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I July, 1950 CLINICOPATHOLOGIC CONFERENCE 359 Clinicopathologic Conference Bowman Gray School of Medicine of Wake Forest College A 31 year old white man was admitted to <the North Carolina Baptist Hospital on January 19, 1950, stating that his urine had been scanty and dark for thirty-six hours. On the day preceding admission he had noted the sudden onset of oliguria associated •with lethargy, nausea, diarrhea (five very dark brown, watery stools), anorexia, vom-iting (twice), and a very dark brown color (to his urine. He had taken no medicine recently, except some pills three weeks prior to admission for vague low back pain. A iweek later he had had an upper respiratory infection lasting seven to eight days. Three days prior to admission he noticed puffiness about his eyes. He had had no known exposure to toxic substances and no recent transfusions. There had been no chills, fever, or pain. He denied any melena, weight loss, ab-idominal pain, or alcoholism, but stated that he had noted a gradual increase in the size \ of his abdomen over a three year period. During World War II the patient had S served in New Guinea and in the Philippines, and had been given suppressive closes I of Atabrine. In the spring of 1946, following ihis discharge from service and the cessation I of Atabrine, he began to have recurrent bouts of fever, chilly sensations, and discomfort in the left upper quadrant. These occurred about every six months and lasted ( several days. The patient was treated with i various anti-malarial drugs, although para-• sites were never demonstrated on repeated I examinations. The last episode—in June, ! 1949—was associated with jaundice for the first time. He entered a Veterans Administration Hospital, where jaundice, splenome-jgaly and impaired liver function were noted, and a diagnosis of chronic infectious hepatitis was made. On admission there, his white cell count ;was 2100, with 5 per cent eosinophils; the sedimentation rate was 26. Serologic tests for syphilis were negative. There was increased urine urobilinogen (no bile). Total serum proteins were 7.5 Gm. per 100 cc.— ie! 3.3 Gm. of albumin and 4.2 of globulin. The ! serum bilirubin was 6.2 mg. per 100 cc., and >n> ,a cephalin flocculation test gave a 2 plus re-i;: action. Febrile agglutination tests, a comple-r iment fixation test for amebiasis, and a bone marrow examination were negative. A chest film showed slight elevation and flattening of the right diaphragm. Abdominal roentgen studies and intravenous pyelograms were negative. At the time of discharge the patient was improved. Physical examination: On admission here, the temperature was 99 F., the pulse 90, respiration 18, blood pressure 114 systolic, 64 diastolic. The patient was pale but oriented and only slightly uncomfortable. No jaundice, petechiae, or glandular enlargement was noted. There was minimal edema of the soft tissues of the orbit, but no other edema. The heart and lungs were normal. A firm, smooth, rounded, non-tender mass was felt in the left upper quadrant; it extended 6 to 8 cm. below the left costal margin, which did not move with respiration. The liver was felt 1 to 2 cm. below the right costal margin, and was firm, smooth, and non-tender. There was no tenderness in the costovertebral angles, and neurologic examination wTas not remarkable. Accessory clinical findings: The hemoglobin was 11.5 Gm., red cell count 4,700,000, white cell count 4,450, with 62 per cent segmented polymorphonuclears, 28 per cent nonsegmented polymorphonuclears, 1 per cent eosinophils, 5 per cent lymphocytes, and 4 per cent monocytes. Toxic granulation of the polymorphonuclear cells was noted. Urinalysis revealed a specific gravity of 1.048, a 4 plus reaction for albumin, and innumerable white cells, red cells, and granular casts. The nonprotein nitrogen was 51 mg. per 100 cc., fasting blood sugar 100 mg., total serum protein 6.5 Gm., with 3.5 Gm. of albumin and 3.0 Gm. of globulin. The carbon dioxide combining power of the blood was 41 vol. per cent, calcium 9.8 mg. per 100 cc., phosphorus 5.1 mg., bilirubin 2.0 mg., chlorides 552 mg. Two stool examinations revealed no blood, ova or parasites, and on culture no pathogens were seen. Serum cholesterol was 247 mg. per 100 cc., alkaline phosphatase 1 unit. The heterophile agglutination test was postive in a dilution of 1:28; cold agglutinins were present in a 1:40 dilution. Electrocardiograms on three occasions showed no evidence of myocardial disease. Course in the hospital: The patient was placed on a "rice diet," and fluids were limited to 1000 cc. daily. During the first few days he did not appear to be in any great distress, and remained afebrile. The urinary
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1950 |
Identifier | NCHH-17-011 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 11 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-011.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-011 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Description
Fixed Title * | Page 359 |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1950 |
Identifier | NCHH-17-011-0365 |
Form General | Periodicals |
Page Type | all; organizational news |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolina111950medi_0365.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 11 |
Issue Number | 7 |
Page Number | 359 |
Health Discipline | Medicine |
Full Text |
I July, 1950
CLINICOPATHOLOGIC CONFERENCE
359
Clinicopathologic Conference
Bowman Gray School of Medicine of Wake Forest College
A 31 year old white man was admitted to |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-011.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-011 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
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