Primary Article

Relationship of Regional Fat Distribution and Obesity to Electrocardiographic Parameters in Healthy Premenopausal Women

ABSTRACTAbdominal obesity is an independent cardiovascular risk factor. The coexistence of abdominal obesity and electrocardiographic abnormalities may facilitate the development of cardiac arrhythmias and sudden death. We determined the relationship of body fat distribution and obesity to ECG indices in 27 obese premenopausal women on an isocaloric diet. Intra-abdominal fat…

Current Concepts

Dupuytren’s Contracture

ABSTRACTDupuytren's contracture is a disease of the palmar and digital fascia that results in a flexion deformity of the fingers. Although the first case was reported more than 350 years ago, many questions remain unanswered. With our present state of knowledge, treatment remains empiric and operative intervention is the only…

Primary Article

Computer-Assisted Comprehensive Geriatric Assessment in a Family Physician’s Office

ABSTRACTFamily physicians and other medical care providers are beginning to realize the importance of a comprehensive assessment examination for elderly patients. The components of such an examination are well documented, and include not only the standard history and physical examination, but also evaluation of mental health, functional status, and socioeconomic…

Primary Article

Percutaneous Intra-aortic Balloon Pump: Emphasis on Complications

ABSTRACTIn a review of our 5-year experience with intra-aortic balloon pump (IABP) insertion I examined the complications of percutaneous IABP placement in 93 patients, and compared them with those reported in other studies in the literature. I analyzed several variables that may affect the complication rate. Of 78 patients in…

Review Article

Oral Contraceptive Drug Interactions: Important Considerations

ABSTRACTInteractions with oral contraceptives (OCs) occur with drugs commonly used to treat epilepsy, tuberculosis, and depression. Most women are more likely to use antibiotics, analgesics, and antihistamines, which have also been shown to interact with OCs. The mechanisms behind these interactions may be hepatic microsomal enzyme induction or inhibition, interference…

Primary Article

Massive Bone Allografts for Traumatic Skeletal Defects

ABSTRACTLarge bone allograft transplants have been successfully used to reconstruct skeletal defects created by tumor resections and failed arthroplasties, but little has been reported on their use in traumatic defects. Of approximately 500 allograft procedures done at the Massachusetts General Hospital from 1979 to 1988, 11 were done for restoration…

Primary Article

Intraoperative Evaluation of Intestinal Ischemia: A Comparison of Methods

ABSTRACTMethods for evaluating intestinal ischemia include standard clinical criteria, Doppler ultrasonography, and intravenous fluorescein injection. Each has disadvantages, and a combination of methods is often used. The purpose of this study was to determine whether surface oximetry could be used to assess perfusion in an animal whose intestinal diameter approximates…

Primary Article

Obstetric Practice Patterns Among Family Practice Residency Graduates

ABSTRACTObstetric services are a critical health care need in the southeastern United States. Until recently, many family physicians included obstetrics as a part of their practice. In recent years there has been significant attrition from the practice of obstetrics among family physicians. This survey looks at attrition among graduates of…

Primary Article

The Diabetic Foot: Consequences of Delayed Treatment and Referral

ABSTRACTThe pathophysiology of foot problems in diabetic patients is poorly understood by many physicians. Two major factors that frequently lead to a delay in appropriate treatment with subsequent limb loss are failure to appreciate the presence and severity of underlying infection and attribution of gangrene of the toe and forefoot…

Article

‘Addiction’ Phenomenon

ABSTRACTThe term “addiction” has become widespread in our society. In this article, I examine the expansion of the medical addiction metaphor to numerous types of behavior. A review of the largely self-help addiction-related literature, selling tens of millions of copies per year, reveals a common path for recovery from these…

Case Report

Adult Respiratory Distress Syndrome From Sulfuric Acid Fume Inhalation

SUMMARYA 23-year-old man had adult respiratory distress syndrome (ARDS) caused by acute exposure to sulfuric acid fumes. The patient survived the initial hospitalization to be readmitted later with a lung abscess. After therapy, his chest roentgeno-gram and pulmonary function tests revealed no abnormalities except a marginally decreased DLCO, and he…

Case Report

Lymphangiosarcoma Associated With Lymphedema in a Man With Maffucci’s Syndrome

SUMMARYA man with Maffucci's syndrome and lifelong lymphedema in the right lower extremity had a lymphangiosarcoma in the same extremity. Despite amputation of the limb and radiotherapy, he died several months later of pulmonary metastases. Malignancies of vascular origin rarely have been reported in this syndrome. Our patient's features suggest…

Case Report

Parathyroid Adenoma Manifested as Pancreatitis and Polyuria

SUMMARYAlthough the data used to explain a relationship between hyperparathyroidism and pancreatitis remain incomplete, there does appear to be a relationship between the two. We believe our patient's clinical course strongly supports this.

