 6f | 73 69 74 69 76 65 20 69 |also..po|sitive i|
|00003c50| 6e 20 33 30 20 28 32 30 | 2e 35 25 29 20 6f 66 20 |n 30 (20|.5%) of |
|00003c60| 74 68 65 20 73 75 72 76 | 69 76 6f 72 73 20 61 6e |the surv|ivors an|
|00003c70| 64 20 31 30 20 28 35 33 | 25 29 20 6f 66 20 74 68 |d 10 (53|%) of th|
|00003c80| 65 20 75 6e 61 75 74 6f | 70 73 69 65 64 0d 0a 70 |e unauto|psied..p|
|00003c90| 61 74 69 65 6e 74 73 2e | 0d 0a 20 20 20 20 20 53 |atients.|.. S|
|00003ca0| 69 67 6e 69 66 69 63 61 | 6e 74 6c 79 20 6d 6f 72 |ignifica|ntly mor|
|00003cb0| 65 20 70 61 74 69 65 6e | 74 73 20 28 36 31 25 29 |e patien|ts (61%)|
|00003cc0| 20 77 69 74 68 20 70 6f | 73 69 74 69 76 65 20 43 | with po|sitive C|
|00003cd0| 61 6e 64 69 64 61 20 61 | 6e 74 69 67 65 6e 20 74 |andida a|ntigen t|
|00003ce0| 69 74 65 72 73 0d 0a 68 | 61 64 20 73 65 72 75 6d |iters..h|ad serum|
|00003cf0| 20 63 72 65 61 74 69 6e | 69 6e 65 20 6c 65 76 65 | creatin|ine leve|
|00003d00| 6c 73 20 6f 66 20 6d 6f | 72 65 20 74 68 61 6e 20 |ls of mo|re than |
|00003d10| 32 20 6d 67 2f 64 6c 20 | 74 68 61 6e 20 64 69 64 |2 mg/dl |than did|
|00003d20| 20 74 68 6f 73 65 20 77 | 69 74 68 20 6e 65 67 61 | those w|ith nega|
|00003d30| 74 69 76 65 0d 0a 74 65 | 73 74 73 20 28 31 33 25 |tive..te|sts (13%|
|00003d40| 29 2e 20 20 46 72 65 71 | 75 65 6e 74 6c 79 2c 20 |). Freq|uently, |
|00003d50| 65 6c 65 76 61 74 69 6f | 6e 20 6f 66 20 74 68 65 |elevatio|n of the|
|00003d60| 20 43 61 6e 64 69 64 61 | 20 61 6e 74 69 67 65 6e | Candida| antigen|
|00003d70| 20 74 69 74 65 72 20 70 | 61 72 61 6c 6c 65 6c 65 | titer p|arallele|
|00003d80| 64 20 61 6e 0d 0a 69 6e | 63 72 65 61 73 65 20 69 |d an..in|crease i|
|00003d90| 6e 20 74 68 65 20 73 65 | 72 75 6d 20 63 72 65 61 |n the se|rum crea|
|00003da0| 74 69 6e 69 6e 65 20 6c | 65 76 65 6c 20 28 46 69 |tinine l|evel (Fi|
|00003db0| 67 20 33 2d 32 29 2c 20 | 61 6e 64 20 65 78 74 72 |g 3-2), |and extr|
|00003dc0| 65 6d 65 6c 79 20 68 69 | 67 68 65 72 20 61 6e 74 |emely hi|gher ant|
|00003dd0| 69 67 65 6e 0d 0a 74 69 | 74 65 72 73 20 77 65 72 |igen..ti|ters wer|
|00003de0| 65 20 61 73 73 6f 63 69 | 61 74 65 64 20 77 69 74 |e associ|ated wit|
|00003df0| 68 20 61 20 66 61 74 61 | 6c 20 6f 75 74 63 6f 6d |h a fata|l outcom|
|00003e00| 65 2e 20 20 46 6f 72 20 | 74 68 65 20 35 32 20 70 |e. For |the 52 p|
|00003e10| 61 74 69 65 6e 74 73 20 | 69 6e 20 77 68 6f 6d 20 |atients |in whom |
|00003e20| 74 68 65 0d 0a 70 72 65 | 73 65 6e 63 65 20 6f 72 |the..pre|sence or|
|00003e30| 20 61 62 73 65 6e 63 65 | 20 6f 66 20 63 61 6e 64 | absence| of cand|
|00003e40| 69 64 69 61 73 69 73 20 | 63 6f 75 6c 64 20 62 65 |idiasis |could be|
|00003e50| 20 75 6e 65 71 75 69 76 | 6f 63 61 6c 6c 79 20 64 | unequiv|ocally d|
|00003e60| 6f 63 75 6d 65 6e 74 65 | 64 2c 20 74 68 65 0d 0a |ocumente|d, the..|
|00003e70| 73 65 6e 73 69 74 69 76 | 69 74 79 2c 20 73 70 65 |sensitiv|ity, spe|
|00003e80| 63 69 66 69 63 69 74 79 | 2c 20 61 6e 64 20 70 6f |cificity|, and po|
|00003e90| 73 69 74 69 76 65 20 61 | 6e 64 20 6e 65 67 61 74 |sitive a|nd negat|
|00003ea0| 69 76 65 20 70 72 65 64 | 69 63 74 69 76 65 20 76 |ive pred|ictive v|
|00003eb0| 61 6c 75 65 73 20 6f 66 | 20 74 68 65 0d 0a 6c 61 |alues of| the..la|
|00003ec0| 74 65 78 20 74 65 73 74 | 20 6f 6e 65 20 73 68 6f |tex test| one sho|
|00003ed0| 77 6e 20 69 6e 20 74 68 | 65 20 28 74 61 62 6c 65 |wn in th|e (table|
|00003ee0| 29 2e 20 20 49 66 20 74 | 68 65 20 63 75 74 2d 6f |). If t|he cut-o|
|00003ef0| 66 66 20 6c 65 76 65 6c | 20 77 61 73 20 69 6e 63 |ff level| was inc|
|00003f00| 72 65 61 73 65 64 20 74 | 6f 0d 0a 31 3a 38 20 6f |reased t|o..1:8 o|
|00003f10| 72 20 31 3a 31 36 2c 20 | 74 68 65 20 73 65 6e 73 |r 1:16, |the sens|
|00003f20| 69 74 69 76 69 74 79 20 | 64 65 63 72 65 61 73 65 |itivity |decrease|
|00003f30| 64 2e 0d 0a 20 20 20 20 | 20 54 68 65 73 65 20 64 |d... | These d|
|00003f40| 61 74 61 20 73 75 67 67 | 65 73 74 20 74 68 61 74 |ata sugg|est that|
|00003f50| 20 74 68 65 20 43 61 6e | 64 69 64 61 20 61 67 67 | the Can|dida agg|
|00003f60| 6c 75 74 69 6e 61 74 69 | 6f 6e 20 6c 61 74 65 78 |lutinati|on latex|
|00003f70| 20 74 65 73 74 20 68 61 | 73 20 6c 69 74 74 6c 65 | test ha|s little|
|00003f80| 0d 0a 72 6f 6c 65 20 69 | 6e 20 64 69 61 67 6e 6f |..role i|n diagno|
|00003f90| 73 69 6e 67 20 69 6e 76 | 61 73 69 76 65 20 63 61 |sing inv|asive ca|
|00003fa0| 6e 64 69 64 69 61 73 69 | 73 20 69 6e 20 69 6d 6d |ndidiasi|s in imm|
|00003fb0| 75 6e 6f 63 6f 6d 70 72 | 6f 6d 69 73 65 64 20 70 |unocompr|omised p|
|00003fc0| 61 74 69 65 6e 74 73 2e | 0d 0a 0d 0a 50 6f 73 74 |atients.|....Post|
|00003fd0| 2d 43 6f 6d 6d 65 6e 74 | 0d 0a 0d 0a 20 20 20 20 |-Comment|.... |
|00003fe0| 20 49 6e 76 61 73 69 76 | 65 20 63 61 6e 64 69 64 | Invasiv|e candid|
|00003ff0| 69 61 73 69 73 20 6b 69 | 6c 6c 73 20 6d 61 6e 79 |iasis ki|lls many|
|00004000| 20 69 6d 6d 75 6e 6f 63 | 6f 6d 70 72 6f 6d 69 73 | immunoc|ompromis|
|00004010| 65 64 20 70 61 74 69 65 | 6e 74 73 2d 2d 70 61 72 |ed patie|nts--par|
|00004020| 74 69 63 75 6c 61 72 6c | 79 0d 0a 74 68 6f 73 65 |ticularl|y..those|
|00004030| 20 72 65 63 65 69 76 69 | 6e 67 20 63 68 65 6d 6f | receivi|ng chemo|
|00004040| 74 68 65 72 61 70 79 20 | 66 6f 72 20 6d 61 6c 69 |therapy |for mali|
|00004050| 67 6e 61 6e 63 69 65 73 | 2c 20 6f 72 20 62 6f 6e |gnancies|, or bon|
|00004060| 65 20 6d 61 72 72 6f 77 | 20 74 72 61 6e 73 70 6c |e marrow| transpl|
|00004070| 61 6e 74 0d 0a 72 65 63 | 69 70 69 65 6e 74 73 20 |ant..rec|ipients |
|00004080| 64 75 72 69 6e 67 20 61 | 70 6c 61 73 69 61 2e 20 |during a|plasia. |
|00004090| 20 49 6e 64 65 65 64 2c | 20 69 6e 20 63 65 72 74 | Indeed,| in cert|
|000040a0| 61 69 6e 20 70 61 74 69 | 65 6e 74 73 20 28 74 68 |ain pati|ents (th|
|000040b0| 6f 73 65 20 77 69 74 68 | 20 6c 79 6d 70 68 6f 6d |ose with| lymphom|
|000040c0| 61 73 0d 0a 6f 72 20 73 | 6f 6c 69 64 20 74 75 6d |as..or s|olid tum|
|000040d0| 6f 72 73 29 20 61 20 67 | 72 6f 75 70 20 61 74 20 |ors) a g|roup at |
|000040e0| 53 6c 6f 61 6e 2d 4b 65 | 74 74 65 72 69 6e 67 20 |Sloan-Ke|ttering |
|000040f0| 68 61 73 20 73 68 6f 77 | 6e 20 61 6e 20 69 6e 63 |has show|n an inc|
|00004100| 72 65 61 73 65 20 69 6e | 20 70 72 6f 62 6c 65 6d |rease in| problem|
|00004110| 73 0d 0a 77 69 74 68 20 | 43 61 6e 64 69 64 61 20 |s..with |Candida |
|00004120| 66 75 6e 67 65 6d 69 61 | 20 64 75 72 69 6e 67 20 |fungemia| during |
