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A 12-year review identified 21 patients with nontyphoidal, nonparatyphoidal salmonella septicemia. Eight of the patients had no predisposing factors. Factors identified included malignancy in five, recent surgery in four, alcoholism with aspiration pneumonia in two, chronic lung disease in two, diabetes in two, systemic lupus erythematosus in one and burns in one. Ten patients presented with gastroenteritis, two with localized abscesses, two with aspiration pneumonia and the remainder with nonspecific septicemia. Three patients died of underlying diseases and three died shortly after the septicemia of related causes. Six cases were nosocomial infection and were not related to hospital outbreaks. Salmonella septicemia with these serotypes is uncommon (1 per 14,000 admissions, 1 per 4000 blood cultures) and can occur in patients without diminished host resistance.
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PMID:Nontyphoidal, nonparatyphoidal salmonella septicemia in adults. 850 19

Organs were donated by a small number of relatives (54/146=37%), genetically related or familial, who volunteered to give a kidney to a relative or spouse at our institution in 1991-1994. The most common reason for not accepting them was an immunological incompatibility (30 cases), followed by a diagnosis of hypertension and/or renal disease (24 cases). Other medical contraindications-including heart/lung disease, obesity, latent diabetes, and hepatic disease-were found in 14 potential donors. One woman (22 years of age) was judged too young for donation. Five ESRD patients died before the investigation of the donor had been completed. Eighteen potential donors changed their minds and decided not to donate a kidney. Interestingly, there was a high percentage of denial of spouses due to positive crossmatches.
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PMID:Reasons for not accepting living kidney donors. 861 Apr 28

Recipient vessels from the head and neck region were histologically examined in 30 patients who had undergone extensive tumor resection necessitating microvascular tissue reconstruction. Past illnesses considered to be risk factors included hypertension, myocardial disease, lung disease, cirrhosis, diabetes, nephritis, as well as extensive nicotine and alcohol abuse. Blood vessels chosen for microsurgical anastomosis were exclusively examined histologically in this study. Patients undergoing microvascular surgery demonstrated vessel abnormalities in 93%. The frequency of dysplasia was higher in the arteries than in the veins (73% and 26%, respectively). Marked thickening of the blood vessel wall and severe exfoliation of the endothelial cells were observed in most arteries. Fibrodysplasia and exfoliated endothelial cells were more frequently observed in the recipient arteries than the graft arteries. Only slight thickening of the vessel wall and mild fibrodysplasia were seen in the veins. Two graft failures were correlated to technical errors rather than pre-existing vessel lesions. This study revealed that most patients undergoing microsurgery in the head and neck region demonstrate pre-existing damage in vessels, which generally hinders anastomosis. Although the study tried to identify fully the interrelationships between the extent of dysplasia, past medical history, preoperative therapy, risk factors and factors that cause free-graft failure, pre-existing changes in the recipient and graft vessels may cause technical difficulties and must be regarded as additional factors contributing to graft failure.
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PMID:Histological changes in vessels used for microvascular reconstruction in the head and neck. 870 38

Psychological status, including depressive symptoms, anxiety, and mastery, was measured in a community-based sample of 3,076 persons aged 55 to 85 with various chronic diseases. Strong, linear associations were found between the number of chronic diseases and depressive symptoms and anxiety, indicating that psychological distress among elderly people is more apparent in the presence of (more) diseases. Furthermore, in contrast to general assumptions that mastery is a relatively stable state, our results indicate that mastery is affected by having chronic diseases. The 8 groups of chronically ill patients (with cardiac disease, peripheral atherosclerosis, stroke, diabetes, lung disease, osteoarthritis, rheumatoid arthritis, or cancer) did differ in their associations with psychological distress. Psychological distress is most frequently experienced by patients with osteoarthritis, rheumatoid arthritis, and stroke, whereas diabetic and cardiac patients appear to be the least psychologically distressed. Differences in disease characteristics, such as functional incapacitation and illness controllability, may partly explain these observed psychological differences across diseases.
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PMID:Psychological status among elderly people with chronic diseases: does type of disease play a part? 880 61

As the practice of lung transplantation in children evolves, the indications are expanding. The major diagnostic groups for which transplantation is offered are similar to those used in adult lung transplantation with the notable absence of obstructive lung disease. Of all children under the age of 18 years undergoing lung transplantation, cystic fibrosis accounts for approximately 35%, pulmonary vascular disease, with or without associated congenital heart disease, accounts for 25-30%, and interstitial lung diseases comprise about 10%. The other categories included retransplantation and a variety of diagnoses which by themselves describe an unusual form of end-stage pulmonary disease. The selection of candidates with transplantable diagnoses is crucial, and as this specialty evolves the contraindications have as well. Colonization of the airway with resistant bacterial or fungal organisms, history of multiple prior thoracic procedures, need for mechanical ventilation, diabetes mellitus, and the presence of other organ failure constitute some relative contraindications for transplantation. Retransplantation is a controversial issue that has not yet been resolved.
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PMID:Pediatric lung transplantation: indications and contraindications. 884 20

