ABSTRACT
The patient presenting with jaundice may have a variety of hepatobiliary or hematologic conditions. Understanding the causes of jaundice and the history and physical examination hallmarks provide the basis for choosing the most efficacious laboratory and diagnostic studies. A case report illustrating the reasoning involved in distinguishing between the different causes of jaundice is presented.
Subject(s)
Carcinoma, Ductal, Breast/diagnosis , Jaundice/diagnosis , Liver Neoplasms/diagnosis , Bilirubin/urine , Carcinoma, Ductal, Breast/physiopathology , Diagnosis, Differential , Humans , Jaundice/etiology , Jaundice/physiopathology , Liver Diseases/diagnosis , Liver Function Tests , Liver Neoplasms/physiopathology , Male , Middle AgedABSTRACT
OBJECTIVE: To determine the cause of clustered bacteremias occurring among chronic hemodialysis patients. DESIGN: A retrospective investigation of clinical and laboratory records with direct observation of dialysis facilities and technique. Bacterial blood isolates were identified and compared with environmental isolates. SETTING: The 11-station chronic hemodialysis unit that serves approximately 50 patients in a 450-bed military hospital. PATIENTS: Hemodialysis unit patients with aerobic gram-negative bacillus or Enterococcus casseliflavus blood isolates between April 1988 and February 1990. RESULTS: The recovery and species identification of the unique isolate, E casseliflavus, from 2 index cases of bacteremia in February 1990 helped identify the cluster and demonstrated its protracted course. Dialysis blood tubing was contaminated with ultrafiltrate waste during dialyzer setup. INTERVENTION: Bacteremias were controlled by halting the practice of attaching the venous tubing directly to a waste container while priming the membrane, by emphasizing glove changes and handwashing after contact with ultrafiltrate waste and by daily decontamination of ultrafiltrate waste bags. CONCLUSIONS: We recommend that other hemodialysis units institute these interventions.
Subject(s)
Bacteremia/etiology , Hemodialysis Units, Hospital , Renal Dialysis/adverse effects , Bacteremia/epidemiology , Equipment Contamination , Hemofiltration/adverse effects , Hospitals, Military , Humans , Medical Waste , Renal Dialysis/instrumentation , Retrospective Studies , Space-Time Clustering , TexasABSTRACT
We report reference intervals for IgG, IgA, IgM, C3, and C4 for a population of 750 well children and 120 healthy adults. Ranges were established by rate nephelometry (previous studies have been based on immunodiffusion). Our results generally agree with previously established immunoglobulin ranges, except for some disagreement as to ages when adult values are attained.
