1/8. The pulmonary physician in critical care. Illustrative case 2: interstitial lung disease.The case history of a patient admitted to the ICU with interstitial lung disease deteriorating to respiratory failure is presented. Problems in distinguishing between infection and disease progression are discussed and the role of transplantation in ventilated patients is examined.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. A neutropenia suggesting an interaction between valacyclovir and mycophenolate mofetil.Mycophenolate mofetil (MMF) is a drug which decreases the frequency of renal transplantation rejection. However, cytomegalovirus infections are a common feature of this treatment leading the physicians to prescribe antiviral prophylactic drugs like valacyclovir. During this association, neutropenia occur and the cause of this adverse effect is difficult to define. This report presents a case of neutropenia in a woman treated with MMF and valacyclovir. As the duration of the valacyclovir treatment exactly corresponds to the neutropenia duration, and the mycophenolate trough levels increased with the neutrophil count, the responsibility of this neutropenia was ascribed to valacyclovir. However, an examination of the literature for cases of neutropenia led to the suspicion of an interaction between MMF and valacyclovir. Mycophenolate may increase intracellular concentrations of valacyclovir up to haematotoxic levels. This mechanism may explain the interaction and further research is needed to confirm this interaction.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
3/8. Cytomegalovirus peritonitis in a patient with the acquired immunodeficiency syndrome.peritonitis has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS). Intestinal or colonic perforation resulting from cytomegalovirus (CMV) enteritis is the most common cause of peritonitis in these patients. We report a patient with CMV peritonitis occurring in the absence of perforation (primary peritonitis) to alert physicians to this potentially treatable disorder.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
4/8. Hemiatrophy and hemiparesis in a patient with congenital cytomegalovirus infection.A 3-year-old girl with congenital cytomegalovirus (CMV) infection has been followed up since birth. Hemiatrophy and hemiparesis occurred at 9 months of age. These unusual sequels of congenital CMV infection should encourage physicians to do longitudinal studies on infants with congenital CMV infection, as well as to examine children with hemiatrophy and hemiparesis for CMV infection.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
5/8. Cytomegalovirus mononucleosis in a healthy adult: association with hepatitis, secondary Epstein-Barr Virus antibody response and immunosuppression.A 35 year old previously healthy physician had clinical manifestations of a mononucleosis illness complicated by arthralgia, vesicular pharyngitis and hepatitis. Initially, the patient had cytomegalovirus (CMV) viremia (predominantly in polymorphonuclear leukocytes) followed by the presence of CMV in the urine, throat and semen. He also had an antibody response to the Epstein-Barr virus which appeared to be a secondary type. During the acute phase of illness, only 7 per cent of the patient's lymphocytes formed spontaneous T cell rosettes as compared to a normal value of 65 to 70 per cent. Concurrently, evidence of abnormal delayed hypersensitivity was manifested by the loss of reactivity to mumps skin test antigen. All clinical and laboratory abnormalities except for the persistence of CMV in the pharynx, urine and semen returned to normal after resolution of the clinical illness.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
6/8. intestinal perforation due to cytomegalovirus infection in patients with AIDS.intestinal perforation due to cytomegalovirus (CMV) infection in patients with AIDS is the most common life-threatening condition requiring emergency celiotomy in these patients. The authors describe a patient with AIDS with intestinal perforation due to CMV infection, and review 14 additional cases reported in the English-language surgical literature. The diagnostic triad of pneumoperitoneum on x-ray, evidence or history of CMV infection, and AIDS occurred in 70 percent of patients. The most common site of intestinal perforation was the colon (53 percent), followed in frequency by the distal ileum (40 percent) and appendix (7 percent); perforation usually occurred between the distal ileum and splenic flexure of the colon. colonoscopy, rather than sigmoidoscopy, is recommended as a screening examination in patients with AIDS suspected of having colonic ulceration due to CMV infection. Multiple biopsies of ulcerated tissue should be obtained. Gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and CMV infection. Despite aggressive therapy, the operative mortality rate in patients with AIDS with intestinal perforation due to CMV infection was 54 percent and the overall mortality rate was 87 percent. postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by pneumocystis carinii infection. An increased awareness of this syndrome by physicians frequently called on to manage patients with AIDS is recommended.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
7/8. Echogenic vasculature in the basal ganglia of neonates: a sonographic sign of vasculopathy.The vessels that supply the basal ganglia and thalami are not normally conspicuous on the cranial sonograms of neonates. Twelve neonates with abnormally echogenic or "bright" vessels on cranial sonograms were studied. Records of these 12 patients were reviewed and were correlated with the neuropathologic findings available in four. The clinical diagnoses were cytomegalovirus infection (five patients), rubella (two patients), congenital syphilis (one patient), and trisomy 13 syndrome (three patients). No diagnosis was made in one infant. At neuropathologic examination, perforating medium-sized arteries to the basal ganglia and thalami had thickened hypercellular walls, with deposits of amorphous basophilic material in three infants. Results of computed tomography and radiography of brain sections were normal in these areas. Sonography is helpful in detecting early noncalcific inflammation and mineralization in vasculitis. Although nonspecific, these findings should alert the physician to the possibility of congenital infection or chromosomal abnormality.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |
8/8. Cytomegalovirus enteritis causing massive bleeding in a patient with AIDS.An emergency operation was performed on a 58 year-old heterosexual male patient for massive lower gastrointestinal bleeding, which was caused by cytomegalovirus (CMV) related ulceration at the terminal ileum. Pre-operative endoscopic evaluation revealed multiple esophageal and gastric ulcerations in upper gastrointestinal tract and much fresh blood in distal colon. angiography showed vascular tufts and extravasation of contrast medium in the cecal area. angiodysplasia of cecum with massive bleeding was initially impressed. However, CMV enteritis was identified in the resected ileum, the diagnosis of acquired immunodeficiency syndrome (AIDS) was confirmed by subsequent serological tests. AIDS was unknown to treating physicians until diagnosed by pathological specimen. Massive lower gastrointestinal bleeding related to CMV ulceration in small bowel is rare, we report this unusual presentation and highlight the the suspicion of immunocompromised state of patients with unusual, multiple gastro-intestinal ulcers.- - - - - - - - - - ranking = 0.25keywords = physician (Clic here for more details about this article) |