Community-acquired Staphylococcus aureus bacteraemia in patients who do not abuse intravenous drugs

Despite advances in antimicrobial therapy and intensive care support, Staphylococcus aureus continues to cause significant morbidity and mortality. We studied community-acquired S. aureus bacteraemia in a population where intravenous drug abuse is extremely uncommon, prospectively reviewing all such patients (n = 113) admitted to Groote Schuur Hospital from February 1986 to January 1991. Overall mortality was 35%. Factors associated with poor outcome were: confusion on presentation, failure to mount a febrile response, acute renal failure, adult respiratory distress syndrome, shock, endocarditis, disseminated intravascular coagulation and platelet count of < 100 x 10(9)/l. Only confusion, acute renal failure and shock were independently associated with death by stepwise regression analysis. Skin infections were the most commonly identified source of bacteraemia (22%), but in 58% of patients the source was not determined. Twenty-six percent of patients were diabetic. Almost all patients (90%) developed one or more complications. In those who survived, therapy was generally prolonged, with a median of 70 days and range of 7-393 days, depending on the associated complications. Community-acquired S. aureus bacteraemia is a serious condition associated with a high complication rate and mortality.      

Diffuse pulmonary opacification in infants undergoing extracorporeal membrane oxygenation: clinical and pathologic correlation

Diffuse pulmonary opacification is commonly seen on chest radiographs from infants with severe respiratory failure treated with extracorporeal membrane oxygenation (ECMO). The chest radiographs and clinical records of 18 such infants were reviewed to determine the correlation among degree of abnormality on chest radiograph (as determined by a radiographic score), clinical severity of disease (as measured by ECMO requirements [ECMO flow rate]), and dynamic lung compliance determinations. Increasing lung compliance and decreasing ECMO flow rates correlated well with decreasing (improving) radiographic score. Pathologic changes were mainly those associated with intensive respiratory support and the underlying pulmonary condition. One patient had diffuse pulmonary hemorrhage. Other than bleeding, no distinctive pathologic features could be attributed to therapy with ECMO. We conclude that the degree of pulmonary opacification seen in infants undergoing ECMO therapy is an accurate reflection of markedly decreased lung compliance and lung volumes caused by hyaline membrane formation, pulmonary edema, and atelectasis associated with the various causes of severe respiratory failure.     

Postoperative hysterosalpingogram: radiographic-surgical correlation

The hysterosalpingograms of 46 patients who underwent previous uterine or tubal surgery were reviewed. Surgical procedures performed included cesarean section, myomectomy, uterine septal repair, tubal reimplantation and reanastomosis, and fimbrioplasty/cuff salpingostomy. The procedures and their resulting hysterosalpingographic appearances are discussed.     

Anatomy of the perirenal area

The authors comment on the use of the renal bridging septa as a sign in distinguishing compartmentalization of the perinephric space. They also address new concepts regarding the spread of pancreatic effusions and provide information on other anatomic features of the perirenal area.     

Academic uroradiology: the future

Radiologic education, research, and the practice of radiology will be of the highest quality in the future if academic departments stress organ-system subspecialization while continuing to integrate and interface with technique-based specialists. Planning should begin now to effect an orderly progression to an organ-system-based subspecialty structure for radiology training in general and for uroradiology specifically. Uroradiologists should remain as central consultants to their clinical counterparts, working collaboratively with urologists in clinical endeavors of mutual relevance. More fellowships in uroradiology should be offered that attempt to incorporate all imaging methods and procedures into the curriculum. These issues are addressed in the context of patient care, service, education, and cost containment.     

Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese,African Surinamese and ethnic Dutch: a cross-sectional population-based study

Background  

While the prevalence of type 2 diabetes mellitus (DM) is high, tailored risk scores for screening among South Asian and African origin populations are lacking. The aim of this study was, first, to compare the prevalence of (known and newly detected) DM among Hindustani Surinamese, African Surinamese and ethnic Dutch (Dutch). Second, to develop a new risk score for DM. Third, to evaluate the performance of the risk score and to compare it to criteria derived from current guidelines.