Case Report

Recurrent Lower Gastrointestinal Hemorrhage: Ileal Neoplasm Diagnosed by Scintigraphy With Tc 99m Red Blood Cells and Angiography

ABSTRACT: A 71-year-old man with recurrent lower gastrointestinal bleeding had negative colonoscopic findings on three occasions. Preoperative diagnosis of a large stromal tumor in the right lower quadrant was based on scintigraphy with tagged red blood cells and mesenteric arteriographic features. The use of nuclear scintigraphy in the diagnosis and…

Article

Possibilities for Unexplained Chronic Illnesses Among Reserve Units Deployed in Operation Desert Shield/Desert Storm

ABSTRACT: Because Armed Forces Reserve members, especially combat support units, were rapidly mobilized during Operation Desert Shield/Desert Storm, they were at higher risk for anxiety and stress-related disorders. Personnel in reserve units in the military force structure are at greater risk for psychologic stress due to rapid mobilization and demobilization,…

Current Concepts

Approaches to the Treatment of Seasonal Allergic Rhinitis

ABSTRACT: Between 15 and 30 million Americans have allergic rhinitis. Costs of diminished job and school performance extend beyond the financial burden of treatment, taking their toll in worker productivity and school absences. Therapeutic approaches include allergen avoidance, pharmaceuticals, and allergy immunotherapy. Among the pharmaceutical agents, decongestants, anti-inflammatory drugs, and…

Case Report

Delayed Posttraumatic Tamponade

ABSTRACT: Delayed cardiac tamponade is a rare phenomenon with two primary causes: delayed hemorrhage after an acute injury or delayed pericarditis with effusion. We present a case of cardiac tamponade 4 weeks after injury, with findings compatible with delayed hemorrhage and pericarditis. Our case emphasizes the need for follow-up of…

Primary Article

Lewy Body Disease

ABSTRACT: Lewy bodies have historically been considered a histopathologic hallmark of idiopathic Parkinson's disease. Recently, it has become clear that Lewy bodies play a role in neurodegenerative processes other than idiopathic Parkinson's disease, including diffuse Lewy body disease and diffuse Lewy bodies with concomitant Alzheimer's disease changes. It is likely…

Primary Article

Multicentric Castleman’s Disease: Imaging Findings

ABSTRACT: Multicentric Castleman's disease is an unusual lymphoproliferative lesion typically associated with systemic manifestations and specific histopathology. We describe two cases of pathologically proven multicentric Castleman's disease along with radiographic and ultrasonographic findings.

Primary Article

Effect of Pregnancy on Maternal Oxygen Saturation Values: Use of Reflectance Pulse Oximetry During Pregnancy

ABSTRACT: Our objective was to evaluate the usefulness of pulse oximetry monitoring in a large population of pregnant patients. We designed our study to measure pulse oximetry saturation in a cross section of 952 obstetric inpatients and outpatients. A group of 366 patients identified as normal were compared with abnormal…

Primary Article

End-Expiratory Carbon Monoxide Levels as an Estimate of Passive Smoking Exposure Aboard a Nuclear-Powered Submarine

ABSTRACT: Passive smoking is the involuntary inhalation of tobacco smoke by nonsmokers. The purpose of this study was to estimate the degree of passive smoking exposure sustained by smokers and nonsmokers in a nonventilated submarine through the measurement of end-expiratory carbon monoxide (EECO) levels. The initial and final EECO levels…

Primary Article

Effect of Birth Order on Incidence of Periventricular-Intraventricular Hemorrhage in Very Low Birth Weight Twins

ABSTRACT: The purpose of the study was to determine whether the incidence of periventricular-intraventricular hemorrhage (PV-IVH) is significantly different between the firstborn and secondborn of very low birth weight twins. The firstborn and secondborn of 102 sets of twins were compared by incidence of PV-IVH, mode of delivery, birth weight,…

Primary Article

Stress Echocardiography for Predicting Cardiac Events in Octogenarians: is Myocardial Perfusion Scintigraphy Necessary Anymore?

