Seronegative acquired immunodeficiency syndrome (AIDS).

The case reported here fulfilled the Centers for Disease Control surveillance case definition for acquired immunodeficiency syndrome without laboratory evidence of human immunodeficiency virus. The patient, a 63-year-old man, had received transfusions of several units of packed red blood cells after a coronary bypass graft. He had recurrent fever and lymphopenia. He had a depressed helper T-cell count, esophageal and tracheobronchial candidiasis, and Pneumocystis carinii pneumonia. Results of all tests for human immunodeficiency virus were negative or inconclusive. However, the patient may have been seroconverting at the time of his death.

Factors influencing osteopathic physicians' decisions to enroll in allopathic residency programs.

A survey of osteopathic physicians who were training in non-American Osteopathic Association (AOA)-approved (ACGME-accredited) internal medicine programs was undertaken in 1988. This was done in response to the AOA approval and implementation of the recommendations of the Task Force to Explore Alternative Mechanisms for Approval of Postdoctoral Training. Of the 188 physicians surveyed by mail, 137 physicians' responses provided the data for the results presented here. These respondents represented 39% of those residents who were training in nonosteopathic medical programs in 1988 and whose records were on file with the AOA Department of Education. The questionnaire investigated the factors that influenced these physicians' decisions to enroll in non-AOA-approved (ACGME-accredited) internal medicine residency programs. These reasons are discussed along with suggested solutions to alter this unhealthy trend.

Chronic lymphocytic leukemia presenting with massive chylous ascites.

A newly diagnosed patient with chronic lymphocytic leukemia who presented with ascites is described. Paracentesis revealed the presence of massive chylous ascites. Further work-up disclosed leukemic infiltration of the liver and bone marrow. Complications leading to his death included renal failure, gastrointestinal hemorrhage, bacterial peritonitis, and Staphylococcus aureus bacteremia. Chylous ascites is a rarely reported manifestation of chronic lymphocytic leukemia. The case is presented, and a review of the literature is discussed.

The effect of upper gastrointestinal endoscopy on arterial O2 tension in smokers and nonsmokers with and without premedication.

Fiberoptic upper gastrointestinal endoscopy has become an accepted procedure with recognized and acceptable complication rates. Recently, significant hypoxemia during upper gastrointestinal endoscopy has been identified. This report evaluates changes in arterial blood gases and investigates the effects of drugs, smoking, and length of procedure. Upper gastrointestinal endoscopy was performed on 60 patients--15 patients in four different groups. Group I and II were smokers and nonsmokers who received sedation; groups III and IV were smokers and nonsmokers who received no sedation. A significant drop in PaO2 was noted in each group. Sedation, length of procedure, or smoking did not affect the PaO2 levels significantly. No significant change in PaCO2 was noted in any of the four groups. A V/Q mismatch related to vasospasm and/or bronchospasm is proposed as the main reason for the hypoxemia.

Celiac disease: case report with an associated arthropathy.

A case is presented of a patient with biopsy documented celiac disease who presented with an acute arthropathy along with symptoms of malabsorption. The etiology of the arthropathy could not be determined; however, the temporal relationship of the presenting manifestations (i.e., malabsorption and the arthropathy) as well as lack of further gastrointestinal of joint symptoms after 2 yr of follow-up suggest that in this case the arthropathy was related to the patient's celiac disease. Possible pathogenetic mechanisms for this heretofore unreported relationship are also presented.

Cimetidine-induced acute interstitial nephritis.

Cimetidine is responsible for changes in serum creatinine. Previously reported, this has been thought to be related to an alteration in the manner in which the kidney handles creatinine. Herein a case of acute interstitial nephritis attributable to the ingestion of routine doses of cimeditine is detailed. Review of the changes in serum creatinine and renal function in patients taking cimetidine reveals that as many as 60% of the patients taking cimetidine may have changes in serum creatinine. In none of those series, however, have changes in urinary protein excretion or urinary sediment been followed. Recently several reports have been published in which patients have developed acute interstitial nephritis while taking cimetidine. However, in no previously reported case has the diagnosis been proved by rechallenging the patient with that drug. In our study the patient had moderate to severe renal insufficiency with acute interstitial nephritis while on cimetidine. Rechallenging the patient with cimetidine resulted in prompt return of clinical signs and symptoms as well as changes in serum creatinine and urinary sediment characteristics diagnostic of interstitial nephritis.