ABSTRACT
Severe necrotic lung disease as a result of infection with a rapidly growing mycobacteria occurred in a 4-month-old infant. Successful treatment required a pneumonectomy.
Subject(s)
Mycobacterium Infections, Nontuberculous/surgery , Pneumonectomy , Tuberculosis, Pulmonary/surgery , Humans , Infant , Lung/diagnostic imaging , Lung/pathology , Male , Mycobacterium Infections, Nontuberculous/diagnostic imaging , Mycobacterium Infections, Nontuberculous/pathology , Radiography , Tuberculosis, Pulmonary/diagnostic imaging , Tuberculosis, Pulmonary/pathologyABSTRACT
Components of the dipstick urinalysis (urine urobilinogen and urine bilirubin) are often used by emergency physicians to screen for the need to obtain liver function tests in many clinical situations. A prospective observational study was conducted to evaluate the sensitivity, specificity, and predictive properties of spot urine bilirubin and urobilinogen assays in the emergency department as screening test for serum liver function test (LFT) abnormalities. Of 122 patients, abdominal pain was the indication for laboratory evaluation in 54%; jaundice and constitutional symptoms were the indication in 29%. Overall sensitivities for both urine assays were 70% to 74% for serum bilirubin, but 43% to 53% for other LFTs; specificities were 77% to 87% for both urine screens. Positive predictive values show that the urine assays were 83% to 86% reliable for detecting at least one LFT abnormality. Negative predictive values were 85% for both urine assays for serum bilirubin elevations, but lower for other LFTs. Urine urobilinogen has its greatest clinical utility as a screen when a normal/abnormal threshold of 2.0/4.0 mg/dL is used.
Subject(s)
Bilirubin/urine , Liver Function Tests/methods , Urobilinogen/urine , Adolescent , Adult , Aged , Aged, 80 and over , Biliary Tract Diseases/urine , Child , Emergencies , Evaluation Studies as Topic , Female , Humans , Liver Diseases/urine , Male , Middle Aged , Prospective StudiesABSTRACT
In a relatively small personal series (41 patients) of first rib resections for thoracic outlet compression, I have encountered 8 patients in whom venous obstruction at the thoracic outlet was the major component. Four of the 8 had typical "stress" thrombosis of the axillary vein. Angiography demonstrated a tight thoracic outlet to be the underlying cause of the venous thrombosis. In the 4 patients with venous compression but without thrombosis, angiograms suggested that each was a candidate for axillary venous thrombosis unless the underlying thoracic outlet compression syndrome was relieved. Although thoracic outlet compression has been documented as a cause of "stress thrombosis" of the axillary vein, the relationship of the two conditions apparently is often overlooked, even by experienced thoracic surgeons. Representative case histories and angiograms are presented to demonstrate the close relationship of thoracic outlet compression and axillary venous thrombosis.