The American journal of medicine
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The risk of overwhelming sepsis in asplenic patients has been recognized increasingly over the past several decades, but the underlying mechanisms are not fully understood, and there is controversy over the true magnitude of risk and the value of specific interventions. Review of recent series indicates that postsplenectomy sepsis is more likely after splenectomy in childhood than after splenectomy in adulthood but may occur after splenectomy at any age. ⋯ Predisposition to pneumococcal sepsis and to other infections reflects the role of the spleen in mechanical filtration of particulate material in the bloodstream, generation of opsonins and other soluble mediators of phagocytosis, and anatomic juxtaposition of different elements of the immune system. Whereas pneumococcal vaccine is indicated in asplenic patients, the value of other interventions requires further evaluation.
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Comparative Study
Abnormal pulmonary function specifically related to congestive heart failure: comparison of patients before and after cardiac transplantation.
A variety of abnormalities in pulmonary function have been attributed to, or are believed to be, exacerbated by congestive heart failure. Separating out specific contributions from cardiac versus pulmonary disease is difficult. In order to investigate the impact of cardiac disease on pulmonary function, we performed spirometry on patients immediately before and after cardiac transplantation. ⋯ We conclude that in patients selected as cardiac transplant candidates (those without severe obstructive lung disease), restrictive but not obstructive pulmonary physiology can be attributed in part to congestive heart failure, and a major part of the reduction in lung volumes is secondary to the space occupied by a large heart. Other factors, such as accompanying pleural effusions and interstitial edema, likely contribute to the reduction in lung volumes. Abnormal pulmonary function secondary to chronic congestive heart failure in this selected population is completely reversible with normalization of cardiovascular physiology and anatomy.
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This study was designed to determine if (1) alcoholics have a higher prevalence of hepatitis B virus (HBV) serologic markers than do non-alcoholic controls and (2) if they respond to hepatitis B vaccination in a manner similar to that of non-alcoholic controls. ⋯ Chronic alcoholics have a higher prevalence of HBV seromarkers than do age-matched controls. Seronegative alcoholics, especially those under age 45, respond well to hepatitis B vaccination, and such vaccination should be considered in all chronic alcoholic persons.