ABSTRACT:An 83-year-old black woman with previously diagnosed essential thrombocythemia was treated with thiotepa to control the excessive number of platelets. Approximately 10 years later, multiple myeloma developed. This appears to be the first case of multiple myeloma occurring after alkylating agent therapy for essential thrombocythemia. Although the mechanism of the…
ABSTRACT:As the American health care system struggles to provide universal access to quality care at an acceptable price, many planners focus on rationing as the only way to make available the necessary resources. I discuss some of the ethical, economic, and political issues that relate to health care rationing. The…
ABSTRACT:Cardiac arrhythmias are disorders of impulse formation, impulse conduction, or both. Part I of this two-part review discusses clinically relevant cardiac electrophysiology, as well as the pathogenesis, recognition, and management of ventricular premature beats and ventricular tachyarrhythmias. Part II will review the pathogenesis, recognition, and management of supraventricular premature beats…
ABSTRACT:Drug resistant tuberculosis (DRTB) is a growing national health concern in both urban populations and rural areas and is exacerbated by the growing epidemic of human immunodeficiency virus (HIV) infection. Between 1989 and 1992, 7 cases of DRTB (5 with multidrug-resistance) were diagnosed in an eight-county region of East Tennessee….
ABSTRACT:Gunshot injuries to the head and neck are frequently seen in patients brought to a level I trauma center. These injuries result in great morbidity and mortality and a significant expenditure of health care dollars. Missile injuries to the temporal bone, though less common, can likewise be devastating. Common sequelae…
ABSTRACT:I present my experience with 180 inflatable penile prostheses inserted in 167 patients with organic sexual impotence of 4 months to 30 years in duration. Mean age was 59.3 years. Prostheses used were AMS 700 (9), Flexiflate (14), Mentor Mark II (99), and Mentor Alpha I (58). Mean follow-up was…
ABSTRACT:Nitric oxide (NO) has recently been found to be the endothelium-derived factor that produces profound relaxation of the vascular smooth muscle. This discovery has led to the experimental use of inhaled NO as a selective pulmonary vasodilator without concomitant systemic vasodilation. Currently, clinical trials of inhaled NO in persistent pulmonary…
ABSTRACT:The purpose of this study was to examine the effects of aerobic exercise on resting systolic and diastolic blood pressure in normotensive adults. The results of nine studies published in journals (1963 to 1992) and representing a total of 438 subjects (289 exercise, 149 control) were statistically aggregated using the…
ABSTRACT:This study was conducted to test the predictive validity of a new alcohol screening test, the Alcohol Use Disorders Identification Test (AUDIT), in a general medicine teaching clinic and to assess physician recognition and treatment of alcohol and drug disorders. The research procedures included completion of the AUDIT, a standardized…
ABSTRACT:Valvular heart disease accounts for considerable morbidity and some mortality among patients with end-stage renal disease (ESRD ). To determine the prevalence and severity of valvular and perivalvular abnormalities, including valvular thickening, stenosis, calcification, regurgitation, and mitral annular calcification (MAC), and the impact of age and duration of dialysis on…
ABSTRACT:WDHA (watery diarrhea, hypokalemia, and achlorhydria) syndrome is an unusual paraneoplastic condition caused by excess vasoactive intestinal polypeptide (VIP) secreted by certain tumors. The onset of the syndrome is insidious, and diagnosis is usually delayed by months to years. Morbidity and mortality from untreated WDHA syndrome are related to long-standing…
ABSTRACT:We report on a man who was HIV-seropositive and who was initially admitted following multiple episodes of syncope. He gradually developed fulminant thrombotic thrombocytopenic purpura (TTP). Twenty-one patients with TTP who were HIV positive have been reported previously. Of these 22 patients, all treated with plasmapheresis, 7 died from TTP…
ABSTRACT:We report the cases of two children, ages 8 and 10 years, with painful defecation and constipation due to impaction of sunflower seed shells that did not respond to laxative and enema therapy. Physical examination revealed a prickly mass in the rectal vault. Proctoscopy revealed bezoars of sunflower seed shells,…
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