Case Report

Amniotic Fluid Embolism

SUMMARYAmniotic fluid embolism is an almost universally fatal complication of pregnancy. We have presented a case and reviewed the literature concerning this rare but catastrophic problem.

Case Report

Bouveret’s Syndrome: An Unusual Twist on the Classic Cause

SUMMARYBouveret's syndrome is a duodenal obstruction caused by a gallstone, manifested mostly as a gastric outlet obstruction. We have reported an instance of Bouveret's syndrome caused by two separate stones, either of which could independently have caused the obstruction. It is imperative to be sure that the obstruction is relieved…

Case Report

Candidal Mediastinitis After Surgical Repair of Esophageal Perforation

SUMMARYCandidal mediastinitis, like Boerhaave's syndrome, is uncommon, and both, if treated late or incompletely, frequently result in death. Early recognition and aggressive medical and surgical intervention are the best means to convalescence and cure in both conditions.

Case Report

Chylothorax Complicating Right Upper Lobectomy

SUMMARYChylothorax after pleuropulmonary surgery is unusual. We have described the case of a patient in whom this complication followed a right upper lobectomy. Early recognition is important to avoid potential morbidity and mortality.

Case Report

Fume Fever and Reactive Airways Dysfunction Syndrome in a Welder

SUMMARYI have reported a case of fume fever and concurrent reactive airways dysfunction syndrome (RADS) after welding. The RADS should be added to the list of potential hazards associated with welding.

Case Report

Kikuchi-Fujimoto Syndrome During Pregnancy

SUMMARYNecrotizing lymphadenitis of the Kikuchi-Fujimoto type developed in our patient during her first trimester of pregnancy, but she carried the infant to full term with no apparent adverse effect. Two subsequent pregnancies were not associated with reactivation of the disorder, nor with any recognizable adverse effect on the fetuses. A…

Case Report

Magnetic Resonance Imaging of Pulmonary Artery Aneurysm

SUMMARYPulmonary artery aneurysm is a rare condition. We have presented what we believe to be the first case in the English literature to be diagnosed by magnetic resonance imaging.

Case Report

Primary Hyperparathyroidism and Coexisting Nephrogenic Diabetes Insipidus: Rapid Postoperative Correction

SUMMARYShortly after diagnosis of primary hyperparathyroidism, a patient had serum hyperosmolality, polyuria, isosthenuria, profound potassium depletion, and elevated plasma antidiuretic hormone levels, all consistent with nephrogenic diabetes insipidus. After parathyroidectomy, serum calcium and serum osmolality levels fell concurrently. Profound potassium deficits did not recur.We propose that (1) hypercalcemia produced a…

Case Report

Streptococcus salivarius Meningitis and Colonic Carcinoma

SUMMARYStreptococcus salivarius caused fulminant meningitis in an elderly patient. A gastrointestinal diagnostic workup revealed an asymptomatic colonic adenocarcinoma. This first reported instance of S salivarius sepsis associated with a colonic neoplasm is not unexpected, since the organism is bacteriologically similar to S bovis, the prime bacterial indicator of occult malignancy….

Case Report

Recurrent Adnexal Torsion and Cystadenoma of Aberrant Ovarian Tissue

SUMMARYThe clinical findings in adnexal torsion can be confused with those of several other conditions. Recurrent and intermittent pelvic pain should always arouse suspicion of adnexal torsion, but more common conditions, such as ectopic pregnancy, salpingitis, appendicitis, and endometriosis, must be excluded. Predisposing factors such as an adnexal mass and…

Letter to the Editor

An Excess of Information

Errata

Correction

Letter to the Editor

Flaming P Pot

Case Report

Foreign Body in the Gastrointestinal Tract Intraluminal Migration of Laparotomy Sponge

Letter to the Editor

Gastrointestinal Endoscopy Versus Radiology

Our Medical Heritage

‘Hand in Glove’ A Centennial Observation on the Surgical Use of Rubber Gloves

Letter to the Editor

In Memoriam, Robert F Butts, 1923-1991

Evagations

MEDICINE IS MORE THAN A PROFESSION

Letter to the Editor

Merkel’s Cell Carcinoma

Case Report

Strongyloides stercoralis Hyperinfection and Central Nervous System Involvement in a Patient With Relapsing Polychondritis

Article

The Future of CME

Editorial

THE OBSTETRIC DWINDLES

Editorial

THINGS AREN’T AS GOOD AS THEY USED TO BE….AND PROBABLY NEVER WERE

Letter to the Editor

To the Editor