ABSTRACTAll reported clinical characteristics of acute retroviral illness with the human immunodeficiency virus (HIV) are nonspecific. Signs and symptoms described are associated with a variety of acute infections. We report the cases of three patients in whom the acute retroviral illness was characterized by transient oral candidiasis and unexplained high…
ABSTRACTDeer hunting is a popular recreational activity in the United States. Although the risks associated with firearms are well known, the hazards related to deer stands are not widely appreciated. From September 1982 through December 1989, there were 19 patients admitted to the Medical College of Georgia Hospital and Clinics…
ABSTRACTExternal abdominal fistulas that arise from the digestive tract are associated with high mortality and prolonged morbidity in terms of infection, malnutrition, and skin excoriation. Such external fistulas most commonly follow anastomotic leak after gastrointestinal surgery. We identified 58 patients seen over a 5-year period at the University of Louisville…
ABSTRACTIn a pilot study, maternal serum was analyzed for placental alkaline phosphatase (PLAP) to evaluate the possibility of using PLAP values as a prenatal marker to predict low birth weight in neonates. Study subjects were selected from among women whose newborns were of low birth weight. These women were screened…
ABSTRACTIt is estimated that as many as 20% of school-aged children have an attention deficit hyperactivity disorder (ADHD). Hyperactivity is recognized as a common symptom of a variety of childhood disorders. In many instances the symptoms of ADHD signal the onset of severe psychopathology and indicate comorbidity. Because a significant…
ABSTRACTMany have discussed hypertonic saline for resuscitation in burned patients only to discourage its use or to emphasize it only as a research tool and not as standard resuscitation. We reviewed the records of 47 adults with burns over 20% or more of the total body surface area (TBSA) in…
ABSTRACTMassive elevation of intra-abdominal pressure (IAP) causes renal, cardiovascular, and respiratory dysfunction. Positive end-expiratory pressure (PEEP) markedly increases the detrimental effect of IAP on the cardiovascular system. The purpose of this study was to determine the effect of PEEP on IAP. In 15 patients requiring mechanical ventilation, IAP was measured,…
ABSTRACTMost regions of the United States are served by poison control centers that provide 24-hour toxicologic guidance resulting in the home management of most poison exposures. It has been suggested that without public access to a poison control hotline the majority of poison-exposed patients would seek medical care in emergency…
ABSTRACTPatients with non-insulin-dependent diabetes mellitus (NIDDM) failing to respond to therapy with a maximum dose of glyburide (GB) or glipizide (GZ) are often given a trial of the alternate second-generation sulfonylurea (SGS) before insulin therapy is considered. The efficacy of this therapeutic maneuver has not been thoroughly tested. We studied…
ABSTRACTPatients with severe burn injuries are generally admitted to specialized units and managed by physicians who specialize in burn care. Complications requiring operative intervention and not directly related to the burn wound occur frequently but are easily overlooked. To determine the nature and frequency of these complications, we conducted a…
ABSTRACTRecommendations concerning postoperative extubation after thymectomy for myasthenia gravis are presently based upon retrospective chart reviews. We present the results of a prospective investigation of time to extubation after thymectomy for 14 patients over a 12-month period based upon a protocol that included preoperative immunologic therapy, combined epidural and general…
ABSTRACTThe effect of race upon renal allograft survival is controversial. Between 1981 and 1987, at Vanderbilt University Medical Center, 448 patients (75 black, 373 white) received azathioprine, 3 mg/kg daily; prednisone, 30 mg daily; and intravenous antithymocyte sera, 0.2 mL/kg/day for 14 days, after transplantation. Prednisone doses were decreased gradually…
ABSTRACTTo assess the possibility of common bile duct distensibility after cholecystectomy, we made a retrospective study of patients who had ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). The study comprised 52 patients without extrahepatic biliary obstruction; 19 had had cholecystectomy, 18 of whom complained of biliary colic similar to that they…
