ABSTRACT: Acute febrile neutrophilic dermatosis (Sweet's syndrome) is a rare inflammatory disease of unknown cause characterized by painful, erythematous plaques and a dermal infiltrate of mature neutrophils. Associated systemic disease is a common finding in patients with Sweet's syndrome, and in fact determines the prognosis; therefore, the diagnosis of Sweet's…
ABSTRACT: Adding to the growing awareness of medications that can cause pancreatitis is a small but significant number of reports implicating the angiotensin converting enzyme (ACE) inhibitors. In this report, I describe the case of a patient who had no risk factors for pancreatitis and who was taking no medications…
ABSTRACT: Although intracranial gliomas carry a poor long-term prognosis, retreatment at the time of tumor progression may prolong survival and maintain or improve the quality of life. Thirty-three patients who underwent retreatment with surgery, radiotherapy, and chemotherapy were reviewed retrospectively. Median survival after initiation of retreatment was 8 months for…
ABSTRACT: Despite a resurgence of interest in the use of activated charcoal in the management of poisoning, most physicians in the developing countries seem not to appreciate the usefulness of this messy fluffy powder. This paper examines some of the questions raised by these physicians and offers suggestions on how…
ABSTRACT: Drug-induced antiphospholipid antibodies have been considered insignificant, a belief that has recently been questioned. Previous studies noted an association between chlorpromazine treatment and the presence of anticardiolipin antibodies (ACA), especially IgM ACA, and have suggested that thrombosis might be more likely in the presence of IgG ACA. We studied…
ABSTRACT: Esophageal perforation and acquired tracheoesophageal fistulae (ATEF) are rare sequelae of foreign body ingestion in the pediatric population. Here we discuss the cases of two patients with esophageal perforation caused by prolonged impaction of a coin; in one case, a tracheoesophageal fistula developed. The presence of aerodigestive symptoms and…
ABSTRACT: Forty volunteers were asked to compare pain from injection of buffered versus unbuffered local anesthetics given for upper lid and lower lid blepharoplasty. The concentration of the solution was 1 part 8.4% sodium bicarbonate to 5 parts local anesthetic. The surgeons performing the operations were asked to identify any…
ABSTRACT: Historically, pancreaticojejunostomy has been responsible for frequent and serious technical complications and significant mortality after pancreaticoduodenectomy. To physiologically isolate this anastomosis from the gastrointestinal and biliary anastomoses, I have used Roux-en-Y pancreaticojejunostomy for reconstruction after pancreaticoduodenectomy since 1981. This report is a retrospective review of a consecutive personal series…
ABSTRACT: I describe a patient who had a dusky finger after a ring avulsion injury. Although blood flow was initially good after removal of the ring, circulatory compromise later developed. Surgical exploration revealed thrombosis of both digital arteries, which was treated with thrombectomy. In such injuries, the circulatory status of…
ABSTRACT: In three generations of a family investigation for coexpression of May- Hegglin anomaly and hereditary nephritis was done by routine studies, as well as electron microscopy of renal tissue and blood cells, platelet aggregation studies, audiograms, and ophthalmologic evaluations. The propositus had typical May-Hegglin anomaly and a mild form…
ABSTRACT: Ketorolac is an effective and popular long-lasting analgesic that is especially useful in the emergency department and postoperatively. It is comparable in potency to the opiates but is preferable to them in many instances. Its relative overall safety as compared to the opiate analgesics may generate an unjustified complacent…
ABSTRACT: Microcystic adnexal carcinoma is a relatively uncommon tumor first described in 1982. Most commonly presenting as a facial plaque or nodule, this highly invasive tumor is characterized by slow growth and relentless local destruction. We report the presence of microcystic adnexal carcinoma in the neck, a previously unreported site….
ABSTRACT: Our patient's acid-base disturbance may be among the highest recorded in nonfatal cases of metabolic alkalosis. This case also shows that life-threatening alkalemia can be safely and effectively treated by defining and removing the causes of alkalosis and applying aggressive supportive therapy with fluid repletion and potassium and electrolyte…
ABSTRACT: Patterns of injuries seen in the emergency department (ED) following an ice storm were evaluated and compared to those seen during a control snow period. We conducted a retrospective chart review for an 11-day ice period and an 11-day control snow period using charts from eight metropolitan area EDs….
