ABSTRACT: A 25-year-old woman ingested a quarter. Three days later, lower abdominal pain, fever, chills, and physical findings compatible with pelvic inflammatory disease developed. Radiographic examination showed the coin in the middle pelvis. Persistent abdominal complaints, abnormal physical examination, and failure of the coin to progress through the gastrointestinal tract…
ABSTRACT: A 37-year-old female physician was admitted to the hospital with severe headache, facial and hand paresthesias, dysarthria, and ataxia. Neurologic examination disclosed signs of brain stem dysfunction. There was rapid neurologic deterioration, and she died in 28 hours. Postmortem studies showed the characteristic features of acute hemorrhagic leukoencephalitis.
ABSTRACT: A 54-year-old man deliberately drank a potassium-gold cyanide solution that contained approximately 1,650 mg of potassium cyanide. He survived after treatment with the Lilly antidote kit and hyperbaric oxygen.
ABSTRACT: A 62-year-old multiparous woman was hospitalized because of nausea, vomiting, anorexia, loose stools, and abdominal discomfort for 3 days. During the hospitalization, she suddenly had hemorrhagic shock with electromechanical dissociation. Intraoperatively, she was found to have a ruptured hepatic artery aneurysm, which was successfully ligated. The patient fully recovered….
ABSTRACT: Although the Food and Drug Administration's spontaneous reporting system for adverse drug reactions has been collecting reports since 1960, the number of adverse drug reactions reported is low. One of the perceived deterrents to reporting adverse drug reactions is physicians' fear of involvement in litigation. We discuss the basis…
ABSTRACT: An 18-year-old woman with thrombotic thrombocytopenic purpura (TTP) had recurrent thrombocytopenia due to antiplatelet antibodies associated with systemic lupus erythematosus (SLE). The simultaneous occurrence of TTP and SLE is rare. We briefly summarize eight previously reported cases in which these two diseases have developed in the same patient within…
ABSTRACT: An elderly woman with a long history of obsessive-compulsive disorder (OCD) was treated with electroconvulsive therapy (ECT) after intractable depression developed. OCD had been well established for many years before onset of the depressive symptoms. After ECT, there was resolution of both OCD and depression. The patient eventually had…
ABSTRACT: Arthritis has not previously been reported as a complication in adult patients with chickenpox. In pediatric patients, the arthritis that complicates chickenpox is most commonly aseptic but does rarely result from bacterial infection. We report the case of a 21-year-old man who developed acute monoarticular septic arthritis due to…
ABSTRACT: Bronchial carcinoids are uncommon pulmonary tumors, considered neuroendocrine in origin and all types may produce various hormones. We describe a young woman with a 2-year history of radiographically stable atypical bronchial carcinoid, ectopic ACTH production, and a markedly elevated calcitonin level. The Cushing's syndrome and diarrheal illness were due…
ABSTRACT: Chylothorax is a rare complication of sarcoidosis; only one well-documented case has been described previously. Before chylothorax is diagnosed in a patient with sarcoidosis, infection and malignancy need to be aggressively excluded as possible diagnoses. We report the case of a 34-year-old black woman with sarcoidosis confirmed by lung,…
ABSTRACT: Extracurricular employment (“moonlighting”) by resident physicians has been a subject of considerable controversy for many years. A review of the medical literature for the past two decades reveals substantial debate regarding the legitimacy of the practice, the establishment of some organizational policies, and the intrusion of some new legal…
ABSTRACT: Heparin-associated thrombotic thrombocytopenia after cardiopulmonary bypass is frequently lethal. The propensity for this syndrome generally goes unrecognized because thrombocytopenia is common in the early postoperative period and because testing for heparih-induced platelet antibody may not distinguish between patients with thrombocytopenia alone and those in whom associated thrombi (the white…
ABSTRACT: In a community-wide screening program conducted in Jacksonville, Florida, 564 participants received free screening for prostate cancer. Frequency of positive results of prostate-specific antigen measurement and digital rectal examination was comparable to that found in similar programs in other communities. The estimated cost for each participant was $231, and…
ABSTRACT: Necrotizing fasciitis is a potentially fatal condition, and the prognosis is worsened by immunosuppression. We describe what appears to be the first reported case of spontaneous vulvar necrotizing fasciitis occurring in a woman with uncontrolled hypercortisolism due to an ACTH-secreting thymic carcinoid tumor.
