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BACKGROUND: Acute renal failure has long been associated with severe Rocky Mountain spotted fever (RMSF). Despite many descriptions of the protean manifestations of this disease, relatively little is known concerning the risk factors for acute renal failure. Only a few studies have examined the outcome of patients infected with Rickettsia rickettsii who develop renal insufficiency, and these studies had methodological problems. OBJECTIVE: To study the incidence, risk factors, and outcomes of acute renal failure in a large group of hospitalized patients with definite or probable RMSF. METHODS: The clinical records of 114 patients with definite or probable RMSF were retrospectively reviewed to identify clinical and biochemical abnormalities at the time of admission that were associated with the development of acute renal failure and subsequent mortality. Renal failure was defined as a serum creatinine (Cr) above 2 mg/dL. Logistic regression was used to study the association between these variables and the outcomes during hospitalization: death and the development of acute renal failure. RESULTS: The mortality rate in this series was 14%; 19% of the patients developed acute renal failure. The development of acute renal failure increased the odds ratio (OR) of dying by a factor of 17 (P = 0.0001). Factors at the time of hospitalization that were associated at a univariate level with subsequent mortality included elevated serum Cr, increased age, increased level of AST, increased level of bilirubin, decreased serum sodium and platelet count, the presence of neurological involvement, and being male. Both the presence of neurological involvement and an elevated serum Cr at presentation were independently associated with increased mortality by multivariate analysis. Three patients developed acute renal failure that required hemodialysist and only 1 of these 3 patients survive ultimately discharged with a normal serum Cr. Factors at presentation that were associated with the development of acute renal failure included increased bilirubin, increasing age, thrombocytopenia, and the presence of neurological involvement. Both age and decreased platelet count at presentation were independently associated with the development of acute renal failure by multivariate analysis. CONCLUSION: Acute renal failure was a frequent complication of RMSF in this series of patients from a tertiary referral medical center. The presence of acute renal failure was strongly associated with death. Clinical and biochemical variables are useful in predicting which patients will develop acute renal failure. 1996 by Excerpta Medica, Inc. Am J Med. 1996;101:621-626.

The preservation of small, independent family practices within a changed health care delivery environment is a goal worth pursuing. Properly organized, such practices would maintain the special fiduciary relationship between [...]

Neil Besougloff's editorial 'How tall to make a layout,' in the April 2011 Model Railroader was very interesting. I've been in a wheelchair for the last 27 years and I've [...]

Because bone marrow contains a large portion of mobile protons in fat and water in blood cell producing spongy tissue it is ideally suited for study with magnetic resonance (MR) imaging. Areas of bone marrow abnormality can be detected with MR, but the use of MR to specifically diagnose marrow abnormalities is unknown. Researchers used quantitative MR imaging of the lumbar spine (lower curve) to characterize hematologic (blood) disorders in 30 patients with clinically and biopsy-proven disorders and 15 healthy control subjects. Images of the patients with infiltrative bone marrow disorders showed longer T1 (spin-lattice) times than the control subjects. However, MR imaging did not demonstrate diagnostic capabilities in evaluating diffuse bone marrow infiltrates. The researchers report that quantitative MR imaging of the lumbar spine may be of value in the detection of focal (centralized) marrow abnormalities in lymphomas (abnormal growth in the lymphatic system), such as Hodgkin's disease. Preliminary results of the use of quantitative MR imaging in childhood and adult leukemia patients who are receiving bone marrow suppression therapy have also been encouraging. The role of quantitative MR imaging for following treatment responses in diseases that focally affect marrow has yet to be fully assessed.

I approached Parkinson's Disease: A Guide for Patient and Family from the perspective of a family member, as my father suffers from the disease. The preface promised an up-to-date book [...]