Southern medical journal
-
Southern medical journal · Apr 1996
Established adult respiratory distress syndrome successfully treated with corticosteroids.
In 1990, we described the treatment of established adult respiratory distress syndrome (ARDS) with a sustained course of adrenocortical steroids (ACS). This report updates our experience with an uncontrolled prospective series. Patients with ARDS of more than 3 days' duration were initially given ACS in intravenous dosages of 125 to 250 mg every 6 hours, with tapering every 3 to 4 days. ⋯ We have treated 26 patients, and overall survival was 81% (21/26). When complicating features were present, survival was 64% (9/14). Our uncontrolled, observational experience in treating established ARDS suggests that a sustained course of ACS may improve survival in these severely ill patients.
-
Southern medical journal · Apr 1996
Case ReportsEarly recognition of risk factors for persistent effects of vecuronium.
Renal failure and hepatic failure are important risk factors for persistent effects of vecuronium. We report a case in which vecuronium therapy after cardiac arrest led to prolonged paralysis due to severe renal and hepatic dysfunction not apparent until after vecuronium therapy. Biochemical and electrophysiologic examinations confirmed that neuromuscular blockade due to accumulation of one active metabolite of vecuronium was the primary cause of the patient's paralysis. This case highlights the importance of recognizing progressive renal and hepatic dysfunction after cardiac arrest when contemplating treatment with vecuronium.
-
Southern medical journal · Apr 1996
Case ReportsPneumocystis carinii pneumonia with an atypical granulomatous response.
Pneumonia due to Pneumocystis carinii may present atypical radiographic and pathologic findings. We report the case of a 32-year-old man with acquired immune deficiency syndrome (AIDS) whose chest roentgenogram showed a bilateral diffuse nodular pattern suggestive of miliary tuberculosis. Diagnosis ultimately required open lung biopsy, which showed evidence of an atypical granulomatous reaction with Pneumocystis carinii in the absence of other organisms. P carinii pneumonia must be considered in the differential diagnosis of patients with AIDS with nodular pulmonary densities and evidence of an atypical granulomatous reaction on pathologic specimens.
-
Southern medical journal · Apr 1996
Case ReportsPersistent pain associated with long-term intrathecal morphine administration.
A 32-year-old man with chronic intractable right lower extremity pain unresponsive to multiple neurosurgical and pharmacologic treatments, including intrathecal morphine administration, was successfully treated with sciatic nerve block, discontinuance of opioid therapy, and psychologic interventions. Plasma and urine ratios of morphine metabolites morphine-3-glucuronide and morphine-6-glucuronide were analyzed at the beginning of our interventions, and the results indicated that morphine-3-glucuronide levels were significantly higher than morphine-6-glucuronide levels. The possible association between the observed morphine metabolite ratio and the intractable pain in patients resistant to opioids may have potential clinical implications.