ABSTRACTUniversal prenatal screening for hepatitis B in low-risk populations remains controversial. The purpose of this study was to characterize the obstetric population of the city/county hospital in a midsize southern city. A total of 2013 patients were screened for hepatitis B surface antigen and antibody between June 1988 and February…
ABSTRACTWe developed an experimental, reproducible method of evaluating the radiographic characteristics of breast implants in vitro using a mammographic phantom and a cadaver. Implant shells tested included smooth silicone, textured silicone, and silicone coated with polyurethane foam. Each type of shell was subsequently filled with saline, silicone gel, and peanut…
ABSTRACTWe prospectively tabulated all isolates of Haemophilus influenzae at DeKalb Medical Center from 1987 through 1989 to assess the occurrence of antibiotic resistance in patients of different ages. Of 325 total strains isolated, 24% produced β-lactamase, rendering them resistant to ampicillin and amoxicillin. Antibiotic resistance was as common in patients…
SUMMARYA 37-year-old black man with presumed Pneumocystis carinii pneumonia who was treated with systemic IV pentamidine had fatal pancreatitis and massive hepatomegaly. Fatal pancreatitis can occur with no hemorrhagic changes seen at autopsy. Awareness of the relationship between pentamidine and pancreatitis should be emphasized. With current clinical trials testing other…
SUMMARYBecause osteomyelitis may complicate puncture wounds about the first metatarsophalangeal joint, we believe sesamoid roentgenograms are mandatory. These views may show subtle demineralization, which cannot be seen on standard films. Treatment must include excision of the sesamoid and culture-directed antibiotics.
SUMMARYMalignant melanoma may display a wide variety of unusual morphologic patterns that simulate unrelated neoplasms. The diagnostic approach to such complex and morphologically divergent lesions requires thorough and extensive scrutiny not only by routine light microscopy, but also by immunohistochemical and ultrastructural evaluation. We have reported the case of a…
SUMMARYThis study shows that conduction abnormalities may occur frequently in Reiter's syndrome of new onset or short duration. Since these conduction defects may be initially life threatening or may progress to life-threatening abnormalities, anyone with RS should be followed up. Because of the strong association between RS and HIV infection,…
SUMMARYWe have described a patient with α1-antitrypsin deficiency who had a disseminated infection with Mycobacterium avium-intracellulare characterized by a suppurative tissue response.
SUMMARYWe have presented a case of fulminant necrotizing fasciitis that occurred after excessive NSAID intake with granulocytopenia. This case parallels those previously reported as outlined in the above discussion. We concur with previous investigators who have concluded that NSAID should be used with caution in patients with phlebitis or apparently…
SUMMARYWe have presented the case of a 32-year-old man who sustained blunt trauma to the chest in a motor vehicle accident. Plain roentgenograms showed a widened mediastinum and pneumomediastinum, and an esophagogram with water-soluble contrast material snowed an esophageal laceration at the T-4 level.
SUMMARYWe have presented two cases of hypothermia associated with altered mental status occurring during the summer in the sunbelt. Both cases represent nonexposure hypothermia of multifactorial origin requiring prompt aggressive diagnostic and therapeutic intervention. The effects of phenothiazines, alcoholism, Wernicke's encephalopathy, Parkinson's disease, and altered mental status contributed to the…
SUMMARYWe have reported a case of E sakazakii primary bacteremia in an elderly patient in whom evaluation failed to reveal a source of infection. This patient had an uneventful recovery after intravenous administration of a third-generation cephalosporin for 7 days followed by 1 week of oral ciprofloxacin. This excellent response…
SUMMARYWe have reviewed the typical clinical manifestations of pseudoxanthoma elasticum and presented the case of a patient with involvement of the skin, eyes, and cardiovascular system. We suggest that patients with periumbilical lesions that might indicate pseudoxanthoma elasticum have, at minimum, a full physical examination with emphasis on the cardiovascular…
SUMMARYWe identified and treated a solid, growing fungal tumor mass in a patient with disseminated histoplasmosis. Although the most commonly reported intraocular lesions from disseminated histoplasmosis are areas of inactive chorioretinal scars or areas of localized subretinal neovascular membrane formation, a focus of active fungal growth needs to be ruled…
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