|00004130| 72 65 63 65 6e 74 20 79 | 65 61 72 73 2e 0d 0a 20 |recent y|ears... |
|00004140| 20 20 20 20 47 69 76 65 | 6e 20 74 68 65 20 68 69 | Give|n the hi|
|00004150| 67 68 20 6d 6f 72 74 61 | 6c 69 74 79 20 61 73 73 |gh morta|lity ass|
|00004160| 6f 63 69 61 74 65 64 20 | 77 69 74 68 20 69 6e 76 |ociated |with inv|
|00004170| 61 73 69 76 65 20 63 61 | 6e 64 69 64 69 61 73 69 |asive ca|ndidiasi|
|00004180| 73 20 61 6e 64 20 74 68 | 65 0d 0a 61 76 61 69 6c |s and th|e..avail|
|00004190| 61 62 69 6c 69 74 79 20 | 6f 66 20 72 65 73 70 65 |ability |of respe|
|000041a0| 63 74 61 62 6c 65 20 61 | 6e 74 69 66 75 6e 67 61 |ctable a|ntifunga|
|000041b0| 6c 20 63 68 65 6d 6f 74 | 68 65 72 61 70 79 2c 20 |l chemot|herapy, |
|000041c0| 6d 61 6e 79 20 68 61 76 | 65 20 62 65 65 6e 20 73 |many hav|e been s|
|000041d0| 65 61 72 63 68 69 6e 67 | 0d 0a 66 6f 72 20 73 69 |earching|..for si|
|000041e0| 6d 70 6c 65 20 77 61 79 | 73 20 74 6f 20 6d 61 6b |mple way|s to mak|
|000041f0| 65 20 61 20 64 65 66 69 | 6e 69 74 69 76 65 20 64 |e a defi|nitive d|
|00004200| 69 61 67 6e 6f 73 69 73 | 20 65 61 72 6c 79 20 77 |iagnosis| early w|
|00004210| 68 65 6e 20 74 72 65 61 | 74 6d 65 6e 74 20 63 61 |hen trea|tment ca|
|00004220| 6e 20 6d 61 6b 65 20 61 | 0d 0a 64 69 66 66 65 72 |n make a|..differ|
|00004230| 65 6e 63 65 2e 20 20 54 | 68 69 73 20 6e 65 77 20 |ence. T|his new |
|00004240| 6c 61 74 65 78 20 66 69 | 78 61 74 69 6f 6e 20 74 |latex fi|xation t|
|00004250| 65 73 74 20 6c 6f 6f 6b | 65 64 20 70 72 6f 6d 69 |est look|ed promi|
|00004260| 73 69 6e 67 2e 20 20 41 | 6c 61 73 2c 20 69 74 20 |sing. A|las, it |
|00004270| 77 61 73 20 6e 6f 74 2e | 0d 0a 46 75 72 74 68 65 |was not.|..Furthe|
|00004280| 72 2c 20 69 6e 20 70 61 | 74 69 65 6e 74 73 20 77 |r, in pa|tients w|
|00004290| 69 74 68 20 72 65 6e 61 | 6c 20 69 6e 73 75 66 66 |ith rena|l insuff|
|000042a0| 69 63 69 65 6e 63 79 2c | 20 43 61 6e 64 69 64 61 |iciency,| Candida|
|000042b0| 20 74 69 74 65 72 73 20 | 72 6f 73 65 20 71 75 69 | titers |rose qui|
|000042c0| 74 65 0d 0a 6e 6f 6e 73 | 70 65 63 69 66 69 63 61 |te..nons|pecifica|
|000042d0| 6c 6c 79 2e 0d 0a 20 20 | 20 20 20 54 68 69 73 20 |lly... | This |
|000042e0| 65 61 72 6c 69 65 72 20 | 64 69 61 67 6e 6f 73 69 |earlier |diagnosi|
|000042f0| 73 20 70 72 6f 62 6c 65 | 6d 20 6e 65 65 64 73 20 |s proble|m needs |
|00004300| 6d 6f 72 65 20 77 6f 72 | 6b 2e 2d 2d 44 2e 45 2e |more wor|k.--D.E.|
|00004310| 20 52 6f 67 65 72 73 2c | 20 4d 2e 44 2e 0d 0a 24 | Rogers,| M.D...$|
|00004320| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 31 31 30 |Unique_I|D{YRB110|
|00004330| 30 34 7d 0d 0a 24 54 69 | 74 6c 65 7b 53 75 72 67 |04}..$Ti|tle{Surg|
|00004340| 69 63 61 6c 20 49 6e 74 | 65 6e 73 69 76 65 20 43 |ical Int|ensive C|
|00004350| 61 72 65 20 55 6e 69 74 | 20 50 6e 65 75 6d 6f 6e |are Unit| Pneumon|
|00004360| 69 61 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 4d 6f 63 |ia}..$Au|thor{Moc|
|00004370| 6b 2c 20 43 4e 0d 0a 42 | 75 72 63 68 61 72 64 2c |k, CN..B|urchard,|
|00004380| 20 4b 57 0d 0a 48 61 73 | 61 6e 2c 20 46 0d 0a 52 | KW..Has|an, F..R|
|00004390| 65 65 64 2c 20 4d 7d 0d | 0a 24 41 66 66 69 6c 69 |eed, M}.|.$Affili|
|000043a0| 61 74 69 6f 6e 7b 42 72 | 6f 77 6e 20 55 6e 69 76 |ation{Br|own Univ|
|000043b0| 3b 20 52 68 6f 64 65 20 | 49 73 6c 61 6e 64 20 48 |; Rhode |Island H|
|000043c0| 6f 73 70 2c 20 50 72 6f | 76 69 64 65 6e 63 65 7d |osp, Pro|vidence}|
|000043d0| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 53 75 72 67 65 |..$Journ|al{Surge|
|000043e0| 72 79 7d 0d 0a 24 56 6f | 6c 75 6d 65 7b 31 30 34 |ry}..$Vo|lume{104|
|000043f0| 7d 0d 0a 24 50 61 67 65 | 7b 34 39 34 2d 34 39 39 |}..$Page|{494-499|
|00004400| 7d 0d 0a 24 44 61 74 65 | 7b 53 65 70 74 65 6d 62 |}..$Date|{Septemb|
|00004410| 65 72 20 31 39 38 38 7d | 0d 0a 24 59 42 56 6f 6c |er 1988}|..$YBVol|
|00004420| 7b 31 39 39 30 20 59 65 | 61 72 20 42 6f 6f 6b 20 |{1990 Ye|ar Book |
|00004430| 6f 66 20 4d 65 64 69 63 | 69 6e 65 7d 0d 0a 24 43 |of Medic|ine}..$C|
|00004440| 68 61 70 74 65 72 7b 33 | 2d 34 7d 0d 0a 24 59 42 |hapter{3|-4}..$YB|
|00004450| 45 64 69 74 6f 72 7b 44 | 72 73 2e 20 52 6f 67 65 |Editor{D|rs. Roge|
|00004460| 72 73 2c 20 44 65 73 20 | 50 72 65 7a 2c 20 43 6c |rs, Des |Prez, Cl|
|00004470| 69 6e 65 2c 20 42 72 61 | 75 6e 77 61 6c 64 2c 20 |ine, Bra|unwald, |
|00004480| 47 72 65 65 6e 62 65 72 | 67 65 72 2c 20 57 69 6c |Greenber|ger, Wil|
|00004490| 73 6f 6e 2c 20 45 70 73 | 74 65 69 6e 2c 20 61 6e |son, Eps|tein, an|
|000044a0| 64 20 4d 61 6c 61 77 69 | 73 74 61 7d 0d 0a 24 54 |d Malawi|sta}..$T|
|000044b0| 61 62 6c 65 7b 54 61 62 | 6c 65 20 4f 6d 69 74 74 |able{Tab|le Omitt|
|000044c0| 65 64 7d 0d 0a 24 43 6f | 6d 6d 65 6e 74 61 74 6f |ed}..$Co|mmentato|
|000044d0| 72 7b 44 2e 45 2e 20 52 | 6f 67 65 72 73 2c 20 4d |r{D.E. R|ogers, M|
|000044e0| 2e 44 2e 7d 0d 0a 0d 0a | 43 6f 70 79 72 69 67 68 |.D.}....|Copyrigh|
|000044f0| 74 20 28 63 29 20 59 65 | 61 72 62 6f 6f 6b 20 4d |t (c) Ye|arbook M|
|00004500| 65 64 69 63 61 6c 20 50 | 75 62 6c 69 73 68 65 72 |edical P|ublisher|
|00004510| 73 2c 20 49 6e 63 2e 2c | 20 31 39 39 30 0d 0a 0d |s, Inc.,| 1990...|
|00004520| 0a 31 39 39 30 20 59 65 | 61 72 20 42 6f 6f 6b 20 |.1990 Ye|ar Book |
|00004530| 6f 66 20 4d 65 64 69 63 | 69 6e 65 20 28 52 29 0d |of Medic|ine (R).|
|00004540| 0a 0d 0a 50 61 72 74 20 | 4f 6e 65 2d 2d 49 6e 66 |...Part |One--Inf|
|00004550| 65 63 74 69 6f 75 73 20 | 44 69 73 65 61 73 65 73 |ectious |Diseases|
|00004560| 0d 0a 0d 0a 43 68 61 70 | 74 65 72 20 33 2d 2d 4e |....Chap|ter 3--N|
|00004570| 6f 73 6f 63 6f 6d 69 61 | 6c 20 49 6e 66 65 63 74 |osocomia|l Infect|
|00004580| 69 6f 6e 73 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |ions....|--------|
|00004590| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045d0| 2d 2d 2d 2d 2d 2d 0d 0a | 53 75 72 67 69 63 61 6c |------..|Surgical|
|000045e0| 20 49 6e 74 65 6e 73 69 | 76 65 20 43 61 72 65 20 | Intensi|ve Care |
|000045f0| 55 6e 69 74 20 50 6e 65 | 75 6d 6f 6e 69 61 0d 0a |Unit Pne|umonia..|
|00004600| 0d 0a 4d 6f 63 6b 20 43 | 4e 3b 20 42 75 72 63 68 |..Mock C|N; Burch|
|00004610| 61 72 64 20 4b 57 3b 20 | 48 61 73 61 6e 20 46 3b |ard KW; |Hasan F;|
|00004620| 20 52 65 65 64 20 4d 0d | 0a 28 42 72 6f 77 6e 20 | Reed M.|.(Brown |
|00004630| 55 6e 69 76 3b 20 52 68 | 6f 64 65 20 49 73 6c 61 |Univ; Rh|ode Isla|
