The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
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Case Reports
A 63-year-old man with recurrent pulmonary infections: a case of Swyer-James Macleod syndrome.
Swyer-James Macleod syndrome is a rare disorder that leads to recurrent respiratory infections. The fibrosis and obstruction of the terminal and respiratory bronchioles, likely caused by respiratory infections in early childhood, prevents normal development of the alveolar bud. Organisms that have been associated with this syndrome include adenovirus, measles, bordetella pertussis, mycobacterium spp, influenza A and mycoplasma. ⋯ The diagnosis of the syndrome can be made in infancy or early childhood, but in asymptomatic individuals can be delayed until adulthood and rarely in the elderly. Chest radiographs and computed tomographic (CT) scan can confirm the diagnosis and exclude other possibilities. A case of Swyer- James Macleod syndrome diagnosed at age 63 in a patient with recurrent respiratory infections and a history of childhood pertussis is presented.
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This retrospective study aimed to evaluate the effect of predisposing (demographic), enabling (organizational), and illness (health status) factors on human immunodeficiency virus (HIV)/acquired immunodeficiency virus (AIDS)-related hospital length of stay (LOS). Inpatient hospital visit record data from 1998 through 2003 was abstracted from the Louisiana Hospital Inpatient Discharge Database. We hypothesized that enabling, not predisposing or illness factors, influenced hospital LOS among HIV-infected persons in Louisiana. ⋯ Other significant independent predictors of LOS in the aggregate time series model were number of comorbid conditions, number of inpatient medical procedures, presence of an AIDS defining illness, and source and type of admission; although effects of only the first two predictors were significant at each year of analysis (all p-values < .05). This study shows that neither gender nor age of HIV patients is a significant predictor of HIV-related LOS. However, the number of comorbid conditions and inpatient medical procedures are significant.
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Louisiana physicians often face difficult predicaments in treating patients with chronic pain complaints. On the one hand, there is a greater appreciation for the debilitating impact of chronic pain on quality of life and better recognition that chronic pain is a disease in its own right deserving treatment. ⋯ This article dispenses common sense advice for the Louisiana physician in approaching chronic pain issues such as defining your treatment population, obtaining independent corroborating records, prescribing extended-release pain medications when possible, considering adjunctive treatments to reduce total opiate use, collaborating with colleagues regularly, utilizing treatment agreements, employing sensible verification methods of proper medication use, opening the doctor-patient relationship to include concerned family or friends, using psycho-social indicators of good functioning, and reappraising the success of treatment at appropriate intervals. By employing these common-sense approaches Louisiana physicians can approach pain management prescribing with more assurance and confidence.