Mayo Clinic proceedings
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Mayo Clinic proceedings · Feb 1992
Outcome of recipients of bone marrow transplants who require intensive-care unit support.
To determine the outcome and prognostic factors associated with bone marrow transplantation (BMT), we reviewed the clinical course of 35 adult recipients of such a transplant who were admitted to our intensive-care unit (ICU). This constituted 24% of patients who underwent BMT for treatment of hematologic disorders during the study period. The reasons for admission to the ICU were postsurgical care in 5, respiratory failure in 25, shock in 4, and renal failure in 1. ⋯ The APACHE II (acute physiology and chronic health evaluation) prognostic scoring system underestimated mortality and had no correlation with the duration of stay in the ICU or the hospital. Vasopressors, total parenteral nutrition, and transfusion of blood components in the ICU had no influence on the outcome. Open-lung biopsy was helpful in making specific diagnoses, and pulmonary artery catheters were used in most patients to guide therapy but did not improve survival.(ABSTRACT TRUNCATED AT 250 WORDS)
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Antituberculous agents have radically improved the prognosis of patients with active tuberculosis. Generally, 6-month and 9-month antituberculous regimens have been successful, and surgical therapy is rarely needed. Extrapulmonary tuberculosis should be managed with the same drug regimens as pulmonary tuberculosis. ⋯ When failure of treatment is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated. A single drug should never be added to a failing regimen. Isoniazid administered prophylactically for 6 to 12 months is effective in most cases.
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In recent years, the antiviral armamentarium has expanded considerably. Currently available agents are virustatic, inhibiting specific steps in the process of viral replication. No agent is active against nonreplicating or latent viruses. ⋯ Patients with human immunodeficiency virus infection and CD4 lymphocyte counts of less than 500 cells/mm3 should be treated with zidovudine. Amantadine is useful in a therapeutic and prophylactic role in the management of influenza A virus infection. With the expanded use of and indications for antiviral therapy, clinically significant resistance to these agents has been encountered with increasing frequency.
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The use of conservative or radical surgical procedures in the management of hepatic echinococcosis is controversial. A review of data on 23 patients with hydatid cysts of the liver that were diagnosed between 1935 and 1990 at our institution was undertaken to determine the safety and efficacy of various surgical procedures. In eight patients (group 1), the cysts were treated conservatively by instillation of a scolicidal agent followed by evacuation of the cyst, drainage, or omentoplasty of the residual cyst cavity. ⋯ Group 1 and group 2 patients had similar complication rates (62% and 54%, respectively) and mean hospital stay (24 and 23 days, respectively). Recurrent cysts, however, were detected in three of six patients who underwent a conservative surgical procedure and participated in follow-up, whereas no patients treated by a radical procedure had a recurrence. Because pericystectomy and hepatic resection resulted in a low rate of recurrence and eliminated the need for use of potentially toxic scolicidal agents, these procedures may be the preferred method for the surgical management of hepatic hydatid disease.