|00004640| 6e 64 20 48 6f 73 70 2c | 20 50 72 6f 76 69 64 65 |nd Hosp,| Provide|
|00004650| 6e 63 65 29 0d 0a 53 75 | 72 67 65 72 79 20 31 30 |nce)..Su|rgery 10|
|00004660| 34 3a 34 39 34 2d 34 39 | 39 2c 20 53 65 70 74 65 |4:494-49|9, Septe|
|00004670| 6d 62 65 72 20 31 39 38 | 38 0d 0a 2d 2d 2d 2d 2d |mber 198|8..-----|
|00004680| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004690| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000046c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 0d 0a 41 62 73 |--------|-....Abs|
|000046d0| 74 72 61 63 74 0d 0a 0d | 0a 20 20 20 20 20 50 61 |tract...|. Pa|
|000046e0| 74 69 65 6e 74 73 20 69 | 6e 20 74 68 65 20 73 75 |tients i|n the su|
|000046f0| 72 67 69 63 61 6c 20 69 | 6e 74 65 6e 73 69 76 65 |rgical i|ntensive|
|00004700| 20 63 61 72 65 20 75 6e | 69 74 20 28 53 49 43 55 | care un|it (SICU|
|00004710| 29 20 61 72 65 20 61 74 | 20 68 69 67 68 20 72 69 |) are at| high ri|
|00004720| 73 6b 20 66 6f 72 0d 0a | 63 6f 6e 74 72 61 63 74 |sk for..|contract|
|00004730| 69 6e 67 20 6e 6f 73 6f | 63 6f 6d 69 61 6c 20 69 |ing noso|comial i|
|00004740| 6e 66 65 63 74 69 6f 6e | 73 2c 20 70 61 72 74 69 |nfection|s, parti|
|00004750| 63 75 6c 61 72 6c 79 20 | 70 6e 65 75 6d 6f 6e 69 |cularly |pneumoni|
|00004760| 61 2e 20 20 48 6f 77 65 | 76 65 72 2c 20 61 6e 0d |a. Howe|ver, an.|
|00004770| 0a 61 63 63 75 72 61 74 | 65 20 64 69 61 67 6e 6f |.accurat|e diagno|
|00004780| 73 69 73 20 6f 66 20 53 | 49 43 55 20 70 6e 65 75 |sis of S|ICU pneu|
|00004790| 6d 6f 6e 69 61 20 69 73 | 20 6f 66 74 65 6e 20 64 |monia is| often d|
|000047a0| 69 66 66 69 63 75 6c 74 | 20 61 6e 64 2c 20 63 6f |ifficult| and, co|
|000047b0| 6e 73 65 71 75 65 6e 74 | 6c 79 2c 20 73 6f 0d 0a |nsequent|ly, so..|
|000047c0| 69 73 20 74 68 65 72 61 | 70 79 2e 20 20 43 6c 69 |is thera|py. Cli|
|000047d0| 6e 69 63 61 6c 2c 20 72 | 61 64 69 6f 6c 6f 67 69 |nical, r|adiologi|
|000047e0| 63 2c 20 61 6e 64 20 6d | 69 63 72 6f 62 69 6f 6c |c, and m|icrobiol|
|000047f0| 6f 67 69 63 20 64 61 74 | 61 20 77 65 72 65 20 6f |ogic dat|a were o|
|00004800| 62 74 61 69 6e 65 64 20 | 66 6f 72 20 38 31 0d 0a |btained |for 81..|
|00004810| 70 61 74 69 65 6e 74 73 | 20 69 6e 20 74 68 65 20 |patients| in the |
|00004820| 53 49 43 55 20 77 69 74 | 68 20 73 70 75 74 75 6d |SICU wit|h sputum|
|00004830| 20 63 75 6c 74 75 72 65 | 73 20 63 6f 6e 74 61 69 | culture|s contai|
|00004840| 6e 69 6e 67 20 70 6f 74 | 65 6e 74 69 61 6c 20 70 |ning pot|ential p|
|00004850| 61 74 68 6f 67 65 6e 73 | 2e 20 20 41 6e 0d 0a 6f |athogens|. An..o|
|00004860| 62 6a 65 63 74 69 76 65 | 20 6e 75 6d 65 72 69 63 |bjective| numeric|
|00004870| 61 6c 20 72 61 74 69 6e | 67 20 73 79 73 74 65 6d |al ratin|g system|
|00004880| 20 77 61 73 20 64 65 73 | 69 67 6e 65 64 20 74 6f | was des|igned to|
|00004890| 20 61 73 73 65 73 73 20 | 74 68 65 20 70 72 65 73 | assess |the pres|
|000048a0| 65 6e 63 65 20 6f 72 0d | 0a 61 62 73 65 6e 63 65 |ence or.|.absence|
|000048b0| 20 6f 66 20 70 6e 65 75 | 6d 6f 6e 69 61 20 6f 6e | of pneu|monia on|
|000048c0| 20 63 68 65 73 74 20 78 | 2d 72 61 79 20 65 78 61 | chest x|-ray exa|
|000048d0| 6d 69 6e 61 74 69 6f 6e | 20 62 61 73 65 64 20 6f |mination| based o|
|000048e0| 6e 20 74 68 65 20 70 72 | 65 73 65 6e 63 65 20 6f |n the pr|esence o|
|000048f0| 66 20 6e 65 77 0d 0a 69 | 6e 66 69 6c 74 72 61 74 |f new..i|nfiltrat|
|00004900| 65 73 20 28 61 63 69 6e | 61 20 73 68 61 64 6f 77 |es (acin|a shadow|
|00004910| 73 2c 20 61 69 72 20 67 | 72 6f 6e 63 68 6f 67 72 |s, air g|ronchogr|
|00004920| 61 6d 73 2c 20 73 65 67 | 6d 65 6e 74 61 6c 20 69 |ams, seg|mental i|
|00004930| 6e 66 69 6c 74 72 61 74 | 65 73 29 20 69 6e 20 74 |nfiltrat|es) in t|
|00004940| 68 65 0d 0a 61 62 73 65 | 6e 63 65 20 6f 66 20 76 |he..abse|nce of v|
|00004950| 6f 6c 75 6d 65 20 6c 6f | 73 73 2c 20 63 61 72 64 |olume lo|ss, card|
|00004960| 69 6f 6d 65 67 61 6c 79 | 2c 20 6f 72 20 68 69 6c |iomegaly|, or hil|
|00004970| 61 72 20 65 6e 6c 61 72 | 67 65 6d 65 6e 74 2e 20 |ar enlar|gement. |
|00004980| 20 55 73 69 6e 67 20 74 | 68 65 20 73 79 73 74 65 | Using t|he syste|
|00004990| 6d 2c 0d 0a 33 39 20 70 | 61 74 69 65 6e 74 73 20 |m,..39 p|atients |
|000049a0| 77 65 72 65 20 61 73 73 | 69 67 6e 65 64 20 74 6f |were ass|igned to|
|000049b0| 20 74 68 65 20 73 69 6d | 70 6c 65 20 63 6f 6c 6f | the sim|ple colo|
|000049c0| 6e 69 7a 61 74 69 6f 6e | 20 67 72 6f 75 70 20 61 |nization| group a|
|000049d0| 6e 64 20 34 32 20 77 65 | 72 65 0d 0a 61 73 73 69 |nd 42 we|re..assi|
|000049e0| 67 6e 65 64 20 74 6f 20 | 74 68 65 20 70 6e 65 75 |gned to |the pneu|
|000049f0| 6d 6f 6e 69 61 20 67 72 | 6f 75 70 2e 0d 0a 20 20 |monia gr|oup... |
|00004a00| 20 20 20 52 65 73 70 69 | 72 61 74 6f 72 79 20 66 | Respi|ratory f|
|00004a10| 61 69 6c 75 72 65 73 20 | 70 72 65 63 65 64 69 6e |ailures |precedin|
|00004a20| 67 20 74 68 65 20 66 69 | 72 73 74 20 70 6f 73 69 |g the fi|rst posi|
|00004a30| 74 69 76 65 20 73 70 75 | 74 75 6d 20 63 75 6c 74 |tive spu|tum cult|
|00004a40| 75 72 65 20 61 6e 64 0d | 0a 68 65 70 61 74 69 63 |ure and.|.hepatic|
|00004a50| 20 6f 72 20 72 65 6e 61 | 6c 20 66 61 69 6c 75 72 | or rena|l failur|
|00004a60| 65 2c 20 6f 72 20 62 6f | 74 68 2c 20 77 65 72 65 |e, or bo|th, were|
|00004a70| 20 73 69 67 6e 69 66 69 | 63 61 6e 74 6c 79 20 6d | signifi|cantly m|
|00004a80| 6f 72 65 20 66 72 65 71 | 75 65 6e 74 20 69 6e 20 |ore freq|uent in |
|00004a90| 74 68 65 0d 0a 70 6e 65 | 75 6d 6f 6e 69 61 20 67 |the..pne|umonia g|
|00004aa0| 72 6f 75 70 2e 20 20 50 | 6f 6c 79 6d 69 63 72 6f |roup. P|olymicro|
|00004ab0| 62 69 61 6c 20 73 70 75 | 74 75 6d 20 69 73 6f 6c |bial spu|tum isol|
|00004ac0| 61 74 65 73 2c 20 45 73 | 63 68 65 72 69 63 68 69 |ates, Es|cherichi|
|00004ad0| 61 20 63 6f 6c 69 2c 20 | 61 6e 64 0d 0a 50 73 65 |a coli, |and..Pse|
|00004ae0| 75 64 6f 6d 6f 6e 61 73 | 20 77 65 72 65 20 6d 6f |udomonas| were mo|
|00004af0| 72 65 20 63 6f 6d 6d 6f | 6e 20 69 6e 20 74 68 65 |re commo|n in the|
|00004b00| 20 70 6e 65 75 6d 6f 6e | 69 61 20 67 72 6f 75 70 | pneumon|ia group|
|00004b10| 2c 20 77 68 65 72 65 61 | 73 20 43 61 6e 64 69 64 |, wherea|s Candid|
|00004b20| 61 20 77 61 73 20 6d 6f | 72 65 0d 0a 63 6f 6d 6d |a was mo|re..comm|
|00004b30| 6f 6e 20 69 6e 20 74 68 | 65 20 63 6f 6c 6f 6e 69 |on in th|e coloni|
