Antibiotic allergy: inaccurate history taking in a teaching hospital.

To evaluate the accuracy of allergy histories obtained by interns, residents, and ward attending physicians, we compared physician-charted allergy histories with our own concurrently performed histories over a 2-month span for all general medicine and surgery patients admitted to a 615-bed suburban teaching hospital. We found 100% agreement between investigator and charted histories for all 318 (88%) of 363 charts identifying no known allergy. We disagreed with 23 (50%) of 46 allergies documented in the charts of the remaining 45 patients. Concurrent review classified 18 (39%) of these 46 charted allergies as clinically unimportant, and 5 charts (11%) were deemed underclassified. A description of the allergy by the primary physician was documented in only 7 charts (16%). Inaccurate allergy histories are frequently documented in the medical record. Simple adjustments in history taking and supervision may have important implications for patient care and training.

Atypical features of primary hyperoxaluria in end-stage renal disease.

Two case histories of patients with end-stage renal disease subsequently found to have primary hyperoxaluria are reported. In the setting of renal failure, the diagnosis is both difficult, due to diminished oxalate excretion, and important, because of frequent graft loss due to oxalate deposition after renal transplantation. The diagnosis was obtained by renal and bone biopsies. Plasma oxalate levels were normal in one patient and the other patient presented with extensive cystic bone lesions. Primary hyperoxaluria should be considered whenever nephrocalcinosis and/or nephrolithiasis are associated with end-stage renal disease.

Changes in transplanted kidney volume measured by ultrasound.

A simple ultrasonic method was used for measuring transplanted kidney volume in 29 patients. Five of these patients developed diabetes mellitus and six women became pregnant following transplantation. Serial measurements were performed over periods of 6-12 months after transplantation. The kidney volume became stable 6 months after transplantation and this volume correlated positively with the renal function. Renal hypertrophy was noted in those transplant patients who developed diabetes mellitus following transplantation and this hypertrophy was associated with improvement in graft function. Transplant volume also rose in acute rejection and returned to normal after appropriate treatment. During pregnancy following transplantation, the transplant volume increased early in pregnancy to return to normal before delivery. This volume increase was also associated with graft function improvement.