The Quarterly journal of medicine
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Four cases of scrub typhus pneumonitis are reported. Diagnosis was confirmed by positive Weil-Felix OX-K reaction and immunofluorescent antibody test for Rickettsia tsutsugamushi. Two patients presented with atypical pneumonia and two had overwhelming pneumonia resembling adult respiratory distress syndrome. All patients made a full recovery after appropriate treatment.
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The frequency and type of psychiatric disease were investigated in 40 patients suffering from systemic lupus erythematosus (SLE) and 27 control subjects with rheumatoid arthritis or inflammatory bowel disease. The psychiatric morbidity at the time of interview was the same in the two groups, but the patients with SLE had experienced more episodes of psychiatric illness in the past, and psychotic symptoms occurred only in this group. ⋯ Magnetic resonance imaging of the brain was performed in 15 patients with SLE. Abnormalities were more often present in those with neurological disease; no such correlation was found with psychiatric illness.
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Plasma lactate concentrations and acid-base status were determined in 53 patients poisoned with paracetamol. Eleven patients (Group 1) had plasma paracetamol concentrations below the standard treatment decision line; 19 cases (Group 2) presenting within 15 h of overdose had plasma paracetamol concentrations above the treatment line and received N-acetylcysteine. The remaining 23 patients (Group 3) arrived at hospital too late (more than 15 h after overdose) for treatment with N-acetylcysteine to be completely effective. ⋯ As uncompensated metabolic acidosis is found in 20 per cent of patients who present early and require protective therapy, it should be sought and corrected if it does not remit spontaneously. Second, half the patients presenting too late for effective treatment are acidotic and those with an uncompensated metabolic acidosis resistant to correction have a poor prognosis. Paracetamol poisoning should be considered in the differential diagnosis of metabolic acidosis of unknown aetiology.
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Four hundred patients who were admitted over the last three years with myocardial infarction were questioned about the presence and pattern of angina before its onset. Two hundred and twenty-four (56 per cent) patients had angina before their infarction; 184 (46 per cent) had the unstable pattern of angina. ⋯ Patients with previous angina had a higher incidence of subendocardial infarction than patients without angina (stable or unstable) (p less than 0.01). In-hospital prognosis was better in patients with chronic or unstable angina than in patients without angina (p less than 0.05).
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As part of a major prospective study of neurological and psychological complications of coronary artery bypass graft surgery, involving 312 patients, detailed psychometric testing was carried out before and after operation on 298 patients using a battery of 10 standard tests of intellectual function. This report is concerned with the early neuropsychological dysfunction detectable one week after operation. Two hundred and thirty-five patients (79 per cent of the cohort) showed impairment in some aspect of cognitive function at the seventh day after operation. ⋯ Eighty-nine patients complained of cognitive impairment, and 23 patients were considered to be overtly disabled by their intellectual dysfunction, during the period soon after operation. There is therefore a high incidence of early cerebral dysfunction detectable by psychometric testing following coronary artery bypass graft surgery. Often this was not of sufficient severity to cause serious concern to the patients or to interfere with their everyday activities in the hospital environment.