Long-term outcome was studied in 233 patients who had undergone renal artery revascularization (51 with balloon angioplasty, 182 with surgery) between 1976 and 1992. Patients (excluding renal transplants) were treated for renal vascular hypertension without or with renal insufficiency (serum creatinine > 1.6 mg/dl. All patients still alive (n = 188) were contacted to determine current blood pressure, medications, serum creatinine, and subsequent significant medical events. In patients who had died the cause of death was determined and renal function status at the time of death noted from medical records. Some follow-up information was obtained on all 233 patients; follow-up serum creatinine data were obtained in 193 (82.8%) patients. Some 24 patients (10.3%) became dialysis-dependent. Using a multiple logistic regression analysis only, preoperative creatinine maintained significance (P < 0.001) for increased dialysis risk. There was no statistically significant association of dialysis for type of revascularization (percutaneous transluminal angioplasty, autogenous artery, saphenous vein, endarterectomy or synthetic material), simultaneous or previous aortic or other vascular surgery (carotid endarterectomy, femoropopliteal bypass, etc.), pathology (atherosclerosis or fibromuscular dysplasia), number of renal arteries stenosed or treated, length of follow-up, age, coronary artery disease, congestive heart failure, stroke, chronic lung disease or type II diabetes. It is concluded that, in patients with renal artery stenosis, the timing of renal artery revascularization relative to the level of renal function is the most important determinant for long-term renal salvage.
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PMID:Late renal function in patients undergoing renal revascularization for control of hypertension and/or renal preservation. 890 17

We studied prospectively the microbiologic findings, management, including the use of intrapleural streptokinase to improve pleural drainage, and outcome of 33 patients with complicated parapneumonic effusions (6) frank empyema (27) treated by our unit over a 4-year period. The mean age was 61 years, with more male (26) than female (7) patients. Seventy-nine percent of the patients had some form of underlying illness, especially chronic lung disease (46%), followed by diabetes mellitus (23%). Fifteen percent of the pleural collections were loculated. Pleural fluid cultures were positive in 58%, Staph aureus and Kleb pneumoniae being the most prevalent aerobic isolates. The incidence of anaerobic isolates was 32%. Besides empirical antibiotics, all patients had drainage of the pleural collections at diagnosis. Four patients were treated with needle aspiration; 28 (85%) required thoracostomy tube drainage for a mean of 8 days, 5 of these went on to surgical decortication. Thirteen patients received intrapleural streptokinase (SK) to facilitate drainage, with significant increase in the volume drained. The mean duration of stay for the whole group was 22 days. The administration of intrapleural SK did not significantly shorten the duration of hospital stay. There were six deaths (18%), none as a direct result of the empyema. We describe a therapeutic approach to parapneumonic effusions and empyema which tailors the interventional modality to the clinical stage of disease.
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PMID:Treatment of complicated parapneumonic effusions and pleural empyema: a four-year prospective study. 910 66

Since 1984, five patients in the cystic fibrosis (CF) clinic at Cork Regional Hospital have developed diabetes mellitus (DM) and were treated with Insulin. None had received systemic corticosteroids but two had high calorie naso-gastric feeding regimes. Two died from lung disease. A fifteen year old boy developed bilateral cataracts. In nine other paediatric CF clinics in the Republic of Ireland (total: 420 patients), three patients have DM, two receiving Insulin. Abnormal glucose tolerance is becoming more common in CF as patients survive longer. The possible role of corticosteroid treatment and intensive carbohydrate feeding regimes in development of glucose intolerance must be considered. DM in CF differs from the usual childhood DM. Regular screening and early Insulin supplementation may be beneficial.
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PMID:Diabetes mellitus in childhood cystic fibrosis. 923 May 62

beta-Adrenoceptor antagonists (beta-blockers) reduce mortality and recurrent myocardial infarction (MI) in older patients after both Q-wave MI and non-Q-wave MI. The effects of beta-blockers are to: (i) reduce complex ventricular arrhythmias, including ventricular tachycardia; (ii) increase the ventricular fibrillation threshold; (iii) reduce myocardial ischaemia; (iv) decrease sympathetic tone; (v) markedly attenuate the circadian variation of complex ventricular arrhythmias: (vi) abolish the circadian variation of myocardial ischaemia; and (vii) abolish the circadian variation of sudden cardiac death or MI. beta-Blockers reduce mortality in patients with MI and complex ventricular arrhythmias. In addition, they are excellent antianginal agents. Older persons with hypertension who have had an MI should be treated initially with a beta-blocker. beta-Blockers reduce mortality in patients with: (i) diabetes mellitus who have had an MI; (ii) MI and congestive heart failure with an abnormal or normal left ventricular ejection fraction; and (iii) MI and an asymptomatic abnormal left ventricular ejection fraction. Severe congestive heart failure, severe peripheral arterial disease with threatening gangrene, greater than first degree atrioventricular block, hypotension, bradycardia, lung disease with bronchospasm, and bronchial asthma are contraindications to treatment with beta-blockers.
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PMID:Postinfarction use of beta-blockers in elderly patients. 941

Nineteen patients with cystic fibrosis were seen in the I Department of Tuberculosis and Lung Diseases during 3.5 years. There were 12 (63%) female, and 7 male, aged from 16 to 35 years (mean 23.2). Most patients were diagnosed in childhood, but 4 were diagnosed in their early adulthood. The diagnosis was confirmed by positive chloride sweat test in all cases. Molecular DNA analyses were performed in 16 cases. In 9 (56%) cases two mutations in the CFTR gene were identified. In 5 cases one mutation was identified. All patients had bronchiectases confirmed by CT. Spirometry showed lung function impairment with predominantly obstructive pattern. Mean VC was 2.57l, mean FEVI was 1.66l. In 7 (37%) cases FEVI was lower then 30% of predictive value. Hypoxemia was found in 11 (58%) cases and hypercapnia in 3 (16%) cases. Sputum cultures were positive for mucoid P. aeruginosa in 12 (63%) cases, for Staph. aureus in 16 (84%) cases. Persistent colonisation with nontuberculous mycobacteria was found in 2 (10.5%) cases. Aspergillus fumigatus was identified in sputum cultures in 2 subjects who had also positive precipitation test. Diabetes mellitus was diagnosed in 2 cases. Meconium ileus equivalent was seen in 1 case. Pneumothorax was seen in 1 case. One patient died in the endstage of the illness.
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PMID:[Cystic fibrosis in adults--clinical aspects]. 948 15


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