oliver@unc.UUCP (Bill Oliver) (12/13/85)
This and the next article were posted in response to Craig Werner's case study. I don't think it made it out - we apparently had some software problems with the news stuff that evening. If this has already hit the net, please accept my apologies... Oh boy. I do love case studies. Craig, you obviously show good taste in your choice of interests - let's hear it for cardiac pathology. YEAH PATHOLOGY!!!! Well folks, I'm back, having learned the wisdom of buying surge protectors. OK, here's one: A forty-two year old man with a history of alcohol and intravenous drug abuse refuses dinner one night complaining of an upset stomach. Full medical history is unavailable. The man is known to police, with a record of drug dealing, public drunkenedness, and numerous fights when a younger man. Later that evening, he suffers through a few hours of nausea and vomiting. The vomitus contains copious "coffee ground" material (for you non-med types, "coffee ground" vomitus is a buzzword for upper GI (read gastric) blood - as opposed to fresh blood or fully digested blood (which carries the buzzword "tarry stool")). He is admitted to a local emergency room where X-ray evaluation of the chest reveals a left sided pleural effusion as well as consolidation of the lower lobe of the left lung. A nasogastric tube is placed to examine the stomach contents, but no fluid is returned. On admission, the patient was mildly febrile, with normal electrolytes. The patient was mildly anemic and displayed a moderately elevated white cell count. On physical examination, there was tenderness to palpation of the left thorax and upper left abdomen. Within a couple of hours of admission, the decedent underwent a cardiac arrest. Cardiopulmonary resuscitative efforts were unsuccessful. Because of sudden death in a healthy younger adult, the history of intravenous drug abuse, lack of adequate history, and the lack of a local personal physician who was familiar with the patient and capable of knowledgeably signing a death certificate, the county Medical Examiner was informed of the case. After consultation with the state office, the Medical Examiner assumed jurisdiction, and the body was transferred to the Office of the Chief Medical Examiner for diagnostic evaluation. An autopsy was performed. Well fans, what's the diagnosis? Answer in following article. Bill Oliver