ABSTRACT
A 73-year-old man with multiorgan failure requiring mechanical ventilation and haemodialysis developed herpes labialis infection during his stay in the ICU. This was treated with enteral acyclovir. He developed persistent neurologic impairment soon after acyclovir administration, which, over the course of seven days, progressed to coma, the aetiology of which was unclear. The computed tomograph (CT) of the brain and the cerebrospinal fluid (CSF) examination was normal. The electroencephalogram (EEG) showed generalized slowing. The possibility of acyclovir neurotoxicity was considered and the drug was discontinued. Haemodialysis was instituted and the patient made a complete neurological recovery. We believe that this is the first reported case of coma due to enteral acyclovir.
Subject(s)
Acyclovir/adverse effects , Antiviral Agents/adverse effects , Coma/chemically induced , Critical Care , Acyclovir/administration & dosage , Administration, Oral , Aged , Antiviral Agents/administration & dosage , Brain/diagnostic imaging , Cerebrospinal Fluid , Critical Illness , Electroencephalography/drug effects , Herpes Labialis/drug therapy , Humans , Male , Multiple Organ Failure/therapy , Renal Dialysis , Respiration, Artificial , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: The purpose of this study was to assess the relative proportions of normal versus impaired left ventricular (LV) systolic function among persons with congestive heart failure (CHF) in the community and to compare their long-term mortality during follow-up. BACKGROUND: Several hospital-based investigations have reported that a high proportion of subjects with CHF have normal LV systolic function. The prevalence and prognosis of CHF with normal LV systolic function in the community are not known. METHODS: We evaluated the echocardiograms of 73 Framingham Heart Study subjects with CHF (33 women, 40 men, mean age 73 years) and 146 age- and gender-matched control subjects (nested case-control study). Impaired LV systolic function was defined as an LV ejection fraction (LVEF) <0.50. RESULTS: Thirty-seven CHF cases (51%) had a normal LVEF; 36 (49%) had a reduced LVEF. Women predominated in the former group (65%), whereas men constituted 75% of the latter group. During a median follow-up of 6.2 years, CHF cases with normal LVEF experienced an annual mortality of 8.7% versus 3.0% for matched control subjects (adjusted hazards ratio = 4.06, 95% confidence interval 1.61 to 10.26). Congestive heart failure cases with reduced LVEF had an annual mortality of 18.9% versus 4.1% for matched control subjects (adjusted hazards ratio = 4.31, 95% confidence interval 1.98 to 9.36). CONCLUSIONS: Normal LV systolic function is often found in persons with CHF in the community and is more common in women than in men. Although CHF cases with normal LVEF have a lower mortality risk than cases with reduced LVEF, they have a fourfold mortality risk compared with control subjects who are free of CHF.
Subject(s)
Heart Failure/mortality , Stroke Volume , Ventricular Dysfunction, Left/mortality , Ventricular Function, Left/physiology , Adult , Case-Control Studies , Echocardiography , Female , Follow-Up Studies , Heart Failure/diagnostic imaging , Heart Failure/physiopathology , Humans , Male , Massachusetts/epidemiology , Middle Aged , Prevalence , Prognosis , Prospective Studies , Reproducibility of Results , Stroke Volume/physiology , Survival Rate , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/physiopathologyABSTRACT
BACKGROUND: The potential complications of molar pregnancy are numerous and well defined, but associated peripartum cardiomyopathy has not been reported. CASE: A 16-year-old primigravida with a family history of peripartum cardiomyopathy requiring cardiac transplantation underwent suction curettage of a complete mole at 12 weeks' gestation. Three months after evacuation, she developed congestive heart failure. Radionuclide ventriculography demonstrated an ejection fraction of 30%, echocardiography revealed enlargement and ventricular hypokinesis, and a myocardial biopsy specimen contained hypertrophy and fibrosis without necrosis or active inflammation. The patient improved with medical therapy. CONCLUSION: Peripartum cardiomyopathy is a potential complication of molar pregnancy. In spite of the poor prognosis sometimes reported for this disease, good functional outcome may follow.
Subject(s)
Cardiomyopathy, Dilated/etiology , Hydatidiform Mole/complications , Puerperal Disorders/etiology , Uterine Neoplasms/complications , Adolescent , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/therapy , Family , Female , Humans , Pregnancy , Puerperal Disorders/diagnosis , Puerperal Disorders/therapyABSTRACT
Confusion remains concerning the role of the regional lymph node in the containment of cancer. Numerous investigators using a variety of assays have reported often conflicting results concerning the immunocompetency of lymphocytes residing in regional nodes. Forty-two axillary lymph nodes from ten stage I and stage II breast cancer patients were studied in lymphocyte blast assays using mitogens and breast cancer antigen (BCA). Three general response patterns to BCA were identified which were related primarily to tumor size. In the patients with the smallest primary tumor (0.5 cm), lymphocytes in the nodes reacted to a much greater extent than peripheral blood lymphocytes (PBL). In two of three patients with intermediate-size tumor (1.0 to 1.5 cm), a mixed pattern of responses was seen with both stimulation suppression occurring within the nodes of the same patient. In the four patients with the largest tumors (2.0 to 3.0 cm), 15 of 19 nodes had a lower stimulation index (SI) than the corresponding PBL. From the results of this study it appears that regional lymph nodes are dynamic immunologic structures which regress in responsiveness as tumor burden increases.
