Hawaii medical journal
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Hawaii medical journal · Jun 2009
Review Case ReportsFirst reported United States case of Legionella pneumophila serogroup 1 pneumonia in a patient receiving anti-tumor necrosis factor-alpha therapy.
Legionellosis has been reported to be an extremely rare disease in Hawai'i. The authors report a case of a 67-year-old woman with a history of rheumatoid arthritis treated with long-term adalimumab who developed severe right-sided community-acquired pneumonia and a parapneumonic effusion. Legionella pneumophila serogroup 1 was confirmed as the microbiologic cause based on a positive urine Legionella antigen as well as direct fluorescent antibody and Legionella culture of bronchoalveolar lavage. ⋯ With the increasing use of TNF-alpha antagonists, Legionella pneumophila should be recognized as a potential re-emerging pathogen. Clinicians should particularly consider the diagnosis of legionellosis in patients who are immunocompromised, including those who receive anti-TNF-alpha therapy, or who have severe pneumonia. In such cases, there should be a low threshold for including empiric Legionella antimicrobial coverage until the diagnosis can be confirmed or reasonably excluded.
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Hawaii medical journal · Apr 2009
Selection criteria for expander/implant breast reconstruction following radiation therapy.
Breast reconstruction with expander/implants is generally discouraged in patients who have undergone radiation therapy. However, not every patient treated with radiation develops sequelae severe enough to preclude the use of prostheses. To date, there have been no studies that have established criteria for selecting which patients may still be considered for expander/implant reconstruction. We present a series of 27 patients--the largest of its kind to date--all of whom underwent bilateral mastectomies, radiation therapy to only one chest wall, and delayed reconstruction with submuscular expander/implants. The aesthetic outcomes of the irradiated and the non-irradiated breasts were compared, and a classification of post-radiation skin changes was devised for selecting candidates for expander/implant reconstruction. ⋯ A history of chest wall radiation should not itself exclude patients from receiving expander/implant reconstruction. Patients who develop neither severe skin changes nor induration may still be considered for prostheses.
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Hawaii medical journal · Oct 2008
Prognostic factors and utility of scoring systems in patients with hematological malignancies admitted to the intensive care unit and required a mechanical ventilator.
Mortality of patients with hematological malignancy requiring mechanical ventilation is high. Neither early prognostic indicators nor scoring systems that discriminate survivors from non-survivors to aid in end-of-life decision making have been identified. ⋯ Mortality of patients with hematological malignancies requiring mechanical ventilation remains high. No single independent risk factor for ICU mortality was identified with multivariate logistic regression analysis. Prognostic scoring systems do not yield adequately reliable information to be used exclusively for end-of-life decision making in individual patients.