Case Report

Facial Arteriovenous Malformation Managed With Ablative Surgery and Dual Rotational Flap Reconstruction

ABSTRACT: A 34-year-old man had previously had partial resection of a left facial hemangioma or arteriovenous malformation which included partial mandibulectomy and external carotid arterial ligation for treatment of recurrent bleeding. Because of recurrent intraoral bleeding with aspiration and profound anemia and angiographic analysis showing large tortuous abnormal vessels feeding…

Case Report

Dapsone Therapy Causing Sulfone Syndrome and Lethal Hepatic Failure in an HIV-Infected Patient

ABSTRACT: A 34-year-old woman with HIV infection and no other opportunistic infections presented a classic sulfone syndrome, manifested by fever, rash, hemolytic anemia, and fulminant hepatitis due to dapsone hypersensitive reaction, with a fatal outcome. We believe this is the first reported fatal complication of dapsone in an HIV-infected patient….

Case Report

Reversible Hyperkalemia During Antihypertensive Therapy in a Hypertensive Diabetic Patient With Latent Hypoaldosteronism and Mild Renal Failure

ABSTRACT: A 66-year-old hypertensive diabetic patient with latent hypoaldosteronism and mild renal failure was treated by adding enalapril, an angiotensin converting enzyme inhibitor, to the furosemide and nifedipine regimen because of an insufficient antihypertensive response for 1 month. Seven days after enalapril addition, the blood pressure was significantly reduced, but…

Case Report

Myasthenic (Eaton-Lambert) Syndrome Associated With Pulmonary Large-Cell Neuroendocrine Carcinoma

ABSTRACT: A 66-year-old woman presented clinical findings of Eaton-Lambert (myasthenic) syndrome (ELS). Fifteen months later, large-cell pulmonary carcinoma was detected. After systemic chemotherapy and radiotherapy, the tumor regressed and neurologic function improved. Although ELS is usually associated with pulmonary small-cell carcinoma, a minority of tumors are of squamous or glandular…

Case Report

Correlation of Liver and Skin Histopathology With Serology in a Patient With Cutaneous Vasculitis and Hepatitis C Infection

ABSTRACT: A strong body of evidence supports a viral etiology for many forms of vasculitis. Recent literature supports the association of the hepatitis C virus (HCV) with essential mixed cryoglobulinemia. We describe a case of cutaneous vasculitis associated with simultaneous active hepatic inflammation demonstrated by skin and liver biopsies. Immunofluorescence,…

Primary Article

Pleural Effusion in Patients With Differentiated Papillary Thyroid Cancer

ABSTRACT: Among 1,772 patients who registered at the MD Anderson Cancer Center between 1944 and 1991 with papillary thyroid cancer, 10 had malignant pleural effusion that developed during the course of the disease. At primary surgery, all 10 were found to have metastases to cervical lymph nodes. Seven of these…

Case Report

Diffuse Large Cell Lymphoma of the Lung An Unusual Cause of Complete Opacification of the Hemithorax

ABSTRACT: Complete opacification on chest radiographs may be due to collapse of the lung, consolidation, massive pleural effusion, empyema, hemothorax, chylothorax, fibrothorax, and other causes. We report a case of complete opacification of the hemithorax produced by large cell lymphoma, a previously unreported cause of this finding. Diagnosis was complicated…

Primary Article

Empyema Thoracis: Medical Aspects of Evaluation and Treatment

ABSTRACT: Empyema thoracis is a disease that, despite centuries of study, still causes significant morbidity and mortality. Sixty-five cases were seen at Brooke Army Medical Center over an 8-year period (March 1, 1985, through March 1, 1993). The majority of the patients were men, older than 50 years of age,…

Case Report

Gastrospirillum hominis in Acute Gastric Erosion

ABSTRACT: Gastrospirillum hominis is a spirochete that has been described in association with chronic gastritis and duodenal ulcers. We report the case of a patient having acute gastric erosion in whom biopsy showed abundant organisms. The erosion resolved while the patient was receiving sucralfate and omeprazole therapy. We discuss the…

Case Report

Intrapericardial Pheochromocytoma Complicated by Massive Intraoperative Hemorrhage

ABSTRACT: Middle mediastinal pheochromocytomas are exceedingly rare. Because so few cases have been reported, consensus has not been reached regarding the anesthetic management of patients with these tumors. The use of cardiopulmonary bypass (CPB) for the resection of intrapericardial pheochromocytomas has met with varied success. We report the first documented…

Primary Article

Laparoscopic Cholecystectomy: What’s So Special?

