Alterations in arterial blood parameters in patients with liver cirrhosis and ascites.

In cirrhotic patients, in addition to hepatocytes and Kuppfer cells dysfunction circulatory anatomic shunt and ventilation/perfusion (V(A)/ Q) ratio abnormalities can induce decrease in partial pressure of oxygen in arterial blood (PaO(2)), in oxygen saturation of hemoglobin (SaO(2)) as well as various acid-base disturbances. We studied 49 cases of liver cirrhosis (LC) with ascites compared to 50 normal controls. Causes were: posthepatic 37 (75.51%), alcoholic 7 (14.24%), cardiac 2 (4.08%), and cryptogenic 3 (6.12%). Complications were: upper gastrointestinal bleeding 24 (48.97), hepatic encephalopathy 20 (40.81%), gastritis 28 (57.14%), hepatoma 5 (10.2%), renal hepatic syndrome 2 (4.01%), HbsAg (+) 24 (48.97%), and hepatic pleural effusions 7 (14.28%). Average PaO(2) and SaO(2) were 75.2 mmHg and 94.5 mmHg, respectively, compared to 94.2 mmHg and 97.1 mmHg of the control group, respectively (p value in both PaO(2) and SaO(2 )was p<0.01). Respiratory alkalosis, metabolic alkalosis, metabolic acidosis, respiratory acidosis and metabolic acidosis with respiratory alkalosis were acid-base disturbances observed. In conclusion, portopulmonary shunt, intrapulmonary arteriovenous shunt and V(A)/Q inequality can induce a decrease in PaO(2) and SaO(2) as well as various acid-base disturbances. As a result, pulmonary resistance is impaired and patients more likely succumb to infections and adult respiratory distress syndrome.

Fever of unknown origin due to dental infections: cases report and review.

Persistent undiagnosed fever remains a common problem in clinical practice. In a variable number of cases, no definitive diagnosis is made. This lack of a clear etiology indicates that certain disorders are not being detected despite the recently developed technology usually applied in this situation. On occasion, dental disease is one potential cause of persistent fever. Oral symptoms usually are not present, thus allowing the oral cavity to be overlooked during physical examination. We describe three patients with persistent fever due to dental disease and discuss the pathogenesis of this disease.

Pericardial involvement as an atypical manifestation of giant cell arteritis: report of a clinical case and literature review.

PURPOSE: Pericardial effusion has been known to be a rare manifestation of giant cell arteritis. During the last six decades, only 24 cases have been cited in the literature. In this report, we describe the case of a patient presenting with nonspecific symptoms and development of pericardial effusion. PROCEDURES AND FINDINGS: A 71-year-old woman was admitted to the hospital with low-grade fever, exertion breathlessness, atypical diffuse muscular pain, and weight loss over a period of about 5 weeks. Pericardial effusion and giant cell arteritis were diagnosed by echocardiography and left temporal artery biopsy, respectively. Treatment with corticosteroids resulted in remarkable improvement of symptoms and complete remission of pericardial effusion. One year after admission, the patient remained in a stable good condition, under low steroid maintenance dosage. CONCLUSIONS: The diversity of clinical manifestations (such as pericardial effusion) in such a potentially severe disease should alert the physician to prompt diagnosis and treatment in view of impending irreparable vascular damages, even in cases in which the initial presentation is quite uncommon.

Pleural effusion in temporal arteritis.

A 73-year-old woman was admitted to hospital with a one-month history of temporal headache, low-grade fever, fatigue, nocturnal sweats and pleural pain. On the fifth day after admission she developed chest pain at the left site of the thorax, productive cough and progressive dyspnea. A pleural effusion was revealed on physical examination, as well as a bilateral temporal artery thickening. An erythrocyte sedimentation rate of 135 mm in the 1st hour was found. Chest X-ray showed left pleural effusion. Thoracocentesis revealed serous fluid exudate. A percutaneous pleural biopsy showed only minimal inflammatory changes. Temporal artery biopsy showed giant cell arteritis. The patient received prednisone 60 mg/daily with a dramatic clinical response. Pleural effusion is a rare manifestation of temporal arteritis; only seven cases have been reported worldwide. We present a new case of temporal arteritis with pleurisy.

