Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

Nocardiosis Nonalcoholic Fatty Liver Disease 1053

■Surgical intervention is indicated to drain or excise large abscesses

and in those who do not clinically respond after several weeks of

therapy; in patients with brain abscesses, surgery indicated if abscess

does not decrease in size after 1 month of therapy or increases in size

after 2 weeks of therapy

follow-up

■Careful early follow-up to ensure clinical response; usually see

improvement in 1–2 weeks; repeat radiographic studies of chest

and/or brain in 2–4 weeks

■When improved and clinically stable (usually after 1–2 months), par-

enteral regimen can be changed to oral therapy and the dose of TMP-

SMX can be reduced to 5–10 mg/kg/day of TMP; serum concentra-

tion of sulfamethoxazole should be measured 2 hours after an oral

dose to ensure adequate absorption (level should be 100–150 micro-

grams/mL) and dose should be adjusted as needed

■Relapse after therapy, particularly in the immunocompromised

patient, warrants careful follow-up for 6 months after completion

of therapy.

complications and prognosis

■Prognosis depends on site of infection and immune status of host;

cutaneous disease is 100% curable; pulmonary disease associated

with 10–20% mortality and brain abscess 20–30% mortality; mortality

higher in all groups if underlying immunosuppression present

NONALCOHOLIC FATTY LIVER DISEASE

EMMET B. KEEFFE, MD

history & physical

History

■spectrum of NAFLD ranges from simple nonalcoholic fatty liver

(NAFL) to nonalcoholic steatohepatitis (NASH) with cirrhosis.

■NAFL found in 12–15% of general population, NASH found in 3–4%

■common risk factors: metabolic syndrome (insulin resistance with

obesity, type II diabetes mellitus, lipid abnormalities, hypertens-

ion)

■less common associated conditions: TPN, rapid weight loss, abetal-

ipoproteinemia, JI bypass, and drugs