Fatal intravenous injection of monooctanoin.

Monooctanoin, a hydrophobic solvent, is used clinically to dissolve gallstones via intrabiliary infusion. We report a therapeutic misadventure in which an intravenous injection of the drug resulted in respiratory and cardiac arrest and death. Autopsy findings included pulmonary lipid embolization, detection of monooctanoin in the lung parenchyma, and histopathological evidence of multifocal pulmonary hemorrhagic infarcts. Respiratory compromise has been observed in the standard treatment of patients. In addition, deaths in laboratory animals have been attributed to hemorrhagic pneumonitis. This case illustrates the potential adverse effects of the inappropriate administration of monooctanoin.

Drowning of a Friedreich's ataxia patient.

We here report an unusual, apparently accidental death, in which weakness associated with a progressive neuromuscular disease, Friedreich's ataxia, apparently resulted in the drowning of the deceased. The possibility of neuromuscular disease as a rare cause of drownings should not be overlooked.

Pathology of paint sniffers' lung.

Deliberate inhalation of metallic paint results in hemorrhagic alveolitis and the intra-alveolar and lymph node accumulation of particulate-laden macrophages. We present a case of a chronic paint sniffer that illustrates these respiratory tract findings.

Four great coccidioidomycologists: William Ophuls (1871-1933), Myrnie Gifford (1892-1966), and Charles Edward Smith (1904-1967) and William A. Winn (1903-1967).

The careers of William Ophuls (1871-1933), Myrnie Gifford (1892-1966), Charles Edward Smith (1904-1967) and William A. Winn (1903-1967) are briefly reviewed, with emphasis on their contributions to knowledge of Coccidioides and coccidioidomycosis. All were students with broad interests, and all were quite willing to suggest new concepts and classifications to replace those of their predecessors.

Circling syndrome and inner ear disease in mice infected intraperitoneally or intravenously with Coccidioides immitis spherule-endospore phase cultures.

Infection was studied in mice with varying doses of spherule-endospore phase cultures of Coccidioides immitis, administered intraperitoneally, intravenously and intranasally. Stain 46 was compared with strain Silveira. The first of these is relatively avirulent in the mycelial phase, the second, rather virulent. Animals were observed for acute death and for circling. Gross and microscopic pathology was studied in mice sacrificed at appropriate intervals after infection. Numbers of fungi were assayed in spleen, lung, kidney, liver, blood, brain, and ear tissue. Strain 46 endospores administered intraperitoneally in doses from 9 X 10(6) to 2.5 X 10(7) produced a high incidence of 'circling syndrome' ataxia attributable to inner ear disease.

Probable fatal cardiac dysrhythmia secondary to diuretic-induced hypokalemia.

This case study describes the investigation of the sudden, unexpected death of a young, slightly hypertensive woman. She had a previous history pf serious hypokalemic-induced cardiac dysrhythmias associated with diuretic usage. Postmortem examination revealed no anatomic cause for her death. Her agonal plasma potassium, 5.4 mmol/L, seemed too low in light of her extreme acidosis, hypoxemia, and emergency treatment. Diuretic analysis indicated surreptitious ingestion of hydrochlorothiazide. Hypokalemia and the control of serum potassium concentration are discussed as are various modifiers of serum potassium.

Computer-controlled instrument system for sequential chemical testing III. Application to liver assessment.

We used the previously described [Clin. Chem. 19, 1114 (1973)] and evaluated [Clin. Chem. 19, 1122 (1973)] computer-controlled instrument system for sequential chemical testing to select and perform tests of hepatic status, to aid the clinician in the diagnosis of liver disease. Results for total bilirubin, aspartate aminotransferase, and alkaline phosphatase obtained from the continuous-flow analysis (SMA 12/60) admission screen were used by the instrument system to determine selectively the values for gamma-glutamyltransferase, alanine aminotransferase, creatine kinase, and total and direct bilirubin. Kit methods for the latter four tests were evaluated on the system; results were similar to manual procedures. A software, enzymatic ratemeter was found to be better than the previously described hardware ratemeter. The follow-up tests of serum prescribed by the system are compared to clinician-prescribed follow-up tests and discharge diagnoses. In 10 of 19 cases, the system and clinician ordered similar follow-up tests; in three cases follow-up differed, and in six cases, the system ordered follow-up tests and the clinician ordered none.

Coccidioidal arthritis and its treatment -- 1975.

The clinical course of disseminated coccidioidomycosis is highly variable. Neither spontaneous cure nor spontaneous ankylosis has ever been demonstrated in an adult with the disease in one or more disseminated articular foci. Coccidioidomycotic arthritis may fluctuate in activity, and may be compatible with years of limited function and moderate morbidity. Amputation as well as arthrodesis accompanied by adequate excision of diseased tissue are generally reliable methods of treatment of infected joints, but the decision whether or not to "cover" such patients with systemic doses of amphotericin is still difficult, and the roles of synovectomy and topical amphotericin remain to be determined.

Female genital coccidioidomycosis.

Three cases of coccidioidomycosis of the female genital tract are reviewed. The diagnosis was made by laparotomy in 2 patients who presented with tender adnexal masses, and by endometrical curettage in a third patient with disseminated coccidioidomycosis. Hysterectomies were performed in all 3 patients; 1 had a bilateral salpingo-oophorectomy and the others a bilteral salpingectomy and unilateral oophorectomy. Two patients received chemotherapy with amphotericin B. One patient died 4 years after her operation from disseminated and meningeal coccidioidomycosis. In a female patient who has resided in an endemic region and who presents with pelvic pain of obscure origin, unexplained infertility, a menstrual disorder, or a chronic, refractory pelvic inflammatory disease, genital coccidioidomycosis should be considered in the differential diagnosis.