Case Report

Multiple Organ Toxicity From Addition of Erythromycin to Long‐term Lovastatin Therapy

ABSTRACTA patient who had taken lovastatin for 7 years received erythromycin before dental procedures. Multiple organ toxicity developed, manifested as rhabdomyolysis, acute renal failure, pancreatitis, ileus, livedo reticularis, and elevated aminotransferase values, without liver injury. No previous reports have identified multiple organ injury of this magnitude. A computer literature search…

Case Report

Prompt Differentiation of Addison's Disease From Anorexia Nervosa During Weight Loss and Vomiting

ABSTRACTAn 18-year-old white woman had nausea, vomiting, weight loss, and a diagnosis of anorexia nervosa. Copper-colored skin was noted on physical examination, and serum chemistry values were normal. Subsequent fever, disorientation, and confusion led to the discovery of Addison's disease, which responded well to corticosteroid replacement therapy. Addisonian and anorexic…

Grand Rounds

Medical Examiner Cases Associated With Previously Undiagnosed Diabetes Mellitus, North Carolina, 1994

ABSTRACTBackgroundApproximately half of the 16 million Americans with diabetes mellitus (DM) are unaware they have the disease; the epidemiology of death from previously undiagnosed DM is unclear. We report medical examiner (ME) cases of death from DM in North Carolina in 1994 to determine the number and characteristics of these…

Grand Rounds

Early Postpartum Discharge Versus Traditional Length of Stay Patient Preferences

ABSTRACTBackgroundDespite a vast body of literature on postpartum safety issues, little has been written about patients' preferences for hospitalized versus home-based support and reasons for those choices.MethodsA questionnaire was offered to obstetric patients at a prenatal class. Data were analyzed using chi-square analysis and logit modeling, searching for factors accounting…

Grand Rounds

Surgical Management of Giant Nonmelanoma Skin Neoplasia

ABSTRACTBackgroundManagement of advanced integumentary malignancy has been controversial. We have evaluated and treated 10 patients with giant nonmelanoma skin neoplasias more than 8 cm in diameter.MethodsAggressive surgical ablation was prospectively recommended to treat giant basal cell or mixed basosquamous tumors and two purely squamous cell tumors. Radiation therapy was given…

Grand Rounds

New Approach to Administrative Medical Decision‐making Evidence‐based Medicine Using High Dose Chemotherapy/Bone Marrow Transplant for Breast Cancer

ABSTRACTBackgroundPayment for experimental treatments using medical necessity criteria has been controversial. The process of obtaining a decision on coverage of an experimental treatment can be distressful for the treating physician, the patient, and family members.MethodThe techniques of evidence-based medicine were used to assist with treatment/coverage decisions concerning high dose chemotherapy…

Current Concepts

Sexually Transmitted Diseases in Adolescents What's New?

ABSTRACTBackgroundSexually transmitted diseases (STDs) are an important cause of morbidity and, potentially, mortality for adolescents in the United States. Each year, 2.5 million teenagers in this country will contract an STD. An understanding of recent advances in risk factors, epidemiology, diagnosis, and treatment of these important infections is vital for…

Grand Rounds

Cesarean Delivery for the Second Twin in the Vertex‐Vertex Presentation Operative indications and Predictability

ABSTRACTBackgroundThe incidence of second twin delivery by cesarean section and whether obstetric parameters are predictive should be studied.MethodsIn this retrospective study, all vertex-vertex twin deliveries during a 48-month period were reviewed.ResultsDuring the study period, 106 sets of vertex-vertex twins were identified. In 68 pairs, both were delivered vaginally (group 1),…

Grand Rounds

Correlation of Gallbladder Ejection Fraction With Pathologic Grade for Chronic Inflammation

ABSTRACTBackgroundThe purpose of this study is to define the sensitivity and specificity of the gallbladder ejection fraction (GBEF) for identifying patients with various grades of histologically proven chronic cholecystitis.MethodsOf 693 consecutive patients who had a scintigraphic GBEF determination at Baptist Medical Center of Oklahoma, 161 subsequently had a cholecystectomy at…

