Posted on 11/04/2004 4:19:17 PM PST by MisterRepublican
Wow.
This morning Mike Gallagher mentioned this thread on his national radio show. He was talking with mayor Weingarten (sic?) about how Arafat is scum and brought up FreeRepublic and this thread (or the other one which is identical).
Arafat night not die for awhile. He could be in a coma for several weeks.
"HIV doesn't cause a low platelet count"
What comic book did you get your medical degree from? In advanced HIV/AIDS thombocytopenia is extremely common, even in those not on anti-viral therapy. In fact, it's one of the tell-tale signs of AIDS.
now let's see the world net daily, they're credible right? Doesn't sound at all like one of Karl Rove's whispering smear campaigns does it? Oh that's right I forgot, Arafat hasn't fathered a black child out of wedlock with a prostitute. Got to get my stories straight
Yes...its AIDS...and he's already kicked the bucket. That means...another TERRORIST has bit the dust. ;o)
Low platelets can be a sign of liver failure, idiopathic thrombocytopenia purpura, metastatic cancer, chronic leukemia, drug reaction, enlarged spleen from parasites found in north Africa (schistosomiasis mansoni or malaria), alcoholism, etc. etc.
The rule in medicine is when you hear hoofbeats, think of horses, not zebras.
He is in his mid 70's. ITP is the most common cause of thrombocytopenia, followed by chronic leukemia...Mild thrombocytopenia is commmon in HIV, but severe is usually related to either the medications or in severe end stage cases. We have no history of Arafat being treated for HIV, nor of recurrant acute infections (e.g. PCP pneumonia, or chronic diarrhea), nor of dementia. The HIV claim seems to be a way of snidely saying he is gay, or he is an IV drug abuser. Is this a political slander, or based on fact? The fact that the original studies implied gall bladder disease, i.e. ascending cholangitis needing an ERCP so they called in specialists, suggests it is liver failure, not HIV.
His problem is not infection, but seems to be a cerebral bleed from his liver failure.
No he is just dead.
He doesn't particularly look very jaundiced though for liver failure or cholangitis. I've considered ITP, TTP, pancreatic ca, and those you mentioned....but why the secrecy and the shroud of a "blood disorder"? Are our French medical colleagues so incompetent that they can't give any one of those diagnosis you mentioned? Doctor, to regard HIV as a "zebra" diagnosis is totally out of step and out of touch with today's landscape. HIV is rampant! Where have you been practicing, sister? Ask any of our Emergency Medicine colleague how many HIV patient they see on a regular basis, especially those working in the inner cities or any busy emergency department for that matter!
Differential diagnosis for thrombocytopenia:
I. Decreased production (marrow in adults)
A. Marrow infiltration with tumor, fibrosis
B. Marrow failure - aplastic and hypoplastic anemias
C. HIV
D. Chronic alcoholism
II. Splenic sequestration
A. Splenic hypertrophy - tumor, portal hypertension (anything that can cause liver failure that leads to splenomegaly such as cirrhosis secondary to alcohol, Hepatitis B, C, etc...)
III. Increased destruction
A. Nonimmune
1. Vascular prostheses, cardiac valves
2. DIC
3. Sepsis
4. Vasculitis
5. TTP
B. Immune
1. Autoantibodies (e.g., ITP)
2. Drug-associated antibodies
3. Circulatory immune complexes - SLE/lupus,
bacterial sepsis, viral agents, parasitic infx
4. HIV
IV. Lab error (my favorite nemesis)
That's all that I can remember from medical school and residency 15 yrs ago. Hey not too shabby, heh? I'm sure you can add more to the list.
Code blue blog speculates that the French accidentally overdosed him, causing hypoxia and coma...
As HIV being rampant, you have to remember that I live in rural areas. The last place I saw HIV regularly was when I was a missionary in Africa...
Many speculated that he had liver failure or that he had an acute cholecystitis, cholangitis with sepsis after a botched ERCP, etc..As to the liver failure part, he didn't really have much stigmata of end stage liver disease...not particularly jaundiced, no ascites. We can only speculate because of the thrombocytopenia. As to the cerebral hemorrhage, could he have had ring enhancing lesions from toxoplasmosis or cryptococcus and the French made the wrong diagnosis? Who knows!
As to HIV being rampant in the US, it certainly is a huge problem in large cities. I've worked at Grady in Atlanta, and hospitals in New Orleans, and Chicago...and took care of too many HIV patients. I'm now settled in the Panhandle of Florida and just 2 months ago was consulted on a patient that came through the ER. He was an emaciated 24 y/o guy with shortness of breath, chest pain, hypotension and massive cardiomegally on CXR. Lab wise, he was pancytopenic. To make the story short, he had cardiac tamponade. As it was 3AM when I saw this guy, I performed an ultrasound guided pericardialcentesis and floated a triple lumen catheter/central line into the pericardial sac. Pulled out 850cc of pericardial fluid. Guess what, it was acid-fast positive! This dude had TB. He was eventually found to be HIV positive as well with high viral load. He eventually got a pericardial window and discharged 2 weeks later.
I've worked on Indian reservatoins and seen lots of TB. And in Africa, it was a common diagnosis for FUO...now it is coming back, and those with HIV never get cured...it's a disaster in the works, but little publicity.
Imagine if we started forcing hospitalization for months like they did in the past for TB...yet that is what they have to do...guess we'll have to wait till a big epidemic in a jail occurs...
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