Biomedical subjects
Publications and source records attributed to M Dan.
An unusual case of neuropathic arthropathy in a patient with tabes dorsalis is presented. The special feature consisted of multiple joint involvement in the upper limbs and spine. This uncommon location of Charcot joints can probably be attributed to the patient's occupation which involved heavy strains on his upper limbs.
Severe herpesvirus infections in 18 immunocompromised patients (25 episodes) were treated with i.v. acyclovir. Six patients had 13 episodes of mucocutaneous herpes simplex infections, eight children had varicella, three patients had generalized zoster, and one patient had cytomegalovirus pneumonia. No patient died from infections. In 18 episodes treatment with acyclovir produced a beneficial effect, in 5 episodes acyclovir was probably beneficial, and in 2 patients the effect could not be evaluated. No serious side effects could be definitely attributed to acyclovir administration. These data support the previous experience that i.v. acyclovir may be useful in the treatment of herpesvirus infections in immunocompromised patients.
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Endocarditis caused by Staphylococcus warneri and necessitating valve replacement occurred in a previously healthy 32-year-old patient following vasectomy. No sign of an underlying valvular defect was noted during the operation. S. warneri is a recently identified species of coagulase-negative staphylococci. Endocarditis caused by coagulase-negative staphylococci is uncommon in young, healthy patients with normal heart valves and has not previously been described as a complication of vasectomy. Similarly, infections caused by S. warneri have not previously been described in humans.
An erythematous eruption with itching developed in an 84-year-old man 4 days after therapy with allopurinol was initiated. The diagnosis of toxic epidermal necrolysis, suspected when separation of the epidermis was noted, was confirmed by skin biopsy. This is the third reported case that can be attributed exclusively to allopurinol and the first patient who did not die.
A 42-year-old woman developed severe, recurrent breast abscesses caused by Corynebacterium minutissimum. Prior reports of C. minutissimum infection have been limited to erythrasma, a minor dermatosis. The microbiological and clinical features of this species were reviewed.
The monocyte function, as measured by phagocytosis and killing of Candida albicans and Candida pseudotropicalis by peripheral blood monocytes, was found impaired in a patient with cirrhosis of the liver on two separate determinations before the occurrence of bleeding from oesophageal varices. Unexpectedly, Hodgkin's disease was diagnosed in enlarged abdominal lymph nodes found on the occasion of an emergency portocaval shunt operation.
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Primary actinomycosis of the thyroid was diagnosed in a 59 year old farmer who presented with a hard, non-tender, thyroid nodule. The difficulties encountered in the diagnosis of actinomycetal infections, its pathogenesis, and treatment are discussed.
A 2-year-old girl with virilization had an adrenal tumor that produced testosterone with little evidence of excessive urinary androgen excretion. Plasma testosterone concentration was 407 ng/dL and urinary 17-ketosteroid (17KS) levels were 3 and 2 mg/day. Excretion of 17KS decreased to 1.8 mg/day after suppression of dexamethasone therapy, but urinary 17-hydroxycorticosteroid excretion did not change from 1.0 to 0.7 mg/day after administration of dexamethasone. She had a blunted response to administration of metyrapone and insulin and a small diurnal variation in cortisol concentration suggesting suppression of corticotropin secretion, even though the plasma cortisol concentration was in the normal range and there were no clinical signs of cortisol excess. High-performance liquid chromatography was used to analyze the steroid content of tumor tissue. Those portions of the tumor that were rich in steroids contained predominantly testosterone.
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To assess and correlate the microbiology of neonatal septic arthritis with the clinical presentation, we reviewed the records of nine infants with neonatal septic arthritis (NSA) diagnosed at Edmonton hospitals between 1964 and 1981, and evaluated 92 other cases reported in the English literature since 1960. Our analysis revealed that the microbiology of NSA seemed to be dependent on whether it was hospital or community acquired. In the hospital-acquired cases, staphylococci were the predominant isolates (62%), followed by Candida species (17%) and gram-negative enteric bacilli (15%). Community-acquired arthritis was caused most often by streptococci (52%), followed by staphylococci (26%) and gonococci (17%). Since 1970, the relative infrequency of staphylococcal (5%) in favor of streptococcal (75%) isolates in community-acquired NSA is even more pronounced.
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