Postgraduate medical journal
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A 47 year old male insulin-dependent diabetic developed two synchronous life-threatening Clostridium perfringens infections under unusual circumstances. Numerous sterile abscesses were also present, being the result of regular pentazocine intramuscular injections. ⋯ The patient made an excellent functional recovery. The pathogenesis of gas gangrene after injection is discussed with particular reference to the diabetic patient.
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A 74 year old man with light-chain myeloma developed amyloidosis with macroglossia after 10 years of therapy with alkylating agents. Over a 2-year period his tongue enlarged to persistently protrude from his mouth, inhibit his speech, interfere with normal swallowing and eventually threaten his airway. ⋯ Within two weeks the patient's speech became comprehensible and his ability to eat returned to normal. Although rare in amyloidosis, massive macroglossia may occur and surgical correction is easily achieved.
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Published data on the role of fibreoptic bronchoscopy in the investigation of pleural effusions are sparse and conflicting. We have reviewed our experience from November 1980 to December 1986. ⋯ Fibreoptic bronchoscopy was diagnostic in 6 of the 32 cases, but less invasive procedures had given the diagnosis in 4, and in the other 2 cases radiological abnormalities other than the effusion suggested an underlying bronchial malignancy. We conclude that routine fibreoptic bronchoscopy is not justified in the evaluation of pleural effusions.