The invisible patient

Article Abstract:

The case of a 79-year-old woman who died from a complication of cardiac catheterization illustrates the tragedy that may occur when patients are not allowed to make decisions about their health care. She had a history of fainting, confusion and slurred speech and was diagnosed with atrial fibrillation. She also had a history of an arteriovenous malformation in her brain, which had been removed 20 years previously. An MRI scan revealed that the malformation had recurred, but her son decided not to tell her. Her doctors decided to investigate her heart disorder to see if she would be a good candidate for brain surgery. Cardiac catheterization revealed minimal coronary heart disease, but six hours later, she developed abdominal pain, vomiting and bloody diarrhea. Abdominal exploration revealed that her intestines had become gangrenous, possibly from a blood clot released during catheterization. She died 12 hours later. Had she known about the recurring malformation, she might have decided against brain surgery, which would have eliminated the need for the catheterization.

Ethical aspects, Informed consent (Medical law), Informed consent, Aged women, Elderly women

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We blew it

Article Abstract:

The case of a 34-year-old HIV-infected man who died of drug-induced liver disease indicates that physicians should not overlook the obvious. He was admitted to a hospital with jaundice, which is a symptom of liver dysfunction. His doctors assumed that it was a result of some kind of opportunistic infection, which is common in people with suppressed immune systems. However, extensive diagnostic tests revealed no evidence of infection. They briefly speculated that his liver dysfunction might be caused by some of the drugs he was taking, including an herbal preparation called PCM4. A liver biopsy confirmed that the liver damage was caused by a drug. His antibiotics were discontinued, but he continued taking trimethoprim-sulfamethoxazole, which is given to HIV patients to prevent Pneumocystis carinii pneumonia. This drug was eventually stopped, but the patient died. This drug appears to have been responsible for his liver disease.

Causes of, Complications and side effects, Liver diseases, HIV patients, Co-trimoxazole, Trimethoprim-sulfamethoxazole (Drug combination)

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Learning from our errors

Article Abstract:

A 50-year-old man was initially diagnosed with a type of brain tumor called a glioma because CT and MRI scans revealed a mass in his brain and a needle biopsy appeared to indicate glioma. However, he also had a mass in his lung and it is very unusual for glioma to spread to the lung. He received radiation treatment to his head but further brain and lung biopsies revealed that he may have had an infectious disease rather than a brain tumor. Analysis of one brain sample revealed the presence of the organism that causes tuberculosis.

Diagnosis, Tuberculosis, Gliomas

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