The American journal of the medical sciences
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A 47-year-old woman presented with cough, pleuritic chest pain and fever of three weeks duration. Although the patient lived in an area where blastomycosis is endemic, this diagnosis was not initially considered owing to the presence of consolidation and a large pleural effusion on the initial chest roentgenogram. Cultures of sputa, bronchial washings and pleural fluid documented the presence of pleuropulmonary infection with Blastomyces dermatitidis. Therapy with amphotericin B was associated with rapid clinical, roentgenographic and bacteriologic resolution of both pleural and parenchymal lung disease.
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Randomized Controlled Trial Clinical Trial
A double blind study of the effects of zinc sulfate on taste and smell dysfunction.
A randomized, double blind crossover study of the effects of zinc sulfate and placebo was carried out in 106 patients with taste and smell dysfunction secondary to a variety of etiological factors. In the patient group prior to treatment, mean serum zinc concentration and leukocyte alkaline phosphatase activity were significantly lower than normal. ⋯ Although these results demonstrate abnormalities of zinc metabolism in some patients with taste and smell dysfunction they fail to provide evidence for a single, therapeutic approach to the many disorders which are associated with abnormalities of taste and smell. However, the methods and procedures developed in this study demonstrate that taste and smell dysfunction can be studied in a quantitative, systematic manner.
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A variety of hemostatic abnormalities has been reported in patients following open-heart surgery. Since surgery itself may induce changes in the coagulation system, the analyses of postoperative coagulation assays in the bleeding patients may be extremely difficult to interpret without an understanding of the coagulation dynamics in the nonhemorrhagic postoperative patients. Thus, we studied the pattern of change in several coagulation assays performed on 36 consecutive patients before and during the first two postoperative weeks. ⋯ Over the following two weeks, the platelet count and platelet adhesiveness returned to normal. Although there was slight lengthening of the Ivy bleeding time on the first postoperative day, this assay was never abnormal. Thus, we conclude that the following cardiopulmonary bypass there is (1) probably activation of circulating procoagulants, (2) progressive increase in fibrinogen levels, (3) activation to the fibrinolytic system, and (4) transient thrombocytopenia with a superimposed platelet defect.
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Localized collection of fluid in an interlobar fissure as a consequence of congestive heart failure is a well-known entity. It has been termed vanishing tumor because of its appearance as a mass lesion in the lung and its propensity to resolve with diuretic therapy. ⋯ This was initially thought to represent an occult metastatic malignancy; however, the cause of the density became obvious when it disappeared with therapy of heart failure and recurred concurrent with cardiac decompensation. Loculated pleural effusion must be included in the differential diagnosis of roentgenographic densities in the chest when seen in subcostal as well as in interlobar locations.