Aortocaval fistula secondary to mediastinitis.

Aortocaval fistula is a rare entity usually associated with a preexistent atherosclerotic abdominal aortic aneurysm or trauma. We present a case of an aortocaval fistula secondary to the subdiaphragmatic progression of a mediastinitis. The pathogenesis, clinical presentation, and treatment are discussed.

Hb Arta [beta 45 (CD4) Phe-->Cys]: a new unstable haemoglobin with reduced oxygen affinity in trans with beta-thalassaemia.

The interaction of rare Hb variants with beta(0)-thalassaemia results in a quasihomozygous state where the erythrocytes contain the variant as the only major adult Hb component. Such a situation is a unique model that enables functional studies even in the case of a neutral variant that could not be isolated from Hb A. We report here an unusual patient carrying Hb Arta, a novel Hb variant [beta 45 (CD4) Phe-->Cys], in trans with beta(0)-thalassaemia gene (beta(0) 39).

Evaluation of One Touch II hospital in a community-hospital setting.

Objective: To compare the linearity and precision of the One Touch II hospital, a bedside reflectance meter for measuring blood glucose, to the Kodak Ektachem 700 and to discuss a few essential elements needed for an excellent bedside testing program.

Setting: Prince George's Hospital Center (PGHC), Cheverly, Maryland, a community hospital with approximately 400 beds.

Patients Or Other Participants: Blood was selected randomly from 100 patients for whom a blood glucose test had been ordered.

Ability of a computerized geriatric assessment to predict need for change in living status among elderly living at home.

The objective of this study was to determine the ability of a software program used in a primary care physician's office to predict the need for alternate living arrangement in a cohort of community-dwelling elderly. An analysis was conducted involving 124 consecutive patients between February 10, 1990, and December 20, 1991, in my private medical practice. These patients, all older than 65 years, underwent a computer-assisted geriatric assessment.

Spinal epidural abscess: an elusive diagnosis.

This case illustrates the enigmatic fashion in which spinal epidural abscess (SEA) may manifest. In any patient with back pain and fever of unclear etiology, the diagnosis of SEA should be considered; this is particularly true when radicular symptoms are present. Some patients with SEA may not have a source of infection.

An analysis of potential and real cost savings by the addition of ranitidine to total parenteral nutrition solutions.

The results of two analyses that assessed the potential savings and the actual savings derived from the addition of ranitidine to total parenteral nutrition solutions are discussed. A clinical pharmacist determined on a daily basis the number of patients receiving concurrent total parenteral nutrition solutions and intermittent intravenous ranitidine in a critical care unit. The cost of each mode of administration was determined and the savings were calculated to be over +16,000/year.

AIDS dementia-related psychosis: is there a window of vulnerability?

Human immunodeficiency virus (HIV) frequently enters the central nervous system (CNS) soon after infection, and frequently produces a wide variety of neurologic, cognitive, and psychiatric complications. Although, the entire spectrum of psychiatric illnesses may be seen in individuals with HIV infection, most are probably not directly caused by the virus. Psychiatric manifestations that are the direct result of HIV infection are usually seen in the setting of HIV-associated dementia.

Effect of lung contusion on pulmonary hemodynamics.

Our purpose was to examine changes in pulmonary hemodynamics for patients with pulmonary contusion. Pulmonary vascular resistance index (PVRI) and shunt fraction were calculated from standard measurements in 25 traumatized patients. The percent of lung volume injured, measured as air-space filling disease (ASF), was quantitated from computed tomograms using a previously described technique.

Neurologic deficits associated with sacral wing fractures.

Twelve of 96 patients with pelvic fractures suffered neurologic deficits. Four secondary to acetabular fractures were excluded from the study. Of the remaining eight, five were found by CT scan to be secondary to fractures of the sacral wing extending through the sacral foramina.

Mid-descending aortic traumatic aneurysms.

Two patients with traumatic rupture of the mid-descending aorta successfully repaired are presented. Most clinical series of aortic tears do not include this entity. A review of the world literature reveals only 9 previous cases.

Disseminated actinomycosis presenting as a testicular mass: a case report.

Actinomycosis of the testicle is a rare clinical entity. A review of the literature reveals only 7 case reports. Patients require prolonged therapy with antibiotics, usually penicillin.

Chromatofocusing and isoelectric focusing in immobilized pH gradients compared for characterization of human hemoglobin variants.

We compared the performance of two highly resolving methods, chromatofocusing (CRF) and isoelectric focusing in immobilized pH gradients (IPGF), for the separation of human hemoglobin variants. Lysates containing 13 different hemoglobins, including variants of clinical and geographical importance, and four electrophoretically "silent" variants (Hb Brockton, Hb Cheverly, Hb Köln, and Hb Waco) were analyzed. Both techniques showed a good intrarun precision (CV = 0.

A comparison of results of extensor tendon repair followed by early controlled mobilisation versus static immobilisation.

To compare the functional results of early controlled mobilisation and static immobilisation following repair of extensor tendons, we conducted a comparative study between two centres. In one, a consecutive series of tenorrhaphy patients was treated post-operatively by the dynamic splinting technique. In the other, a consecutive group was treated by static splinting.

Quantitation and pattern of parenchymal lung injury in blunt chest trauma. Diagnostic and therapeutic implications.

Sixty-nine patients with nonpenetrating pulmonary trauma were studied by chest computed tomography (CT) within 24 hours of admission. The percentage of air-space filling was quantitated and compared with the requirement for ventilatory support. Pulmonary intraalveolar hemorrhage always is gravity dependent originating at the site of injury.

Carcinoid tumor with intradural spinal metastases.

A case of spinal intradural metastasis from a carcinoid tumor is reported. The case is of interest due to the rarity of central nervous system involvement by these tumors and the long latency period of the patient's presentation.

Classification of parenchymal injuries of the lung.

Pulmonary contusion, implying interstitial and alveolar injury without significant laceration, has been accepted as the primary lung injury in nonpenetrating chest trauma. Computed tomographic (CT) findings were compared with those of chest radiography in 85 consecutive patients with chest trauma in which there was a pulmonary radiodensity consistent with pulmonary contusion or patients with a history of severe chest trauma with normal parenchyma despite rib fractures, hemothorax, pneumothorax, or widened mediastinum. CT was found to be more sensitive than radiography in that 151 abnormalities (excluding rib fractures) were demonstrated on radiographs versus 423 abnormalities on CT scans, and 99 lacerations were seen on CT scans versus five on radiographs.

Free rupture of the ascending aorta: successful resuscitation at a regional trauma center.

After sustaining a free rupture of the intrapericardial ascending aorta secondary to blunt chest trauma, a 27-year-old man underwent successful aortic repair. To our knowledge, this is the first time a patient has ever survived this condition. Pericardial tamponade-together with rapid transport to the hospital and an aggressive surgical approach-was a key to the recovery of effective cardiac function and successful aortic repair.

Hemoglobin Cheverly: an unstable hemoglobin associated with chronic mild anemia.

The evaluation of a family with chronic mild anemia led to the identification of a new unstable hemoglobin (Hemoglobin Cheverly). Modest anemia and reticulocytosis, normal to slightly increased mean corpuscular volume (MCV), and normal mean corpuscular hemoglobin concentration (MCHC) were present in the affected family members. Electrophoresis of blood samples on cellulose acetate and on citrate agar revealed normal patterns.

Use of Doppler ultrasound in performing percutaneous cannulation of the radial artery.

Doppler ultrasound has been used extensively in assessing adequacy of circulation. We have found it to be convenient in the identification of blood flow, particularly in hypotensive states where percutaneous radial artery cannulation of the vessel is tedious and difficult to perform. The technique is simple, atraumatic, and usually successful.