ABSTRACT: Proteus syndrome (PS) is a congenital disorder manifesting with severe deformities, the salient features being gigantism and vascular tumors. The disorder is poorly understood, and there has been much discrepancy in the terminology regarding the vascular tumors in PS. The purpose of this study was to elucidate the histogenesis…
ABSTRACT: Sepsis due to Pseudomonas aeruginosa continues to be an important source of morbidity and mortality in hospitalized patients. Early recognition of this condition is of paramount importance in choosing specific therapy at the earliest possible moment. We present three cases in which P aeruginosa bacteremia was manifested by subcutaneous…
ABSTRACT: Simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CE) were done on 133 patients over an 8-year period. Twenty-seven patients (20%) had previous transient ischemic attacks (TIAs), 12 (9%) had previous strokes, and the remainder (71%) were asymptomatic. All asymptomatic patients had greater than 85% stenosis of the…
ABSTRACT: Systemic calciphylaxis is a rare, poorly understood syndrome of progressive ischemic necrosis, usually associated with hyperparathyroidism. The combination of hyperparathyroidism, usually secondary or tertiary, and chronic renal failure seems to produce a particular biochemical environment conducive to the development of an unusual progressive form of ischemia. Early recognition and…
ABSTRACT: The comparative value of palpation, light percussion, and auscultatory percussion for detecting the liver below costal margin was studied in 45 normal subjects and 20 patients. The presence of the liver 2 cm or more below the costal margin was considered abnormal, since this organ was found no more…
ABSTRACT: The literature contains reports documenting a foodborne etiology for bacterial infections caused by Salmonella spp, Listeria monocytogenes, Campylobacter jejuni, and Vibrio spp in individuals with the human immunodeficiency virus (HIV). The incidence of these infections and the life-threatening complications that result are elevated in people with HIV infection. We…
ABSTRACT: The temporomandibular joint (TMJ) may require surgical violation or resection when involved in primary malignant or benign tumors of bone, regional tumors of the oral cavity adjacent to the mandible or with mandibular erosion, or in soft tissue tumors around the joint. The TMJ may require total resection with…
ABSTRACT: This case illustrates the enigmatic fashion in which spinal epidural abscess (SEA) may manifest. In any patient with back pain and fever of unclear etiology, the diagnosis of SEA should be considered; this is particularly true when radicular symptoms are present. Some patients with SEA may not have a…
ABSTRACT: To assess the impact of a quality improvement program on the occurrence of serious complications related to endotracheal tube misplacement and to identify risk factors, we did a before and after comparison in the adult intensive care units of a military referral hospital. All adult patients requiring endotracheal intubation…
ABSTRACT: We describe, for the first time, a patient with both symptomatic acromegaly and Chiari-I malformation. These conditions could coexist by chance alone, but the probability of both presenting simultaneously in a previously healthy man seems quite remote. Alternatively, acromegaly through associated bony and soft tissue enlargement could lead to…
ABSTRACT: We highlight the diagnostic consideration of lymphocytic adenohypophysitis (LAH) in the postpartum patient with unexplained partial pituitary insufficiency. Further, we emphasize that in patients with a normal magnetic resonance imaging scan, the measurement of antipituitary antibodies (APA) may provide an alternative means of confirming the diagnosis. Finally, although assays…
ABSTRACT: We present a case of accidental death due to cocaine ingestion in which the victim's bizarre behavioral manifestations initially led law enforcement officials to consider the death a homicide. By virtue of the medical examiner's thorough investigation, the true accidental nature of the death was brought to light.
ABSTRACT: We present a case of renal cell carcinoma extending into the inferior vena cava and resulting in total occlusion. Perioperative transesophageal echocardiography allowed us to assess cardiac function, follow the extent of vascular involvement, and prevent embolization of tumor and air.
ABSTRACT: We report a case of Coombs-positive anemia, neutropenia, Eaton-Lambert syndrome, and cerebellar degeneration with anti-Purkinje cell antibodies. No definitive cause has been established despite an extensive search for a malignancy or a known autoimmune disease. The histology of spleen and lymph nodes showed marked polyclonal B and T cell…
ABSTRACT: We report a case of sepsis due to Trichosporon cutaneum in a 20-year-old patient with acute promyelocytic leukemia. Neutropenia with a hypocellular marrow persisted for 90 days after two courses of induction chemotherapy with mitoxantrone and ara-C. Amphotericin B, fluconazole, and granulocyte-macrophage colony-stimulating factors were administered. Neutropenia (ANC <1,000/μ…
ABSTRACT: We review our collective experience over the past 4 years using a portable instrument that measures the International Normalized Ratio (INR) and the prothrombin time (PT). The device can be used readily in ambulatory clinic settings and by patients in their homes. The major advantage of the monitor is…
ABSTRACT: We reviewed all randomized, controlled angiographic trials to assess the impact of intensive lipid modulation on the progression or regression of angiographically defined coronary disease. Five of seven trials satisfied selection criteria: Cholesterol- Lowering Atherosclerosis Study, Program on the Surgical Control of the Hyperlipidemias, Familial Atherosclerosis Treatment Study, Regression…
ABSTRACT: We reviewed gastrointestinal manifestations in 40 patients with amyloidosis. Gastrointestinal symptoms included anorexia, macroglossia, intestinal pseudo-obstruction, and altered bowel habits. Hepatomegaly was detected in eight patients, but none had clinically significant infiltrative liver disease. Mucosal friability and erosions were common endoscopic findings. Barium enema was noncontributory in the diagnosis…
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