ABSTRACTEight patients with osteomyelitis of the jaw were identified at two county hospitals over a 4-year period. Three patients (37.5%) were found to be HIV-seropositive, including two patients not previously known to be HIV-seropositive. Signs and symptoms of infection were similar in both groups of patients, and commonly included fever,…
ABSTRACTEvaluation of trauma to the cervical spine usually includes predominantly normal x-ray studies that prevent expeditious workup and treatment and increase cost. In a retrospective review of the cases of 1,686 consecutive trauma patients who had routine radiographs for possible injury to the cervical spine, injuries were detected in 32…
ABSTRACTFrom January 31, 1990 to November 15, 1991, I treated three patients by cesarean hysterectomy with cervical conization for cervical neoplasia. All three hysterectomies were facilitated by the use of a combined abdominal-vaginal technique, which is described in this report.
ABSTRACTGrain's stain (GS) and culture of sputum are used routinely for diagnosis of lung infection. We prospectively studied physicians' use of sputum GS and culture for management of lung infection, the correlation between GS and culture in 224 adequate sputum specimens from patients admitted to our hospital over a 15-month…
ABSTRACTHuman herpesvirus 6 (HHV-6) is a relatively recently discovered virus. Although systematic studies on the spread of this virus are lacking, considerable data have been collected regarding the prevalence of HHV-6 infection. A number of laboratory methods are available for the diagnosis of HHV-6 infection, but currently these tests are…
ABSTRACTImmediate staging and debulking of an unsuspected ovarian malignancy detected at the time of diagnostic laparoscopy is appropriate when personnel knowledgeable in these procedures are available. However, when assistance is unavailable, termination of the diagnostic laparoscopy and timely referral is acceptable. This report reviews techniques to preoperatively distinguish a benign…
ABSTRACTIn the past, chronic daily headaches have been attributed to many possible causes, including “tension,” excessive contraction of pericranial muscles, and depression. A careful history reveals that many patients start out with fairly typical intermittent migraine attacks that evolve over the years into a pattern of daily or almost daily…
ABSTRACTKaposi's sarcoma (KS) is common in individuals infected with the human immunodeficiency virus (HIV-1). Although KS is frequently indolent, it can also be aggressive and life-threatening, especially in patients with pulmonary involvement (PKS), who have poor survival rates when untreated. In an effort to develop treatment regimens for PKS that…
ABSTRACTOf 239 patients with erectile dysfunction (aged 36 to 70 years) who were evaluated with dynamic infusion cavernosometry-cavernosography, 32 (13.4%) developed priapism after the procedure and were successfully managed with immediate intracorporal injection of phenylephrine. No single risk factor for the development of priapism was identified in this group. Early…
ABSTRACTOne hundred three ambulatory elderly men had serum free testosterone (FT) assessed as part of a study of bone loss. The FT was analyzed using radioimmunoassay. Each participant was questioned regarding the presence of erections adequate for sexual activity and the presence of sexual desire. Each was examined for decreased…
ABSTRACTPseudoseizures are a somatic form of communication involving dissociative mechanisms. This paper outlines basic strategies for psychotherapeutic management with a case example.
ABSTRACTPublic outcry regarding unsafe interhospital patient transfers led to the passage of the COBRA Law of 1985. Since its implementation in 1986, the law has been sharply criticized for its sporadic enforcement, narrow focus, and lack of care provisions for the poor. We reviewed retrospectively the charts of all emergency…
ABSTRACTThe incidence of middle ear disorders in patients with cleft palate deformities was determined in a retrospective review of 110 children with palate or palate and lip involvement. Ages ranged from 2 months to 18 years and included patients with associated abnormalities such as Pierre Robin syndrome and Treacher Collins…
ABSTRACTTo evaluate the effectiveness of flumazenil in reversing midazolam-induced conscious sedation and general anesthesia, we gave either flumazenil or placebo to 55 patients in a double-blind manner after surgery. Whether surgery was done under conscious sedation (CS group) or general anesthesia (GA group) depended on the procedure. Recovery was assessed…
ABSTRACTWe reviewed the clinical courses of 37 patients treated for pyogenic liver abscesses. These abscesses were cryptogenic in 38% of the patients, associated with biliary tract or intra-abdominal disease processes in 48%, and hematogenous in 11%. Computed tomography was more accurate (96%) in diagnosing a hepatic abscess than ultrasonography (82%)….
ABSTRACTWe studied 27 patients with venographically documented bilateral subclavian vein occlusion thrombosis after the use of dual lumen hemodialysis catheters. Immediate venous access was severely limited because all patients had previously had multiple access failures. The rate of venous pressure rise between hemodialysis treatments is inconsistent in suggesting imminent thrombosis…
ABSTRACTWhether the compensation status of patients injured in occupational accidents influences treatment outcome remains a controversial issue. This article describes the treatment outcome status of compensated versus noncompensated patients who received comprehensive functional restoration treatment of low back pain in a hospital-based, interdisciplinary, occupational rehabilitation and pain management program. Results…
SUMMARYCystic pheochromocytomas are unusual variants of adrenal pheochromocytomas. Computed tomography and pathologic findings in the two cases reported here illustrate three cardinal principles in the diagnosis of cystic pheochromocytomas: (1). A suprarenal cystic tumor discovered on CT may be the result of hemorrhage and necrosis of an adrenal pheochromocytoma. (2)…
SUMMARYDespite the simplicity, effectiveness, and safety of spinal anesthesia, arachnoiditis can occur as a complication. The cause of this is often unknown, especially since disposable spinal kits are now normally used. It is postulated that an untoward reaction to the anesthesia or chemical contamination was the cause of arachnoiditis in…
SUMMARYDrug dispensing error should be considered as a cause of hypoglycemia when the usual initial workup is unrevealing, as in the case described.
SUMMARYI have described a 17-year-old adolescent in whom retroperitoneal fibrosis was the initial manifestation of systemic lupus erythematosus. She had thrombosis of the inferior vena cava during the course of her illness. Standard treatment with corticosteroids resulted in apparent resolution of this complication.
SUMMARYMyocutaneous sclerosis is a known complication of intramuscular and subcutaneous injection of narcotics. We have described the MRI findings of this entity with superimposed infection in a patient addicted to intramuscular and subcutaneously administered nalbuphine. The clinical and imaging features of this disorder are sufficiently characteristic to allow confident diagnosis….
SUMMARYThe case of cutaneous larva migrans presented here is typical for its mechanism and geographic location of infection, evolution of lesions, and prompt response to treatment. Except for pin-worms, helminth infections are rarely thought of in emergency departments away from the areas where the parasites are especially prevalent. The several-day…
SUMMARYWe have described the case of a 58-year-old woman in whom acute hemolytic anemia, renal failure, and granulocytopenia developed after intake of mefenamic acid and diclofenac. Results of direct and indirect Coombs' tests were negative, but the lymphocyte transformation test was positive for these two nonsteroidal anti-inflammatory drugs (NSAIDs). We…
SUMMARYWe have reported the unusual case of a 7-year-old boy who was admitted with respiratory symptoms of several months' duration. He was found to have a tumor of the trachea, which proved to be a low-grade fibrosarcoma with smooth muscle differentiation.
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