Grand Rounds

Routine Diagnostic Laparoscopy Is Unnecessary in Staging Tumors of the Pancreatic Head

ABSTRACTBackgroundThis study examined the success of computed tomography (CT) and angiography in predicting resectability of tumors of the pancreatic head and retrospectively examined whether diagnostic laparoscopy would have contributed additional staging information.MethodsThe records of 67 patients with tumors of the pancreatic head were reviewed. Thirty-four patients had unresectable tumors, and…

Grand Rounds

Measles, Mumps, and Rubella Serology in Premature Infants Weighing Less Than 1,000 Grams

ABSTRACTBackgroundThis study was done to determine antibodies to measles, mumps, and rubella within the first 2 weeks of life and 3 months of age in premature infants.MethodsAll premature infants (<32 weeks' gestation) weighing less than 1,000 g and admitted to the neonatal intensive care unit were eligible for inclusion in…

Grand Rounds

Survival Rates Among Children With Severe Neurologic Disabilities

ABSTRACTBackgroundThis study was done to determine survival rates in subpopulations of severely neurologically disabled children who reside in pediatric skilled nursing facilities and to compare these survival rates with those in previously published studies.MethodsData were collected at three pediatric skilled nursing facilities over the 1986 to 1996 decade. The total…

Grand Rounds

Morphologic Study of Lumbar Vertebral Osteophytes

ABSTRACTBackgroundVertebral osteophytes are one of the principal radiographic diagnostic criteria for degenerative change in the lumbar spine. These osteophytes have been previously classified by morphologic features into two groups, the “traction spur” and the “claw spur.” It has been stated that the traction spur is a sign of spinal instability.MethodsLumbar…

Grand Rounds

Assessing the Burden of Cancer in Texas Using Vital Statistics Data

ABSTRACTBackgroundVital statistics data were used to describe the burden of cancer in Texas.MethodsAverage annual age-adjusted mortality data in Texas (1986 to 1990) for 17 cancer types were compared with the US data for whites and blacks and with California data for Hispanics. Trends were examined from 1980 to 1990 for…

Grand Rounds

Traumatic Vulvar Hematomas Conservative Versus Surgical Management

ABSTRACTBackgroundVulvar hematomas are relatively uncommon and usually result from blunt trauma. They are more commonly diagnosed in postpartum patients, but hematomas after straddle-type injuries, coitus, or physical assault have been reported. Conservative and surgical management have both been advocated as the appropriate initial treatment.MethodsIn this study, we have done a…

Grand Rounds

Cardiology for the Primary Care Provider Heparin&hyphen;Induced Thrombocytopenia

ABSTRACTHeparin-induced thrombocytopenia (HIT) is classified as two distinct entities: HIT I and HIT II. HIT I is mild thrombocytopenia that occurs in approximately 25&percnt; of patients within the first 5 days of starting therapy and is clinically benign. HIT II is a syndrome of severe thrombocytopenia and thrombosis that occurs…

Case Report

Streptococcus sanguis Bacteremia and Colorectal Cancer

ABSTRACTStreptococcal bacteremia is an uncommon presentation for colorectal malignancy, yet most physicians are aware of the association between Streptococcus bovis infection and these malignancies. Many are unaware, however, that other streptococcal species are associated with colon and rectal cancers. In this case report and brief review, we highlight this association…

Case Report

Calcification in Untreated Non&hyphen;Hodgkin's Mediastinal Lymphoma

ABSTRACTWe report a case of calcifications in mediastinal non-Hodgkin's lymphoma. Although calcification may occur in lymphoma after chemotherapy or radiotherapy in areas of fibrous healing and scar formation, it has been reported only rarely in untreated non-Hodgkin's lymphoma.

Editorial

FIRST DO NO HARM

Correspondence

Itching to Understand the Phenomenon of Craving in Addiction

Correspondence

Training Physicians To Be Competent Communicators