Arch Intern Med
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Affiliation between community hospitals and university centers has become a prominent trend. St Mary's Hospital, a 298-bed community hospital, affiliated with the University of Rochester, School of Medicine and Dentistry, and in five years developed an academic program. ⋯ The program was financed through third-party reimbursement, faculty-generated Department of Medicine funds, gifts by private patrons, and extramural grants. At a time of diminishing investigative support, a medium-sized community hospital can develop a research program.
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Twenty cases of the adult respiratory distress syndrome (ARDS) in 86 cases of Gram-negative bacteremia were identified. Features of Gram-negative bacteremia associated with the development of ARDS included a history of cardiac disease, hypotension, and thrombocytopenia. The mortality of patients with and without ARDS was 90% and 55%, respectively. The association of hypotension and thrombocytopenia with the subsequent development of ARDS suggests the possible role of endotoxin-induced coagulopathy in this complication.
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In a 74-year-old woman, excessive insensible water loss developed secondary to a period of hot, humid weather, associated with an underlying inability to obtain adequate water replacement. On admission to the hospital she was comatose, clinically dehydrated, and had laboratory values consistent with a water deficit of approximately 30% (9 L) of body water. ⋯ The patient remained comatose for seven days, during which time she was vigorously treated with fluids, and she gradually recovered. This case represents what we believe is a unique report in the literature of the severity of hypernatremia developing via this pathogenic mechanism and survival in an adult with this degree of disturbance of sodium and water homeostasis.
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Six cases of acute thrombocytopenic purpura occurred secondary to heroin abuse. Five of the six affected patients were seen over a six-month period between November 1977 and March 1978, and the last patient was seen in November 1978. The clinical manifestations were characteristic of drug-induced immune thrombocytopenia. We suspect this syndrome is related to a new adulterant added to local street heroin.