Serious infections caused by Staphylococcus aureus in HIV-infected patients have been reported. Contributing factors in the development of invasive S aureus infections include a high rate of skin and nasal colonization, frequent dermatologic disease, and the use of intravenous catheters. The authors report three cases of S aureus pericarditis in HIV-infected patients. While cases of viral, mycobacterial, and malignant pericardial effusions in HIV-infected patients have been reported, a review of the literature disclosed only three cases of bacterial pericarditis. Despite appropriate antibiotic therapy and drainage, a patient's condition may abruptly deteriorate and progress to tamponade. Early recognition of bacteremia and pericarditis and monitoring for cardiac tamponade, along with aggressive treatment, can result in a favorable outcome, but mortality remains high, particularly when S aureus is the causative agent.

Pulmonary cavitary coccidioidomycosis with fungus ball formation was observed in two individuals with hemoptysis. The first patient had no overt compromise; the second was an insulin-dependent diabetic. In both, fiberoptic bronchoscopy was performed and cultures yielded Coccidioides immitis. The coexistence of spherules and hyphae of C immitis was seen histologically on bronchoscopic biopsy specimen of one cavitary lesion. Specific antifungal therapy and surgical excision were withheld and each patient has done well. This report provides for the first time nonsurgical confirmation that C immitis can produce an intracavitary fungus ball.

We describe two patients who develop torsades de pointes in a temporal relationship to the intravenous administration of erythromycin lactobionate in the absence of other drugs or metabolic abnormalities known to cause the arrhythmia. We also review the current literature regarding this topic, including other case histories and the evidence for erythromycin's effect on cardiac tissue. Due to the increasing use of erythromycin in clinical practice, we believe it is important that all physicians be made aware of this potential complication, which was not recognized at our institutions until these patients were seen by one of us (B.G.).

The preponderance of evidence indicates that high airway pressure is not by itself injurious to the lung. Rather, overdistention of the lung appears to be the fundamental mechanism underlying VALI. The physician must bear in mind the factors (ie, flow-resistive pressure losses, respiratory muscle activity, and abnormalities in rib cage or abdominal compliance) that may alter the relationship between PAP and lung volume. Under some circumstances, high PAP may, in fact, reflect lung overdistention, and maneuvers that minimize overdistention may also reduce PAP. Similarly, the goal of improving oxygenation may sometimes entail strategies (such as prolonging inspiratory time) that lower PAP. In these settings, however, the reduction in PAP should be regarded as a by-product of achieving another therapeutic goal and not an end point in and of itself. In other settings, such as the mechanically ventilated patient with severe airflow obstruction, measures that lower PAP by reducing inspiratory flow rate may worsen pulmonary hyperinflation, and thereby increase the risk of complications.

One hundred forty-six cases of Gorham's syndrome are documented in the literature. Twenty-five (17 percent) patients have been reported to have chylothorax as a complication. To our knowledge, this high incidence of chylothorax has not been reported previously. We describe two such patients treated by thoracic duct ligation and compared our results with others to support early surgical intervention via a low right-sided thoracotomy in these cases.

Ameloblastoma is a rare disease of odontogenic origin with indeterminate metastatic potential. The first site of metastatic disease is usually the lung. We report aggressive surgical treatment of a patient with bilateral disease with five subsequent recurrences. A review of the literature suggests that in the absence of effective chemotherapy or radiation, surgery should be considered the treatment of choice for metastatic ameloblastoma confined to the lung.

To formulate recommendations for the development of early intensive care unit (ICU) discharge criteria for low-risk monitor patients.

To formulate recommendations for the development of intensive care unit (ICU) admission policies.

We report a case of Behçet's disease with pulmonary and splenic involvement. The radiologic presentation was quite different from the modes defined in the literature. A large, anteriorly located, well circumscribed ovoid mass was the x-ray film image of a large area of infarction with hemorrhage. The involved pulmonary artery showed signs of vasculitis with thrombus formation. To our knowledge, this mode of presentation is different from the cases reported in the literature.

A case of double-orifice mitral valve in a 16-year-old Japanese boy is presented. Two-dimensional echocardiography, including transesophageal approach, showed two approximately equal orifices with three papillary muscles. Color Doppler echocardiography showed a mild mitral regurgitation from both orifices. No other cardiac anomaly was associated. The patient's left ventricular function is presently normal.

We describe a 46-year-old splenectomized patient who died of Haemophilus influenzae septicemia 16 h following bronchoscopy. Although rare, postsplenectomy overwhelming sepsis is always a danger in splenectomized patients undergoing invasive procedures. Chemoprophylaxis should be considered in asplenic patients peribronchoscopy.