|00004b40| 7a 61 74 69 6f 6e 20 67 | 72 6f 75 70 20 28 74 61 |zation g|roup (ta|
|00004b50| 62 6c 65 29 2e 20 20 53 | 70 75 74 75 6d 20 6f 72 |ble). S|putum or|
|00004b60| 67 61 6e 69 73 6d 73 20 | 77 65 72 65 20 66 6f 75 |ganisms |were fou|
|00004b70| 6e 64 20 6d 6f 72 65 0d | 0a 66 72 65 71 75 65 6e |nd more.|.frequen|
|00004b80| 74 6c 79 20 69 6e 20 74 | 68 65 20 62 6c 6f 6f 64 |tly in t|he blood|
|00004b90| 20 6f 72 20 70 6c 65 75 | 72 61 6c 20 63 75 6c 74 | or pleu|ral cult|
|00004ba0| 75 72 65 73 20 6f 66 20 | 70 61 74 69 65 6e 74 73 |ures of |patients|
|00004bb0| 20 77 69 74 68 20 70 6e | 65 75 6d 6f 6e 69 61 2e | with pn|eumonia.|
|00004bc0| 20 20 54 68 65 0d 0a 6f | 76 65 72 61 6c 6c 20 6d | The..o|verall m|
|00004bd0| 6f 72 74 61 6c 69 74 79 | 20 77 61 73 20 33 32 25 |ortality| was 32%|
|00004be0| 2e 20 20 42 72 6f 61 64 | 73 70 65 63 74 72 75 6d |. Broad|spectrum|
|00004bf0| 20 61 6e 74 69 62 69 6f | 74 69 63 20 74 68 65 72 | antibio|tic ther|
|00004c00| 61 70 79 20 64 69 72 65 | 63 74 65 64 20 61 74 20 |apy dire|cted at |
|00004c10| 61 6c 6c 0d 0a 73 70 75 | 74 75 6d 20 70 61 74 68 |all..spu|tum path|
|00004c20| 6f 67 65 6e 73 20 64 65 | 63 72 65 61 73 65 64 20 |ogens de|creased |
|00004c30| 6d 6f 72 74 61 6c 69 74 | 79 20 69 6e 20 74 68 65 |mortalit|y in the|
|00004c40| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 70 | patient|s with p|
|00004c50| 6e 65 75 6d 6f 6e 69 61 | 20 62 75 74 20 68 61 64 |neumonia| but had|
|00004c60| 20 6e 6f 0d 0a 65 66 66 | 65 63 74 20 6f 6e 20 6d | no..eff|ect on m|
|00004c70| 6f 72 74 61 6c 69 74 79 | 20 69 6e 20 74 68 65 20 |ortality| in the |
|00004c80| 63 6f 6c 6f 6e 69 7a 61 | 74 69 6f 6e 20 67 72 6f |coloniza|tion gro|
|00004c90| 75 70 2e 0d 0a 20 20 20 | 20 20 41 6e 20 6f 62 6a |up... | An obj|
|00004ca0| 65 63 74 69 76 65 20 6e | 75 6d 65 72 69 63 61 6c |ective n|umerical|
|00004cb0| 20 72 61 74 69 6e 67 20 | 73 79 73 74 65 6d 20 66 | rating |system f|
|00004cc0| 6f 72 20 63 68 65 73 74 | 20 78 2d 72 61 79 20 64 |or chest| x-ray d|
|00004cd0| 69 61 67 6e 6f 73 69 73 | 20 70 72 6f 76 69 64 65 |iagnosis| provide|
|00004ce0| 73 20 61 0d 0a 72 65 61 | 73 6f 6e 61 62 6c 65 20 |s a..rea|sonable |
|00004cf0| 6d 65 74 68 6f 64 20 66 | 6f 72 20 64 69 73 74 69 |method f|or disti|
|00004d00| 6e 67 75 69 73 68 69 6e | 67 20 70 61 74 69 65 6e |nguishin|g patien|
|00004d10| 74 73 20 77 69 74 68 20 | 70 6e 65 75 6d 6f 6e 69 |ts with |pneumoni|
|00004d20| 61 20 66 72 6f 6d 20 74 | 68 6f 73 65 20 77 68 6f |a from t|hose who|
|00004d30| 0d 0a 61 72 65 20 73 69 | 6d 70 6c 79 20 63 6f 6c |..are si|mply col|
|00004d40| 6f 6e 69 7a 65 64 20 77 | 69 74 68 20 70 6f 74 65 |onized w|ith pote|
|00004d50| 6e 74 69 61 6c 20 70 61 | 74 68 6f 67 65 6e 73 2e |ntial pa|thogens.|
|00004d60| 20 20 41 6e 74 69 62 69 | 6f 74 69 63 20 74 68 65 | Antibi|otic the|
|00004d70| 72 61 70 79 20 73 68 6f | 75 6c 64 20 62 65 0d 0a |rapy sho|uld be..|
|00004d80| 64 69 72 65 63 74 65 64 | 20 61 74 20 61 6c 6c 20 |directed| at all |
|00004d90| 73 70 75 74 75 6d 20 70 | 61 74 68 6f 67 65 6e 73 |sputum p|athogens|
|00004da0| 20 69 6e 20 53 49 43 55 | 20 70 61 74 69 65 6e 74 | in SICU| patient|
|00004db0| 73 2c 20 62 75 74 20 66 | 6f 72 20 73 75 63 68 20 |s, but f|or such |
|00004dc0| 74 68 65 72 61 70 79 20 | 74 6f 20 62 65 0d 0a 73 |therapy |to be..s|
|00004dd0| 75 63 63 65 73 73 66 75 | 6c 2c 20 64 69 61 67 6e |uccessfu|l, diagn|
|00004de0| 6f 73 74 69 63 20 63 72 | 69 74 65 72 69 61 20 6d |ostic cr|iteria m|
|00004df0| 75 73 74 20 62 65 20 70 | 72 65 63 69 73 65 20 61 |ust be p|recise a|
|00004e00| 6e 64 20 65 78 63 6c 75 | 64 65 20 63 6f 6c 6f 6e |nd exclu|de colon|
|00004e10| 69 7a 65 64 0d 0a 70 61 | 74 69 65 6e 74 73 2e 0d |ized..pa|tients..|
|00004e20| 0a 0d 0a 50 6f 73 74 2d | 43 6f 6d 6d 65 6e 74 0d |...Post-|Comment.|
|00004e30| 0a 0d 0a 20 20 20 20 20 | 48 6f 73 70 69 74 61 6c |... |Hospital|
|00004e40| 2d 61 63 71 75 69 72 65 | 64 20 70 6e 65 75 6d 6f |-acquire|d pneumo|
|00004e50| 6e 69 61 20 69 73 20 74 | 68 65 20 6d 6f 73 74 20 |nia is t|he most |
|00004e60| 63 6f 6d 6d 6f 6e 20 6e | 6f 73 6f 63 6f 6d 69 61 |common n|osocomia|
|00004e70| 6c 20 69 6e 66 65 63 74 | 69 6f 6e 0d 0a 6c 65 61 |l infect|ion..lea|
|00004e80| 64 69 6e 67 20 74 6f 20 | 64 65 61 74 68 2e 20 20 |ding to |death. |
|00004e90| 42 75 74 2c 20 61 73 20 | 70 6f 69 6e 74 65 64 20 |But, as |pointed |
|00004ea0| 6f 75 74 20 62 79 20 74 | 68 69 73 20 52 68 6f 64 |out by t|his Rhod|
|00004eb0| 65 20 49 73 6c 61 6e 64 | 20 67 72 6f 75 70 2c 20 |e Island| group, |
|00004ec0| 70 6e 65 75 6d 6f 6e 69 | 61 0d 0a 69 73 20 74 6f |pneumoni|a..is to|
|00004ed0| 75 67 68 20 74 6f 20 64 | 69 61 67 6e 6f 73 65 20 |ugh to d|iagnose |
|00004ee0| 69 6e 20 73 69 63 6b 20 | 73 75 72 67 69 63 61 6c |in sick |surgical|
|00004ef0| 20 70 61 74 69 65 6e 74 | 73 20 69 6e 20 69 6e 74 | patient|s in int|
|00004f00| 65 6e 73 69 76 65 20 63 | 61 72 65 20 75 6e 69 74 |ensive c|are unit|
|00004f10| 73 2e 0d 0a 43 6c 69 6e | 69 63 61 6c 20 73 69 67 |s...Clin|ical sig|
|00004f20| 6e 73 20 6f 66 20 66 65 | 76 65 72 20 61 6e 64 20 |ns of fe|ver and |
|00004f30| 6c 65 75 6b 6f 63 79 74 | 6f 73 69 73 20 6d 61 79 |leukocyt|osis may|
|00004f40| 20 61 6c 72 65 61 64 79 | 20 62 65 20 70 72 65 73 | already| be pres|
|00004f50| 65 6e 74 2e 20 20 50 75 | 6c 6d 6f 6e 61 72 79 0d |ent. Pu|lmonary.|
|00004f60| 0a 69 6e 66 69 6c 74 72 | 61 74 65 73 20 6d 61 79 |.infiltr|ates may|
|00004f70| 20 62 65 20 63 61 75 73 | 65 64 20 62 79 20 61 74 | be caus|ed by at|
|00004f80| 65 6c 65 63 74 61 73 69 | 73 2c 20 70 75 6c 6d 6f |electasi|s, pulmo|
|00004f90| 6e 61 72 79 20 65 64 65 | 6d 61 2c 20 70 75 6c 6d |nary ede|ma, pulm|
|00004fa0| 6f 6e 61 72 79 0d 0a 63 | 6f 6e 74 75 73 69 6f 6e |onary..c|ontusion|
|00004fb0| 2c 20 61 6e 64 20 74 68 | 65 20 6c 69 6b 65 2e 20 |, and th|e like. |
|00004fc0| 20 46 75 72 74 68 65 72 | 2c 20 73 70 75 74 75 6d | Further|, sputum|
|00004fd0| 20 63 75 6c 74 75 72 65 | 73 20 69 6e 20 74 68 65 | culture|s in the|
|00004fe0| 73 65 20 70 61 74 69 65 | 6e 74 73 2c 20 77 68 6f |se patie|nts, who|
|00004ff0| 20 61 72 65 0d 0a 6f 66 | 74 65 6e 20 61 6c 72 65 | are..of|ten alre|
|00005000| 61 64 79 20 62 65 69 6e | 67 20 74 72 65 61 74 65 |ady bein|g treate|
|00005010| 64 20 77 69 74 68 20 61 | 6e 74 69 6d 69 63 72 6f |d with a|ntimicro|
|00005020| 62 69 61 6c 73 2c 20 61 | 72 65 6e 27 74 20 74 68 |bials, a|ren't th|
