LABORATORY EXAMINATION: Includes the following; hemoglobin 11.6, hematocrit 34.5, white blood cell count 5100 and platelet count 293,000. INR 1.5. Urinalysis shows positive esterase, negative nitrites and negative protein. Sodium 142, potassium 4.4, chloride 106 and CO2 of 26. BUN 36 and creatinine 1.5. Glucose 96. Protein 5.5 and albumin 3.4. Calcium 8.9. Bilirubin 0.7. AST 21, ALT 39 and alkaline phosphatase 86. CK 35. Magnesium 2.2. Troponin of 0.72. Triglyceride 106, cholesterol 136, HDL 23 and LDL 91. B12 of 810 and folic acid 24. T4 of 1.2 and TSH 1.29. CEA of 2.1. ANA negative. Hepatitis A negative. Hepatitis B surface antigen negative. Hepatitis B core IgM negative. Hepatitis C negative. The pH is 7.4, pCO2 of 24, pO2 of 79 and bicarbonate of 82. Urine culture showed no growth. Chest x-ray showed cardiomegaly, right effusion. CT of the chest shows moderate right effusion with no mass. EKG shows atrial fibrillation, poor R-wave progression.
LAB DATA: Biopsy of the duodenum showed focal mild chronic inflammation. There was intact villous architecture. On MM/DD/YYYY, WBC 5300, hemoglobin 12.8, hematocrit 38.6 and platelets 239,000. Sodium was 136, potassium 3.8, chloride 104, CO2 of 26, glucose 282, BUN 6, creatinine 1.1, total protein 5.6, albumin 3.2 and calcium 8.6. Total bilirubin 0.7, alkaline phosphatase 132, AST was 298, ALT was 318 and this was on MM/DD/YYYY. On MM/DD/YYYY, AST was 172 and ALT was 238. Hepatitis B surface antibody was negative, hepatitis B surface antigen was positive and hepatitis C antibody was negative. Urinalysis showed 2+ glucose, otherwise normal. CT scan of the abdomen without contrast showed pneumobilia, air within the gallbladder, and cholelithiasis and contrast in both renal collecting systems, most likely from prior contrast study. X-ray of the abdomen and KUB were normal.
LABORATORY DATA: BUN 52, creatinine 2.4, sodium 132, potassium 5.2, chloride 102, CO2 of 24, AST 44, alkaline phosphatase 362. Albumin was low at 2. Total protein 5.6, calcium 7.8, ALT 56, amylase 18 and lipase was normal at 156. CBC, white count 11.6, hemoglobin 11.8, platelets 306. BNP was 154. Significantly, the patient did have positive hepatitis C antibody. Hepatitis B surface antigen nonreactive. Urinalysis today reveals 1+ protein, 3+ blood, 1+ leukocyte esterase, 10 to 15 hyaline casts, 20 to 40 wbc’s, 20 to 40 rbc’s and 2+ bacteria.
LAB DATA: Hemoglobin 13.6, hematocrit 40.2, white blood cell count 6400 and platelet count 466,000. UA did show positive blood. Sodium 138, potassium 4.2, chloride 104, CO2 of 28, BUN 8, creatinine 0.8, glucose 104, protein 6.6, albumin 3.2 and calcium 9.2. Bilirubin 0.44, AST 66, ALT 92 and alkaline phosphatase 132. Amylase 52 and lipase 218. Hepatitis B surface antigen negative. Hepatitis B core antibody negative. KUB showed no free air. Chest x-ray showed improvement of pleural effusions. EKG showed normal sinus rhythm with no acute ischemia.
LABORATORY DATA: The patient’s initial blood work showed blood type to be A positive, VDRL nonreactive, rubella titer indicated immunity, hepatitis B surface antigen was negative, HIV screen was negative, GC and Chlamydia cultures were negative. Pap smear was normal. Her 1-hour glucose tolerance test was within normal parameters. The patient’s blood count remained well within normal parameters as well. Her quad screen for maternal serum alpha-fetoprotein was normal. Strep culture was likewise negative at 34-35 weeks.
LAB DATA: Includes the following; hemoglobin 11.4, hematocrit 34.2, white blood cell count 5100 and platelet count 294,000. INR of 1.5. UA shows positive esterase, negative nitrites and negative protein. Sodium 142, potassium 4.6, chloride 104 and CO2 of 26. BUN 34 and creatinine 1.5. Glucose of 94. Protein 5.6 and albumin 3.4. Calcium 8.9. Bilirubin 0.7. AST 22, ALT 39 and alkaline phosphatase 88. CK 35. Magnesium 2.2. Troponin of 0.72. Triglyceride 106, cholesterol 136, HDL 24 and LDL 92. B12 of 812 and folic acid 24. T4 of 1.4 and TSH 1.29. CEA of 2.3. ANA negative. Hepatitis A negative. Hepatitis B surface antigen negative. Hepatitis B core IgM negative. Hepatitis C negative. The pH is 7.4, pCO2 of 25, pO2 of 79 and bicarbonate of 82. Urine culture showed no growth. Chest x-ray showed cardiomegaly, right effusion. CT of the chest shows moderate right effusion with no mass. EKG shows atrial fibrillation, poor R-wave progression.
