Treatment of sickle cell disease.

The treatment of sickle cell disease requires familiarity with the medical manifestations of the vaso-occlusive and hematologic crises and their complications. This discussion deals with treatment of the sickle cell crises and major clinical manifestations of the disease. At present, treatment is primarily symptomatic despite intensive efforts during the past decade to provide more definitive therapy.

Exchange transfusion for sickle cell intrahepatic cholestasis.

Only one of eight previously described patients with sickle cell intrahepatic cholestasis (SCIH) survived. Death usually resulted from liver failure and/or a hemorrhagic diathesis. This report deals with the successful treatment of SCIH by partial blood-plasma exchange transfusion. This treatment led to regression of hepatic encephalopathy, impending bleeding diathesis, and noticeable clinical improvement withn 48 hours. Within six days, the serum bilirubin level decreased from 146 to 16 mg/dL. Partial blood-plasma exchange transfusion may be valuable for the treatment of SCIH.

Tuberculosis and alcoholism. A partial solution through detection.

Alcoholism and tuberculosis often coexist, and patients with this combination have the most frequent failures of therapy. Several intriguing alternatives to standard outpatient chemotherapy are now available. The brief MAST interview (a shortened version of the Michigan Alcoholism Screening Test) has been demonstrated to be effective in identifying alcoholism in public health clinics for tuberculosis in New Orleans and Birmingham, Ala., with scores indicating populations of alcoholic patients of 25% and 28%, respectively. The test could be administered without interrupting the routine of the clinic. We believe that the problem of inadequate therapy in the alcoholic patient with tuberculosis is significant and widespread and is not being handled well is most places. Identification of the potential problem patient at first contact will be most helpful in choosing candidates for specialized forms of therapy, including short-term and supervised treatment, begun before failure of therapy ensues.

Case report: factitious hypoglycemia in diabetic patients.

Factitious hypoglycemia (FH) in a diabetic patient represents a difficult diagnostic and costly management problem. An adolescent diabetic with FH is reported. A literature search revealed 10 adolescent and 45 adult diabetic patients with FH. Tests currently available for diagnosis are evaluated. The role of psychiatric therapy in relation to overall management and prognosis is stressed.

Alcohol and the heart. How it helps, how it harms.

Does regular consumption of alcohol protect against coronary artery disease but not against sudden death? In this article, Dr Sheehy examines several theories that have been proposed to explain the cardioprotective effect of ethanol and also reviews the factors related to sudden death in alcoholics.

Diabetic gustatory sweating.

Gustatory sweating is an unusual entity that may occur as an idiosyncratic reaction to certain foods, as a localized reaction to trauma or infection, or as the result of diabetic neuropathy. This report deals with a severe case of diabetic gustatory sweating, discusses the various types of gustatory sweating, and reviews the English literature dealing with the diabetic form.

Sickle cell hepatopathy.

Hepatic dysfunction is a common finding in patients with sickle cell disease but viral hepatitis appears to be an unusual complication in the adult SS patient. Only five cases of viral hepatitis were recorded in 378 admissions for SS crisis. In contrast, hepatic crisis occurred as a distinct event in 9% of 88 patients with sickle cell anemia. This entity must be differentiated from acute cholecystitis or viral hepatitis. Transiently abnormal results of hepatitic function tests were observed in another 26 patients with extrahepatic crisis. Cirrhosis is relatively common and often the terminal event in SS disease. Choledocholithiasis and cholecystitis are infrequent complications despite the prevalence of gallstones in SS anemia.

Colitis associated with clindamycin therapy.

Clindamycin (7-chloro-7-deoxylincomycin) may induce mild or severe colitis. In 28 months, clindamycin-associated diarrhea was encountered in 8 patients who had received oral therapy. Severe, acute colitis was seen in 4 older patients, 3 of whom had acute pseudomembranous colitis and one who had an adynamic ileus mimicking an acute abdomen. Mild colitis with protracted diarrhea occurred in 4 younger patients who had mild, nonspecific inflammation in the rectum which responded to symptomatic treatment. The mechanism and true incidence of diarrhea as a sequel of clindamycin therapy are unknown. In all 8 patients, the use of clindamycin was arbitrary. Because of potentially serious gastrointestinal disturbance, including acute pseudomembranous colitis, clindamycin should be reserved for anaerobic and other serious infections.

Giardia-induced malabsorption in pancreatitis.

This report deals with the onset of Giardia-induced, primary malabsorption in patients with chronic pancreatitis. To our knowledge, this association has been reported only once previously. A further review of the literature suggests that malnourished patients with chronic pancreatitis may be susceptible to G lamblia infection. Therapy for giardiasis rapidly reverses the diarrhea, malabsorption, and edema seen in these patients.

Geotrichum septicemia.

Although disseminated geotrichosis is an unusual disease (to our knowledge, only six cases have been reported), Geotrichum candidum is not a very virulent fungus. In our case, there was neutrophillic phagocytosis of the arthrosphores of G candidum, with rapid clearance of the fungus from the plasma of a chronically ill patient whose immune defenses were still intact.