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Biomedical subjects

P C Dickinson

Publications and source records attributed to P C Dickinson.

13 recordsLinked to original sources
PubMed1990

The diagnosis and treatment of cerebral mycotic aneurysms.

Seventeen patients were treated for 28 documented cerebral mycotic aneurysms. Initial neurological symptoms were attributable to aneurysm rupture in only 7 patients, and in 3 of them symptoms did not suggest subarachnoid hemorrhage. Six patients presented with embolic infarction and 1 with meningitis; in 3 patients it was uncertain if aneurysm rupture occurred. Four patients had rupture of at least one aneurysm while receiving appropriate antibiotic treatment and another had rupture at the conclusion of therapy. Of 20 aneurysms followed angiographically or with computed tomography during medical treatment, 10 became smaller or disappeared and 10 remained unchanged or enlarged, 1 with fatal rupture. Eight ruptured aneurysms were surgically excised; 2 of the patients with ruptured aneurysms died and 2 had residual aphasia or cognitive impairment. All 4 patients whose only surgery was for an unruptured aneurysm made uneventful recoveries. Recognizing the retrospective and anecdotal nature of our data and the differing views of previous investigators, we recommend: (1) that careful neurological examination, computed tomography, and (unless contraindicated) lumbar puncture be performed on any patient with endocarditis; (2) that those with neurological abnormalities not attributable to systemic toxicity, including pleocytosis in the cerebrospinal fluid or apparent infarction on computed tomographic scans, undergo four-vessel cerebral angiography; (3) that single accessible mycotic aneurysms in medically stable patients be promptly excised, with individualization of multiple or proximal aneurysms; and (4) that repeat angiography be performed at the conclusion of antibiotic therapy in patients requiring long-term anticoagulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Mycotic aneurysms of the pulmonary arteries in intravenous drug addicts. Report of three cases and review of the literature.

During the postmortem study of pulmonary lesions in intravenous drug addicts, three patients were found to have bilateral multiple mycotic aneurysms of the peripheral pulmonary arteries in association with embolic pneumonia. Two of these patients had infective tricuspid endocarditis, and one had hemoptysis. This report draws attention to the occurrence of mycotic aneurysms in this unusual location and suggests that these pulmonary lesions may be more common than currently believed.

Adult↗
PubMed1984

Nonspecificity of ring enhancement in "medically cured" brain abscess.

Since the introduction of computed tomography (CT), there have been numerous reports of brain abscess treated successfully without surgery. Because pathologic confirmation was lacking in these patients, diagnosis was based on CT abnormalities, usually ring enhancement. However, our recent clinical experience and the experimental work of others indicate that the "ring sign" on contrast-enhanced CT is not absolutely diagnostic of encapsulated brain abscess. Moreover, in the reported cases of alleged brain abscess cured medically, atypical clinical features suggest that some patients may have had cerebral infarction or cerebritis. Stricter clinical and radiologic criteria are needed before concluding that encapsulated brain abscess can be cured by medical therapy alone.

Adult↗
PubMed1981

Failure of CT sharing in a large municipal hospital.

Harlem Hospital Center lacks computed tomography (CT) facilities. During 1979 it attempted to share the CT facilities of two other institutions. Retrospective analysis reveals that under this arrangement only a small percentage of Harlem patients needing CT obtained it. Among patients recommended for CT, 252 of 1528 without trauma and six of 342 with trauma received it. In some instances there were difficulties in moving patients between hospitals. If transportation had been optimal, however, the other hospitals, because of their own needs, would have been unable to provide Harlem Hospital with more than a third of the CT scans requested. Furthermore, even if unlimited opportunities for scanning had been available, patients whose need for CT seemed most urgent--the very ill--would have been unable to receive it; of 163 patients who died without receiving CT as recommended, 93 were too sick or deteriorating too rapidly to be moved to the CT facilities. We conclude that CT cannot be effectively shared by large acute-care hospitals.

Adolescent↗
PubMed1977

Serratia marcescens pneumonia.

Though rare, Serratia marcescens pneumonia is being reported with increasing frequency, especially in patients in intensive care units. We report three cases of S. marcescens pneumonia that presented striking similarities for age, group, type of surgical procedure, and microbiological, hemodynamic, and respiratory patterns. All patients survived after prolonged ventilatory support.

Aged↗
PubMed1974

Treatment of Bacteroides infection with clindamycin-2-phosphate.

Eighteen patients with serious Bacteroides infections were treated with systemic clindamycin-2-phosphate. Sixteen patients recovered without complications while two patients died. Few side effects were noted. The infections treated included septic abortion, posthysterectomy infections, pelvic inflammatory disease, perforation of the bowel, postoperative complications of abdominal surgery and pancreatic abscess. The clinical usefulness of this drug in treating Bacteroides infection is confirmed.

Abortion, Septic↗