Background: We sought to examine the preoperative time for hip stabilization procedure among Hispanics, non-Hispanic blacks (blacks) and non-Hispanic whites (whites). Methods: This was a secondary data analysis using Medicare claims data. Our analysis included 40,321 patients admitted for hip fracture hospitalization from 2001-2005. Our primary analysis was generalized linear…
The increase in antibiotic resistance among Gram-negative bacteria is a notable example of how bacteria can procure, maintain, and express new genetic information that can confer resistance to one or several antibiotics. This genetic plasticity can occur both inter- and intragenerically. Reports of resistance vary, but a general consensus appears…
The case of a 75-year-old female suffering from recurrent abdominal pain and nausea is presented. Ultrasound showed gallstones without inflammation of the gallbladder. The patient underwent laparoscopic cholecystectomy and her symptoms resolved. Histological examination of the operation specimen disclosed heterotopic pancreatic tissue within the cystic duct. An accurate clinical diagnosis…
Paralytic ileus is a common problem in trauma patients. We present two cases of ileus leading to septicemia. Both patients developed sudden septicemia on hospital day six and underwent urgent exploratory laparotomies, and both were found to only have paralytic ileus without evidence of bowel injury or obstruction. We attribute…
The accurate assessment and appropriate management of blood pressure (BP) is critical for primary care physicians. Traditional office-based BP measurement has limitations that can be addressed, in part, through the use of ambulatory BP monitoring (ABPM). Because BP readings are provided at specific time intervals throughout a 24-hour period, ABPM…
Objective: The effect of ezetimibe on blood lipids, oxidative stress, and fibrinolytic activity in hyperlipidemic patients was investigated after three months of therapy. Methods: Thirty hyperlipidemic patients were treated for twelve weeks with ezetimibe 10 mg/day. A healthy control group with matching age and gender was also included. Fasting blood…
Ectopic intratracheal thyroid (EITT) is a rare abnormality, with few cases reported in the literature. We describe a case of a 36-year-old woman with dyspnea due to EITT. We also discuss the epidemiology, etiologies, presentation, diagnosis, and management of EITT. Because EITT is a rare cause of airway obstruction, we…
To the Editor: Granular cell tumor (GCT), first described by Abrikossoff in 1926, is the most common peripheral nerve sheath-originated neoplasm in the vulva.1 Schwannomas are neurogenic neoplasms derived from Schwann cells. We report a rare case of vitiligo coexistent with GCT and schwannoma and discuss the relationship of these…
Despite significant advances in perinatal and neonatal medicine, infant mortality (IM) remains a significant public health problem. The causes of IM are complex, numerous, and a result of interacting genetic and environmental factors. This paper explores genetic contributions to IM using data from Virginia. Leading causes of IM in Virginia…
Hypocalcemia is a rare complication of malignancy. We present the case of a 30-year-old lady presenting with a grand mal seizure due to profound hypocalcemia. She was subsequently found to be hypoparathyroid and was diagnosed with metastatic breast carcinoma. Treatment with goserelin and exemestane produced a significant reduction in her…
Background: Intravenous recombinant tissue plasminogen activator (IV rt-PA) is an effective medication currently used to treat acute ischemic stroke within three hours of symptom onset in patients with an identifiable clinical deficit measured using the National Institute of Health Stroke Scale (NIHSS). Methods: We compared the outcomes of 27 identified…
The practice of clinical cardiology faces the continuous struggle of minimizing recurrent cardiovascular events by risk factor modification. Current clinical guidelines assist the practicing physician in these efforts. Two of the primary risk factors are that of cholesterol and overall adverse dyslipidemic burden. Current guidelines are based primarily on low…
Submassive pulmonary embolism (PE) is common and depending on the degree of hemodynamic compromise can carry a 25-65% mortality. The mainstay of treatment is fibrinolytic therapy, although data is limited and based on several small randomized controlled trials that enrolled less than 800 patients in total. A meta-analysis of these…
Recurrent pleural effusions are associated with significant morbidity and mortality. Drug-related reactions causing pleural effusions are not common, but their identification can potentially improve patient outcome. Minoxidil has been implicated in pleuropericardial effusions in patients with chronic kidney disease. The exact mechanism by which pleural effusion occurs is still unclear….