ABSTRACT: Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts in the subcutaneous tissues. The lesions are generally small and solitary, arising commonly in the upper extremities of adults and in the head and neck region of infants and children. A history of trauma may precede these reactive lesions,…
ABSTRACT: Primary aortoenteric fistulas are rare vascular entities. Their recognition involves astute clinical observation. Diagnostic testing is frequently nonconfirmatory and usually impedes urgently needed operative intervention. We present a case of primary aortoenteric fistula and emphasize the necessity for immediate surgical evaluation.
ABSTRACT: Pseudomonas vesicularis is a gram-negative rod infrequently found in environmental sources or clinical specimens. We report a case of bacteremia due to Pseudomonas vesicularis in a child with sickle cell anemia, fever, and pneumonia. This is the first published report of invasive P vesicularis in a child.
ABSTRACT: Retention mucocele of the appendix is caused by a variety of obstructive lesions such as postinflammation, fecalith, carcinoid tumor, and endometriosis. Appendiceal mucocele due to endometriosis is extremely rare; only one documented case of such condition has been recorded in the literature. We describe a young black woman who…
ABSTRACT: Squamous cell carcinoma of the penis usually arises from the glans, corona, or prepuce. We present an unusual patient with two primary carcinomas arising on the penile shaft.
ABSTRACT: The incidence of inappropriate use of magnetic resonance imaging (MRI) by nonsurgeon physicians for evaluation of musculoskeletal disorders is high when assessed using treatment-oriented, criteria in a university medical center. The charts of 71 patients who underwent 90 MRIs of the spine or extremity revealed an inappropriateness rate of…
ABSTRACT: The syndrome of pseudothrombophlebitis is a well-known complication of popliteal cysts. We report the case of a patient with a neuropathic arthropathy of the shoulder in whom pseudothrombophlebitis of the upper extremity subsequently developed. To our knowledge, this is the first such case that has been reported.
ABSTRACT: There are a number of potential causes for false-positive results on a barium enema study. We report three cases in which patients had to have colonoscopy because a nifedipine slow-release tablet (Procardia XL) was misinterpreted as a colonic polyp on a barium enema study. The pill did not move…
ABSTRACT: To evaluate the accuracy of allergy histories obtained by interns, residents, and ward attending physicians, we compared physician-charted allergy histories with our own concurrently performed histories over a 2-month span for all general medicine and surgery patients admitted to a 615-bed suburban teaching hospital. We found 100% agreement between…
ABSTRACT: Ulcerative colitis is a surgically curable mucosal disease of the colon and rectum. Optimal management of this chronic condition requires close coordination between the patient, surgeon, and primary care provider or gastroenterologist. Knowledge of surgical indications and the operative alternatives available helps to individualize therapy. Acute and chronic indications…
ABSTRACT: We describe a case of gallbladder carcinoma involving full thickness of the gallbladder-wall after laparoscopic cholecystectomy for cholecystitis. Laparotomy for removal of the gallbladder bed and excision of the umbilical cannula site revealed focal residual tumor in the liver bed and microscopic tumor implant in the cannula site. Postoperatively,…
ABSTRACT: We describe the case of a patient in whom a syndrome of fever, pancytopenia, pleural effusion, hepatosplenomegaly, positive ANA antibodies, and bone marrow granulomas developed in association with tocainide therapy. Tocainide, a recognized, albeit rare, cause of fever, lupus-like syndrome, and cytopenias, should be added to the list of…
ABSTRACT: We report a case of Haemophilus paraphrophilus causing primary liver abscesses after blunt nonpenetrating trauma. A 32-year-old previously healthy white man sustained a back injury 2 months prior to admission with fever, chills, and night sweats. A computed tomography (CT) scan-directed needle aspirate of several hypoechoic hepatic lesions grew…
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