ABSTRACT: A 40-year-old man with diabetes mellitus, congestive heart failure, alcoholic cirrhosis, and chronic pancreatitis had an exacerbation of pancreatitis due to alcohol abuse. His condition deteriorated rapidly with development of apparent sepsis; cultures were negative. He slowly improved with multiple antibiotic therapy and total parenteral nutrition. Serial imaging of…
ABSTRACT: A 55-year-old man was admitted to the hospital with chest pain and electrocardiogram consistent with the diagnosis of evolving myocardial infarction. Treatment with streptokinase was administered, resulting in clinical and electrocardiographs signs of reperfusion. Hypotension and ST segment elevation occurred 2 hours later and cardiac catheterization was done. At…
ABSTRACT: A 7-month-old immunocompetent child was brought to the emergency department with fever and diarrhea. Blood and stool cultures grew Campylobacter species. Campylobacter bacteremia resolved without treatment.
ABSTRACT: A pregnant patient with gallstone-induced pancreatitis initially responded to medical treatment, but the pancreatitis recurred. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy were done at 28 weeks' gestation. The remainder of the pregnancy was unremarkable. Although 20 cases of laparoscopic cholecystectomy have been reported for cholecystitis during pregnancy, this is…
ABSTRACT: Adrenal myelolipomas are nonfunctioning benign tumors composed of hematopoietic elements and mature adipose tissue. These tumors usually remain small and asymptomatic; occasionally, however, they reach massive proportions and become symptomatic. To date, only two giant adrenal myelolipomas ( >4,000 g) have been described in the literature. We describe the…
ABSTRACT: Although cytomegalovirus (CMV) is commonly found in the lungs of patients with acquired immunodeficiency syndrome (AIDS), CMV is an infrequent cause of pneumonia in AIDS. We describe an unusual case of proven CMV pneumonia in an AIDS patient that manifested as a large mass on chest radiography and computed…
ABSTRACT: Aminoglycosides have been reported to cause tetany by inducing renal wasting of magnesium and secondary hypocalcemia. A 9-year-old girl with AIDS was brought to the emergency department because of tetany. She had just finished a 3-week course of intravenous tobramycin for bronchiectasis and had an elevated serum tobramycin trough…
ABSTRACT: Bone remodeling results from the adaptation of bone to the stresses that act upon it. The insertion of an endoprosthesis into a femur changes the stress distribution within the femur, causing the bone to remodel. In this paper, we show how radiographic bone remodeling changes can be used to…
ABSTRACT: Calciphylaxis is a rare condition found in patients with end-stage renal disease and secondary hyperparathyroidism. We describe two cases of prominent cutaneous manifestations of calciphylaxis in which skin lesions were refractory to topical treatments. We also include a brief description of calciphylaxis.
ABSTRACT: Extensive urethral defects in the presence of insufficient local skin can challenge the reconstructive urologist. We report a case of complete anterior urethral loss due to Fournier's gangrene that was successfully reconstructed using autologous buccal mucosa. A 17.5 x 2.5 cm tube graft was harvested, extending from the left…
ABSTRACT: Factors associated with cumulative trauma disorders (CTDs) of the upper extremities were studied retrospectively, using data from three apparel manufacturing plants in the southeastern United States. Reported CTDs among the employees at risk during fiscal years 1991 and 1992 were analyzed focusing on individual and plant variables. Results showed…
ABSTRACT: Gas gangrene is a life-threatening emergency. Most cases are caused by clostridial infections, but nonclostridial causes are being increasingly recognized. Nonclostridial gas gangrene is most often due to polymicrobial organisms. Early diagnosis and therapy are required, since the disease may rapidly progress to fatal toxemia. We report a case…
ABSTRACT: One of the foremost problems in evaluating patients who have had spinal surgery is the difficulty in reliably assessing changes in symptoms and function attributable to the operative procedure. In this study, a questionnaire was sent to patients who had had spinal surgery at least 6 months earlier. The…
ABSTRACT: Religious objections to the autopsy are as old as autopsies themselves. The development of anatomic studies was hindered in ancient eras, as well as in more recent times, by spiritual views occasionally hostile to the opening of bodies. This review addresses historical and recent attitudes of the three major…
ABSTRACT: Residual or recurrent stones in the common bile duct can pose a difficult diagnostic problem in the symptomatic postcholecystectomy patient. Although incrustation of unabsorbed suture material is the most important cause of stone recurrence in the common bile duct after surgery, hemostatic clips may also (though rarely) provide a…
ABSTRACT: Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential…
ABSTRACT: The long-term safety and effectiveness of calcipotriene 0.005% ointment has been evaluated in the treatment of 397 patients with stable plaque psoriasis. In this multicenter, open-label clinical investigation, the psoriasis characteristics of scaling, erythema, and plaque elevation and overall disease severity were evaluated periodically. Patients were carefully questioned and…
ABSTRACT: This review of osteoarthritis of the knees in the elderly touches on the clinical presentation and examination, epidemiology, etiology, radiologic characteristics, and origin of the pain. The discussion includes drug treatment, intra-articular drug use, nondrug therapy, and the role of arthroscopy and joint lavage.
ABSTRACT: To determine which type of patient should receive routine postoperative nasogastric decompression (NGD), we observed 76 patients who were randomized into two groups: those who received routine NGD (n=39) and those who received selective NGD (n=37). Eighteen patients in the selective NGD group never required intubation, while 19 did…
ABSTRACT: To investigate physicians' use of computed tomography (CT) of the chest and their attitudes regarding the risks and benefits of chest CT, we conducted a nationwide survey of 1,000 board certified physicians from several specialties of medicine, using a self-administered mail questionnaire. Three hundred thirteen surveys were completed. Overall,…
ABSTRACT: To show the usefulness of the Society of Thoracic Surgeons (STS) National Database in providing clinical and cost-related outcome data, we studied 297 consecutive patients who had isolated coronary artery bypass grafting (CABG) and who were assigned to either a “fast track” or traditional track. The observed overall mortality…
ABSTRACT: Tumors of the pineal region are rare but pose interesting diagnostic and therapeutic challenges. A diverse group of neoplasms may occur in the pineal region, and correct histologic diagnosis is critical to proper management of the disease. To emphasize the need for tissue diagnosis, we present five cases of…
ABSTRACT: Two cases of fentanyl-induced muscle rigidity are presented. Significant features of these cases include the unusual pattern of rigidity and the use of fentanyl doses lower than those usually associated with muscle rigidity.
ABSTRACT: We describe the case of a 56-year-old woman with terminal metastatic breast cancer who had delirium in the form of frightening hallucinations, paranoid delusions, and nightmares resulting in violent agitation. During this period, her bone pains from metastases were well controlled with narcotic analgesics, but her delirium proved refractory…
ABSTRACT: We report a case of severe oxidative hemolysis and rhabdomyolysis in a patient with sickle cell trait and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The patient was a 34-year-old black man admitted 24 hours after vigorous exercise with myalgias, malaise, myoglobinuria, anemia, low haptoglobin, and a peripheral blood smear with bite…
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