|00005030| 61 74 20 68 65 6c 70 66 | 75 6c 2e 0d 0a 20 20 20 |at helpf|ul... |
|00005040| 20 20 55 73 69 6e 67 20 | 67 72 6f 75 6e 64 20 72 | Using |ground r|
|00005050| 75 6c 65 73 20 66 6f 72 | 20 64 69 61 67 6e 6f 73 |ules for| diagnos|
|00005060| 69 6e 67 20 70 6e 65 75 | 6d 6f 6e 69 61 20 6f 6e |ing pneu|monia on|
|00005070| 20 63 68 65 73 74 20 78 | 2d 72 61 79 20 66 69 6c | chest x|-ray fil|
|00005080| 6d 73 20 28 74 68 61 74 | 20 74 6f 0d 0a 6d 65 20 |ms (that| to..me |
|00005090| 73 65 65 6d 65 64 20 74 | 6f 20 62 65 20 6f 6e 65 |seemed t|o be one|
|000050a0| 73 20 6d 6f 73 74 20 6f | 66 20 75 73 20 69 6e 74 |s most o|f us int|
|000050b0| 65 72 6e 69 73 74 73 20 | 68 61 76 65 20 75 73 65 |ernists |have use|
|000050c0| 64 20 66 6f 72 20 79 65 | 61 72 73 29 20 74 68 65 |d for ye|ars) the|
|000050d0| 20 61 75 74 68 6f 72 73 | 0d 0a 66 6f 75 6e 64 20 | authors|..found |
|000050e0| 74 68 61 74 20 73 70 65 | 63 69 66 69 63 20 61 6e |that spe|cific an|
|000050f0| 74 69 6d 69 63 72 6f 62 | 69 61 6c 20 74 72 65 61 |timicrob|ial trea|
|00005100| 74 6d 65 6e 74 20 64 69 | 72 65 63 74 65 64 20 61 |tment di|rected a|
|00005110| 74 20 74 68 65 20 70 61 | 74 68 6f 67 65 6e 73 20 |t the pa|thogens |
|00005120| 69 73 6f 6c 61 74 65 64 | 0d 0a 72 65 64 75 63 65 |isolated|..reduce|
|00005130| 64 20 6d 6f 72 74 61 6c | 69 74 79 20 69 6e 20 74 |d mortal|ity in t|
|00005140| 68 65 20 22 70 6e 65 75 | 6d 6f 6e 69 61 22 20 67 |he "pneu|monia" g|
|00005150| 72 6f 75 70 2c 20 62 75 | 74 20 6e 6f 74 20 73 6f |roup, bu|t not so|
|00005160| 20 69 6e 20 74 68 6f 73 | 65 20 77 68 6f 20 61 70 | in thos|e who ap|
|00005170| 70 65 61 72 65 64 0d 0a | 74 6f 20 62 65 20 73 69 |peared..|to be si|
|00005180| 6d 70 6c 79 20 22 63 6f | 6c 6f 6e 69 7a 65 64 22 |mply "co|lonized"|
|00005190| 20 77 69 74 68 20 70 6f | 74 65 6e 74 69 61 6c 20 | with po|tential |
|000051a0| 70 61 74 68 6f 67 65 6e | 73 2e 20 20 47 6f 6f 64 |pathogen|s. Good|
|000051b0| 2e 20 20 4d 61 6b 65 73 | 20 73 65 6e 73 65 20 74 |. Makes| sense t|
|000051c0| 6f 20 6d 65 2e 0d 0a 44 | 6f 63 74 6f 72 73 20 73 |o me...D|octors s|
|000051d0| 68 6f 75 6c 64 20 73 74 | 69 6c 6c 20 6c 6f 6f 6b |hould st|ill look|
|000051e0| 20 61 74 20 74 68 65 69 | 72 20 6f 77 6e 20 78 2d | at thei|r own x-|
|000051f0| 72 61 79 73 20 61 6e 64 | 20 6b 6e 6f 77 20 77 68 |rays and| know wh|
|00005200| 61 74 20 70 6e 65 75 6d | 6f 6e 69 61 20 6c 6f 6f |at pneum|onia loo|
|00005210| 6b 73 0d 0a 6c 69 6b 65 | 20 6f 6e 20 74 68 65 6d |ks..like| on them|
|00005220| 21 2d 2d 44 2e 45 2e 20 | 52 6f 67 65 72 73 2c 20 |!--D.E. |Rogers, |
|00005230| 4d 2e 44 2e 0d 0a 24 55 | 6e 69 71 75 65 5f 49 44 |M.D...$U|nique_ID|
|00005240| 7b 59 52 42 31 31 30 30 | 35 7d 0d 0a 24 54 69 74 |{YRB1100|5}..$Tit|
|00005250| 6c 65 7b 4f 6e 63 65 2d | 44 61 69 6c 79 20 49 72 |le{Once-|Daily Ir|
|00005260| 72 69 67 61 74 69 6f 6e | 20 6f 66 20 4c 6f 6e 67 |rigation| of Long|
|00005270| 2d 54 65 72 6d 20 55 72 | 65 74 68 72 61 6c 20 43 |-Term Ur|ethral C|
|00005280| 61 74 68 65 74 65 72 73 | 20 57 69 74 68 20 4e 6f |atheters| With No|
|00005290| 72 6d 61 6c 20 53 61 6c | 69 6e 65 3a 20 20 4c 61 |rmal Sal|ine: La|
|000052a0| 63 6b 20 6f 66 20 42 65 | 6e 65 66 69 74 7d 0d 0a |ck of Be|nefit}..|
|000052b0| 24 41 75 74 68 6f 72 7b | 4d 75 6e 63 69 65 2c 20 |$Author{|Muncie, |
|000052c0| 48 4c 20 4a 72 0d 0a 48 | 6f 6f 70 65 73 2c 20 4a |HL Jr..H|oopes, J|
|000052d0| 4d 0d 0a 44 61 6d 72 6f | 6e 2c 20 44 4a 0d 0a 54 |M..Damro|n, DJ..T|
|000052e0| 65 6e 6e 65 79 2c 20 4a | 48 0d 0a 57 61 72 72 65 |enney, J|H..Warre|
|000052f0| 6e 2c 20 4a 57 7d 0d 0a | 24 41 66 66 69 6c 69 61 |n, JW}..|$Affilia|
|00005300| 74 69 6f 6e 7b 55 6e 69 | 76 20 6f 66 20 4d 61 72 |tion{Uni|v of Mar|
|00005310| 79 6c 61 6e 64 7d 0d 0a | 24 4a 6f 75 72 6e 61 6c |yland}..|$Journal|
|00005320| 7b 41 72 63 68 20 49 6e | 74 65 72 6e 20 4d 65 64 |{Arch In|tern Med|
|00005330| 7d 0d 0a 24 56 6f 6c 75 | 6d 65 7b 31 34 39 7d 0d |}..$Volu|me{149}.|
|00005340| 0a 24 50 61 67 65 7b 34 | 34 31 2d 34 34 33 7d 0d |.$Page{4|41-443}.|
|00005350| 0a 24 44 61 74 65 7b 46 | 65 62 72 75 61 72 79 20 |.$Date{F|ebruary |
|00005360| 31 39 38 39 7d 0d 0a 24 | 59 42 56 6f 6c 7b 31 39 |1989}..$|YBVol{19|
|00005370| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|00005380| 4d 65 64 69 63 69 6e 65 | 7d 0d 0a 24 43 68 61 70 |Medicine|}..$Chap|
|00005390| 74 65 72 7b 33 2d 35 7d | 0d 0a 24 59 42 45 64 69 |ter{3-5}|..$YBEdi|
|000053a0| 74 6f 72 7b 44 72 73 2e | 20 52 6f 67 65 72 73 2c |tor{Drs.| Rogers,|
|000053b0| 20 44 65 73 20 50 72 65 | 7a 2c 20 43 6c 69 6e 65 | Des Pre|z, Cline|
|000053c0| 2c 20 42 72 61 75 6e 77 | 61 6c 64 2c 20 47 72 65 |, Braunw|ald, Gre|
|000053d0| 65 6e 62 65 72 67 65 72 | 2c 20 57 69 6c 73 6f 6e |enberger|, Wilson|
|000053e0| 2c 20 45 70 73 74 65 69 | 6e 2c 20 61 6e 64 20 4d |, Epstei|n, and M|
|000053f0| 61 6c 61 77 69 73 74 61 | 7d 0d 0a 24 54 61 62 6c |alawista|}..$Tabl|
|00005400| 65 7b 54 61 62 6c 65 20 | 4f 6d 69 74 74 65 64 7d |e{Table |Omitted}|
|00005410| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 44 |..$Comme|ntator{D|
|00005420| 2e 45 2e 20 52 6f 67 65 | 72 73 2c 20 4d 2e 44 2e |.E. Roge|rs, M.D.|
|00005430| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00005440| 63 29 20 59 65 61 72 62 | 6f 6f 6b 20 4d 65 64 69 |c) Yearb|ook Medi|
|00005450| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00005460| 49 6e 63 2e 2c 20 31 39 | 39 30 0d 0a 0d 0a 31 39 |Inc., 19|90....19|
|00005470| 39 30 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |90 Year |Book of |
|00005480| 4d 65 64 69 63 69 6e 65 | 20 28 52 29 0d 0a 0d 0a |Medicine| (R)....|
|00005490| 50 61 72 74 20 4f 6e 65 | 2d 2d 49 6e 66 65 63 74 |Part One|--Infect|
|000054a0| 69 6f 75 73 20 44 69 73 | 65 61 73 65 73 0d 0a 0d |ious Dis|eases...|
|000054b0| 0a 43 68 61 70 74 65 72 | 20 33 2d 2d 4e 6f 73 6f |.Chapter| 3--Noso|
|000054c0| 63 6f 6d 69 61 6c 20 49 | 6e 66 65 63 74 69 6f 6e |comial I|nfection|
|000054d0| 73 0d 0a 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |s....---|--------|
|000054e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000054f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005500| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005510| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005520| 2d 2d 2d 0d 0a 4f 6e 63 | 65 2d 44 61 69 6c 79 20 |---..Onc|e-Daily |