Splenic abscess due to Staphylococcus lentus: a rare entity.

Splenic abscess is an unusual condition, most often seen in immunocompromised patients. Splenic abscesses are due to aerobic and anaerobic bacteria, fungi and parasites, Staphylococcus aureus being the most common aetiological agent. We describe a case of splenic abscess in an alcoholic patient due to Staphylococcus lentus, a rare aetiology included in the microbiology of this disease.

The 20-year outcome of the charnley arthroplasty in younger and older patients.

The purpose of this study is to present the 20-year outcome of 206 Charnley low-friction arthroplasties done by the same surgeon on 181 patients who were separated into two age groups (younger and older). In Group A (76 patients, 92 hips) the mean age at surgery was 44 years (range, 24-55 years), and in Group B (105 patients, 114 hips) the mean age at surgery was 65 years (range, 56-82 years). All patients were evaluated clinically and radiographically. At final followup, 71 patients (87 hips) in Group A and 90 patients (99 hips) in Group B were available for study. The overall failure rate for the hips of Group A was 37.9%, and the overall failure rate for the hips of Group B was 20%. The main cause of failure in Group A was aseptic loosening of the components and breakage of the femoral stem, whereas in Group B the main cause of failure was deep infection. We concluded that by eliminating the above factors, and using new cementing techniques and improved implants, the 20-year results of this arthroplasty would be better. Our results show that the Charnley arthroplasty is a reliable procedure for hip replacement, even in younger patients.

Biliary excretion of antimicrobial drugs.

The development of drugs able to prevent and cure bacterial infections is one of the 20th century's major contributions to human longevity and quality of life. Antibacterial agents are among the most commonly prescribed drugs of any kind worldwide. Used appropriately, these drugs are lifesaving. To eliminate an infection as rapidly as possible, a sufficient concentration of the drug(s) chosen must reach the site of infection. Serum/tissue concentration is a result of various parameters such as absorption, excretion, protein binding and metabolic inactivation. Biliary excretion is an important route for the elimination of some drugs and drug metabolites in humans. Thus, drugs with a high bile concentration are indicated for the treatment of gallbladder infectious diseases. We present a review of a large number of antimicrobial agents most commonly used in daily clinical practice, with regard to their biliary excretion.

Penetration of antimicrobial agents into the prostate.

In the present review article, the penetration of antimicrobial agents into prostatic fluid and tissue was examined. Three major factors determining the diffusion and concentration of antimicrobial agents in prostatic fluid and tissue are the lipid solubility, dissociation constant (pKa) and protein binding. The normal pH of human prostatic fluid is 6.5-6.7, and it increases in chronic prostatitis, ranging from 7.0 to 8.3. A greater concentration of antimicrobial agents in the prostatic fluid occurs in the presence of a pH gradient across the membrane separating plasma from prostatic fluid. Of the available antimicrobial agents, beta-lactam drugs have a low pKa and poor lipid solubility, and thus penetrate poorly into prostatic fluid, expect for some cephalosporins, which achieve greater than or equal to the inhibitory concentration. Good to excellent penetration into prostatic fluid and tissue has been demonstrated with many antimicrobial agents, including tobramycin, netilmicin, tetracyclines, macrolides, quinolones, sulfonamides and nitrofurantoin.

Fever of unknown origin in carcinoma of the colon.

OBJECTIVE: To report a case of fever of unknown origin in a patient with carcinoma of the colon but without gastrointestinal symptoms. CLINICAL PRESENTATION AND INTERVENTION: A 65-year-old man presented with a long-standing fever (of 38 degrees C, about two months' duration), night sweats, fatigue, malaise and anxiety. General physical examination including rectum, radiographic examinations of the chest, abdomen and bones (including ultrasonography and CT scanning) was normal. Biochemistry profile as well as other laboratory studies including blood, urine and stool cultures were normal except for erythrocyte sedimentation rate, which was 105 mm/h. A barium enema showed a rectosigmoid carcinoma. A left sigmoidal colectomy was performed. The patient recovered quickly and remained well for eight years postoperatively. CONCLUSION: This case shows that carcinoma of the colon should be included in the differential diagnosis of patients with fever of unknown origin.