Whipple's disease: a rare disease revisited.

Since the original postmortem diagnosis of "intestinal lipodystrophy" by Dr. George H. Whipple in 1907, the complexities of Whipple's disease have been elucidated through case reports.

Prophylaxis for travelers' diarrhea.

Travelers' diarrhea affects more than 10 million people per year and is usually contracted through the ingestion of microbially contaminated food or water. Although most cases resolve in 3 to 5 days, chronic conditions are associated with acute infections. Prevention encompasses avoidance of ingesting contaminated products and, in certain situations, taking prophylactic medications.

Aspergillosis in liver transplant recipients: successful treatment and improved survival using a multistep approach.

Background: Invasive aspergillosis is a life-threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population.

Methods: We retrospectively reviewed all fungal cultures from 200 liver transplant patients between 1996 and 1999 at a single tertiary referral center.

Influenza infection in patients before and after liver transplantation.

Infection with influenza virus poses specific problems in pediatric and adult liver transplant recipients, both before and after liver transplantation. These include a higher rate of pulmonary and extrapulmonary complications, development of rejection with graft dysfunction, prolonged shedding of influenza virus, and increased drug-resistance. Hepatic decompensation may occur during influenza infection in patients with cirrhosis.

Orthopaedic infections.

Patients with orthopaedic infections may require admission to the intensive care unit (ICU). Necrotizing fasciitis and clostridial myonecrosis (gas gangrene) are serious soft tissue infections that may cause life-threatening complications. Patients suffering from infectious arthritis, osteomyelitis, or prosthetic joint infections may be seen in the ICU as a result of a previous injury, surgery, or delayed infectious processes.

Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol.

A prospective study that compared a traditional emergency department (ED) triage protocol with an expedited protocol was conducted to determine if minimizing the subjectivity of nursing triage would result in more efficient management of adult patients presenting with nontraumatic chest pain. The traditional protocol triaged 382 patients into 1 of 5 categories of acuity. The expedited study group (418 patients) were triaged as usual but subsequently were treated as if they were triage category 1 or 2 (medical evaluation within 15 minutes of arrival).

Waldenström's macroglobulinemia: long-term results with the M-2 protocol.

Thirty-three patients with symptomatic Waldenström's macroglobulinemia have been treated with the M-2 protocol (BCNU, cyclophosphamide, vincristine, melphalan, and prednisone). Therapy was administered every 5 weeks for 2 years and every 10 weeks for an additional 1-3 years. Median clinical and laboratory parameters included age 70 years (range 52-87), performance status 1 (1-3), prior therapy 7, weight loss 12, symptomatic hyperviscosity 13, splenomegaly 22, lymphadenopathy 7, hemoglobin 9.

Double-blind placebo-controlled trial of oral acyclovir in first-episode genital herpes simplex virus infection.

One hundred nineteen patients with primary and 31 patients with nonprimary first-episode genital herpes were treated for ten days with 200 mg of acyclovir capsules or placebo capsules orally five times daily. Among acyclovir recipients with primary genital herpes, the median duration of viral shedding (two days), time to crusting of all lesions (seven days), time to healing of all lesions (12 days), and duration of local pain (five days) and constitutional symptoms (three days) were shorter than among placebo recipients (9, 10, 16, 7, and 6 days, respectively). Among patients with nonprimary first-episode genital herpes, oral acyclovir shortened the median duration of viral shedding but had no significant effect on the duration of lesions or symptoms.

Treatment of recurrent genital herpes simplex infections with oral acyclovir. A controlled trial.

Two hundred fifty patients were entered into a multicenter trial to evaluate the efficacy and toxicity of orally administered acyclovir for treatment of recurrent genital herpes. The study consisted of part A, in which patients entered the study within 48 hours of the onset of lesions, and part B, in which patients self-initiated therapy as soon as possible after the onset of a recurrent episode. In both parts, patients received either acyclovir (200 mg) or placebo, five times daily for five days.

Rapid viral diagnosis.

The advent of antiviral chemotherapy provides a strong impetus to develop methods to diagnose viral infections rapidly and accurately. Several other potential contributions of rapid viral diagnoses to patient management also exist. Virus isolation remains the "gold standard" of viral diagnosis against which most newly developed diagnostic approaches--including serologic testing, viral-enzyme detection, microscopic techniques, radioimmunoassays, and enzyme immunoassays--must be compared.

Detection of herpes simplex virus in clinical specimens by DNA hybridization.

An assay to detect herpes simplex virus (HSV) DNA in clinical specimens has been developed. It utilizes nucleic acid hybridization with a 32P-labeled DNA probe prepared from a fragment of HSV DNA cloned in a plasmid vector. This assay can detect 5 X 10(4) plaque-forming units of cell-free HSV and as few as four virus-infected cells.

Enzyme immunofiltration technique for rapid diagnosis of herpes simplex virus eye infections in a rabbit model.

A rapid enzyme immunofiltration assay for herpes simplex virus (HSV) has been developed which is sensitive enough to detect viral antigens in eye swabs from rabbits with primary herpes keratitis. This assay employs a specially designed filter manifold to immobilize whole cells and cell debris dissociated from the swabs. Viral antigens trapped on the filters are then detected in an indirect immunoassay utilizing staphylococcal protein A conjugated with horseradish peroxidase.

Controlled trial of oral acyclovir in the therapy of recurrent herpes simplex genitalis. A preliminary report.

A randomized, placebo-controlled, double-blind study was performed to evaluate the efficacy and toxicity of orally administered acyclovir in the treatment of patients with recurrent herpes simplex genitalis (HSG). A total of 107 patients from centers in Burlington, Vermont, and San Diego, California, were entered into the study within 48 hours of the onset of lesions. Patients who received acyclovir shed virus for 1.

Antibiotic treatment of acute shigellosis: failure of cefamandole compared with trimethoprim/ sulfamethoxazole and ampicillin.

Intravenously administered ampicillin (AMP), trimethoprim-sulfamethoxazole (TMP-SMX) and cefamandole (CEF) were evaluated in 30 children with shigellosis: 11 children received AMP, 10 TMP-SMX, and 9 CEF for a maximum of five days. Discharge criteria included; afebrile greater than 12 hrs, less than 9 stools/day, absence of seizures, and adequate oral intake. AMP or TMP-SMX patients required significantly fewer median days to meet discharge criteria than those who received CEF.

Psoralen inactivation of influenza and herpes simplex viruses and of virus-infected cells.

Psoralen compounds covalently bind to nucleic acids when irradiated with long-wavelength ultraviolet light. This treatment can destroy the infectivity of deoxyribonucleic acid and ribonucleic acid viruses. Two psoralen compounds, 4'-hydroxymethyltrioxsalen and 4'-aminomethyltrioxsalen, were used with long-wavelength ultraviolet light to inactivate cell-free herpes simplex and influenza viruses and to render virus-infected cells noninfectious.

Use of trained mothers to teach interviewing skills to first-year medical students: a follow-up study.

This report describes an attempt to evaluate the effectiveness of "trained mother" interviews early in the medical school curriculum. As an adjunct to a first-year course that teaches interviewing techniques, half of the students were exposed to an interview with one of three trained mothers early in the course. This treatment interview was immediately followed by a feedback session which concentrated on the content and process of interviewing.

The use of paraprofessionals to teach interviewing skills.

Two nonphysician mothers were each trained to give a consistent and authentic history of a child's common medical problem. At the beginning of a Pediatric Clerkship, one half the students were randomly assigned to interview one of the trained mothers. The interviews were videotaped and then replayed in an evaluative feedback session with each student.