ABSTRACT: One hundred seventy-one laparoscopic cholecystectomies were done by senior surgery residents who received only traditional “hands-on” training. Eight patients (5%) required conversion to open cholecystectomy, and two had complications requiring immediate celiotomy (one common bile duct injury, one “dropped” gallbladder). The average operative time was 91 minutes (range, 30…

Case Report

Management of Postpneumonectomy Syndrome With a Bronchoscopically Placed Endobronchial Stent

ABSTRACT: Postpneumonectomy syndrome is a rare complication of right pneumonectomy characterized by marked shift and counterclockwise rotation of the heart and mediastinum into the evacuated hemithorax. Typically the left primary bronchus is draped over the aorta or spine and is markedly compressed. We describe one patient with postpneumonectomy syndrome successfully…

Case Report

Severe Preeclampsia Mimicking Acute Appendicitis

ABSTRACT: Preeclampsia has been frequently misdiagnosed as an entity unrelated to pregnancy, with resultant delay in appropriate management. In the case presented here, severe preeclampsia complicated by hemolysis, elevated liver enzymes, and low platelet count (“HELLP syndrome”) in a 32-week twin gestation was misdiagnosed as acute appendicitis. Delay in diagnosis…

Primary Article

Military Rank as a Measure of Socioeconomic Status and Survival From Prostate Cancer

ABSTRACT: Previous studies have shown an association between cancer survival and socioeconomic status. In the United States Armed Forces, military rank is a measure of socioeconomic status. To determine whether an association exists between socioeconomic status (as measured by military rank) and prostate cancer, we carried out a retrospective review…

Primary Article

Accuracy of Fingerstick Glucose Determination in Patients Receiving CPR

ABSTRACT: Recent demonstration of the dangers of hyperglycemia in the setting of cerebral hypoperfusion has resulted in recommendations to abandon the long-standing practice of empiric administration of dextrose to patients with altered mental status. Patients receiving basic cardiopulmonary resuscitation (CPR) have been identified as being at particular risk from inappropriate…

Case Report

Unilateral Phrenic Nerve Paralysis From Cutting Down a Christmas Tree

ABSTRACT: Stretch injury to the phrenic nerve is an unusual cause of unilateral diaphragmatic paralysis. In this case the injury occurred while the patient was lying on the ground and cutting down a Christmas tree with a hand saw.

Primary Article

Religious Affiliation and Obstetric Outcome

ABSTRACT: The purpose of this study was to explore the relationship between religious affiliation and obstetric outcome. We reviewed 1,919 records of patients whose infants were born at a university medical center. Data obtained from maternal and newborn records included demographic information, prenatal history, labor and delivery records, and religious…

Primary Article

Experimental Manipulation of Cocaine Craving by Videotaped Environmental Cues

ABSTRACT: Thirteen male patients consecutively admitted to an inpatient drug and alcohol rehabilitation hospital with the primary diagnosis of crack cocaine dependence were shown a 30-minute videotape that included salient environmental cues intended to elicit cocaine craving. The subjects were tested before and after the videotape by the use of…

Primary Article

Frequency and Outcome of Infectious Disease Admissions to a Pediatric Intensive Care Unit

ABSTRACT: This prospective clinical study was designed to assess patients with primary infectious disease (ID) necessitating admission to a pediatric intensive care unit (PICU), to identify morbidity and mortality risk factors, and to better define this subpopulation of critically ill children and compare them with patients who had a noninfectious…

Primary Article

Left Bronchial Intubation by a Single-Lumen Tube in Adults: Effects of Bevel and Curvature

ABSTRACT: This study was designed to determine whether left bronchial intubation could be accomplished by reversal of the direction of the bevel or by changing the direction of curvature of a normal tracheal tube. The 60 study patients were divided into three groups. In group 1, the patients were intubated…

Case Report

Thrombotic Thrombocytopenic Purpura Associated With Sickle Cell–Hemoglobin C Disease

