Biomedical subjects

W H Chew

Publications and source records attributed to W H Chew.

3 recordsLinked to original sources

PubMed1979

Tuberculous peritonitis.

Tuberculous peritonitis is an uncommon disorder and is often not considered on initial evaluation of ascites. A negative 5-TU PPD test, a normal chest roentgenogram, or a low level of ascitic fluid protein may erroneously direct attention away from tuberculosis. Failure to thoroughly evaluate nonmalignant exudative ascites, especially in alcoholics, is a common diagnostic pitfall. TB peritonitis should be considered in the differential diagnosis in every patient who presents with ascites, fever, and abdominal pain, particularly when alcoholism, a lung lesion, weight loss, or cirrhosis is also present. Percutaneous needle biopsy of peritoneum, followed by peritoneoscopy if necessary, may preclude the need for laparotomy. Antituberculous drugs, when conscientiously taken, afford a rapid response with a cure in most patients. Case material on four patients is presented.

Adult↗

PubMed1978

Therapeutic failures with miconazole.

A retrospective review of therapeutic failures of miconazole in three patients is presented. Miconazole, a new imidazole derivative, is a broad-spectrum antifungal agent purportedly effective topically, orally, and parenterally against a number of species of fungi. Three patients with the following culturally proven deep fungal infections were treated with miconazole: (i) destructive arthritis (Sporothrix schenckii), (ii) meningoencephalitis (Cryptococcus neoformans), and (iii) disseminated aspergillosis (Aspergillus fumigatus). All the organisms were susceptible in vitro to 1.56 mug or less of miconazole per ml using a broth dilution technique. In each patient, miconazole administered intravenously in dosages of 30 mg/kg per day failed to control or eradicate infection. Miconazole serum levels ranged from <0.5 to 4.35 mug/ml as determined by radial diffusion bioassay. Cerebrospinal fluid levels were virtually undetectable. In one patient (C. neoformans), miconazole was given intraventricularly in doses of 15 mg without response. Therapeutic failures were attributed to suboptimal body fluid levels of miconazole. The reason(s) for such low levels of activity was not clear, but may have been poor penetrance into tissues, in vitro inactivation, and/or unusually rapid excretion. Untoward reactions from miconazole included fever, chills, nausea, vomiting, and phlebitis.

Adult↗

PubMed1977

72 kidney transplants at the Medical College of Georgia 1968-1976.

Seventy-two kidneys have been transplanted-47 from related donors, and 25 from cadaver donors-into 63 recipients. No donor died or experienced a complication requiring more than one extra week of hospitalization. Six recipients died. Three of the six recipients died from complications. Two of the six died only because they declined to resume hemodialysis, and one died in prison of unusual circumstances after seven and one-half years of good health and kidney function. Five patients are surviving by virtue of a second transplant. Eight patients are now on hemodialysis. Seven patients with transplants are not in excellent physical health and five other patients with excellent health and renal function are nonetheless frequently depressed and easily upset over minor physical disabilities. A majority of the recipients have been rehabilitated to a gratifying extent.

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