A relationship between intravenous epinephrine infusion and the development of lactic acidosis has been well described. We report a temporal association between the administration of subcutaneous epinephrine and the development of lactic acidosis in the setting of status asthmaticus. A 20-year-old woman with a history of asthma came to the…
Although neither sarcoidosis nor HIV infection is rare, only eight patients with both diseases have been described. None of the eight had sarcoid myopathy. We describe a patient who had HIV infection and decreased CD4+ T-lymphocytes as well as sarcoidosis with muscle involvement. During 3 years of observation, primary sarcoidosis…
Cervical spinal epidural hematoma is an unusual neurosurgical disorder that usually requires emergent surgical decompressive therapy. We report the case of an 85-year-old woman with acute, severe neck and shoulder pain with progressive neurologic deficits. A computed tomography scan of the neck revealed an acute cervical spinal epidural hematoma. This…
Diagnostic evaluation of the neonatal airway requires special training and instrumentation. The subglottis of a normal full-term infant will allow passage of a 3.0 bronchoscope (outer diameter 5.0 mm, inner diameter 4.3 mm). On occasion, diagnostic rigid endoscopy with simultaneous ventilation in premature infants necessitates use of a 2.5 bronchoscope…
In a retrospective study, the first 301 patients who had laparoscopic cholecystectomy (LC) in a university-affiliated community hospital were compared with a historical matched control group of patients who had open cholecystectomy. The patients who had LC had a shorter hospital stay, required less postoperative pain medication, resumed normal activities…
In this 5-year prospective study, we determined the feasibility of reducing polypharmacy in a long-term care institution by a systematic review of the pharmacy records. At 6-month intervals, the computer printout of all medications prescribed to patients in a 550-bed institution was reviewed. After patients taking more than 10 different…
In this series, 35 patients with medical renal disease had renal biopsy guided by computed tomography (CT). Biopsies were done by a coaxial technique in which a thin-walled 16 gauge guide needle is placed adjacent to the renal capsule of the lower pole. An 18 gauge cutting needle is then…
Increasing experience with colonoscopy has altered recommendations for the frequency of follow-up surveillance examinations for adenomatous polyps and colorectal cancer. Current recommendations include a follow-up colonoscopy at 1 year for patients with more than two adenomatous or highly suggestive polyps and after curative surgery for colorectal cancer. Other patients can…
Multiple defects in host defense mechanisms produce an increased incidence of community-acquired bacterial pneumonia in individuals infected with the human immunodeficiency virus. Clinical studies suggest that Staphylococcus aureus is an uncommon cause of such infections, though its incidence is increased in the setting of intravenous drug use, indwelling vascular catheters,…
Numerous human studies have shown that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with various gastroduodenal mucosal lesions, collectively referred to as NSAID gastropathy. NSAIDs should not be prescribed unless there is a clear-cut indication for them. Acetaminophen should be used initially to treat most patients with osteoarthritis….
Postoperative ileus following gynecologic surgery can prolong hospitalization and may predispose patients to mechanical obstruction. Our objective was to study the safety and efficacy of a water-soluble, hyperosmolar, radiocontrast material in the management of postoperative ileus in patients having gynecologic surgery. Of 115 cases, 57 were studied prospectively and received…
This report evaluates the motivation of a group of patients to continue a program of pelvic floor musculature exercises as conservative therapy for genuine stress incontinence. Fourteen women with urodynamically documented genuine stress incontinence had subjective improvement; nine of them showed objective improvement after 4 weeks of supervised pelvic floor…
This report represents the first attempt to assemble existing data from a variety of sources regarding children less than 18 years of age in the work force in Texas. These data include the frequency of detected violations of child labor laws, reports of injuries to the Texas Workers' Compensation Commission,…
To determine patterns of medication use based on clinical variables in patients with heart failure, we analyzed data from 5,999 patients participating in the Registry of Studies of Left Ventricular Dysfunction (SOLVD). The Registry comprised a broad spectrum of patients with heart failure, including some with predominantly diastolic dysfunction. Drug…
Vibrio vulnificus, part of the normal marine flora of the Gulf of Mexico, is being increasingly recognized as an important human pathogen. V vulnificus contamination of superficial wounds can cause a severe, rapidly progressive, necrotizing cellulitio with bullous skin lesions that may require surgical debridement and is occasionally fatal. We…
We describe a patient with acquired immunodeficiency syndrome (AIDS) and non-Hodgkin's lymphoma of the duodenum manifested as obstructive jaundice. Endoscopic retrograde cholangiography led to the diagnosis and was used to relieve the obstruction. The patient received chemotherapy and is in remission 21 months after the diagnosis, thus justifying an aggressive…
We examined present and anticipated future levels of career satisfaction among psychiatrists in the greater Houston area. We gathered data by means of an anonymous questionnaire. The strongest univariate correlations between background variables and current and anticipated future levels of career satisfaction were found with age, years in practice, and…
We report a case of perforated solitary jejunal diverticuluum in an 80-year-old woman. Jejunal diverticulosis occurs in 0.07% to 2.0% of the population. Jejunal diverticulitis with perforation is rare and is associated with high mortality. Treatment is surgical resection of the involved segment. Several theories to explain the pathogenesis of…
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