ABSTRACT Several recent reports suggest that emergency physicians do not use adequate analgesia for patients with acutely painful conditions in the emergency department (ED). To quantify the extent of this problem, we retrospectively studied 401 patients who were treated for acute fracture over a 17-day period in eight area-wide emergency…
ABSTRACT This review summarizes results of hormonal management in patients with metastatic prostate cancer in terms of both timing and amount of androgen blockade. The standard of delayed hormonal therapy resulted from data of the Veterans Administration Cooperative Urologic Research Group showing high toxicity in patients treated with estrogen therapy….
ABSTRACT Trends of US suicide rates show great variations among demographic groups over time. Although more attention has been directed to the increasing suicide rate among adolescents, persons aged 65 years and older continue to commit suicide at a higher rate than for any other age group. To examine the…
ABSTRACT: A 50-year-old man with an 8 x 4 cm mass on the posterior chest was found to have a large retroperitoneal abscess due to Klebsiella pneumoniae. The abscess dissected through the right lower lobe of the lung and the posterior chest wall to produce a subcutaneous mass. The source…
ABSTRACT: Hypokalemia occurs in 50% to 68% of trauma patients. To investigate the pathophysiology of these changes in serum potassium, we prospectively studied 133 trauma patients. Among the patients who had hypokalemia, the serum potassium usually decreased within 1 hour of trauma and returned to normal within 24 hours without…
ABSTRACT: Little is known about the epidemiology of Bartholin's duct abscess and cyst. We did an emergency department-based case-control study to examine demographic risk factors for this condition. We found that risk varied by age. After adjustment for pregnancy status, the relative odds (odds ratio [OR]) of occurrence of Bartholin's…
ABSTRACT: Progressive conductive deafness may be caused by otosclerosis, a bone fixation of the stapes that causes reduced transmission of sound from the eardrum to the inner ear. Since the late 1950s, stapes surgery has been considered the treatment of choice for alleviating hearing loss due to otosclerosis. Over the…
ABSTRACT: The newly available Haemophilus influenzae type b (HIB) protein conjugate vaccines are efficacious among study populations in which a high proportion of infants and children are vaccinated. In this retrospective study, we show the impact of the availability of HIB conjugate vaccines on the incidence of HIB meningitis at…
ABSTRACT: The relationship between serum concentration of certain electrolytes and the pathogenesis of ventricular arrhythmia in myocardial infarction has been the subject of frequent review. The role of hypophosphatemia in the pathogenesis of arrhythmia in patients with acute myocardial infarction has not been as well studied. In our study group…
ABSTRACT: This prospective study was done to identify the incidence of asymptomatic hernias diagnosed during laparoscopic surgery. Previously unidentified inguinal hernias were discovered in 13 of 100 consecutive patients undergoing laparoscopic procedures (13%). Nine of the patients were male, four were female. The average age was 43.3 years. Four defects…
ABSTRACT: To determine the incidence of arteriographically proven coronary artery disease in black men evaluated for chest pain, we retrospectively reviewed the charts of 208 black men, aged 20 to 60, who had coronary arteriography at the Medical Center of Central Georgia (MCCG) from 1985 through January 1990. Age, type…
ABSTRACT: Traumatic injury frequently follows alcohol abuse. Between October 1, 1988 and January 31, 1992, 2,219 patients were admitted to the Trauma Service at the University Medical Center of Eastern Carolina-Pitt County. Of the 1,602 who were tested for serum ethanol, 685 (43%) were found to have measurable levels. Thirty-seven…
ABSTRACT: Varicella is an infrequent but potentially severe infection in adult HIV-infected patients. We reviewed five cases of varicella in HIV-seropositive men; two were complicated by severe headache and meningismus, and one of these patients also had hepatitis and thrombocytopenia. All five patients responded well to acyclovir therapy, but one…
ABSTRACT: We report four cases of niacin-induced hepatotoxicity. All four patients were using sustained-release niacin preparations. When they stopped taking niacin, symptoms and laboratory abnormalities resolved. Two of the patients had focal fatty infiltration of the liver on imaging studies, a presentation of niacin hepatotoxicity not previously described. One patient…
BSTRACT: A patient with an acute ischemic stroke had an interatrial septal aneurysm shown by transesophageal echocardiography. Interatrial shunting, compatible with a patent foramen ovale, was observed on a follow-up study after a second stroke. This was seen in association with a right atrial thrombus. This case illustrates that an…
BSTRACT: I tested the hypothesis that the most frequently used textbooks of internal medicine are inadequate in their coverage of the evaluation and management of common complaints and management problems of primary care. Fourteen common complaints (symptoms) and nine common management problems (diseases) representing 20% to 40% of primary care…
BSTRACT: S milleri should be added to the list of organisms producing wound infections in parenteral drug addicts. Recovery of “viridans streptococci” from an antecubital aspirate should prompt the clinician to request speciation, examine closely for abscess formation, and anticipate prolonged antibiotic therapy.
BSTRACT: TIA is an important risk factor for ischemic stroke. Early diagnosis and management can result in a significant reduction in the risk of subsequent stroke. We report the case of a 54-year-old man who developed a 5-second episode of leg weakness and in whom a tight stenosis of the…
BSTRACT: Twenty-four consecutively hospitalized patients with clinical evidence of lower extremity deep vein thrombosis (DVT) had blinded ipsilateral ultrasonographic duplex imaging (US), contrast venography (VG), and a one-time bilateral impedance plethysmography (IPG) examination. The cases of eight (33%) of the study patients were thought to be complicated due to a…
BSTRACT: We describe a patient with progressive cutaneous T-cell lymphoma (CTCL) and development of subacute cardiac failure. Symptomatic lymphomatous involvement of the heart may be more common in patients with CTCL than in other lymphomas because the former is more likely to be associated with circulating tumor cells and hematogenous…
BSTRACT: We present this case to emphasize the potentially fatal outcome of supraventricular tachycardia in infancy, particularly if it has been undiagnosed for several days. Certainly, careful monitoring needs to take place during any attempt at cardioversion or any other noxious stimulation of the patient. Bicarbonate therapy should be provided…
BSTRACT: We report the 10th known case of Crohn's disease associated with cystic fibrosis. Because the symptoms of Crohn's disease may easily be confused with those of cystic fibrosis, this association probably exceeds that predicted by existing prevalence data.
BSTRACT: We reviewed the operative complications in 333 living related donor nephrectomies done at our institution over the past 12 years. The overall complication rate was 17.1%; only three patients (0.9%) had major complications, and none died. The major complications were a delayed splenectomy because of bleeding, an adrenalectomy, and…
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