Withdrawing fluids and nutrition: an alternate view.
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Biomedical subjects
Publications and source records attributed to F Rosner.
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Fifty-five cases of the occurrence of serious pneumococcal infections in both splenectomized and nonsplenectomized individuals who received pneumococcal vaccine were reviewed from the literature. Reasons for vaccine failure included the occurrence of non-vaccine-type pneumococcal infections (18 cases), possible poor antibody response to the vaccine, especially if it is given postsplenectomy and/or following intensive steroid or other immunosuppressive therapy, and decline in antibody titer over time. Although the total number of vaccinated individuals is unknown, the overwhelming majority of the many thousands of vaccinees have been successfully protected with pneumococcal vaccine. In spite of very rare vaccine failures, pneumococcal vaccination (and perhaps penicillin prophylaxis) is strongly recommended for patients at high risk of developing serious pneumococcal infections, including all individuals undergoing splenectomy for any reason, or for those who have had a splenectomy or have functional asplenia.
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Metastatic cancer to the heart is difficult to diagnose ante-mortem. This report describes a patient with adenocarcinoma of the lung who presented with cardiac manifestations mimicking coronary artery disease. Two-dimensional echocardiography demonstrated massive cardiac infiltration with tumor, correlating with subsequent autopsy findings, which were also remarkable for endocardial implants and coronary artery emboli without myocardial infarction. Use of two-dimensional echocardiography may detect intracardiac tumor at an earlier stage.
All splenectomized individuals are at risk of developing pneumococcal sepsis, but most reports fail to mention how many patients are given prophylactic penicillin therapy. Fourteen reported cases of postsplenectomy bacterial sepsis in patients receiving prophylactic penicillin therapy are reviewed. In only five cases, the patients had penicillin-sensitive pneumococcal infection. Hence, the exact frequency of the failure of penicillin prophylaxis cannot be calculated, but it appears to be very rare. Continuous antibiotic prophylaxis used indefinitely and pneumococcal vaccine are both strongly recommended for all children and adults undergoing splenectomy.
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Seventeen patients with Streptococcus mitis endocarditis were treated at a municipal hospital over a three-year period. Thirteen patients were intravenous drug addicts. Streptococcus mitis has a predilection for right-sided endocarditis in intravenous drug addicts and left-sided endocarditis in non-drug addicts. Streptococcus mitis is highly susceptible to therapy with penicillin G potassium (minimal inhibitory concentration less than or equal to 0.1 mg/L of penicillin in all of these 17 cases), and four to six weeks of therapy is safe and effective.
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