Treatable Complication Research Articles

Lambert-Eaton Myasthenic Syndrome Associated with Sjögren's Syndrome and Discoid Lupus Erythematosus

A 65-year-old woman with facial erythema and hypergammaglobulinemia developed excessive fatigability. A diagnosis of Lambert-Eaton myasthenic syndrome (LEMS) was made from electrophysiological studies. She had symptoms and laboratory data compatible with probable Sjögren's syndrome. Skin biopsy revealed the histological findings of discoid lupus erythematosus. Treatment with 3,4-diaminopyridine resulted in the improvement of fatigability. LEMS should be recognized as a treatable complication of systemic autoimmune diseases.

Candida Endocarditis: A Treatable Form of Pacemaker Infection

Fungal endocarditis is a rare complication of permanent pacemaker implantation. In all reports we have identified, this infection has been fatal, diagnosed postmortem. We present a patient in whom early echocardiographic diagnosis resulted in curative surgical and antimicrobial therapy. Fungal endocarditis is an unusual, but treatable complication of permanent pacemakers.

Nontuberculous Mycobacterial Peritonitis During Continuous Ambulatory Peritoneal Dialysis: Case Report and Review of Diagnostic and Therapeutic Strategies

Nontuberculous mycobacteria (NTM) are responsible for an increasing proportion of mycobacterial disease. Peritonitis due to NTM is an unusual but treatable complication of continuous ambulatory peritoneal dialysis (CAPD). Its presentation is similar to that of typical bacterial peritonitis, but special culture techniques are required to avoid a delay in diagnosis. Successful treatment depends on early catheter removal, drainage of fluid collections, and appropriate use of antimicrobial agents. We report a case of Mycobacterium fortuitum peritonitis in a patient undergoing CAPD, and review all previously reported cases. Diagnostic and therapeutic strategies are summarized based on available literature.

Disseminated strongyloidiasis in AIDS

Disseminated Strongyloides stercoralis infection is a rare and severe but treatable complication of AIDS. We present a case where this infection was successfully treated and review the available literature. Cases may present many years after they have left an area endemic for Strongyloides infection, emphasizing the need for a full travel history. Symptoms are typically gastrointestinal and pulmonary, with infiltrates often seen on chest radiography. Diagnosis requires stool examination and biopsy of affected sites. Treatment with repeated courses of thiabendazole (25 mg/kg twice daily for 5 days) was successful in our case, but maintenance regimens have not yet been defined. The relative rarity of this complication of AIDS suggests that, where both infections are present, disseminated strongyloidiasis only arises either when HIV-induced immunodeficiency is profound or, possibly, when it is accompanied by impaired granulopoiesis.

Undiagnosed Tuberculosis in Patients with Human Immunodeficiency Virus Infection

We describe the clinical features of 11 patients with human immunodeficiency virus infection in whom tuberculosis was undiagnosed and untreated prior to death. Most patients (9 of 11) had pulmonary complaints and 8 of 11 had roentgenographic findings suggestive of tuberculosis (hilar or mediastinal adenopathy, pleural effusion, apical infiltrate or miliary pattern). Despite these findings, tuberculin skin tests were not performed in any of the patients. Acid-fast smears of sputum were obtained in three cases and bronchoscopy performed in only four, reflecting the low index of suspicion for tuberculosis. Pneumocystis carinii pneumonia was the presumptive diagnosis in nine cases but was confirmed in only one case. Autopsy revealed tuberculosis as the cause of death in four patients. Of the seven patients who did not undergo autopsy, disseminated tuberculosis, manifest by mycobacteremia, was the only life-threatening illness identified and probably contributed to death. Increased awareness of the clinical and roentgenographic features of tuberculosis in HIV-infected patients, combined with more intensive use of acid-fast smears and tuberculin skin testing, are necessary in order to decrease mortality from this treatable complication of HIV-infection.

Impact of HIV on tuberculosis in Zambia: a cross sectional study.

To examine the contribution of HIV infection to the apparently increasing incidence of tuberculosis in central Africa. Cross sectional study. Outpatient clinic in teaching hospital, Lusaka, Zambia. 346 Adult patients with tuberculosis. Overall, 206 patients (60%; 95% confidence interval 54% to 65%) were positive for HIV: in one or both assays used. The peaks for both tuberculosis and HIV infection were among men aged 25-34 years and women aged 14-24 years. Of patients with confirmed pulmonary tuberculosis, 73/149 (49%; 41% to 57%) were positive for HIV; 67/83 (81%; 70% to 89%) patients with pleural disease and 16/19 (84%; 60% to 97%) patients with pericardial disease were positive. HIV positive patients with positive sputum culture were less likely to have had a positive sputum smear, and their chest x ray films less often showed classic upper zone disease or cavitation. Of 72 patients who fulfilled clinical criteria for AIDS, 17 were negative for HIV. The high prevalence of HIV in patients with tuberculosis suggests that an epidemic of reactivating tuberculosis is arising in those who are infected with HIV. The redirection of public health priorities towards tuberculosis would focus on a major treatable and preventable complication of the AIDS epidemic.

