Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Peritonitis Persistent Vegetative State 1163

suspected dialysis-related cases and intestinal ischemia/perfor-

ation, respectively

■tuberculous peritonitis: 8 weeks of isoniazid, rifampin, and pyrazi-

namide, followed by 4 more months of isoniazid and rifampin

■Fitz-Hugh-Curtis: doxycycline usually curative

■fungal peritonitits: amphotericin B (intraperitoneal and intravenous

combination therapy) may be curative

follow-up

■repeat paracentesis to access improvement in peritonitis with

decreasing WBC

complications and prognosis

■recurrent infection is common and may require replacement or

removal of peritoneal catheter in dialysis patients

■fungal peritonitis more difficult to cure

■worse in AIDS patients

PERSISTENT VEGETATIVE STATE

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Pt previously in coma from bihemispheric disease appears awake,

but w/o evidence of mental awareness or responsiveness

■Is totally dependent

■No evidence of mental activity

■Periods w/ opened eyes but no environmental contact

■May be decerebrate or decorticate posturing, recovery of brain stem

reflexes, but no purposive responses

■Pt has sleep-wake cycles

tests

■EEG abnormal but shows evidence of sleep-wake cycles in previously

comatose pt

differential diagnosis

■History of preceding coma distinguishes this disorder from de-

efferented state (“locked-in syndrome”) in which pt is conscious but

mute & quadriplegic

management

■Supportive care

■Discuss poor prognosis w/ family & consider withdrawal of support