Since the 1995 publication of the National Institutes of Health (NIH) randomized clinical trial and subsequent Federal Drug Administration (FDA) approval in 1996, tissue plasminogen activator (t-PA) has been widely accepted as an effective treatment strategy for the management of acute ischemic stroke. Among the potential complications associated with intravenous…
Objective: In the United States, religious practice is inversely associated with several chronic conditions, but no reports show whether it is inversely associated with prevalence of positive serology for infections. Methods: Data on a multiethnic, national sample included 11,507 persons aged 17 years and over with complete data on frequency…
An Enterobacter cloacae blood culture isolate expressing carbapenem resistance via the Klebsiella pneumoniae carbapenemase KPC-2 gene is reported. To our knowledge, this is the first report of a nosocomial isolate with carbapenemase-mediated resistance causing infection in a patient from Tennessee.
Penile cancer is very rare in North America and Europe, as compared with the rest of the world. Squamous cell carcinoma (SCC) accounts for more than 95% of the cancer type. Paraneoplastic syndrome (PNS), a clinical syndrome of nonmetastatic systemic effects that occurs in patients with malignant disease, is often…
To the Editor: Pseudotumor cerebri developing during pregnancy is a rare condition and has frequently been described as “benign.”1 However, not all reports of pseudotumor cerebri during pregnancy show a “benign” trend.2 The most worrisome complication of this pathology is permanent vision damage. Pregnancy complications may occur, including miscarriage and…
Pulmonary embolism is a common and sometimes devastating disease caused by many factors, most commonly deep venous thrombosis. Treatment is typically systemic anticoagulation depending on patient clinical presentation. For patients with life threatening pulmonary embolism, IV tPA (Activase, Genentech, South San Francisco, CA) is the most common medication given emergently…
Background: Considering the role of superoxide dismutase (SOD) as one of the most important salivary antioxidant enzymes, this study was performed to compare the level of this enzyme in smokers and nonsmokers. Methods: Unstimulated saliva of 60 volunteers (30 smokers and 30 nonsmokers) was collected. The activity of salivary SOD…
A spherical mass of the right psoas muscle was found incidentally by magnetic resonance health examination in a 43-year-old woman. The patient had complained of numbness in her right leg over the previous six months and neuralgia at the time of computed tomography-guided core biopsy, which was done to establish…
Background: Laboratory evidence is presented of significant associations between reduced maternal serum folate and vitamin B12 levels and neural tube birth defects (NTD) compared to referents. Methods: This was an incident case-control study. Cases of neural tube defects (including anencephaly and open spina bifida) diagnosed in residents within 100 miles…
Allergic rhinitis affects approximately 40% of children and generally presents in children from 10-19 years of age; however, the condition has been seen in children as young as 6 months. Antihistamines are commonly prescribed in infants and children for the relief of allergic symptoms. A 23-month-old male with a history…
To the Editor: A 68-year-old man presented with epigastric pain and abdominal fullness of two months’ duration. Physical examination showed hepatomegaly. Laboratory values were not significant for chronic liver diseases. Endoscopy disclosed squamous cell carcinoma of the lower esophagus. Computed tomography (CT) scan of the abdomen disclosed multiple hepatic metastases…
To the Editor: Chronic lymphocytic leukemia (CLL) is a disease of the elderly with an incidence of about 20 to 30 per 100,000 population in the group aged 70 years or older.1 Gastrointestinal (GI) involvement with CLL is unusual, and GI complications generally occur after malignant transformation to diffuse large…
In young adults, hypertrophic obstructive cardiomyopathy (HOCM) is an acknowledged risk factor for sudden cardiac death (SCD) in an otherwise healthy and active patient. While the incidence of SCD in young people is not high enough for extensive, wide-scale examinations, the potential for prevention of some deaths via pre-exercise imaging…
Objectives: Endothelial dysfunction (ED) has been reported in patients with autosomal-dominant polycystic kidney disease (ADPKD). Coronary flow velocity reserve (CFVR) is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of this study was to investigate the effect of the angiotensin receptor blocker,…
Although infiltration of the gallbladder by lymphoma is rare, it has to be considered in the differential diagnosis of patients presenting with cholecystitis-like symptoms. The most common lymphomas masquerading as acute cholecystitis are mucosa-associated lymphoid tissue lymphoma and large B-cell lymphoma. We describe a 75-year-old patient who presented with an…
There is a wealth of epidemiological and clinical data linking low-density lipoprotein cholesterol (LDLc) with atherosclerotic cardiovascular disease. Numerous primary and secondary prevention trials have demonstrated that reduction in LDLc leads to significant decrease in cardiovascular event rates. However, patients continue to be at significant risk for recurrent events despite…
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