Through a literature review, the epidemiology and pathophysiology, including alterations in inflammation, coagulation, and impaired fibrinolysis that occur in the course of severe sepsis, is presented. Treatment guidelines that are evidence-based and endorsed by 11 professional societies representing multispecialty groups are described. Severe sepsis is common; 750,000 cases are estimated…
Pulmonary capillaritis presenting as diffuse alveolar hemorrhage is a rare manifestation in patients with IgA nephropathy. A 20-year-old male with hemodialysis dependent, end-stage renal failure presented with recurrent hemoptysis and respiratory failure. A histologic diagnosis of pulmonary capillaritis was established by transbronchial lung biopsy. He was successfully treated with intravenous…
Penetrating brain injury resulting from nail-gun use is a well-characterized entity, one that is increasing in frequency as nail guns become more powerful and more readily available to the public. We present a case and offer management strategies for a 50-year-old male with two intracranial penetrating nail gun injuries. Nail…
To the Editor: A 56-year-old male health technician presented with fatigue and unstable angina pectoris. He had obesity, hypertension and a smoking habit as risk factors for coronary artery disease. EKG showed biphasic T waves in leads V2 through V6 (Fig.A). In the laboratory analysis, his hemoglobin value was 7…
The prevalence of orofacial cleft birth defects is approximately 0.5 to 3 per 1000 births worldwide, and rates vary by geographic region, gender, race/ethnicity, and socioeconomic status.1,2 Asian and American-Indian populations are reported to have the highest frequency of cleft defects, followed by Caucasian populations and African-Americans.2 Several potential causal…
To the Editor: Current standards for assessing birth weight rely on data that may not approximate specific populations.1,2 The objective of this study was 1) to develop a regional reference of birth weight for gestational age curves for an urban population of African Americans and Hispanics at sea level; 2)…
How is spirituality relevant to mental health and to the busy practice of medicine? Until recently, a supplement devoted to this question would have been highly improbable—owing in part to Sigmund Freud’s antireligious bias and to the subsequent focus of American psychiatry on the biologic aspects of mental illness.
From the dawn of history, anxiety has been associated with religious, spiritual and existential issues. In animistic cultures people suffered from anxiety when rules and rituals that were meant to calm deities and ancestral spirits were disobeyed. Fear of being accused of being the source of some misfortune paralyzed members…
Eating disorders transcend medical specialty boundaries, unlike other conditions of body and mind. Given the significance of food, fasting, and eating customs in world religions, religious and spiritual issues figure prominently in the development, assessment, and management of anorexia, bulimia nervosa and obesity.
Even though psychotic disorders can have debilitating effects, many clinicians and researchers have observed that some psychotic episodes result in improvements in an individual’s functioning. Karl Menninger, often recognized as a founder of American psychiatry, noted: “Some patients have a mental illness and then get well and then they get…
Mental health systems in this country are undergoing a quiet revolution. Former patients and other advocates are working with mental health providers and government agencies to incorporate spirituality into mental healthcare. While the significance of spirituality in substance abuse treatment has been acknowledged for many years due to widespread recognition…
For 25 years I have led spirituality focused groups for men and women who suffer with serious mental illness.1 In this issue, David Lukoff2 refers to a quiet revolution that is taking place; a new development in such work. When I began working with these groups, the idea was novel…
The relevance of Buddhism in healthcare and patient management in the U.S. is dependent on 1) the healthcare system and its personnel’s appreciation of the tradition and culture, and more specifically, its notions of health, medicine, and therapies; and 2) the varying degrees of enculturation and acculturation of Buddhist devotees,…
Background: While both ionizing and nonionizing radiation are known to impair human reproductive capacity, the role of low-level domestic radiation continues to be an unsettled issue. Objectives: We examined the geostatistical distribution (residential longitude and latitude) of orofacial cleft birth cases adjusted for the underlying population distribution. Furthermore, we examined…
A retrospective study of 45 patients hospitalized with blastomycosis of bones or joints revealed 41 cases of osteomyelitis and 12 cases of septic arthritis. The majority were men (35 [78%] patients) and non-Aboriginal (32 [71%] patients). Median time from the onset of symptoms to hospitalization was shorter in women than…
Interstitial lung disease (ILD) is a final common pathway for a large number of lung insults. It is characterized by progressive scarring of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are nonspecific (cough and progressive dyspnea on exertion) and are often attributed…
Abstract:Splenosis is a common benign condition that occurs after splenic rupture via trauma or surgery. Splenosis is usually found incidentally and unless symptomatic, therapy is not indicated. However, since radiographically it can mimic malignancy, most patients have an extensive workup. The diagnostic method of choice is nuclear scintigraphy, specifically, a…
A 58-year-old man diagnosed with ileocolonic Crohn disease was admitted to the emergency room with massive lower gastrointestinal hemorrhage and hypovolemic shock. Treatment was started with methylprednisolone, metronidazole and omeprazole. Within the next 24 hours, he received a total of 9 U of red blood cell concentrate and 2 U…
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When the systemic response to infection leads to organ dysfunction, it is termed severe sepsis.1 Severe sepsis and septic shock are the 10th leading cause of death in the United States and one of the two most common causes of death in the noncoronary intensive care unit.2 Currently sepsis mortality…
In this edition of the SMJ, Dr. Sonye Danoff and colleagues from the Johns Hopkins University School of Medicine present a review of the current evidence guiding the diagnosis and treatment of interstitial lung diseases. They appropriately emphasize the importance of early recognition and the need for close collaboration between…
Crohn disease (CD) may be responsible for life-threatening gastrointestinal (GI) bleeding, and the management of severe GI bleeding in CD is a therapeutic challenge.