|00005530| 49 72 72 69 67 61 74 69 | 6f 6e 20 6f 66 20 4c 6f |Irrigati|on of Lo|
|00005540| 6e 67 2d 54 65 72 6d 20 | 55 72 65 74 68 72 61 6c |ng-Term |Urethral|
|00005550| 20 43 61 74 68 65 74 65 | 72 73 20 57 69 74 68 20 | Cathete|rs With |
|00005560| 4e 6f 72 6d 61 6c 20 53 | 61 6c 69 6e 65 3a 0d 0a |Normal S|aline:..|
|00005570| 4c 61 63 6b 20 6f 66 20 | 42 65 6e 65 66 69 74 0d |Lack of |Benefit.|
|00005580| 0a 0d 0a 4d 75 6e 63 69 | 65 20 48 4c 20 4a 72 3b |...Munci|e HL Jr;|
|00005590| 20 48 6f 6f 70 65 73 20 | 4a 4d 3b 20 44 61 6d 72 | Hoopes |JM; Damr|
|000055a0| 6f 6e 20 44 4a 3b 20 54 | 65 6e 6e 65 79 20 4a 48 |on DJ; T|enney JH|
|000055b0| 3b 20 57 61 72 72 65 6e | 20 4a 57 0d 0a 28 55 6e |; Warren| JW..(Un|
|000055c0| 69 76 20 6f 66 20 4d 61 | 72 79 6c 61 6e 64 29 0d |iv of Ma|ryland).|
|000055d0| 0a 41 72 63 68 20 49 6e | 74 65 72 6e 20 4d 65 64 |.Arch In|tern Med|
|000055e0| 20 31 34 39 3a 34 34 31 | 2d 34 34 33 2c 20 46 65 | 149:441|-443, Fe|
|000055f0| 62 72 75 61 72 79 20 31 | 39 38 39 0d 0a 2d 2d 2d |bruary 1|989..---|
|00005600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005630| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005640| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 0d 0a 50 |--------|---....P|
|00005650| 72 65 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |re-Comme|nt.... |
|00005660| 20 20 20 53 6f 6d 65 20 | 69 64 65 61 73 20 68 61 | Some |ideas ha|
|00005670| 76 65 20 73 75 63 68 20 | 61 20 73 74 72 6f 6e 67 |ve such |a strong|
|00005680| 20 69 6e 74 72 69 6e 73 | 69 63 20 61 70 70 65 61 | intrins|ic appea|
|00005690| 6c 20 74 68 61 74 20 70 | 65 6f 70 6c 65 20 61 72 |l that p|eople ar|
|000056a0| 65 20 6c 6f 61 74 68 65 | 20 74 6f 0d 0a 67 69 76 |e loathe| to..giv|
|000056b0| 65 20 74 68 65 6d 20 75 | 70 2c 20 65 76 65 6e 20 |e them u|p, even |
|000056c0| 77 68 65 6e 20 64 61 74 | 61 20 74 6f 20 74 68 65 |when dat|a to the|
|000056d0| 20 63 6f 6e 74 72 61 72 | 79 20 61 72 65 20 61 76 | contrar|y are av|
|000056e0| 61 69 6c 61 62 6c 65 2e | 20 20 55 72 69 6e 61 72 |ailable.| Urinar|
|000056f0| 79 20 63 61 74 68 65 74 | 65 72 0d 0a 69 72 72 69 |y cathet|er..irri|
|00005700| 67 61 74 69 6f 6e 20 73 | 65 65 6d 73 20 74 6f 20 |gation s|eems to |
|00005710| 62 65 20 6f 6e 65 20 6f | 66 20 74 68 65 73 65 20 |be one o|f these |
|00005720| 70 65 72 73 69 73 74 65 | 6e 74 20 69 64 65 61 73 |persiste|nt ideas|
|00005730| 2e 20 20 52 65 67 75 6c | 61 72 20 73 61 6c 69 6e |. Regul|ar salin|
|00005740| 65 0d 0a 69 72 72 69 67 | 61 74 69 6f 6e 20 77 6f |e..irrig|ation wo|
|00005750| 75 6c 64 20 73 65 65 6d | 20 74 6f 20 22 63 6c 65 |uld seem| to "cle|
|00005760| 61 6e 22 20 74 68 65 20 | 63 61 74 68 65 74 65 72 |an" the |catheter|
|00005770| 2c 20 77 61 73 68 69 6e | 67 20 6f 75 74 20 62 61 |, washin|g out ba|
|00005780| 63 74 65 72 69 61 2c 0d | 0a 65 6e 63 72 75 73 74 |cteria,.|.encrust|
|00005790| 61 74 69 6f 6e 73 2c 20 | 61 6e 64 20 74 68 65 20 |ations, |and the |
|000057a0| 6c 69 6b 65 2e 20 20 54 | 68 65 20 6e 6f 74 69 6f |like. T|he notio|
|000057b0| 6e 20 77 61 73 20 73 6f | 20 69 6e 74 75 69 74 69 |n was so| intuiti|
|000057c0| 76 65 6c 79 20 61 70 70 | 65 61 6c 69 6e 67 20 74 |vely app|ealing t|
|000057d0| 68 61 74 0d 0a 73 6f 6d | 65 20 79 65 61 72 73 20 |hat..som|e years |
|000057e0| 61 67 6f 20 6d 61 6e 79 | 20 73 68 6f 72 74 2d 74 |ago many| short-t|
|000057f0| 65 72 6d 20 75 72 69 6e | 61 72 79 20 63 61 74 68 |erm urin|ary cath|
|00005800| 65 74 65 72 73 20 77 65 | 72 65 20 69 72 72 69 67 |eters we|re irrig|
|00005810| 61 74 65 64 20 72 6f 75 | 74 69 6e 65 6c 79 2e 0d |ated rou|tinely..|
|00005820| 0a 20 20 20 20 20 4f 66 | 20 63 6f 75 72 73 65 2c |. Of| course,|
|00005830| 20 74 68 65 20 66 61 63 | 74 73 20 61 72 65 20 6a | the fac|ts are j|
|00005840| 75 73 74 20 74 68 65 20 | 6f 70 70 6f 73 69 74 65 |ust the |opposite|
|00005850| 2e 20 20 43 6c 6f 73 65 | 64 20 75 72 69 6e 61 72 |. Close|d urinar|
|00005860| 79 20 64 72 61 69 6e 61 | 67 65 0d 0a 73 79 73 74 |y draina|ge..syst|
|00005870| 65 6d 73 20 77 65 72 65 | 20 73 68 6f 77 6e 20 74 |ems were| shown t|
|00005880| 6f 20 68 61 76 65 20 61 | 20 6d 75 63 68 20 72 65 |o have a| much re|
|00005890| 64 75 63 65 64 20 61 73 | 73 6f 63 69 61 74 69 6f |duced as|sociatio|
|000058a0| 6e 20 77 69 74 68 20 69 | 6e 66 65 63 74 69 6f 6e |n with i|nfection|
|000058b0| 20 61 6e 64 20 6f 74 68 | 65 72 0d 0a 63 6f 6d 70 | and oth|er..comp|
|000058c0| 6c 69 63 61 74 69 6f 6e | 73 20 74 68 61 6e 20 77 |lication|s than w|
|000058d0| 65 72 65 20 74 68 65 20 | 6f 70 65 6e 2c 20 69 72 |ere the |open, ir|
|000058e0| 72 69 67 61 74 65 64 20 | 73 79 73 74 65 6d 73 2e |rigated |systems.|
|000058f0| 20 20 49 74 20 73 65 65 | 6d 73 20 74 68 61 74 20 | It see|ms that |
|00005900| 74 68 65 20 6d 6f 72 65 | 0d 0a 6f 6e 65 20 6d 65 |the more|..one me|
|00005910| 64 64 6c 65 73 20 77 69 | 74 68 20 74 68 65 20 63 |ddles wi|th the c|
|00005920| 61 74 68 65 74 65 72 20 | 73 79 73 74 65 6d 2c 20 |atheter |system, |
|00005930| 74 68 65 20 6d 6f 72 65 | 20 61 70 74 20 69 74 20 |the more| apt it |
|00005940| 69 73 20 74 6f 20 62 65 | 63 6f 6d 65 20 69 6e 66 |is to be|come inf|
|00005950| 65 63 74 65 64 2e 0d 0a | 54 68 65 20 69 72 72 69 |ected...|The irri|
|00005960| 67 61 74 69 6f 6e 20 70 | 72 6f 63 65 73 73 20 69 |gation p|rocess i|
|00005970| 72 72 69 74 61 74 65 73 | 20 74 68 65 20 75 72 65 |rritates| the ure|
|00005980| 74 68 72 61 6c 20 6d 75 | 63 6f 73 61 2c 20 61 6e |thral mu|cosa, an|
|00005990| 64 20 74 68 65 20 69 72 | 72 69 67 61 74 69 6f 6e |d the ir|rigation|
|000059a0| 20 66 6c 75 69 64 0d 0a | 61 63 74 75 61 6c 6c 79 | fluid..|actually|
|000059b0| 20 66 6c 75 73 68 65 73 | 20 62 61 63 74 65 72 69 | flushes| bacteri|
|000059c0| 61 20 69 6e 74 6f 20 74 | 68 65 20 62 6c 61 64 64 |a into t|he bladd|
|000059d0| 65 72 2e 0d 0a 20 20 20 | 20 20 41 73 20 61 20 63 |er... | As a c|
|000059e0| 6f 6e 73 65 71 75 65 6e | 63 65 20 6f 66 20 74 68 |onsequen|ce of th|
|000059f0| 65 73 65 20 73 74 75 64 | 69 65 73 20 61 6e 64 20 |ese stud|ies and |
|00005a00| 6d 75 63 68 20 65 64 75 | 63 61 74 69 6f 6e 20 6f |much edu|cation o|
|00005a10| 66 20 6e 75 72 73 65 73 | 20 61 6e 64 0d 0a 64 6f |f nurses| and..do|
|00005a20| 63 74 6f 72 73 2c 20 74 | 68 65 20 70 72 61 63 74 |ctors, t|he pract|