ABSTRACT: The use of stress echocardiography (SE) in an elderly population was retrospectively evaluated and compared with myocardial perfusion scintigraphy (MPS) in a similar group. Patients ≥80 years of age were evaluated by treadmill or pharmacologic SE (group 1; n=65) to determine its predictive value for cardiac events. A second…

Case Report

Inability to Attain Oral Anticoagulation Warfarin-Rifampin Interaction Revisited

ABSTRACT: The warfarin-rifampin interaction is a well-described but underappreciated drug interaction. A case is reported in which therapeutic anticoagulation could not be achieved after nearly 4 weeks of warfarin therapy because of simultaneous administration of rifampin. This patient had the highest warfarin clearance ever reported in the literature. The world's…

Primary Article

Borderline Personality Disorder and Health Care Utilization in a Primary Care Setting

ABSTRACT: We examined health care utilization by subjects with symptoms of borderline personality disorder. The study included 194 female subjects between the ages of 17 and 52 who were consecutively seen for nonemergency medical care in a health maintenance organization. Each subject completed the borderline personality scale of the Personality…

Case Report

Lhermitte-Duclos Disease (Cerebellar Gangliocytoma)

ABSTRACT: We report a case of Lhermitte-Duclos disease (cerebellar gangliocytoma) in a 7-year-old child with café au lait spots and mild cerebellar symptoms. Findings on computed tomography 4 years earlier had been normal. Subsequent development of intracranial hypertension caused by hydrocephalus led to ventriculoperitoneal shunting. The appearance of the cerebellum…

Case Report

Recurrent Massive Hemothorax in Rendu-Osler-Weber Syndrome

ABSTRACT: We report a case of Rendu-Osler-Weber syndrome, occurring as sudden death after two episodes of massive hemothorax. Autopsy revealed massive hemothorax resulting from spontaneous rupture of one of three subpleural arteriovenous malformations. Review of the patient's hospital records showed that she had had a massive spontaneous hemothorax 13 years…

Case Report

Cytomegalovirus Hepatitis Mimicking an Acute Exacerbation of Chronic Hepatitis B

ABSTRACT: We report the case of a 29-year-old woman who had acute cytomegalovirus hepatitis superimposed on previously unrecognized chronic hepatitis B infection. We then review the diagnostic approach to acute hepatitis and positive hepatitis B surface antigen.

Case Report

Combined Sequestration, Bronchogenic Cyst, and Dysgenetic Lung Simulating Congenital Lobar Emphysema

ABSTRACT: We report the case of a newborn with bronchopulmonary sequestration, bronchogenic cyst, and dysgenetic lung that radiographically simulated congenital lobar emphysema. We discuss congenital malformations of the lungs and the concept of a continuum in the development of pulmonary anomalies.

Case Report

Acute Pulmonary Edema Complicating Diagnostic Laparoscopy Preceded by Thoracotomy

ABSTRACT: We report the case of a patient with pelvic endometriosis and recurrent spontaneous pneumothoraces who had thoracotomy and diagnostic laparoscopy, with subsequent acute pulmonary edema. Potential causes are discussed. After a thorough literature search, we believe this to be the first case in which thoracotomy has been combined with…

Primary Article

EMLA Cream as a Topical Anesthetic Before Office Phlebotomy in Children

ABSTRACT: We studied the effectiveness of EMLA cream (2.5% lidocaine, 2.5% prilocaine)in reducing distress, anxiety, and pain associated with phlebotomy in pediatric outpatients. This was a randomized, double-blind, placebo-controlled study using EMLA cream or placebo 1 hour before phlebotomy. Distress, anticipatory anxiety, pain, and adverse reactions were measured. Measurements of…

Current Concepts

Dual Diagnosis: Developmental Disability Complicated

ABSTRACT: When mental retardation is complicated by mental illness, the clinical result is “dual diagnosis.” Though recognized as such only since the 1970s, these patients have long been the subset of the developmentally disabled most resistant to integration into the community. The maladaptive behavior or mental illness often prevents training…

Acknowledgment

ACKNOWLEDGMENT

Correspondence

After the Calomel Rebellion: What Happened to Surgeon General William A. Hammond?

Correspondence

Identification of Foreign Drugs

Correspondence

Is the Syndrome of Inappropriate Secretion of Antidiuretic Hormone Responsible for Hyponatremia in a Patient With Herpes Varicella Zoster Virus?