a cough aerosol sampling system to test 16 subjects with smear-positive pulmonary TB. Cough-generated aerosols were positive in 4 subjects (25 percent). The authors said that there was a rapid decrease in the cough-generated aerosol cultures within the first 3 weeks of effective treatment. The culture-positive cough aerosols were associated with lack of treatment during the prior week. The studies were done in the morning before breakfast when patients were asked to provide sputa specimens for clinical purposes. All studies were performed in negative pressure isolation rooms that had six air changes per hour. No cultured M. tuberculosis was isolated from the room air. Two separate 5-minute air sampling times were chosen with the intent of maximizing aerosol collection and minimizing the discomfort of coughing. The investigators isolated 633 colony-forming units from the initial aerosol generated by one subject. After one week of treatment, the count dropped to 3 colony-forming units. This finding occurred despite the person's persistently positive smear and cultures. The authors said that their cough sampling system could be used to study the mechanics of aerosolization of the bacilli from the human respiratory tract, an area of investigation that has received relatively little attention.

DEALING WITH THE SPECIAL CLINICAL PROBLEMS OF THE MORBIDLY OBESE IN THE INTENSIVE CARE UNIT

The growing interest in gastric bypass surgery points up the problems faced by critically ill morbidly obese patients and the serious challenges seen by physicians in treating these patients. According to the American Society for Bariatric Surgery, the rate of obesity surgeries has risen from 37,000 in 2000 to 62,400 in 2001. It is expected that the total number of cases will exceed 100,000 when figures are released for 2003. This "Clinical Commentary" in the ATS journal addresses the significant differences in care for the critically ill morbidly obese
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Contact: Cathy Carlomagno
ccarlomagno@thoracic.org
212-315-6442
American Thoracic Society
27-Feb-2004

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