1/8. Acute disseminated histoplasmosis complicated with hypercalcaemia.A case of acute progressive disseminated histoplasmosis complicated with hypercalcemia is reported and the literature is reviewed. This and the previously reported cases imply that physicians should have a higher index of suspicion for this infection and the probable underlying diseases resulting from impaired cellular-mediated immunity when encountering patients with hypercalcaemia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Gastrointestinal toxicity associated with weekly docetaxel treatment.Previous studies have demonstrated a marked reduction of haematological and non-haematological toxicity if weekly doses of docetaxel <40 mg/m2 were used. Reviewing the literature, neutropenic enterocolitis is uncommon but not unknown in patients treated with taxane-based chemotherapy. Although this complication occurs rarely, here we report on two patients, one with metastatic breast cancer and one with non-small-cell lung cancer, treated on a weekly schedule with single-agent docetaxel. Both patients developed excessive and fatal haemorrhragic gastroduodenitis and enterocolitis associated with grade 2 and 3 neutropenia. We would like to stress the importance of symptoms such as abdominal pain and tenderness, fever, diarrhoea and mucositis, with or without neutropenic fever, in patients treated with docetaxel-based chemotherapy. These symptoms should alert the physician and supportive care management should be started aggressively and immediately.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Tailored therapy of adult acute leukaemia in jehovah's witnesses: unjustified reluctance to treat.Treatment of acute leukaemia in adult jehovah's witnesses (JW) is challenging because of 'a priori' refusal of most physicians to apply diagnostic and therapeutic procedures to haematological abnormalities resembling acute leukaemia. Rejection of blood transfusions by individuals of this faith is usually blamed to justify this attitude, thus leading to severe personal, medical and psychological distress related to the lack of care. We therefore intended to verify whether a standard (tailored) chemotherapy, without the use of prophylactic blood product transfusions, could be applied during treatment of acute leukaemia under such circumstances. Eleven consecutive JW adult patients with acute leukaemia, all of whom had been denied care in other institutions, were treated at the European Institute of Oncology (EIO) in Milan, italy. Five had acute lymphoblastic leukaemia (ALL) (one bcr/abl positive), six had acute myeloid leukaemia (AML) with immunophenotype and/or cytogenetic intermediate-high risk features, except one patient with acute promyelocytic leukaemia (APML). Standard induction chemotherapy [cytosine arabinoside (ARA-C) and daunorubicin (DNR) for AML, vincristine (VCR), DNR and prednisone (PDN) for ALL, all-trans retinoic acid (ATRA) and DNR for APML] with the antracycline dose of at least 30 mg/sqm were used. All patients experienced severe anaemia after induction chemotherapy despite erythropoietin. Median haemoglobin nadir for patients with ALL and AML was 4.5 g/dL (range 1.3-6.9) and 5.1 g/dL (range 2.6-6.8), respectively. Median platelet nadir counts for all patients was 14.5 x 10(9))/L (range 1-24). One patient died during induction probably due to haemorrhage. Four of five patients with ALL achieved a complete remission (CR) (including the bcr/abl case) while among patients with AML only the one with APML achieved CR. Three patients (APML = 1 and ALL = 2) are still alive and disease-free. This small series of adult patients with leukaemia illustrates difficulties in treating patients who are practising JW, yet nevertheless provides a significant argument against the prejudicial decision leading to evasion of treatment in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. sepsis and multisystem organ failure in a woman attempting interval delivery in a triplet pregnancy: a case report.BACKGROUND: Interval delivery of the fetuses in multiple gestations has been shown to increase perinatal survival. CASE: A woman attempting interval delivery of triplets at 21 weeks developed chorioamnionitis, acute respiratory distress syndrome and tubular necrosis 7 days after delivery of the first fetus. CONCLUSION: When counseling women about the typically favorable outcomes of delayed interval deliveries, physicians should also warn of the potential risk of complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. gas gangrene secondary to clostridium perfringens in pediatric oncology patients.OBJECTIVE: To report 2 cases of severe gas gangrene secondary to clostridium perfringens in pediatric oncology patients. methods: We describe 2 children with acute presentations of gas gangrene secondary to C. perfringens. Both children were initially seen and treated in a community hospital emergency department and subsequently were cared for in a pediatric intensive care unit in a tertiary care, university-based children's hospital. RESULTS: Both children demonstrated severe and unrelenting decompensation and required operative intervention within the first hospital day, which included amputation of the infected limb. One child survived and one child expired despite heroic measures. CONCLUSIONS: gas gangrene secondary to C. perfringens is an uncommon but life-threatening and limb-threatening condition in pediatric cancer patients. A high index of suspicion in a immunocompromised child with cancer who presents with extremity pain in combination with neutropenia is the key to early diagnosis and may lead to improved survival. This disease requires prompt recognition and aggressive treatment to allow any hope of recovery. emergency medicine physicians who treat these children should be aware of this severe and potentially fatal infectious process and should not delay treatment or prompt orthopedic surgery consultation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. bacillus cereus pneumonia in a patient with acute lymphoblastic leukemia.Reported here is a case of bacillus cereus pneumonia that occurred in a patient with acute lymphoblastic leukemia. The presentation was severe, essentially marked by respiratory distress and pleuritic chest pain. Classic empirical treatment initiated for febrile neutropenia did not cover this rare pathogen and appropriate therapy was therefore delayed. B. cereus is most often a culture contaminant, but it can also be responsible for self-limited gastrointestinal intoxication and, more rarely, severe systemic diseases. virulence in the case of systemic disease is attributed to tissue necrosis mediated by toxin release. B. cereus pneumonia, as described in the English-language literature, mainly affects immunocompromised patients and most often has a fatal outcome. Thus, the identification of B. cereus in clinical specimens of severely ill immunocompromised patients should lead physicians to question its clinical significance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Deaths due to hunger strike: post-mortem findings.hunger strike is described as voluntary refusal of food and/or fluids. Prolonged starvation may produce many adverse events including even death in rare circumstances. Here, we present three fatal cases (all males, 25-38 years) died from hunger strike. In all corpses, obvious muscle wasting with reduced subcutaneous and internal fat deposits, and atrophy in some organs were demonstrated at autopsy. The extraordinary long starvation period before death could presumably be linked to the thiamine uptake in this period, which had been discontinued by all subjects before the death occurred. Prolonged caloric deficiency with subsequent complications such as multiple organ failure, severe sepsis and ventricular fibrillation could account as major causes of death in these subjects. The competence of the physicians working with hunger strikers about the processes and potential problems is of great importance since they have to acknowledge about them to their patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Recognition and management of adrenal emergencies.Although clinical conditions associated with dysfunction of the ad-renal gland are often subtle, even insidious, in their presentation,and diagnosis and treatment usually are confined to outpatient clinics and offices, there are several situations that warrant the attention of emergency physicians. Recognition of the spectrum of presentations of pheochromocytoma, adrenal insufficiency, and pituitary apoplexy, and the sequelae of corticosteroid therapy and withdrawal, are critically important areas to emergency medicine.Prompt diagnosis with appropriate treatment and referral will reduce morbidity and mortality in many patients each year. A related topic pertinent to emergency physicians is the management of incidental adrenal masses that are discovered on abdominal radio-logic imaging.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |