Cleveland Clinic Journal of Medicine: 61 (3)

May 01, 1994; Volume 61,Issue 3

Medical Grand Rounds

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Diagnosing infective endocarditis
David L. Longworth, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 172-173;
The diagnosis has been based on the presence of fever, a new heart murmur, peripheral stigmata, and sustained bacteremia with a typical microorganism—all of which are not invariably present. New criteria offer greater diagnostic accuracy.
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Assessing depression in medical patients
George E. Tesar, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 174-175;
Suicidal ideation is an intensely personal matter, and many patients may be alarmed by questions about it. A less threatening approach is described.

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The clinical usefulness of urinalysis
Phillip M. Hall, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 177-178;
Two challenging cases to test your diagnostic acumen.

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Preglomerular and postglomerular blood flow: relationship to kidney disease and treatment
Sharon R. Inman, PhD, Ben H. Brouhard, MD and Nicholas T. Stowe, PhD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 179-185;
Clinicians are taking the first steps toward preventing or slowing kidney failure, thanks to special techniques for studying renal microcirculation.

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Prophylaxis of opportunistic infections in persons with HIV infection
Benjamin F. Stearn, MD and Michael A. Polis, MD, MPH
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 187-194;
Effective regimens are available for preventing some of these infections. Studies are in progress to establish optimum regimens for others.
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Chemotherapy-induced Raynaud's phenomenon
Eugenia Toumbis-Ioannou, MD and Philip R. Cohen, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 195-199;
Cure of malignancy is most important, but detecting delayed toxic effects of antineoplastic therapy deserves close attention, as well.

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Metastasis or adenoma? CT evaluation of the adrenal mass
Anne A. Singer, MD, Nancy A. Obuchowski, PhD, David M. Einstein, MD and David M. Paushter, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 200-205;
Documenting the stability of adrenal lesions should be done for longer than usual to increase the likelihood of identifying malignant adenomas.
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Commentary
Emmanuel L. Bravo, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 205;
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Azathioprine vs cyclosporine in recipients of HLA-identical renal allografts
Inderbir S. Gill, MD, Ernest E. Hodge, MD, Andrew C. Novick, MD, Stevan B. Streem, MD, William E. Braun, MD and Lata Paranandi, MSHP
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 206-210;
These two agents produce equally satisfactory outcomes in this immunologically favored group. The need for continued steroid therapy in these patients requires further study.

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Transesophageal echocardiography: why and when to use it
Anthony Demaria, MD, Allan Klein, MD, Guido Belli, MD and Kingsley Annan, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 211-218;
In this open discussion of an important health care utilization issue, panelists expound on the appropriateness of TEE in several clinical situations.

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A 51-year-old man with a history of stroke and red streaks in the legs
Mark E. Mayer, MD, Jeffrey W. Olin, DO, Thomas J. Masaryk, MD and Kandice Kottke-Marchant, MD, PhD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 219-227;
A diagnostically challenging case is worked up. Based on a presentation at a Cleveland Clinic Foundation Clinical Pathological Conference.

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Echocardiographically guided removal of an intracardiac foreign body
Vicente E. Font, MD, Carl C. Gill, MD and David E. Lammermeier, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 228-231;
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An unusual ocular manifestation of discoid lupus erythematosus
Robert E. Foster, MD, Careen Y. Lowder, MD, David M. Meisler, MD, Rafael Valenzuela, MD, James T. McMahon, PhD and Charles Camisa, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 232-237;

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Clinical practice guidelines for HIV infection: progress towards making AIDS a primary care disease
Johanna Goldfarb, MD and David L. Longworth, MD
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 238-239;
An appraisal of the guidelines released in January by the Agency for Health Care Policy and US Public Health Service.

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Correction
Cleveland Clinic Journal of Medicine May 1994, 61 (3) 239;