Arch Intern Med
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Classic pernicious anemia with abnormal Schilling test results developed in a previously described vegan patient who had coexisting subtle cobalamin malabsorption (demonstrable by abnormal ovalbumin-cobalamin absorption test results but normal Schilling test results). This suggests that the ovalbumin-cobalamin absorption test or a modified version may serve as a prodromal phenomenon to identify patients at risk for developing pernicious anemia. The patient's transformation was also accompanied by the appearance of serum anti-intrinsic factor antibody. A modified assay retrospectively detected this antibody a year earlier than did the standard assay, indicating that such modification enhances the sensitivity of this useful test.
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Pseudomonas aeruginosa has emerged into the limelight mainly as a result of compromised host problems and the development of resistance leading to serious treatment difficulties. The organism possesses virulence factor that produce an effect in certain clinical situations. Changes in local anatomy, often with the presence of foreign bodies, are important (bladder and intravenous catheters, tracheostomy, burns, wounds, and injuries). ⋯ A mucoid form of P aeruginosa is a characteristic feature of cystic fibrosis. Resistance of P aeruginosa to antibiotics is very definitely associated with overuse of broad-spectrum antibiotics in hospitals. New and more effective antibiotics may be needed.
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An unconventional presentation of an elderly man with sepsis and a nonfunctioning permanent cardiac pacemaker is reviewed. Our interpretations of signs of an acute abdomen and laboratory evidence suggestive of acute cholecystitis did not lead to the correct diagnosis. The pacemaker electrode had perforated the myocardium and this event is believed to be secondary to bacterial endocarditis at the electrode tip. The therapeutic implications of this unique case are discussed.