Biomedical subjects
H W Wallach
Publications and source records attributed to H W Wallach.
Sciatic nerve compression during anticoagulation therapy. Computerized tomography aids in diagnosis.
Severe hip pain developed in a patient who was receiving anticoagulation therapy of heparin sodium and warfarin sodium (Coumadin) for femoral vein phlebitis. The patient had exquisite tenderness but no ecchymoses along the sciatic nerve. A drop in the hemoglobin level showed a large volume loss of blood. Retroperitoneal hematoma with lumbar plexopathy was suspected, but a computerized tomographic scan revealed instead hemorrhage into the gluteal muscles. The anticoagulation therapy was corrected with the addition of protamine sulfate and vitamin K; the patient's pain lessened and the hemoglobin level stabilized. Computerized tomography allowed clear visualization of the hematomas in the buttock, and invasive studies were avoided. Hip pain and a falling hemoglobin level in a patient receiving anticoagulation therapy should alert one to the possibility of bleeding into the retroperitoneal space, thigh, or buttock.
Treatment of thrombotic thrombocytopenic purpura with plasma infusions and cyclophosphamide.
Our patient presented with thrombotic thrombocytopenic purpura. Treatment failed despite splenectomy, corticosteroids, dextran, and antiplatelet drugs. Plasma infusions induced neurologic recovery, but hematologic improvement could not be sustained when they were discontinued. Cyclophosphamide, however, induced a sustained remission.
Intrapleural therapy with tetracycline and lidocaine for malignant pleural effusions.
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Lupus-like syndrome associated with carcinoma of the breast.
Two patients with locally advanced carcinoma of the breast had radiation therapy as primary treatment. Within one year, a lupus-like syndrome developed characterized by pneumonitis, pleural effusion, and positive fluorescent antinuclear antibody (FANA) reaction and lupus erythematosus (LE) preparation. Pericarditis developed in one patient and leukopenia in the other. The bilateral pulmonary disease, serological abnormalities, and rapid and sustained response to administration of prednisone made the diagnosis of systemic lupus erythematosus more likely than radiation-induced disease or metastic carcinoma. Radiation to normal and/or malignant tissue may have initiated an immunological response leading to a lupus-like syndrome.
Intrapleural tetracycline for malignant pleural effusions.
After drainage by closed-tube thoracostomy, tetracycline was instilled in seven patients with malignant pleural effusions. None of the patients had clinically significant recurrence of effusion, even though four patients worsened while receiving systemic chemotherapy and died.
Medroxyprogesterone acetate (Provera R ) therapy in acromegaly associated with heart disease.
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