Biomedical subjects
Publications and source records attributed to J R Middleton.
A case of seminoma is described in a patient with HIV infection. The tumor presented atypically with no lymphocytic infiltrates within the stroma. HIV infection has been reported to be associated with an increased incidence of Kaposi's sarcoma, non-Hodgkin's lymphomas, oropharyngeal carcinoma and pancreatic carcinoma.
We have assessed right and left ventricular function by multigated radionuclide ventriculography in 12 consecutive patients with acquired immunodeficiency syndrome (AIDS) grouped according to the CDC classification system for HIV infection. Results were correlated with clinical, electrocardiographic and echocardiographic findings. Clinical examination and chest x-ray films showed no evidence of acute cardiac or pulmonary pathology. Five patients had evidence of ventricular dysfunction by radionuclide ventriculography along with significant ECG abnormalities. Three patients had abnormal ECG findings with normal ejection fractions. Echocardiography showed no evidence of significant valvulopathy or pericardial disease except for one patient with fibrinous strands associated with the pericardium. Decreased ejection fractions did not correlate with disease classification, risk group or survival. This study suggests that a major percentage of AIDS patients have some evidence of cardiac abnormalities. We conclude that abnormal ECG findings in an AIDS patient should alert the clinician to possible underlying ventricular dysfunction.
Piperacillin has been shown to be as safe and effective an agent as cephalothin and cefoxitin when used in patients undergoing elective intra-abdominal surgical procedures. Enterococcus species have been shown in other studies to be susceptible to piperacillin, perhaps making it the preferred antibiotic for prophylaxis in clinical settings when enteric flora will be encountered.
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The total number of cases of heroin-induced endocarditis occurring over a four-year period were reviewed in order to explain an increase in the number of cases in the last year studied (1975). Brown heroin was noted to be used more frequently by addicts during the period of increased incidence. Cultures of "street samples" of brown and white heroin as well as cocaine were obtained in order to elucidate a possible relationship between the increased use of brown heroin and the increased number of endocarditis cases. Despite frequent contamination of both white and brown heroin, none of the common endocarditis-causing pathogens were isolated from the samples. Staphylococcus aureus, the most common etiological agent, frequently resulted in tricuspid endocarditis. That the accepted criteria for tricuspid endocarditis may be present without actual cardiac valve involvement is demonstrated by a most unusual case of hepatic vasculature infection.
Massive hemoptysis in patients with tuberculosis is reported infrequently and then virtually always in association with cavitary disease or aspergilloma. In contrast, we describe herein five cases characterized by hemoptysis on admission, bilateral pulmonary disease, samples of sputum positive for acid-fast bacilli by Ziehl-Neelsen stain, and no obvious cavitary disease. In each, hemoptysis subsided and then suddenly recurred in prodigious amounts, leading to death, probably from asyphyxiation. In patients hospitalized with tuberculous hemoptysis of any amount, with or without an obvious cavity, aggressive diagnostic evaluation, including bronchoscopic examination, may define the site of bleeding, thus permitting rapid surgical intervention if the hemoptysis increases.
Fibrosarcoma is a common tumor affecting bone, but is uncommon in cows. Reported here are two bovine cases of facial fibrosarcoma that were very invasive.
A 4-month-old, 6.8-kg, castrated male pygmy goat was examined for recurrent episodic fever and red urine of 7 days' duration. A second, 3-month-old, 7-kg, intact female pygmy goat was presented for similar clinical signs. The red discoloration of the urine in each case was determined to be due to hemolysis with subsequent hemoglobinuria. In both cases, hemolysis and hemoglobinuria were closely associated with the goats consuming large volumes of water from a human infant's nipple bottle. A diagnosis of water intoxication-induced hemolysis and hemoglobinuria was made. Episodes of hemoglobinuria in the first case were consistently associated with dilute (specific gravity < 1.010) urine. Water intoxication has been associated with bottle-feeding in human infants and is also widely reported in human psychiatric patients. The small erythrocytes in goats appear to be the most sensitive of the domestic species to hypotonicity-induced hemolysis.
The sensitivity, specificity, and accuracy of classification of 4 tests for failure of passive transfer (FPT) were examined in clinically ill neonatal calves. Comparisons were made with serum IgG1 concentrations determined by radial immunodiffusion. Serum samples were obtained from 27 clinically ill calves < or = 21 days of age. The results of 4 commonly used assays, the sodium sulfite turbidity test, the zinc sulfate turbidity test, refractometry, and the serum gamma-glutamyl transferase (GGT) activity test, were compared with radial immunodiffusion determinations of serum IgG1 concentration. Serum GGT activity using a 50 IU/L threshold resulted in correct classification of the highest percentage of calves (93%) with regard to their passive transfer status. The sodium sulfite test with a 1+ end point and refractometry using a 5.5 g/dL end point resulted in correct classification of 85% of the calves studied. When using the sodium sulfite test, the 2+ and 3+ test end points had lower specificity, 0.58 and 0.00, respectively, than the 1+ end point. This loss in specificity resulted in misclassification of calves with adequate serum immunoglobulin concentrations as having FPT. The zinc sulfate turbidity test was inadequately specific (0.33) and resulted in misclassification of 33% of calves.