The death of Thomas Wolfe: a 60-year retrospective.

It seems likely that an old tubercular lesion of the lung had been activated during Wolfe's acute pneumonia and that the disease had spread to the brain. The chest x-ray with the right upper lobe infiltrate was certainly typical of pulmonary tuberculosis, and the spinal fluid findings were characteristic of tuberculous meningitis with 230 cells, 75% of which were mononuclear, which Dandy felt "practically made the diagnosis." Tuberculosis was so prevalent worldwide in the early 20th Century, around the time of Wolfe's birth, but began to decline dramatically in the early 1950s with the introduction of modern chemotherapy and isoniazid (INH). In the U.S. the number of reported cases of TB decreased from 84,304 to in 1953 to 22,201 in 1985. Unfortunately, however, the number of cases has been increasing since 1985, due to a variety of factors including decline in public funding for TB control, HIV infection, immigration, homelessness, substance abuse, and incomplete therapy. Today, Wolfe would have been easily treated and probably cured. Would earlier diagnosis of his condition have made any difference in the outcome? The answer is uncertain, since sanatorium therapy (rest and environment) and surgery were the only available treatments at the time of his illness. Had he lived in a later generation, he might not have met his death at the age of 37.

A run for the record. Studies on a trans-American ultramarathoner.

We examined an ultramarathon runner who recently established world records for the 24-hour run and the trans-American run. Although not endowed with extraordinary physical or biochemical advantages, he has nevertheless been able to run ultralong distances without injury.

Postoperative pulmonary edema.

BACKGROUND: Noncardiogenic pulmonary edema may be caused by upper airway obstruction due to laryngospasm after general anesthesia. This syndrome of "negative pressure pulmonary edema" is apparently well known among anesthesiologists but not by other medical specialists. METHODS: We reviewed the cases of seven patients who had acute pulmonary edema postoperatively. RESULTS: There was no evidence of fluid overload or occult cardiac disease, but upper airway obstruction was the most common etiology. Each patient responded quickly to therapy without complications. CONCLUSIONS: Of the seven patients with noncardiogenic postoperative pulmonary edema, at least three cases were associated with documented laryngospasm causing upper airway obstruction. This phenomenon has been reported infrequently in the medical literature and may be underdiagnosed. Immediate recognition and treatment of this syndrome are important. The prognosis for complete recovery is excellent.

Hyponatremia and ultramarathon running.

Two ultramarathon runners were hospitalized with hyponatremic encephalopathy after completing 80 and 100 km (50 and 62 miles), respectively, of the 1983 American Medical Joggers Association ultramarathon race in Chicago. The two runners consumed such large quantities of free water during the race that apparent water intoxication developed. Both recovered satisfactorily after treatment with intravenous saline. The hyponatremia was caused primarily by increased intake and retention of dilute fluids and contributed to by excessive sweat sodium loss. A possible explanation for the postrace onset of symptoms might be the sudden absorption of fluid in the gastrointestinal tract after exercise ceased, with subsequent further dilution of the plasma sodium. Hyponatremia, which has not been commonly associated with exercise, should be considered as a possible consequence of ultraendurance events.