Dr. Lucid's word rounds.

Between Oct. 1, 1983, and June 30, 1985, Cryptosporidium oocysts were identified in stool specimens from 74 patients who presented with gastrointestinal symptoms to their physicians. Questionnaires prepared to determine travel history, symptoms, duration of illness and epidemiologic characteristics of the infection were completed for 67 (90%) of the patients by their physicians; the information on the other 7 patients was obtained from the requisitions accompanying the specimens. Of the 67, 35 (52%) had recently been to Mexico. The infection was likely transmitted through contaminated water, food and, possibly, milk. The infections in patients who had not travelled were thought to be due to contact with infected pets or farm animals or with infected children attending daycare centres. Diarrhea, vomiting, fever and nausea usually lasted for 1 to 2 weeks, except in those with immune deficiency, in whom the symptoms persisted for up to 6 months. The condition was diagnosed by identification of oocysts in stool specimens that underwent formalin-ether sedimentation and modified cold Kinyoun staining.     

Dr. Lucid's word rounds: IMRAD on the wards.

The classic site for paracentesis in generalized ascites is in the left lower quadrant of the abdomen at a position equivalent to McBurney''s point. Its use has an average success rate of 58%, depending on the amount of liquid. To assess the efficacy of paracentesis at this site and to establish the ideal site for blind puncture, we studied 27 consecutive patients with ascites detected by abdominal ultrasonography. The amount of ascites was graded from 1 to 4. Free fluid had accumulated mostly in the perihepatic region, then around the bladder and in the right paracolic gutter, and finally in the left flank. In six of the eight patients in whom fluid was found in the left or right flank, air-filled bowel loops were observed between the abdominal wall and the fluid, in the expected path of a blind puncture. These findings suggest that the safety and efficacy of paracentesis would be greatly improved by ultrasonographic guidance.     

Trauma rounds: Orthopedic emergencies.

To determine how adequately patients who participate as subjects for clinical investigation understand their commitment, 50 patients admitted to the Clinical Research Center of the University of Washington were interviewed. Their responses were compared with the detailed statements in the consent forms for the 23 specific protocols under which they were being studied. In spite of careful controls in accord with guidelines of a review committee, only half the patients were able to describe accurately their expectations of the studies to which they had given signed consent.     

An Interview with Dr. Mondo

Yes, this is an unusual dawn. Even the timid zebra challenges the leopard. This is the dawn in which the prey takes courage and turns on the predator. It is the dawn in which the underdog finds the strength to rebel and nothing disorients the mighty more than the attack of those who have already feared him in the past. In the great game, the same ones don't always win. [From the epilogue of the film Mondo Violence, c. 1978]