|00005a30| 69 63 65 20 6f 66 20 63 | 61 74 68 65 74 65 72 20 |ice of c|atheter |
|00005a40| 69 72 72 69 67 61 74 69 | 6f 6e 20 73 6c 6f 77 6c |irrigati|on slowl|
|00005a50| 79 20 64 69 73 61 70 70 | 65 61 72 65 64 20 66 72 |y disapp|eared fr|
|00005a60| 6f 6d 20 74 68 65 20 77 | 61 72 64 73 0d 0a 6f 66 |om the w|ards..of|
|00005a70| 20 61 63 75 74 65 20 63 | 61 72 65 20 68 6f 73 70 | acute c|are hosp|
|00005a80| 69 74 61 6c 73 2e 20 20 | 42 75 74 20 77 65 20 68 |itals. |But we h|
|00005a90| 61 76 65 20 64 69 73 63 | 6f 76 65 72 65 64 20 74 |ave disc|overed t|
|00005aa0| 68 61 74 20 74 68 69 73 | 20 70 72 61 63 74 69 63 |hat this| practic|
|00005ab0| 65 20 70 65 72 73 69 73 | 74 73 0d 0a 69 6e 20 65 |e persis|ts..in e|
|00005ac0| 78 74 65 6e 64 65 64 20 | 63 61 72 65 20 66 61 63 |xtended |care fac|
|00005ad0| 69 6c 69 74 69 65 73 20 | 61 6e 64 20 6e 75 72 73 |ilities |and nurs|
|00005ae0| 69 6e 67 20 68 6f 6d 65 | 73 2e 20 20 49 74 20 69 |ing home|s. It i|
|00005af0| 73 20 61 72 67 75 65 64 | 20 74 68 61 74 20 6c 6f |s argued| that lo|
|00005b00| 6e 67 2d 74 65 72 6d 0d | 0a 63 61 74 68 65 74 65 |ng-term.|.cathete|
|00005b10| 72 69 7a 61 74 69 6f 6e | 20 70 72 65 73 65 6e 74 |rization| present|
|00005b20| 73 20 61 20 64 69 66 66 | 65 72 65 6e 74 20 73 65 |s a diff|erent se|
|00005b30| 74 20 6f 66 20 69 73 73 | 75 65 73 20 74 68 61 6e |t of iss|ues than|
|00005b40| 20 64 6f 65 73 20 73 68 | 6f 72 74 2d 74 65 72 6d | does sh|ort-term|
|00005b50| 20 46 6f 6c 65 79 0d 0a | 63 61 74 68 65 74 65 72 | Foley..|catheter|
|00005b60| 20 75 73 65 2e 20 20 46 | 6f 72 20 65 78 61 6d 70 | use. F|or examp|
|00005b70| 6c 65 2c 20 76 69 72 74 | 75 61 6c 6c 79 20 65 76 |le, virt|ually ev|
|00005b80| 65 72 79 20 70 61 74 69 | 65 6e 74 20 69 73 20 61 |ery pati|ent is a|
|00005b90| 6c 72 65 61 64 79 20 69 | 6e 66 65 63 74 65 64 2c |lready i|nfected,|
|00005ba0| 20 6f 66 74 65 6e 0d 0a | 77 69 74 68 20 6d 6f 72 | often..|with mor|
|00005bb0| 65 20 74 68 61 6e 20 31 | 20 62 61 63 74 65 72 69 |e than 1| bacteri|
|00005bc0| 61 6c 20 73 70 65 63 69 | 65 73 2e 0d 0a 20 20 20 |al speci|es... |
|00005bd0| 20 20 43 6c 65 61 72 6c | 79 2c 20 74 68 65 20 69 | Clearl|y, the i|
|00005be0| 73 73 75 65 20 68 61 64 | 20 74 6f 20 62 65 20 61 |ssue had| to be a|
|00005bf0| 64 64 72 65 73 73 65 64 | 20 69 6e 20 74 68 69 73 |ddressed| in this|
|00005c00| 20 73 70 65 63 69 61 6c | 20 70 61 74 69 65 6e 74 | special| patient|
|00005c10| 0d 0a 70 6f 70 75 6c 61 | 74 69 6f 6e 2e 20 20 54 |..popula|tion. T|
|00005c20| 68 65 20 66 6f 6c 6c 6f | 77 69 6e 67 20 70 61 70 |he follo|wing pap|
|00005c30| 65 72 20 70 72 65 73 65 | 6e 74 73 20 74 68 65 20 |er prese|nts the |
|00005c40| 72 65 73 75 6c 74 73 20 | 6f 66 20 73 75 63 68 20 |results |of such |
|00005c50| 61 6e 0d 0a 69 6e 76 65 | 73 74 69 67 61 74 69 6f |an..inve|stigatio|
|00005c60| 6e 2e 2d 2d 44 2e 45 2e | 20 52 6f 67 65 72 73 2c |n.--D.E.| Rogers,|
|00005c70| 20 4d 2e 44 2e 0d 0a 0d | 0a 41 62 73 74 72 61 63 | M.D....|.Abstrac|
|00005c80| 74 0d 0a 0d 0a 20 20 20 | 20 20 4c 6f 6e 67 2d 74 |t.... | Long-t|
|00005c90| 65 72 6d 20 69 6e 64 77 | 65 6c 6c 69 6e 67 20 75 |erm indw|elling u|
|00005ca0| 72 65 74 68 72 61 6c 20 | 63 61 74 68 65 74 65 72 |rethral |catheter|
|00005cb0| 69 7a 61 74 69 6f 6e 20 | 6f 66 74 65 6e 20 72 65 |ization |often re|
|00005cc0| 73 75 6c 74 73 20 69 6e | 0d 0a 63 6f 6d 70 6c 69 |sults in|..compli|
|00005cd0| 63 61 74 69 6f 6e 73 20 | 73 75 63 68 20 61 73 20 |cations |such as |
|00005ce0| 62 61 63 74 65 72 69 75 | 72 69 61 2c 20 63 61 74 |bacteriu|ria, cat|
|00005cf0| 68 65 74 65 72 20 6f 62 | 73 74 72 75 63 74 69 6f |heter ob|structio|
|00005d00| 6e 20 6f 72 20 6c 65 61 | 6b 61 67 65 2c 20 61 6e |n or lea|kage, an|
|00005d10| 64 20 66 65 76 65 72 2e | 0d 0a 49 74 20 69 73 20 |d fever.|..It is |
|00005d20| 77 69 64 65 6c 79 20 74 | 68 6f 75 67 68 74 20 74 |widely t|hought t|
|00005d30| 68 61 74 20 70 65 72 69 | 6f 64 69 63 20 69 72 72 |hat peri|odic irr|
|00005d40| 69 67 61 74 69 6f 6e 20 | 6f 66 20 74 68 65 20 63 |igation |of the c|
|00005d50| 61 74 68 65 74 65 72 20 | 77 69 6c 6c 20 72 65 64 |atheter |will red|
|00005d60| 75 63 65 0d 0a 74 68 65 | 73 65 20 73 65 71 75 65 |uce..the|se seque|
|00005d70| 6c 61 65 2e 0d 0a 20 20 | 20 20 20 54 6f 20 65 76 |lae... | To ev|
|00005d80| 61 6c 75 61 74 65 20 74 | 68 69 73 20 74 65 63 68 |aluate t|his tech|
|00005d90| 6e 69 71 75 65 2c 20 31 | 30 20 77 65 65 6b 73 20 |nique, 1|0 weeks |
|00005da0| 6f 66 20 6f 6e 63 65 2d | 64 61 69 6c 79 20 6e 6f |of once-|daily no|
|00005db0| 72 6d 61 6c 20 73 61 6c | 69 6e 65 0d 0a 69 72 72 |rmal sal|ine..irr|
|00005dc0| 69 67 61 74 69 6f 6e 20 | 77 61 73 20 63 6f 6d 70 |igation |was comp|
|00005dd0| 61 72 65 64 20 77 69 74 | 68 20 31 30 20 77 65 65 |ared wit|h 10 wee|
|00005de0| 6b 73 20 6f 66 20 6e 6f | 20 69 72 72 69 67 61 74 |ks of no| irrigat|
|00005df0| 69 6f 6e 20 69 6e 20 61 | 20 72 61 6e 64 6f 6d 69 |ion in a| randomi|
|00005e00| 7a 65 64 0d 0a 63 72 6f | 73 73 6f 76 65 72 20 73 |zed..cro|ssover s|
|00005e10| 74 75 64 79 20 6f 66 20 | 77 6f 6d 65 6e 20 77 69 |tudy of |women wi|
|00005e20| 74 68 20 6c 6f 6e 67 2d | 74 65 72 6d 20 63 61 74 |th long-|term cat|
|00005e30| 68 65 74 65 72 69 7a 61 | 74 69 6f 6e 2e 20 20 45 |heteriza|tion. E|
|00005e40| 61 63 68 20 70 61 74 69 | 65 6e 74 20 65 6e 74 65 |ach pati|ent ente|
|00005e50| 72 65 64 0d 0a 61 20 32 | 2d 77 65 65 6b 20 22 72 |red..a 2|-week "r|
|00005e60| 75 6e 2d 69 6e 22 20 70 | 65 72 69 6f 64 20 6f 66 |un-in" p|eriod of|
|00005e70| 20 6e 6f 6e 69 72 72 69 | 67 61 74 69 6f 6e 20 64 | nonirri|gation d|
|00005e80| 75 72 69 6e 67 20 77 68 | 69 63 68 20 62 61 63 74 |uring wh|ich bact|
|00005e90| 65 72 69 61 6c 20 73 74 | 75 64 69 65 73 20 77 65 |erial st|udies we|
|00005ea0| 72 65 0d 0a 62 65 67 75 | 6e 2e 20 20 54 68 65 72 |re..begu|n. Ther|
|00005eb0| 65 20 77 61 73 20 61 20 | 32 2d 77 65 65 6b 20 77 |e was a |2-week w|
|00005ec0| 61 73 68 6f 75 74 20 70 | 65 72 69 6f 64 20 6f 66 |ashout p|eriod of|
|00005ed0| 20 6e 6f 6e 69 72 72 69 | 67 61 74 69 6f 6e 20 62 | nonirri|gation b|
|00005ee0| 65 74 77 65 65 6e 20 70 | 68 61 73 65 73 20 6f 66 |etween p|hases of|
|00005ef0| 0d 0a 74 68 65 20 74 72 | 69 61 6c 2e 20 20 43 6f |..the tr|ial. Co|
|00005f00| 6d 70 61 72 69 73 6f 6e | 73 20 6f 66 20 74 68 65 |mparison|s of the|
|00005f10| 20 69 6e 63 69 64 65 6e | 63 65 20 6f 66 20 65 70 | inciden|ce of ep|