Abnormal Airway Function in Individuals with the Acquired Immunodeficiency Syndrome

Pulmonary function test results of individuals with the acquired immunodeficiency syndrome (AIDS) were analyzed to determine the prevalence of abnormally low forced expiratory flow rates and bronchial hyperreactivity. Of 99 individuals with AIDS, a total of 44 (44 percent) had either low forced expiratory flow rates or a significant response to inhaled bronchodilator. Thirty-one (31 percent) individuals exhibited significant improvement in airflow rates after bronchodilator inhalation, while 33 (33 percent) had low flow rates. Twenty (20 percent) individuals had both low flow rates and a significant response to bronchodilator. In 83 percent of symptomatic individuals treated with bronchodilators there was clinical improvement. Thus, we conclude that abnormally low forced expiratory flow rate with or without bronchial hyperreactivity is a common and treatable complication of AIDS.

Temporal bone fractures and their complications. Examination with high resolution CT.

A total of 84 patients with 89 fractures of the temporal bone were examined with high resolution CT (HRCT) a few hours to 21 months after the initial trauma. Axial HRCT disclosed 63 longitudinal, 13 transverse, 10 complex and 3 atypical fractures. The diagnosis of a temporal bone fracture was established by axial HRCT in almost every case. However, for the precise topographic analysis of the course of the fracture, additional coronal HRCT proved helpful. The most common, surgically treatable complication of temporal bone fracture is disruption of the ossicular chain. Twenty-three such lesions were demonstrated by combined axial and coronal HRCT; 22 lesions of the facial canal could be demonstrated in 27 patients presenting with facial nerve palsy. The most common site of injury to the facial canal was the region of the geniculate ganglion. The only life-threatening complication of a temporal fracture may be otorhinoliquorrhea. This was present in 9 cases. The most common site of leakage identified was the tegmen tympani. With Metrizamide-HRCT precise localisation of the dural laceration was possible in 7 of these 9 cases.

Posttraumatic hydrocephalus.

Posttraumatic hydrocephalus is a treatable complication of head injury and can present with several different clinical syndromes. These include obtundation; simple failure to improve; a tetrad of psychomotor retardation, memory loss, gait trouble, and incontinence; and unusual symptoms including emotional disorder. Posttraumatic hydrocephalus seems to result from a blockage of cerebrospinal fluid (CSF) flow around the cerebral convexities. When the lumbar CSF pressure is consistently above 180 mm H2O, the hydrocephalus should be treated unless a contraindication to operation exists. Underlying brain injury from the trauma itself, however, may prevent recovery. When the typical symptoms of normal pressure hydrocephalus (NPH) are present, a shunt is also indicated. Decision-making is difficult when the patient has normal pressure, but is too injured to display the symptoms of NPH or has atypical symptoms. Overnight pressure recording, lumboventricular infusion testing, or cisternography may clarify whether a shunt is needed in this situation, but there is still considerable uncertainty about shunt prediction in this setting.

Eosinophilic Meningitis in Hodgkin's Disease

Eosinophilic meningitis is rare in Hodgkin's disease. Five previous cases have been reported. We describe an additional patient whose CSF showed an eosinophilic pleocytosis with Reed-Sternberg cells while in complete systemic remission from Hodgkin's disease. The patient responded to intrathecal administration of methotrexate given by Ommaya reservoir. Six months later, systemic relapse occurred, but the CSF remained normal. Eosinophilic meningitis is a treatable complication of Hodgkin's disease, and prolonged response is possible.

Massive Endobronchial Hemorrhage During Cardiopulmonary Bypass: Treatable Complication of Balloon-tipped Catheter Damage to the Pulmonary Artery

Massive endobronchial hemorrhage due to balloon-tipped catheter rupture of a branch of the pulmonary artery in a fully heparinized patient undergoing cardiopulmonary bypass is potentially lethal. Death occurs due to asphyxiation. Endobronchial intubation (double-lumen endotracheal tube) appears to be a simple and effective method for control of the airway and tamponade of the bleeding site, which allows for completion of the surgical procedure until protamine sulphate reversal can be achieved.

Ventricular Pseudo-Aneurysm Demonstrated by Multiple Gated Cardiac Imaging

The use of multiple gated cardiac imaging in the diagnosis of left ventricular pseudo-aneurysm is reported and the clinical and therapeutic implications are discussed. Complemented with myocardial perfusion imaging, it is the method of choice for screening patients following infarction or chest trauma who may develop this potentially treatable complication of myocardial necrosis.

Status epilepticus in immature rats. Protective effects of glucose on survival and brain development.

The role of glucose metabolism in alleviating the complications of status epilepticus (SE) was investigated in developing rats. Pretreatment with glucose reduced mortality from SE by 90% in rats under 1 week of age, 80% in 10-day-old rats, 50% in 15- to 20-day-olds, and not at all in adults. In 4-day-old animals, brain DNA synthesis during seizures, and in survivors, brain weight, DNA, RNA, protein, and cholesterol contents at 7 days of age were reduced less in glucose-treated than in saline-treated littermates. In the saline group, seizures caused a progressive fall in brain glucose level but no fall in blood glucose level, suggesting that glucose transport from blood to brain could not keep pace with glycolytic demands. In glucose-treated rats, blood and brain glucose concentrations remained elevated throughout the convulsive period. There was no reduction of brain adenosine triphosphate levels in either group. Thus, the protection by glucose appears to be related to its roles as a carbon source rather than an energy source. It is concluded that in immature animals, depletion of brain glucose can occur in the absence of hypoglycemia, and may be an important and potentially treatable complication of status epilepticus.

Infection of ascitic fluid in patients with hepatic cirrhosis

Infection of the ascitic fluid is a treatable complication which can easily escape diagnosis. The clinical features are recorded in this paper. The use of a special trocar and cannula...