The Swedish International Network of Agencies for Health Technology Assessment (INAHTA) http://www.inahta.org/inahta_web/index.asp seeks to “.. inform health policy makers by using the best scientific evidence on the medical, social, economic and ethical implications of investments in healthcare. Technology is broadly defined to include the drugs, devices, medical and surgical procedures…
Adolescent behavior and mental health have increasingly become matters of public concern. While the biologic aspects of depression were recently emphasized, the etiology of affective disorder in adolescence remains multifactorial. Most models suggest that depressive states develop when a (genetically) vulnerable individual encounters a social stressor (eg, an abusive relationship).1
Primary care physicians are taking an increasing interest in both the mental health and spiritual needs of patients as part of medical treatment. Dealing with spiritual distress has long been central to palliative care,1 which recently became recognized as a board-certified subspecialty (via the American Academy of Hospice and Palliative…
Anxiety, like spirituality, involves a person’s beliefs, experiences, feelings about the self, and important relationships. The following case illustrates the use of spiritual resources in the psychotherapy of a middle-aged, Roman Catholic man with anxiety and depression.
Interstitial Lung Disease Interstitial lung disease (ILD) refers to a number of different lung diseases that have been grouped together because of their common effects on the lungs: inflammation and fibrosis (scarring). Although many causes have been identified, in most instances, there is no clear cause for IDL. Anyone can…
To the Editor: Memantine, a noncompetitive N-methyl-D-aspartate glutamate receptor inhibitor currently indicated for treatment of moderate Alzheimer disease, was originally developed for Parkinson disease and is still widely prescribed in Europe as an anti-Parkinsonian agent.1–3 Derived from the older drug amantadine, memantine dampens output from the subthalamic nucleus, potentiates dopamine…
To the Editor: Multiple agents are known to cause anaphylactic reactions after surgical or interventional procedures. Opioids are known to cause histamine release and anaphylactic reactions. The mechanisms of these reactions could be either IgE-dependent or IgE independent.1,2 We describe a case of anaphylactoid reaction to hydromorphone responding to IV…
To the Editor: We thank Drs. Hubbard and Tobias for their fascinating report of two infants with devastating intracerebral bleeding,1 and Dr. Waseem for his accompanying editorial.2 These cases of hemorrhagic disease of the newborn, now better termed vitamin K deficiency bleeding (VKDB),3 are tragic but most instructive. The series…
To the Editor: Lesser and Hillesheim1 reported the case of a young woman whose acute pancreatitis was attributed to the recent use of a “supplement” alleged to enhance libido and the sexual response. Rechallenge with the product, however, did not induce an attack.
To the Editor:Infectious spondylitis is an infection by a specific organism of one or more components of the spine, namely the vertebrae, intervertebral disks, paraspinal abnormal soft tissues, and epidural space. Differential diagnosis enables proper treatment of the different types and may reduce the rate of disability and functional impairment….
To the Editor: A 30-year-old female was admitted to the Emergency Department because of left abdominal, dull, ill-defined pain for 2 days. She did not have any prior history of medical or psychiatric illnesses. Two days before this admission, she had gradually experienced uncomfortable pain over the chest and upper…
Kirov G, Kemp R, Kirov K, et al. Religious faith after psychotic illness. Psychopathology 1998;31:234–245.Relatively little data is available about what role religion plays in the lives of psychotic individuals. The authors of this paper used a semistructured format to interview 52 consecutive patients hospitalized for psychosis about their religious…
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