ABSTRACT
A 75 year-old man developed fever after one month of quinidine administration 800 mg/day. Significant enlargement of the liver and spleen became evident, associated with marked rise in serum GOT, GPT and alkaline phosphatase. Arthritis also developed, but there was no skin rash nor any changes in the haemoglobin, leucocytes or platelets. The signs and biochemical findings regressed within a few days of stopping quinidine and the temperature became normal. Rechallenge with four doses of the drug produced a rise in the GOT, GPT and alkaline phosphatase. It is thought that this hypersensitivity response is consistent with the description of granulomatous hepatitis, and represents a much less common manifestation of quinidine hypersensitivity than the well known skin, gastro-intestinal and haematological side-effects.
Subject(s)
Drug Hypersensitivity/complications , Hepatomegaly/chemically induced , Quinidine/adverse effects , Splenomegaly/chemically induced , Aged , Drug Hypersensitivity/blood , Humans , MaleABSTRACT
Subdural hematoma (SDH) in the elderly often occurs following a relatively mild fall. Compared to the old person's high risk of falling, SDH is relatively uncommon and the diagnosis may be elusive. Five cases are presented, two in detail. In one, despite the acute onset within hours and manifestations of an ipsilateral neurologic deficit, operative removal of the SDH gave excellent results. The second patient represented a dementia assessment problem prior to admission to an institution. Inpatient observation eventually revealed a deteriorating neurologic state and led to the correct diagnosis of SDH. The patient returned home, fully recovered, two weeks after the appropriate surgical procedure. The pathogenesis of SDH is discussed. Clinical suspicion of its presence should prompt the performance of an echoencephalogram and a computerized axial tomogram of the brain.
Subject(s)
Hematoma, Subdural/diagnosis , Aged , Cerebrovascular Disorders/diagnosis , Dementia/diagnosis , Diagnosis, Differential , Echoencephalography , Electroencephalography , Female , Hematoma, Subdural/surgery , Humans , Male , Middle Aged , Neurocognitive Disorders/diagnosis , Prognosis , Tomography, X-Ray ComputedABSTRACT
Changes in level of isoenzyme LDH1 seem to be a valuable criterion in differentiating acute myocardial infarction from active coronary insufficiency without infarction. LDH1 level increases noticeably within 48 hours after onset of pain from acute myocardial infarction but tends to decrease if the pain is due to active coronary insufficiency.