|00005f20| 69 73 6f 64 65 73 20 6f | 66 20 66 65 76 65 72 2c |isodes o|f fever,|
|00005f30| 20 72 65 70 6c 61 63 65 | 6d 65 6e 74 73 20 6f 66 | replace|ments of|
|00005f40| 0d 0a 74 68 65 20 63 61 | 74 68 65 74 65 72 2c 20 |..the ca|theter, |
|00005f50| 61 6e 64 20 63 61 74 68 | 65 74 65 72 20 6f 62 73 |and cath|eter obs|
|00005f60| 74 72 75 63 74 69 6f 6e | 20 77 65 72 65 20 61 6e |truction| were an|
|00005f70| 61 6c 79 7a 65 64 20 73 | 65 70 61 72 61 74 65 6c |alyzed s|eparatel|
|00005f80| 79 20 66 6f 72 20 70 61 | 74 69 65 6e 74 73 0d 0a |y for pa|tients..|
|00005f90| 77 68 6f 20 66 69 6e 69 | 73 68 65 64 20 74 68 65 |who fini|shed the|
|00005fa0| 20 65 6e 74 69 72 65 20 | 32 34 2d 77 65 65 6b 20 | entire |24-week |
|00005fb0| 73 74 75 64 79 20 61 6e | 64 20 66 6f 72 20 74 68 |study an|d for th|
|00005fc0| 6f 73 65 20 77 68 6f 20 | 66 69 6e 69 73 68 65 64 |ose who |finished|
|00005fd0| 20 31 20 70 68 61 73 65 | 20 61 6e 64 0d 0a 61 74 | 1 phase| and..at|
|00005fe0| 20 6c 65 61 73 74 20 35 | 20 77 65 65 6b 73 20 69 | least 5| weeks i|
|00005ff0| 6e 20 74 68 65 20 6f 74 | 68 65 72 2e 0d 0a 20 20 |n the ot|her... |
|00006000| 20 20 20 54 68 65 20 6d | 65 61 6e 20 61 67 65 20 | The m|ean age |
|00006010| 6f 66 20 74 68 65 20 73 | 74 75 64 79 20 70 61 72 |of the s|tudy par|
|00006020| 74 69 63 69 70 61 6e 74 | 73 20 77 61 73 20 37 31 |ticipant|s was 71|
|00006030| 20 79 65 61 72 73 2e 20 | 20 46 6f 72 20 74 68 65 | years. | For the|
|00006040| 20 32 33 20 70 61 74 69 | 65 6e 74 73 0d 0a 77 68 | 23 pati|ents..wh|
|00006050| 6f 20 63 6f 6d 70 6c 65 | 74 65 64 20 74 68 65 20 |o comple|ted the |
|00006060| 65 6e 74 69 72 65 20 74 | 72 69 61 6c 2c 20 72 65 |entire t|rial, re|
|00006070| 73 75 6c 74 73 20 77 65 | 72 65 20 63 6f 6d 70 61 |sults we|re compa|
|00006080| 72 65 64 20 62 79 20 63 | 72 6f 73 73 6f 76 65 72 |red by c|rossover|
|00006090| 20 61 6e 61 6c 79 73 69 | 73 2e 0d 0a 46 6f 72 20 | analysi|s...For |
|000060a0| 74 68 65 20 39 20 77 68 | 6f 20 63 6f 6d 70 6c 65 |the 9 wh|o comple|
|000060b0| 74 65 64 20 31 20 70 68 | 61 73 65 20 61 6e 64 20 |ted 1 ph|ase and |
|000060c0| 61 74 20 6c 65 61 73 74 | 20 35 20 77 65 65 6b 73 |at least| 5 weeks|
|000060d0| 20 6f 66 20 74 68 65 20 | 6f 74 68 65 72 20 70 68 | of the |other ph|
|000060e0| 61 73 65 2c 20 74 68 65 | 0d 0a 69 6e 63 69 64 65 |ase, the|..incide|
|000060f0| 6e 63 65 20 6f 66 20 65 | 76 65 6e 74 73 20 70 65 |nce of e|vents pe|
|00006100| 72 20 31 30 30 20 64 61 | 79 73 20 6f 66 20 63 61 |r 100 da|ys of ca|
|00006110| 74 68 65 74 65 72 69 7a | 61 74 69 6f 6e 20 77 61 |theteriz|ation wa|
|00006120| 73 20 63 6f 6d 70 61 72 | 65 64 20 77 69 74 68 20 |s compar|ed with |
|00006130| 77 68 61 74 65 76 65 72 | 0d 0a 74 69 6d 65 20 74 |whatever|..time t|
|00006140| 68 65 79 20 73 70 65 6e | 74 20 69 6e 20 74 68 65 |hey spen|t in the|
|00006150| 20 74 72 69 61 6c 2e 0d | 0a 20 20 20 20 20 44 61 | trial..|. Da|
|00006160| 69 6c 79 20 69 72 72 69 | 67 61 74 69 6f 6e 20 68 |ily irri|gation h|
|00006170| 61 64 20 6e 6f 20 73 69 | 67 6e 69 66 69 63 61 6e |ad no si|gnifican|
|00006180| 74 20 65 66 66 65 63 74 | 20 6f 6e 20 74 68 65 20 |t effect| on the |
|00006190| 69 6e 63 69 64 65 6e 63 | 65 20 6f 66 20 6c 65 61 |incidenc|e of lea|
|000061a0| 6b 69 6e 67 20 6f 72 0d | 0a 6f 62 73 74 72 75 63 |king or.|.obstruc|
|000061b0| 74 65 64 20 63 61 74 68 | 65 74 65 72 73 20 6f 72 |ted cath|eters or|
|000061c0| 20 74 6f 74 61 6c 20 72 | 65 70 6c 61 63 65 6d 65 | total r|eplaceme|
|000061d0| 6e 74 20 6f 66 20 63 61 | 74 68 65 74 65 72 73 20 |nt of ca|theters |
|000061e0| 28 74 61 62 6c 65 29 2e | 20 20 50 61 74 69 65 6e |(table).| Patien|
|000061f0| 74 73 20 77 68 6f 0d 0a | 68 61 64 20 66 72 65 71 |ts who..|had freq|
|00006200| 75 65 6e 74 20 63 61 74 | 68 65 74 65 72 20 65 76 |uent cat|heter ev|
|00006210| 65 6e 74 73 20 69 6e 20 | 6f 6e 65 20 70 68 61 73 |ents in |one phas|
|00006220| 65 20 6f 66 20 74 68 65 | 20 73 74 75 64 79 20 63 |e of the| study c|
|00006230| 6f 6e 74 69 6e 75 65 64 | 20 74 6f 20 68 61 76 65 |ontinued| to have|
|00006240| 20 74 68 65 6d 0d 0a 69 | 6e 20 74 68 65 20 6f 74 | them..i|n the ot|
|00006250| 68 65 72 20 70 68 61 73 | 65 2e 20 20 54 68 65 20 |her phas|e. The |
|00006260| 69 6e 63 69 64 65 6e 63 | 65 20 6f 66 20 63 61 74 |incidenc|e of cat|
|00006270| 68 65 74 65 72 20 6f 62 | 73 74 72 75 63 74 69 6f |heter ob|structio|
|00006280| 6e 73 20 61 6e 64 20 6f | 66 20 6c 65 61 6b 69 6e |ns and o|f leakin|
|00006290| 67 0d 0a 63 61 74 68 65 | 74 65 72 73 20 69 73 20 |g..cathe|ters is |
|000062a0| 73 69 6d 69 6c 61 72 20 | 77 69 74 68 20 6f 72 20 |similar |with or |
|000062b0| 77 69 74 68 6f 75 74 20 | 64 61 69 6c 79 20 69 72 |without |daily ir|
|000062c0| 72 69 67 61 74 69 6f 6e | 2e 20 20 46 75 72 74 68 |rigation|. Furth|
|000062d0| 65 72 6d 6f 72 65 2c 20 | 64 61 69 6c 79 0d 0a 69 |ermore, |daily..i|
|000062e0| 72 72 69 67 61 74 69 6f | 6e 20 64 6f 65 73 20 6e |rrigatio|n does n|
|000062f0| 6f 74 20 72 65 64 75 63 | 65 20 65 70 69 73 6f 64 |ot reduc|e episod|
|00006300| 65 73 20 6f 66 20 66 65 | 76 65 72 2e 20 20 4e 6f |es of fe|ver. No|
|00006310| 20 73 69 67 6e 69 66 69 | 63 61 6e 74 20 63 6c 69 | signifi|cant cli|
|00006320| 6e 69 63 61 6c 0d 0a 62 | 65 6e 65 66 69 74 73 20 |nical..b|enefits |
|00006330| 61 72 65 20 61 63 68 69 | 65 76 65 64 20 62 79 20 |are achi|eved by |
|00006340| 64 61 69 6c 79 20 73 61 | 6c 69 6e 65 20 69 72 72 |daily sa|line irr|
|00006350| 69 67 61 74 69 6f 6e 20 | 6f 66 20 6c 6f 6e 67 2d |igation |of long-|
|00006360| 74 65 72 6d 20 69 6e 64 | 77 65 6c 6c 69 6e 67 0d |term ind|welling.|
|00006370| 0a 63 61 74 68 65 74 65 | 72 73 2e 0d 0a 0d 0a 50 |.cathete|rs.....P|
|00006380| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00006390| 20 20 20 20 54 68 69 73 | 20 73 74 75 64 79 20 70 | This| study p|
|000063a0| 72 65 73 65 6e 74 65 64 | 20 73 6f 6d 65 20 66 6f |resented| some fo|
|000063b0| 72 6d 69 64 61 62 6c 65 | 20 6d 65 74 68 6f 64 6f |rmidable| methodo|
|000063c0| 6c 6f 67 69 63 20 69 73 | 73 75 65 73 2e 20 20 42 |logic is|sues. B|
|000063d0| 65 63 61 75 73 65 20 6f | 66 0d 0a 63 6f 6e 73 69 |ecause o|f..consi|
|000063e0| 64 65 72 61 62 6c 65 20 | 70 61 74 69 65 6e 74 2d |derable |patient-|
|000063f0| 74 6f 2d 70 61 74 69 65 | 6e 74 20 76 61 72 69 61 |to-patie|nt varia|
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.