Bone disease and pathologic fractures in a patient with tenofovir-induced Fanconi syndrome.

We report the case of an HIV-positive patient with preexisting bone disease who developed tenofovir-induced Fanconi syndrome and subsequently sustained pathologic fractures. We suggest that tenofovir treatment may have contributed to the patient's pathologic fractures through its effects on phosphorus balance and vitamin D metabolism. This case highlights the importance of monitoring not only for renal impairment but also for bone disease in patients receiving tenofovir treatment, especially given the high prevalence of osteopenia and osteoporosis in HIV-positive patients.

Neuroradiologic characteristics of astroblastoma.

INTRODUCTION: Astroblastoma is a rare glial tumor of uncertain origin. Only a few scattered case reports and one small case series have described the radiologic appearance of this uncommon tumor. Many features previously identified are similar to those of other primary malignant brain tumors. We report the largest imaging series to date and further delineate the CT and MRI features of astroblastoma. We identify those features that may be useful in distinguishing astroblastoma from other neoplasms. METHODS: The radiologic images, pathology reports, and clinical information of 12 patients with pathology-confirmed astroblastoma were retrospectively reviewed. CT and MRI findings including location, morphology, signal intensity, and presence and patterns of enhancement were tabulated. RESULTS: Patients ranged in age from 0 (newborn) to 50 years with a mean of 20 years at the time of initial diagnosis. A striking female preponderance (11:1) was found. All tumors were supratentorial. There were multiple intratumoral cysts in 7 (58%) of the 12 patients. Nine (75%) showed strong rim enhancement and 3 (25%) showed no rim enhancement. CONCLUSION: The imaging features of astroblastoma are identified in 12 previously unreported cases. Distinguishing features that can be used to narrow the differential diagnosis with more common primary brain neoplasms reflect a combination of age, anatomic location, and specific imaging findings such as demarcation, heterogeneous tumor enhancement, rim enhancement, and a multicystic "bubbly" appearance. Intraventricular location, intratumoral hemorrhage with a fluid-fluid level, and dural "tails" are less common but important additions to the imaging spectrum.

Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey.

The aim of this study was to provide a broad characterization of the epidemiology of acute renal failure (ARF) in the United States using national administrative data and describe its impact on hospital length of stay (LOS), patient disposition, and adverse outcomes. Using the 2001 National Hospital Discharge Survey, a nationally representative sample of discharges from nonfederal acute care hospitals in the United States, new cases of ARF were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Multivariate regression analyses were used to explore the relation of ARF to hospital LOS and mortality as well as discharge disposition. Review of discharge data on a projected total of 29,039,599 hospitalizations identified 558,032 cases of ARF, with a frequency of 19.2 per 1000 hospitalizations. ARF was more commonly coded for in older patients; men; black individuals; and the setting of chronic kidney disease, congestive heart failure, chronic lung disease, sepsis, and cardiac surgery. ARF was associated with an adjusted prolongation of hospital LOS by 2 d (P < 0.001) and an adjusted odds ratio of 4.1 for hospital mortality and of 2.0 for discharge to short- or long-term care facilities. In a US representative sample of hospitalized patients, the presence of an ICD-9-CM code for ARF in discharge records is associated with prolonged LOS, increased mortality, and, among survivors, a greater requirement for posthospitalization care. These findings suggest that in the United States, ARF is associated with increased in-hospital and post-hospitalization resource utilization.

Human Exposures to N,N-diethyl-m-toluamide insect repellents reported to the American Association of Poison Control Centers 1993-1997.

This study analyzed 20,764 exposures involving insect repellants containing N,N-diethyl-m-toluamide (DEET) that were reported to poison control centers from 1993 to 1997. Nearly 70% of the cases reported no symptoms related to the exposure. The occurrence of symptoms was related to the route of exposure, with the highest rates associated with ocular exposures, followed by inhalation, multiple exposure routes, dermal, and ingestion. Two deaths were reported, one in a 26-year-old male and one in a 34-year-old female, both following a dermal exposure. Twenty-six subjects experienced major effects. The greatest number of reported exposures involved infants and children, but this group experienced lower rates of adverse effects than teens or adults. There was no clear relationship between DEET concentration and presence or severity of clinical effects. For the cases reported to poison control centers and included in this analysis, the risk of serious medical effects for labeled use of insect repellants containing N,N-diethyl-m-toluamide appears to be low.