The American journal of the medical sciences
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Case Reports
Extreme hyperbilirubinemia in a patient with hereditary spherocytosis, Gilbert's syndrome, and obstructive jaundice.
Hyperbilirubinemia may be of several etiologies in the individual patient. An 18-year-old man presented with extreme hyperbilirubinemia (direct bilirubin 23.0 mg/dl, total bilirubin 60.0 mg/dl), hepatosplenomegaly, and anemia. ⋯ Common bile duct obstruction secondary to choledocholithiasis was found, and a cholecystectomy and splenectomy were performed. This case stresses the potential confusion among several diseases which may present with hyperbilirubinemia.
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Sudden death after subcutaneous injection of silicone has been described. However, there are no cases in the literature of clinically diagnosed noncardiogenic pulmonary edema. ⋯ The presence of birefringent particles in the alveolar macrophages implies entrance of this material into the vascular compartment, its embolization to the lung and migration across the damaged alveolar-capillary membrane. Large volume subcutaneous injections of silicone should be added to the differential diagnosis of the etiology of the adult respiratory distress syndrome.
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A 47-year-old woman presented with cough, pleuritic chest pain and fever of three weeks duration. Although the patient lived in an area where blastomycosis is endemic, this diagnosis was not initially considered owing to the presence of consolidation and a large pleural effusion on the initial chest roentgenogram. Cultures of sputa, bronchial washings and pleural fluid documented the presence of pleuropulmonary infection with Blastomyces dermatitidis. Therapy with amphotericin B was associated with rapid clinical, roentgenographic and bacteriologic resolution of both pleural and parenchymal lung disease.
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Randomized Controlled Trial Clinical Trial
A double blind study of the effects of zinc sulfate on taste and smell dysfunction.
A randomized, double blind crossover study of the effects of zinc sulfate and placebo was carried out in 106 patients with taste and smell dysfunction secondary to a variety of etiological factors. In the patient group prior to treatment, mean serum zinc concentration and leukocyte alkaline phosphatase activity were significantly lower than normal. ⋯ Although these results demonstrate abnormalities of zinc metabolism in some patients with taste and smell dysfunction they fail to provide evidence for a single, therapeutic approach to the many disorders which are associated with abnormalities of taste and smell. However, the methods and procedures developed in this study demonstrate that taste and smell dysfunction can be studied in a quantitative, systematic manner.