Internal medicine
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We studied the prognostic applicability of electroencephalograms (EEGs) of seventy-nine patients within 24 hours after successful cardiopulmonary resuscitation. The EEGs were classified into five grades according to a modified Hockaday's scale. The EEGs of grades I and II implied full recovery, while those of grade III gave a varied but generally unfavorable prognosis. ⋯ Several cases showed EEGs with different periodic patterns in consecutive records. We conclude that an EEG is a good indicator of patient prognosis after cardiopulmonary resuscitation. However, the clinical significance of morphological differences of various periodic patterns that can occur during an EEG remains to be established.
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Case Reports
IL-5 predominant in bronchoalveolar lavage fluid and peripheral blood in a patient with acute eosinophilic pneumonia.
We describe an acute eosinophilic pneumonia (AEP) patient with bronchoalveolar lavage fluid (BALF). Eosinophil cell number (47%), content of interleukin (IL)-5 (8.22 x 10(2) pg/ml) and eosinophil cationic protein (9.25 micrograms/ml) were high in BALF. No eosinophilia was seen in peripheral blood on admission; however, content of IL-5 was 9.47 x 10(2) pg/ml. ⋯ However, a high content of IL-5 (6.9 x 10(2) pg/ml) and transient eosinophilia (17.5%) were seen in peripheral blood. It is important to distinguish between AEP and infectious pneumonia, because of the differing treatments. If the diagnosis of AEP is doubtful, BALF should be performed early.
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A 14-year-old female with ulcerative colitis developed right anterior cervical pain and high fever. Cervical contrast-enhanced computed tomography (CE-CT) showed a wall thickness of the right common carotid artery which suggested aortitis. Her pulmonary angiography demonstrated a narrowing of the pulmonary arteries and she was diagnosed as having Takayasu's disease associated with ulcerative colitis. HLA analysis showed Bw52 and DR2 haplotype, which is frequently found in patients with Takayasu's disease associated with ulcerative colitis.
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A 39-year-old housewife who underwent intramammary injections of a proprietary silicone fluid mixture showed clinical and novel transbronchial lung biopsy (TBLB) findings. She presented with complaints of progressive dyspnea, dry cough, and pleuritic chest pain 2 days after the last silicone injections. ⋯ The documentation of intramammary injections, the clinical and radiographic features of acute pneumonitis, and the histopathologic evidence by TBLB, may support the causal relationship between illicit injections and the silicone embolism. We discuss the pathogenesis and urge that this potentially toxic source of pulmonary embolism be removed.
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A case of rhabdomyolysis associated with bacteremic pneumonia due to Staphylococcus aureus is reported. A 58-year-old man was admitted because of severe left lobar pneumonia, and presented myoglobinuria on admission. ⋯ Rhabdomyolysis has rarely been reported in cases of bacterial infection, especially those due to Staphylococcus aureus. This case might be an extremely rare case of rhabdomyolysis complicating Staphylococcus aureus bacteremia following severe left upper lobar pneumonia.