1/8. Infections in the heart transplant recipient.The overall incidence of infection after transplantation has decreased with improved immunosuppressive agents, increased knowledge and use of prophylaxis, and better detection and treatment of infection. Nevertheless, infection continues to be a major cause of morbidity and mortality in heart transplant recipients. The knowledgeable nurse in any setting who cares for a transplant recipient must be aware of the lifelong susceptibility to common and opportunistic infections. The transplant recipient and his or her family must also be aware of the risks of early opportunistic infection. Infection is a lifelong concern for all persons on immunosuppressant medications, and the individual must learn appropriate precautions to reduce this risk. hand washing and avoidance of infected individuals are the most important self-care actions that the transplant patient should adopt. Recipients must also learn to monitor for subtle signs of infection. The nurse is responsible for teaching self-care to patients and family members. Ultimately, a team effort by the patient, family, nurses, and physicians can reduce the risk of infection in this vulnerable population.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. cardiac tamponade complicating postpericardiotomy syndrome.We present 2 children who developed postpericardiotomy syndrome (PPS) and the rare complication of cardiac tamponade after cardiac surgery, each requiring life-saving pericardiocentesis in the emergency department (ED). Each child presented with vomiting as a chief complaint, an initial sign that has not been reported previously. As the frequency of orthotopic heart transplants and other cardiac surgeries among children increases, it is likely that ED physicians will encounter PPS and cardiac tamponade with greater frequency, and it is imperative that it be recognized promptly and treated appropriately. We review PPS, cardiac tamponade, and the proper performance of a pericardiocentesis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Postviral bronchial hyperreactivity syndrome: recognizing asthma's great mimic.Although there are no prospective studies regarding the frequency of postviral bronchial hyperreactivity syndrome, it is a common complication of upper and lower respiratory tract viral infections. The respiratory symptoms closely resemble those of asthma, but they are present for only 3 weeks to 3 months following the acute infection phase. Defining the mechanisms of this syndrome may provide insight into the pathogenesis of asthma. Postviral bronchial hyperreactivity syndrome is frequently misdiagnosed and inappropriately managed because many physicians are unfamiliar with this illness. Because of its characteristic history, diagnosis is straightforward when the physician knows what to look for, and response to therapy is excellent. This report presents a case history followed by a review of the proposed mechanisms of bronchial hyperreactivity following viral respiratory infections. The clinical features and criteria for diagnosing postviral bronchial hyperreactivity syndrome are also discussed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/8. Fatal rotavirus gastroenteritis: an analysis of 21 cases.During the period of May 1972 to March 1977, twenty-one fatal cases of rotavirus acute gastroenteritis were recorded in the city of Toronto. The mean age of these subjects was approximately 1 year. Boys outnumbered girls by 12 to 9. death occurred within three days of onset of symptoms in all cases. Sixteen of the subjects were profoundly dehydrated and had sodium levels (serum or vitreous humor) in excess of 150 mEq/liter. In 11 subjects, sodium values were greater than 160 mEq/liter. Although a physician was contacted in 16 instances, these infants still perished. We suggest that both language difficulties and the rapid rate of fluid depletion contributed significantly to the fatal outcome. At autopsy the bowel was often dilated and filled with fluid. Postmortem autolysis precluded an accurate histological assessment of the small bowel mucosa.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Diagnostic virology in clinical practice.Viral illnesses are among the most common clinical problems encountered in medicine. Some have important epidemiologic implications and some are preventable by immunization, improved sanitation or other means. Recently, drugs have been developed which show promise for specific prophylaxis or treatment. It is thus increasingly important that physicians in practice be acquainted with methods of identification of common viral illnesses so they can intervene with appropriate counsel, preventive measures or treatment for their own patients. physicians should also consider the larger epidemiologic implications of many viral illnesses and cooperate with local, state and national efforts to accurately determine the number of patients involved and the severity of their illnesses. It is only with this sort of information that an estimate of medical, social and economic impact of the common viral diseases can be made, so that attention will be given to development of better prevention and methods of control.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Atypical bacterial infections explained by a concomitant virus infection.Because both viral and bacterial infections are common during early childhood, dual infections are not unexpected. However, the clinical manifestation of such combined infections may be, difficult to interpret, and they are often misdiagnosed as "atypical bacterial infection." Five patients with concomitant viral-bacterial infections are described. In all five cases, virus detection enabled the physicians to better understand an otherwise puzzling clinical presentation. In view of the recent progress in rapid viral diagnoses and the potential of antiviral drugs, the possibility of dual infection should be investigated more often.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. superinfection: another look.superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections. Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |