Medicine
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Normoglycemic remission has been observed in black non-insulin-dependent diabetic individuals. Thirty-three patients presented with severe hyperglycemia (mean glucose 682 mg/dl) and were hospitalized for initial treatment. Following intensive outpatient therapy including insulin or sulfonylurea for 0.25 to 96 weeks, they became normoglycemic without pharmacologic treatment. ⋯ Islet cell antibodies were uniformly absent, implying that these individuals did not have an autoimmune form of diabetes. It is not known if remission in non-insulin-dependent diabetes is unique to the black population. Neither the prevalence nor the mechanism of the development of remission is known at this time.
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With over 143,000 cases of AIDS reported to the World Health Organization from 145 countries and with an estimated 5 to 10 million people worldwide infected with HIV, AIDS has become firmly established as a global pandemic. In the region of the Americas over 100,862 cases of AIDS have been reported with indigenous transmission documented in 45 to 46 countries. While North America has the highest annual number of AIDS cases per population, with 72 cases/million, the Caribbean subregion has a disproportionately high number of cases, with annual rates as high as 200 to 300 cases/million population for some countries. ⋯ Clinically, a resurgence of diarrheal diseases, respiratory infections, and tuberculosis has been documented in association with HIV infection in many tropical countries of the Americas. With relatively high rates of HTLV-I infection already established in the Caribbean subregion, the overall public health problems of the Americas will be markedly potentiated by further spread of these 2 human retroviruses. If HIV infection continues to penetrate the poor and less advantaged populations in Latin America and the Caribbean, the potential exists for a massive epidemic in the Americas that may rapidly parallel the situation in Africa.
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The clinical, epidemiological and laboratory characteristics of bacteremia caused by anaerobic organisms other than Clostridium spp. in cancer patients are described and compared to other previously reported series. Of the 315 episodes, 246 (78%) were caused by a single organism and 69 (22%) were polymicrobial. The most common underlying malignancies were genitourinary and gynecological tumors, acute leukemia, and gastrointestinal malignancies. ⋯ Overall response to penicillin was only 13%. Suboptimal responses were also observed for the antipseudomonal penicillins. High response rates (82%) were also obtained with cefoxitin, metronidazole, and moxalactam.
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We evaluated the clinical features of 96 cases of amebic liver abscess and 48 of pyogenic hepatic abscess. Most patients with amebic abscess were young Hispanic males. Those with pyogenic abscess were older, without any ethnic predominance. ⋯ Seven patients with pyogenic abscess died, 5 as a result of hepatic abscess. In 3 of these cases, the diagnosis was unsuspected till autopsy. Improved awareness of this disease may decrease morbidity and mortality from this treatable condition.
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Cardiac myxoma is a true intracardiac neoplasm, which is histologically benign but which on occasion may exhibit behavior suggestive of a true malignancy. It is the most common form of primary cardiac tumor, accounting for 50% of such neoplasms. Seventy-five percent of myxomas are found in the left atrium, typically arising from a stalk attached to the area of the foramen ovale. ⋯ Four cases with unusual manifestations are high-lighted in the text to illustrate the protean manifestations of this potentially curable illness. Non-invasive cardiac imaging is essential to establish the diagnosis and differentiate myxoma from the other more common illnesses it imitates. Echocardiography is highly accurate for its diagnosis, has proved invaluable for the management of these patients, and is the imaging technique of choice for initial evaluation of patients in whom the diagnosis of cardiac myxoma is suspected.