Peritonsillar abscess following tonsillectomy.

Peritonsillar abscess is an unusual complication following tonsillectomy. A series of five such patients is herein reported. Proper treatment begins with the initial tonsillectomy ensuring complete removal of the tonsils. Should a late peritonsillar abscess following tonsillectomy be found, the patient may be treated with needle aspiration of the affected area plus antibiotics. Removal of the remaining tonsillar tissue and surgical capsule of the tonsil is also advocated.

High volume, low frequency continuous ambulatory peritoneal dialysis.

Intra-abdominal pressure (IAP), forced vital capacity (FVC), and forced expiratory volume at 1 sec (FEV1) were measured in 18 stable continuous ambulatory peritoneal dialysis (CAPD) patients maintained on 2-liter exchanges, in the supine, sitting, and upright positions after infusing dialysis solutions in 0.5-liter increments up to 4 liters as tolerated. Thereafter, five patients did not increase to 3-liter volumes (RUT-0), four used 3-liter volumes occasionally (RUT-1), and nine chose 3-liter volumes for routine dialysis (RUT-2). IAP was similar in all groups and dependent on the intraperitoneal volume (IPV). The mean IAP increased 2.0, 2.7, and 2.8 cm H2O/liter of IPV in the supine, upright, and sitting positions, respectively. The patients of the RUT-0 group had dramatic deterioration (up to 42%) of FVC and FEV1 in the supine position with IPV above 2 liters. The patients with the greatest deterioration of pulmonary functions could not continue the measurements above 3 liters of IPV. Two of these patients were switched to 1-liter overnight exchanges. Even in patients who tolerated up to 4 liters, FVC and FEV1 decreased significantly in the supine and sitting positions, with IPV greater than 3 or 4 liters, respectively. In the upright position, the values did not decrease significantly below those with the empty abdomen up to 4.6 liters of IPV. Each liter of IPV increased the abdominal girth by 2.1 cm. Exchange volume and frequency should be individualized. In our studies, 50% of the patients could increase daily dialysate volume from 8 to 9 liters while decreasing daily exchanges from 4 to 3.

Endobronchial pH. Relevance of aminoglycoside activity in gram-negative bacillary pneumonia.

The in vitro bactericidal activity of certain antimicrobials, especially aminoglycosides, is markedly diminished at an acid pH. In an attempt to correlate this factor with the poor response of gram-negative bacillary pneumonia to aminoglycoside therapy, the endobronchial pH of selected groups of subjects was measured via a bronchoscopically directed pH electrode. The average peripheral, i.e., subsegmental, endobronchial pH of normal persons, patients with chronic lung disease, and patients with pneumonia was 6.58 +/- 0.06, 6.62 +/- 0.10, and 6.61 +/- 0.06, respectively. The average central airway, i.e., major bronchi or tracheal, pH at 6.64 +/- 0.07 did not vary significantly from that of peripheral airways. The presence of pneumonia in individual bronchi was associated with a significantly lower pH than that in noninfected bronchi: 6.48 +/- 0.12 versus 6.69 +/- 0.13 (p less than 0.05). This relatively acid environment appears exaggerated within pneumonic airways and may contribute toward decreasing the effectiveness of aminoglycosides and certain other antimicrobials used in treating lung infection.

Asymptomatic IgA nephropathy associated with pulmonary hemosiderosis.

A glomerular lesion identical to that of IgA nephropathy was demonstrated unexpectedly in a 17 year old boy who presented with clinical manifestations of pulmonary hemosiderosis and with no evidence of renal disease. This subclinical glomerular lesion would have remained undetected in this patient unless kidney tissue was obtained and examined by immunofluorescence or electron microscopy. It is unknown if the glomerular lesion in this case is causally related to pulmonary hemosiderosis.

Tracheal obstruction associated with a fungus ball. A case of primary tracheal candidiasis.

An elderly patient developed acute respiratory failure secondary to airway obstruction by a Candida fungus ball which probably developed secondary to the use of broad-spectrum antibiotics when the patient had a decreased gag reflex while in a semicomatose state. The frequency of pulmonary fungus balls and their precipitating causes are briefly discussed. This potentially frequent, previously unreported complication should be recognized as a contributing factor in the development of acute respiratory failure requiring management by bronchoscopic techniques, as opposed to intubation.

Chronic pulmonary histoplasmosis with declining complement fixation titers and persistence of positive sputum culture. A case report.

A patient with culturally proved chronic pulmonary histoplasmosis was treated with amphotericin B. Complement fixation titers decreased but sputum cultures remained positive for Histoplasma capsulatum 5 months after original therapy. Lobectomy and a subsequent course of amphotericin B were necessary. Exceeding the minimal inhibitory concentrations of amphotericin B did not eradicate the organism and declining complement fixation titers failed to have prognostic significance.