The American journal of the medical sciences
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Review Case Reports
An Unusual Case of Explosive Pleuritis without Mediastinal Shift.
Explosive pleuritis (EP) is an under-reported condition. Although there is no agreed-upon definition, generally, the term EP denotes a dramatic clinical and radiologic progression of pleural space inflammation in the setting of pneumonia. The pleural space inflammation leads to the formation of loculated complex pleural effusion or empyema, and pleural adhesion within a matter of hours, typically in less than 24 hours. ⋯ Streptococcal pneumonia is the most common cause of EP. Here we present a case and discuss the clinical, microbiologic, radiologic, and treatment aspects of EP. We also scrutinize the medical literature to compare the previously reported cases.
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Review Case Reports
Collapsing glomerulopathy in a patient with mixed connective tissue disease.
Collapsing glomerulopathy (CG) is a form of podocytopathy that is challenging to manage. CG can be idiopathic or associated with other conditions including autoimmune connective tissue diseases. In the setting of autoimmune connective tissue diseases, there are no current guidelines to guide therapy. ⋯ CG in the setting of autoimmune connective tissue diseases is more common in females and black patients. Response to therapy was inconsistent. Many patients progressed to dialysis despite use of various treatment modalities.
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Review Case Reports
A 49-year-old Man with Ischemic Cardiomyopathy and Persistent Hemoptysis for Eighteen Months.
Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of recurrent episodes of diffuse alveolar hemorrhage (DAH). IPH commonly manifests with hemoptysis, radiologic chest infiltrates and anemia. The etiology of IPH is unknown, but an immunologic mechanism is widely speculated. ⋯ Bronchoscopy revealed DAH. A surgical lung biopsy showed 'bland pulmonary hemorrhage.' A right heart catheterization ruled out cardiac causes of DAH. The patient was diagnosed with IPH and started on systemic corticosteroids with rapid improvement of hemoptysis.
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Review Case Reports
Septic arthritis due to Nocardia: Case report and literature review.
Nocardia is an uncommon cause of septic arthritis. We found only 37 cases reported in the literature thus far. Amongst these, only five involved prosthetic joints. ⋯ Septic arthritis due to Nocardia has a favorable outcome with a combination of surgical debridement and prolonged antimicrobial therapy of three to six months. For prosthetic joint infections, removal of hardware seems to carry a better prognosis. Trimethoprim-sulfamethoxazole continues to remain the drug of choice.
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Recent studies suggest that balanced fluids improve inpatient outcomes compared to normal saline. The objective of this study was to obtain insights into clinicians' knowledge, attitudes and perceived prescribing practices concerning IV isotonic fluids and to analyze perceived prescribing in the context of actual prescribing. ⋯ Persistent normal saline utilization is associated with certain specialties, care locations, and the rate and volume of fluid administered, but not with other clinical considerations or cost. These findings can guide interventions to improve evidence-based fluid prescribing.