Eugene L. Coodley

Actinomycosis: Clinical Diagnosis and Management

Two cases of thoracic actinomycosis are described. In one, pericarditis was an unusual feature. These cases point up the need for suspicion of actinomycosis in patients with pulmonary, cervicofacial or abdominal disease accompanied by a draining sinus. The therapeutic agent of choice is penicillin G.

Laboratory tests in the elderly. What is abnormal

Comparison of studies on the elderly is difficult. This study is one of the largest done on healthy, ambulatory persons aged 65 and up. Findings indicate that most laboratory values in elderly persons fall in the normal range. A significantly abnormal test result should raise the suspicion of underlying disease. A small percentage of patients show an abnormality on specific tests (ie, for glucose, calcium, serum lipids). Changes in a few test values are to be expected with aging: These include an increase in alkaline phosphatase, a decrease in serum phosphorus, a decrease in creatinine clearance without a concomitant rise in serum creatinine, and an increase in postprandial glucose level. Vitamin deficiencies and decrease in serum albumin are usually the result of chronic malnutrition rather than aging.

Coronary artery disease in the elderly.

Clearly, management of heart disease is quite different in the elderly than in younger patients, and it represents a significant problem in light of the increasing numbers of elderly patients. For physicians, the challenges are to recognize the many cardiac entities, to avoid the problems that can result from prescribing drugs in dosages similar to those given to younger patients, and to acquire a better understanding of cardiac anatomy and physiology associated with the aging process.

Case Report Thoracic duct-subclavian vein anastomosis in management of cirrhotic ascites

Reanastomosis of the thoracic duct and subclavian vein has been performed in three patients with intractable ascites. Following surgery, these patients were placed on a loop-blocking diuretic plus Aldactone, and prompt diuresis ensued with gradual improvement in the ascites. Improvement in the ascites was probably the result of several factors including removal of obstruction at the upper end of the thoracic duct, mobilization of fluid in the intravascular space, improved lymphatic drainage, and diuretic effect. Complications included necessity for re-exploration in one patient and development of encephalopathy in a second patient.

A Preliminary Study of Butirosin in the Treatment of Susceptible Bacterial Infections

B UTm0SIN* is a new aminoglycoside antibiotic possessing an antibacterial spectrum similar to gentamicin and possessing activity against gentamicinresistant strains of Pseudonionas.1 Laboratory evidence indicates that butirosin would be expected to be nephrotoxic and ototoxic like other aminoglycosides. Preliminary human studies2 demonstrated prompt absorption following intramuscular injection, a half-life of 2 hours, and almost complete excretion of unmetabolized drug into the urine.

Cardiac arrhythmias. An update on identification and therapy.

Cardiac arrhythmias result from conduction block, abnormal impulse formation, or a combination of both. The decision to treat arrhythmias depends on symptoms, hemodynamic problems, the presence or absence of organic heart disease, and the presence of malignant arrhythmias. Holter monitoring, treadmill exercise testing, and electrophysiologic stimulation can facilitate identification. Control involves correction of precipitating or contributing factors and selection of an appropriate antiarrhythmic drug or surgical technique.

Heart Disease in Pregnancy

Normal pregnancy causes physiologic changes that may mimic symptoms of heart disease, but organic heart disease does complicate about 1 percent of pregnancies. Once the physician has made his diagnosis, he usually can manage the pregnant cardiac patient medically. Surgical intervention, either to terminate the pregnancy or to correct the heart condition, is not often necessary.