Biomedical subjects
Publications and source records attributed to M E Pauszek.
Agitated and disruptive behavior is a common complication of senile dementia. Therapy with antipsychotic and anxiolytic agents is frequently unsuccessful and problematic. Though there are no controlled studies, Propranolol, the non-specific beta blocker, suppresses agitated behavior in patients with senile dementia.
A patient complaining of fishy smelling urine and perspiration appeared for evaluation. No other family members were similarly affected, and dietary manipulation partially controlled his complaint. Trimethylaminuria, originally described in 1970, is secondary to a deficiency of the liver enzyme, trimethylamine oxide. The frequency of the anomaly is unknown. Fishy smelling urine and perspiration are diagnostic of the anomaly. There are no known associated developmental defects.
Serious cellulitis, a common acute illness, frequently is associated with underlying venous and lymphatic compromise. The process is easily treated but, when recurrent, is associated with significant morbidity. Local measures, such as support hose and elimination of tinea pedis, have a role in its therapy but do not uniformly prevent recurrence. Prophylactic antibiotic therapy modeled after rheumatic fever prophylaxis can be effective in the prevention of this process.
Patients with paroxysmal supraventricular tachycardia (PSVT) who are either not adequately controlled with chronic suppressive therapy or who have infrequent attacks may be treated with oral diltiazem with a high probability of conversion to sinus rhythm within 30 minutes of ingestion of the calcium channel blocker. Due to its rapid absorption, the diltiazem appears to be effective in converting PSVT and may eliminate the need for emergency department evaluation and parenteral drug therapy.
The ampicillin analog, amoxicillin, can potentially produce the same hypersensitivity reaction as the ampicillin. The case of a patient treated with amoxicillin for a sore throat, who later presented with a rash, is reviewed. Infectious mononucleosis was considered and then supported by a positive mono spot. It would appear therefore that amoxicillin can produce the same hypersensitivity reaction as ampicillin in the setting of acute infectious mononucleosis. The clinical decision to use antibiotics in acute pharyngitis is complicated by the identical presentation of both viral and bacterial illnesses. If empiric therapy is elected, the incidence of hypersensitivity reaction is less common with penicillin or tetracycline compared to ampicillin or its analog, amoxicillin.
A patient with a focal transient neurologic deficit and no evidence of other underlying disease as an etiology is diagnosed with episodic asystole. His neurologic deficit was reproduced with episodes of asystole. The combination of asystole and localized intracranial atherosclerotic disease can produce focal neurologic deficits and should be considered in the differential for transient ischemic attack. It is easily preventable and responds to permanent implantation of a transvenous pacemaker.
An elderly patient with upper gastrointestinal bleeding of peptic ulcer disease and renal insufficiency was presented. Her bleeding was complicated by an underlying hemostatic defect related to her renal disease and secondary bleeding prolongation. Cryoprecipitate reversed the defect and stopped the clinical bleeding. In the elderly adult population where renal insufficiency and elevated creatinines are more common, it is important to consider the hemostatic defect that may be associated with renal disease and bleeding. Infusion of cryoprecipitate may result in both a delayed correction of the abnormal bleeding time and reversal of clinical bleeding.
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