Infection control and human immunodeficiency virus: perceptions of risk among nurses and hospital domestic workers.

In December 1993 the first case of patient-to-patient transmission of human immunodeficiency virus (HIV), at a doctor's surgery in New South Wales, was documented. In an environment of heightened anxiety about HIV transmission and the adequacy of infection-control measures taken by health providers, it is important to explore perceptions of occupational risk of exposure to infection among hospital workers, reasons why hospital domestic workers sometimes depart from standard procedure in infection control, and how they regard the patients who have infectious diseases. In this study, at an infectious diseases hospital where there is an acute awareness of such issues, nurses had accurate knowledge about control of infection, including HIV, but had limited trust of that knowledge. They gave rationales for why they sometimes departed from infection-control procedures. They had low levels of fear of homosexuals and of acquired immune deficiency syndrome. The hospital domestic workers had lower levels of accurate knowledge about infection control, including HIV, and less trust of that knowledge and of protection by health provider from occupational exposure to infection. They had low levels of fear of homosexuals and HIV. Both groups sought regular, small-group, interactive education programs on infection control and HIV to allow them to discuss their concerns. Participatory education of workers should include eliciting concerns of participants, and should discuss concerns regarding administrators' and educators' interests in their safety and wellbeing.

Malignant fibrous histiocytoma of the heart presenting as hemoptysis. Association with pseudothrombocytopenia.

A 24-year-old patient presented with hemoptysis. Pulmonary evaluation was unrevealing. After being lost to follow-up, he again presented with worsening symptoms and physical findings of severe pulmonary hypertension. A large left atrial mass was found on echocardiogram. This was subsequently found to be a malignant fibrous histiocytoma. He also had pseudothrombocytopenia due to platelet cold agglutinins. Left atrial masses must be considered in unexplained hemoptysis.

Painless giant cell thyroiditis diagnosed by fine needle aspiration and associated with intense thyroidal uptake of gallium.

A 52-year-old woman presented with fever, goiter, and no evidence of pain or tenderness in the thyroid. A diagnosis of silent thyroiditis was made after obtaining evidence of biochemical thyrotoxicosis, intense gallium-67 citrate thyroidal localization, and cytologic thyroiditis. Fine needle aspiration biopsy of the thyroid revealed numerous giant cells in all areas of the thyroid, typical of subacute thyroiditis. This is believed to be the first time painless thyroiditis is reported with the classic cytologic feature of painful subacute thyroiditis.

Cholelithiasis demonstrated on hepatobiliary scintigraphy as a photopenic defect within the inferior portion of the liver.

A 47-year-old man presented with the clinical findings of acute cholecystitis. During hepatobiliary scintigraphy using Tc-99m DISIDA, a persistent photopenic defect was noted within the inferior portion of the liver in the region of the gallbladder. Abdominal ultrasonography revealed large gallstones with acoustic shadowing within a normal-sized gallbladder. Eleven large gallstones were found within a normal-sized intrahepatic gallbladder at surgery.

Scintigraphic and radiographic findings in Caroli's disease.

In recent years, noninvasive evaluation of Caroli's disease has been demonstrated by computed tomography, ultrasonography, and nuclear scintigraphy. Confirmation of Caroli's disease requires invasive procedures such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography. All of the techniques give valuable information making it easier to diagnose Caroli's disease and to determine its extent. In addition, associated abnormalities in organs outside of the biliary system may be revealed. Two cases are presented to illustrate the radiographic and scintigraphic findings of Caroli's disease.