The American journal of medicine
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Case Reports
Granulomatous mediastinitis due to Aspergillus flavus in a nonimmunosuppressed patient.
A patient with granulomatous mediastinitis due to Aspergillus flavus is described. A 22 year old black man presented with cough, fever and a right hilar mass. Mediastinal biopsies revealed granulomatous fibrosing mediastinitis with fungal elements compatible with aspergillus species. ⋯ The patient was treated with amphotericin B and 5-fluorocytosine but esophageal and superior vena caval compression developed and he died. This is the first reported case of granulomatous mediastinitis due to A. flavus in a patient whose immune responses were not suppressed (nonimmunosuppressed patient). Infection with Aspergillus species should be considered in the differential diagnosis of granulomatous mediastinitis.
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Accidental needle sticks sustained by hospital personnel account for many hospital-related injuries, but little information is available dealing with risk factors amenable to control. We reviewed 316 reported needle stick injuries--accounting for one third of all work-related accidents--occurring in employees of our hospital over a 47-month period from 1975 to 1979. Housekeeping (127.0 cases per thousand employees annually) and laboratory personnel (104.7 per thousand) experienced the highest incidence of needle-stick injuries, followed by registered nurses (92.6 per thousand), but 60 percent of all injuries occurred in nursing personnel. ⋯ The total cost of needle puncture injuries in our hospital over a 27-month period of $6,331. We recommend not recapping used needles and making widely available and promoting use of an efficient needle disposal system. All hospital personnel, including physicians, are urged to report needle-stick injuries to the hospital's Employee Health Service where evaluation and management can be effected most consistently by established protocols.
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A patient with systemic lupus erythematosus (SLE) is described who displayed the unusual extraglomerular syndromes of interstitial cystitis with obstructive uropathy and severe secretory-type diarrhea with intestinal malabsorption. Pathologic investigations into the nature of these events revealed immunofluorescent deposits in blood vessel walls of the small intestine and urinary bladder. The patient's malabsorption state and cystitis with urinary obstruction regressed with therapy of the SLE. We are postulating that immune complexes from the circulation may deposit in blood vessel walls, and may be responsible for tissue injury in these sites and the clinical manifestations of this patient.