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G Dworkin

Publications and source records attributed to G Dworkin.

7 recordsLinked to original sources

Association of hematuria and mycobacterial infection.

Hematuria has been noted to be a presenting symptom of urinary tuberculosis. In the last few decades because of the decreasing incidence of tuberculosis in the United States, the association of tuberculosis and hematuria has been neglected. Now that the incidence of tuberculosis is again on the rise, it is timely to remind the medical community of this association. We present 3 children with hematuria associated with positive tuberculin tests. Mycobacterium tuberculosis was cultured from the urine of one patient. Mycobacterium avium-intracellulare was cultured from a second patient. All 3 patients showed clearing of their hematuria with antituberculosis therapy. A tuberculin test should once again be considered part of the standard work-up of hematuria.

Adolescent

Mechanical ventilation for status asthmaticus in children.

We retrospectively reviewed the time course of recovery of pediatric patients in status asthmaticus who were undergoing mechanical ventilation for life-threatening respiratory failure to evaluate the results with current medications and technology. Ten patients between 2 and 18 years of age underwent intubation on 20 occasions. Mechanical ventilation was maintained for a mean of 2 days. Positive end-expiratory pressure was introduced in the recovery phase to prevent hypoxemia. Twelve episodes (Group 1) involved intubation less than 48 hours; in eight episodes (group 2) the patients required ventilatory support greater than 48 hours. The two groups did not differ in regard to age, pharmacologic therapy, preintubation arterial blood gas data, or initial ventilator settings, but the rise in pH and fall in Paco2 differed significantly over the first 12 hours of therapy. In the group 2 patients, peak pressures were not increased greater than 60 cm H2O despite elevated Paco2 values, and aggressive sodium bicarbonate therapy for pH correction was not pursued. Complications were few and all patients survived. We conclude that asthma patients have variable resolution of airway obstruction during mechanical ventilation and that controlled hypoventilation can be a safe therapy for the patients with more severe obstruction.

Adolescent