ABSTRACT: A structured interview conducted during the postpartum hospitalization of 184 patients aged 17 years or younger was used to study teenagers' perceptions of barriers to prenatal care. The interview consisted of more than 100 questions on demographic characteristics, family and social support, desire for the pregnancy, perceptions of the…
ABSTRACT: According to established diagnostic and therapeutic guidelines for chronic pulmonary aspiration, clinical suspicion is raised by coughing and choking with feeding, coughing during sleep, recurrent pneumonia, failure to thrive, and radiologic signs of chronic lung injury. The upper gastrointestinal series accurately defines anatomy and function, can differentiate between direct…
ABSTRACT: Carisoprodol (Soma, others) is a commonly prescribed, noncontrolled, skeletal muscle relaxant whose active metabolite is meprobamate. Patients for whom carisoprodol is prescribed are at risk for meprobamate dependence; several such cases have been reported. Toxicity and withdrawal associated with the use of meprobamate is high and has led to…
ABSTRACT: Cocaine is now regarded as one of the most dangerous illicit drugs available today. A disturbing trend in the pattern of cocaine use is that groups long considered unlikely to be involved in drug use, including women of childbearing age, pregnant women, the pediatric age group, fetuses, and neonates,…
ABSTRACT: Highly trained medical specialists now possess a vast array of sophisticated technical apparatus with which to fight diseases. These tools, coupled with a growing emphasis on cost accounting and a medical paradigm emphasizing facts and depicting the human body as a machine, depersonalize health care by militating against a…
ABSTRACT: Hyperpyrexia, defined as temperature elevation of at least 106°F, is generally thought to be infrequently associated with infection. In a 3-year retrospective analysis of 39 episodes of hyperpyrexia in adults, 94%. of cases were associated with infection. In 35 patients (90%) the causes were potentially treatable, and the majority…
ABSTRACT: Medical advances make continuing medical education (CME) necessary. Thirty practicing internists and 14 medical residents completed questionnaires and tests of critical appraisal knowledge designed to compare attitudes, behaviors, and skills for maintaining current knowledge. Eighteen internists were then given practical guidelines for “keeping up” with the literature, and this…
ABSTRACT: Midazolam is used frequently as an oral premedication in children. To make it more palatable, it is often mixed in various syrups and solutions. No previous studies have documented the stability of midazolam when mixed in these solutions. Using high-pressure liquid chromatography, we assayed midazolam concentrations over time when…
ABSTRACT: Nitrogen, derived from breakdown of dietary amino acids as ammonia, is normally converted to urea and excreted. Impairment in the conversion process (called the urea cycle) can occur, either as a consequence of primary genetic defects or through secondary suppression of enzyme activity. Either process results in hyperammonemia, producing…
ABSTRACT: One hundred significantly overweight patients sequentially applying to a very low calorie diet (VLCD) program were interviewed to learn how the onset of obesity correlated with other life events. By comparison with a control group of 100 always-slender adults, the obese applicants were found to be different at a…
ABSTRACT: Radial nerve injury produced by anterior dislocation of the shoulder is uncommon. Here I present a probable case from 3,000 years ago, described in the Bible. My report is based on the “medical history” only. Differential diagnosis, laboratory findings, and treatment are discussed.
ABSTRACT: The Pelorus Stereotactic Surgical System is a relatively new, commercially available device that can be used to perform computed tomography (CT)-guided stereotactic brain biopsy. It has been promoted as being a relatively simple and inexpensive system that is more rapid, less cumbersome, and generally easier to use than conventional…
ABSTRACT: Three previously healthy young male patients had brain stem infarction (stroke) after swimming or wading in shallow water along the southeastern North Carolina coastline. Each patient remembered an unusual encounter with something in the water. None sustained any obvious local envenomation. Although these cases may be a highly unusual…
ABSTRACT: To evaluate cardiac pacing thresholds and the safety of a 2.5 V amplitude setting, we prospectively studied 29 pediatric patients during a mean follow-up of 16.4 months. Exit block (EB) at 2.5 V was confirmed during threshold analysis in 26% of 58 leads. No new cases were detected by…
ABSTRACT: To investigate racial differences in hypertensive patients' understanding of their disorder, we administered a questionnaire to 83 black and 260 white outpatients with the diagnosis of hypertension designated in their medical chart. No racial differences in systolic or diastolic blood pressure, age, or male/female ratio were observed. However, blacks…
ABSTRACT: We reviewed the experience with needle-directed breast biopsies (NDBB) in a military medical center. In 195 patients, 207 NDBBs were done; 49 of these biopsies (24%) rendered a diagnosis of malignancy. The majority of patients (78%) had invasive cancer; 44% of them were found to have associated malignant axillary…
ABSTRACT: We use the case of a 62-year-old retired widow, referred for psychiatric evaluation by the internal medicine house staff, to illustrate the complexities of diagnosing depressive syndromes in medically ill patients. The patient's presenting symptoms included diarrhea, severe weight loss, and abdominal pain. She appeared cachectic, but diagnostic findings…
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