Complement your knowledge with a rare cause of pauci-immune glomerulonephritis.

RPGN can be subdivided into three categories on an immunopathologic basis: pauci-immune glomerulonephritis (PIGN), anti-glomerular basement membrane glomerulonephritis (anti-GBM disease), or immune complex-mediated glomerulonephritis (GN). PIGN is the most common cause of RPGN (80% of cases). The most common etiology of PIGN is anti-neutrophil cytoplasmic antibody (ANCA)-associated GN, which accounts for up to 90% of PIGN. PIGN is unique in that few to no immunoglobulin deposits are seen on glomerular immunofluorescence (IF) and electron microscopy (EM), but it is important to remember that dysregulation of the alternative pathway may result in the deposition of complements leading to inflammatory injury even in PIGN. Membranoproliferative glomerulonephritis (MPGN) is a rare, primary glomerular disorder. Both ANCA-associated GN and complement-mediated MPGN will lack immunoglobulin staining on immunofluorescence (IF) and thus present as PIGN on pathologic examination. This may lead to occurrences where these entities mimic one another, therefore necessitating heightened suspicion and close pathologic examination of a renal biopsy with electron microscopy to differentiate the diagnoses. This case highlights a rare case of C3 GN mimicking ANCA-associated GN.

FLIGHT ASSOCIATED DISSECTION.

"Economy Class Stroke "is a term recognized in the literature pertaining to paradoxical strokes of patent foramen ovale. However, other central nervous system (CNS) processes should be considered with long distance fights. We present two cases of vascular dissection associated with long distance flights.

Alcoholism among indigent inpatients: identification and intervention by internal medicine residents.

BACKGROUND: This study examined alcoholism identification and interventions by internal medicine residents, determined the prevalence of alcoholism among indigent inpatients, and examined some variables related to alcoholism in this population. METHODS: The alcohol abuse and dependence section of the Diagnostic Interview Schedule was administered to 197 inpatients, and chart audits were done. RESULTS: The obtained prevalence of alcoholism was 17%. Residents identified current alcohol abuse among 71% of current alcoholics, 17% of past alcoholics, and 3% of nonalcoholics. Sixty-two percent of alcoholics identified by the residents did not receive advice or referral, 13% received advice, 17% were referred to Alcoholics Anonymous, and 8% were referred to an inpatient facility. CONCLUSIONS: Our results suggest that although residents' identification of alcoholism is satisfactory, it is necessary to improve their rates of intervention. The profile of the alcoholic inpatients in this study includes demographics, presence of chronic illnesses, and utilization of medical services as compared with nonalcoholics.