International health and internal medicine residency training: the Duke University experience.

Objective: To evaluate the impact of the Duke University Medicine Residency International Health Program (IHP) on program participants and to evaluate the relationship of the IHP to the residency program.

Subjects And Methods: The Duke University Medicine Residency Program classes of 1988 to 1996 participated in a questionnaire-based survey. All program participants (n = 59), a group of nonparticipants (n = 138), and residents who had not yet had an opportunity to participate (preparticipants; n = 106).

Cytomegalovirus pericarditis: a case series and review of the literature.

Cytomegalovirus (CMV) commonly infects both normal and immunocompromised hosts. Although it usually produces an asymptomatic infection to mild illness, CMV has the potential to significantly injure many different organs. Reports of CMV causing pericardial disease, however, are limited and documentation of infection by growth of the virus from tissue or fluid is rare.

Consultation in university-based and community-based infectious disease practices: a prospective study.

Infectious disease physicians in university and community practices completed a standard data form following each of 1,366 inpatient consultations during a 7-month period. The rate of consultation was higher in the university practice than in the community practice (3.4 vs.

Ethical and legal issues in group counseling.

Legal and ethical issues involved in group work are reviewed and discussed. Variations in different professional ethics codes are discussed. Recommendations for consideration by group leaders are made.

The diagnosis of Plasmodium falciparum infection using a new antigen detection system.

With the widespread emergence of drug-resistant Plasmodium falciparum infection, febrile patients in the tropics can no longer be empirically treated with inexpensive yet effective antimalarials. The substitution of newer and more costly drugs brings with it the need for rapid, accurate, and inexpensive diagnostic procedures so that directed therapy can be used. We report a field trial comparing standard microscopic malaria diagnosis and quantitative buffy coat analysis to a new P.

Mycoplasma hominis septic arthritis: two case reports and review.

Mycoplasma hominis is normally a commensal of humans. When the organism is pathogenic, it primarily causes disease in the genitourinary tract. Septic arthritis caused by M.

Treatment of Mycobacterium haemophilum infection with an antibiotic regimen including clarithromycin.

A patient with rheumatoid arthritis developed ulcerated nodules predominantly on his legs. Skin biopsy and culture demonstrated rheumatoid vasculitis and infection with Mycobacterium haemophilum. Improvement was not seen until clarithromycin was added to his treatment regimen.

Clostridium septicum abscess in hepatic metastases: successful medical management.

Clostridium septicum bacteremia is frequently associated with hematologic and colonic malignancies and neutropenia. It frequently produces 'metastatic' gangrene with excessive mortality. Standard therapy usually includes surgical debridement and antibiotics.

The use of a polymerase chain reaction as a diagnostic test for Rocky Mountain spotted fever.

A polymerase chain reaction (PCR) for amplifying ribosomal DNA of Rickettsia rickettsii was performed on blood clots and urine samples from 10 patients with suspected Rocky Mountain spotted fever (RMSF) and five controls with nonrickettsial diseases. The results of this PCR-based procedure were positive in four of the five patients with probable RMSF, but reamplification was required in three patients. Rickettsia rickettsii was grown from the blood of two of these four patients.

A prospective trial of subxiphoid pericardiotomy in the diagnosis and treatment of large pericardial effusion. A follow-up report.

Objective: This study was designed to determine the cause of large pericardial effusions and evaluate the efficacy of subxiphoid pericardiotomy.

Summary Background Data: Despite great advances in the techniques used to diagnose pericardial effusions, much controversy remains concerning their cause and the optimal treatment of these effusions.

Methods: In a prospective consecutive case series, 57 patients underwent a thorough preoperative evaluation followed by a subxiphoid pericardiotomy.

Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review.

Osteitis pubis is a painful inflammatory process resulting in bony destruction of the margins of the symphysis pubis. Despite six decades of speculation, the pathogenesis of, criteria for diagnosis of, natural history of, and optimal therapy for osteitis pubis remain controversial. We present four cases of postoperative pubic osteomyelitis that were initially thought to be typical cases of osteitis pubis.

Mycoplasmal pericarditis: evidence of invasive disease.

Although the pathogenic mycoplasmas usually infect the respiratory and urogenital tracts, these organisms also can cause disease in remote sites. Such infections are difficult to diagnose because of both the fastidious nature of the mycoplasmas and the failure to consider their presence. Pericarditis is an uncommonly diagnosed and rarely confirmed example of invasive mycoplasmal infection.

Brazilian spotted fever in Espirito Santo, Brazil: description of a focus of infection in a new endemic region.

Although Brazilian spotted fever is known to occur in several adjacent states, infection with spotted fever group (SFG) rickettsiae has not previously been documented in the Brazilian state of Espirito Santo. We report a cluster of two proven and four suspected cases of Brazilian spotted fever in a small valley near Colatina, Espirito Santo. Four patients died without confirmatory serologic or pathologic studies.

Etiology of large pericardial effusions.

Purpose: To determine the effectiveness of the preoperative evaluation and overall diagnostic efficacy of subxiphoid pericardial biopsy with fluid drainage in patients with new, large pericardial effusions.

Design: A prospective interventional case series of consecutive patients admitted with new, large pericardial effusions.

Patients And Methods: Fifty-seven of 75 consecutive patients admitted to a university tertiary-care center and a university-affiliated Veterans Administration Medical Center with new, large pericardial effusions were studied over a 20-month period.

Disseminated infection with rapidly growing mycobacteria.

Disseminated infection with the rapidly growing mycobacteria Mycobacterium chelonae and Mycobacterium fortuitum is uncommon. Only eight cases were diagnosed at Duke University Medical Center (Durham, NC) over the last 14 years. We identified 46 other cases by review of the medical literature since 1960.

Assessing housestaff diagnostic skills using a cardiology patient simulator.

Objective: To assess the cardiovascular physical examination skills of internal medicine housestaff.

Design: Cross-sectional assessment of housestaff performance on three valvular abnormality simulations conducted on the cardiology patient simulator, "Harvey." Evaluations were done at the beginning (session I) and end (session II) of the academic year.

Rocky Mountain "spotless" and "almost spotless" fever: a wolf in sheep's clothing.

In 10 (10.8%) of 93 laboratory-confirmed or probable cases of Rocky Mountain spotted fever seen at Duke University Medical Center from 1969 to 1991, illness without rash or fleeting or atypical skin eruptions were noted. Data from these 10 cases and 33 similar previously reported cases of Rocky Mountain "spotless" or "almost spotless" fever support the premise that human Rickettsia rickettsii infection has a broader spectrum than that indicated by its classic description.

Diagnosis and management (by subxiphoid pericardiotomy) of large pericardial effusions causing cardiac tamponade.

To determine the clinical features, course and outcome of patients with cardiac tamponade, 57 consecutive patients with new, large pericardial effusions were prospectively studied. Twenty-five patients (44%) developed cardiac tamponade with venous hypertension and a pulsus paradoxus greater than 10 mm Hg. Electrocardiography, radiographic studies and echocardiography did not differentiate patients with and without tamponade.

Subxiphoid pericardiotomy in the diagnosis and management of large pericardial effusions associated with malignancy.

To determine the safety, diagnostic value, and clinical outcome of patients with malignancy undergoing subxiphoid pericardiotomy for large pericardial effusions, we prospectively studied 25 consecutive patients with malignancy and new, large pericardial effusions diagnosed by echocardiography. Twenty-two of the 25 operations were done under local anesthesia, and no patient died at surgery. Pericardial fluid cytology revealed malignant cells in 11 patients (44 percent), while tumor was seen in only five (45 percent) of these 11 patients on pathologic examination.