LABORATORY TESTS: WBC 17.8, hemoglobin 11.4, hematocrit 35.8, platelets 156, neutrophils 67, bands 17, lymphocytes 7, monos 8. Creatinine 7.46, on hemodialysis. Alkaline phosphatase 98, ALT 24, AST 36. Vancomycin random 22.6. Blood cultures shows gram-positive cocci, 4/4. X-ray of the foot; bony destructive changes suggestive of osteomyelitis, but there is no evidence of soft tissue swelling along the plantar aspect of the foot.
LABORATORY DATA: Inpatient white blood cell count was 11,200, hemoglobin 12.8 and hematocrit 38.2. INR was 1. Sodium was normal at 142, potassium was reduced at 3.2. Amylase, lipase and transaminases were all normal. Urinalysis was normal. The patient was typed and crossed. Occult bloods were done which came back positive. Hemoglobin has fluctuated and is currently at 10.8 with hematocrit of 32.4. Renal function has remained normal.
LAB DATA: Laboratory evaluation revealed a white cell count of 5700, hemoglobin 11.6 and platelets of 226,000; polymorphs 69, lymphocytes 21, monocytes 5 and eosinophils 2.6. Glucose 86, BUN 9, creatinine 1, sodium 142 and potassium 4.2. His albumin was 4.2, alkaline phosphatase 83, total bilirubin 0.6, SGOT 18 and SGPT 28. His T4 was 1.27 and TSH was 1.6. His urinalysis revealed no protein, no glucose, but nitrite was positive and wbc’s were 6 to 15 and a culture showed MRSA greater than 100,000 colonies, which was sensitive to tetracycline, rifampin, vancomycin and linezolid.
LABORATORY DATA: CBC on admission revealed a white blood cell count of 5200, hemoglobin 9.2, hematocrit 27.6 and platelet count 282,000. Lowest hemoglobin was 8.9. Final H&H 11.8 and 34.8. The patient received 2 units of packed red blood cells. The INR on admission was 2.55. The INR at the time of discharge was 3.72. Electrolytes on admission showed sodium of 139, potassium 4.4, chloride 106, CO2 of 24, glucose 106, BUN 34, creatinine 2.2. The final electrolytes showed sodium of 141, potassium 3.7, chloride 108, CO2 of 24, glucose 151, BUN 16, creatinine 1. B-type natriuretic peptide was 224. Iron 45, iron-binding capacity 238, 28% saturation. Serial cardiac enzymes showed no evidence of myocardial injury. The liver function tests were normal. Urinalysis normal. Stool for CDT was positive. Chest x-ray showed postsurgical findings, no acute changes. CT of brain showed old-appearing lacunar infarct, left periventricular white matter, encephalomalacia, right occipital cortex, consistent with previous injury or infarction. No acute intracranial hemorrhage. Renal ultrasound showed no focal abnormalities of the kidneys.
DIAGNOSTIC DATA: Radiographs show good joint space maintained in both hips. Concerned about the left one being slightly lateralized. Her left lateral center edge angle is about 21 and the right is about 24. Tonnis angle is less than 10 with the right being about 4 and the left being closer to 3. The patient has lines intact bilaterally. There is good offset on both hips on the frog lateral and cross-table laterals. False profile shows about 20 degrees of anterior coverage with good congruency of both hips. The patient had an MRI, which was read as unremarkable. No signs of labral tears as read by the radiologist.
LABORATORY DATA: The patient had a recent metabolic profile that showed sodium of 142, potassium 5.2, chloride 108, bicarbonate 24, BUN 26, creatinine 1.3 with her baseline being around 1.2 to 1.3. Glucose 102. Urine culture showed mixed urogenital flora. Urinalysis was positive for occult blood, as well as leukocyte esterase. There were no red blood cells or white blood cells. CT of the abdomen and pelvis performed, hematuria protocol, which showed a 1.3 x 0.6 cm nonobstructing calculus in the left kidney. Also had evidence of known polycystic kidney disease bilaterally. Of note, the CT contrast did not extend into the distal parts of bilateral ureters. There was no evidence of any masses in the upper urinary tract or bladder on CT.
LABORATORY DATA: Labs show antimitochondrial antibody negative, anti-smooth muscle antibody negative, anti-endometrial antibody less than 20, alpha-1 antitrypsin 162, iron level 156, percent saturation is 32, ferritin is 34, albumin 4.2, AST 64, ALT 72, alkaline phosphatase 66, total bilirubin 1.4, direct bilirubin 0.2. White count 4.6, hematocrit 45.6, platelets 214. Liver biopsy results are as above. The patient’s hepatic iron index is 0.1.
DIAGNOSTIC DATA: Chest x-ray revealed new retrocardiac infiltrate. X-ray of the hip and pelvis revealed progression of osteoporosis, stable erosive changes of the left sacroiliac joint. X-ray of the knee revealed osteopenia with mild degenerative changes. MRI of the right hip revealed changes consistent with septic arthritis with associated osteomyelitis involving the right sacroiliac joint and adjacent musculature. MRI of the left hip revealed no evidence of osteomyelitis. MRI of the pelvis revealed chronic osteomyelitis of the coccyx with marked improvement of the left sacroiliac joint.