ABSTRACT: Thrombotic thrombocytopenic purpura (TTP) complicated a vaso-occlusive crisis in a patient with sickle cell–hemoglobin C (HbSC) disease. Markedly abnormal HbSC red blood cell morphology confused the initial diagnostic evaluation of the peripheral smear. Sustained, severe thrombocytopenia and the patient’s failure to respond clinically to RBC exchange transfusion helped to…

Primary Article

National Survey on Physicians’ Attitudes Toward Social and Sexual Contact With Patients

ABSTRACT: To determine the attitudes of physicians toward social and sexual contact with patients, we mailed a self-report survey to a nationwide randomized sample including general practitioners, internists, obstetrician-gynecologists, and ophthalmologists. The 777 physicians who responded specified whether or not behavior such as hugging, dating, and sexual contact with their…

Primary Article

Haemophilus influenzae Type B Invasive Disease in Urban and Rural Children: Immunization Patterns and Prevalence of Disease

ABSTRACT: To examine the impact of the introduction of Haemophilus influenzae type b (Hib) conjugate vaccine, we reviewed the incidence of Hib invasive disease in the state of Florida from 1984 to 1992. We analyzed the incidence of disease in two populations of children, one residing in an urban area…

Primary Article

Southern Adolescents: A Survey of Attitudes and Beliefs About Smoking

ABSTRACT: Using data collected by the National Center for Health Statistics, we examined the relationships between smoking-related beliefs and attitudes and smoking status for a sample of adolescents (N = 3,198) from southern states. Stepwise logistic regression was used to identify the best predictors of smoking prevalence. Results indicated that…

Primary Article

Postnatal Penicillin Prophylaxis and the Incidence of Group B Streptococcal Sepsis in Neonates

ABSTRACT: We conducted a retrospective chart review of infants, born over a 3-year period, who had positive urine latex agglutination and/or positive blood culture for group B streptococci (GBS). Infants routinely received intramuscular aqueous penicillin for the first half of the study period, and no penicillin was given for the…

Case Report

Tuberculous Mastitis

ABSTRACT: We present a case of tuberculous mastitis. The patient's only other focus of tuberculosis, besides the clinical infection in the right breast, was a simple calcified primary complex in the right lung. Our review of records from the past 27 years yielded no other case of proven tuberculous mastitis…

Primary Article

Clozapine Therapy and Clinical Outcomes in Kentucky Psychiatric Hospitals

ABSTRACT: We reviewed the protocol for determining patient eligibility to receive clozapine in Kentucky state psychiatric facilities. Results of a retrospective review of the clinical outcomes of the initial 42 patients who received clozapine under this protocol are reported. Patients receiving clozapine were severely ill patients with a mean duration…

Primary Article

Factors Associated With Hypochromia and Microcytosis Among High School Students in the Southeastern United States

ABSTRACT: We studied hematologic findings in 617 apparently healthy Georgia elementary, middle, and high school students, aged 10 to 19 years, and examined the influence of several parameters (race, sex, iron status, and genetic hemoglobin [Hb] abnormalities) on hypochromia and microcytosis, with or without anemia. Fourteen students (2%) (6 male,…

Primary Article

Compliance With Doxycycline Therapy for Outpatient Treatment of Pelvic Inflammatory Disease

ABSTRACT: Women discharged from a municipal emergency department with the diagnosis of pelvic inflammatory disease were surveyed by telephone about their compliance with a standard 10-day regimen of doxycycline. Of the 386 women who completed the survey, 31% reported complete compliance; 28% reported that they did not fill their prescriptions…

Primary Article

Effectiveness of Yohimbine in Treating Narcolepsy

ABSTRACT: Yohimbine was used in four men and four women ranging in age from 21 to 64 years with nocturnal polysomnography and multiple sleep latency test-verified narcolepsy. All achieved a stimulant response in doses ranging from 2.7 to 16.2 mg/day. The effective dose was defined as the amount of medication…

Correspondence

A Blunt Proposal for a Safer Surgical Environment

Correspondence

Anion Gap in Metabolic Alkalosis

Correspondence

Anion Gap in Metabolic Alkalosis Reply

Correspondence

Prognostic Significance of Intraoperative Rupture of Ovarian Cancer

Editorial

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