ABSTRACT: A 46-year-old man with fever and pancytopenia was found to have a myelodysplastic syndrome. During the course of the illness, he had localized cervical tuberculous lymphadenitis. We believe this association of the myelodysplastic syndrome with localized tuberculosis has not been previously described.
ABSTRACT: A physician education program altered the consumption of hospital resources by orthopedic surgeons doing total hip replacement. They were presented with verbal and written physician-specific materials during a 7-week period. Xbar and R charts were used to display measurements of resource consumption before and after the educational program. Physicians…
ABSTRACT: An otherwise healthy 57-year-old man was found to have an early stage, high-grade, non-Hodgkin's lymphoma (NHL) of the spermatic cord. A plan of treatment involving surgery, radiation therapy, combination chemotherapy, and central nervous system prophylaxis was recommended. He did not complete the recommended treatment plan, and subsequently returned with…
ABSTRACT: Asthma and cocaine abuse are both common. While cocaine has been associated with numerous pulmonary complications, only smoking cocaine has been clearly linked to the precipitation of life-threatening exacerbations of asthma. We report a case in which nasal insufflation of cocaine (“snorting”) triggered a near-fatal asthmatic attack.
ABSTRACT: Hantavirus is a rodent-borne pathogen that has been well characterized since the 1950s in Asia and Northern Europe. The classic hantaviral illnesses hemorrhagic fever with renal syndrome and nephropathia epidemica are indistinguishable from the hantaviral pulmonary syndrome (HPS) in early symptoms and laboratory data, but HPS goes on to…
ABSTRACT: In the context of increasing flank pain, hematuria, lack of toxicity, and absence of a stone on imaging studies, the cause may be a urinary tract infection due to Staphylococcus saprophyticus. When symptoms suggest renal lithiasis but intravenous pyelogram, renal ultrasonography, or renal cortical scan is negative for obstructive…
ABSTRACT: In this study, 26 patients (average age, 44.3 years) with chronic noncancer pain averaging 115 months' duration had implantation of an infusion pump with intrathecal catheter placement. In general, preservative-free morphine sulfate was used. Average follow-up was 23 months. Measurements of pain reduction, activity improvement, oral medication use, and…
ABSTRACT: Infection due to Helicobacter pylori may be associated with gastritis and peptic ulcer disease in children. The aim of this study was to compare the presentation of gastritis due to H pylori with that of gastritis not associated with H pylori infection. The medical records of 296 children who…
ABSTRACT: Leiomyomatosis peritonealis disseminata (LPD) is an exceedingly rare, usually benign condition that clinically simulates a disseminated malignancy. It occurs predominantly in women of childbearing age. Approximately 50 cases of LPD have been described in the literature with 2 cases reported to have progressed into aggressive leiomyosarcomas. Excessive hormonal stimulation…
ABSTRACT: Magnetic resonance imaging showed a massive intracranial invasion by an adenoid cystic carcinoma (cylindroma) originating from an ethmoid sinus. The tumor was excised and follow-up radiation therapy was planned because of bone involvement and superficial invasion of the right olfactory tract area.
ABSTRACT: Mammography of an asymptomatic Filipino woman revealed microcalcifications suggestive of carcinoma. Excisional biopsy of the breast showed that the mass was caused by calcified ova of Schistosoma japonicum.
ABSTRACT: Multiple sclerosis (MS) is among the most crippling diseases of the nervous system in young adults, and diagnosis can be difficult. It is true that MS can exist without magnetic resonance imaging or cerebrospinal fluid abnormalities, but whenever there are an atypical clinical pattern and no confirmatory laboratory tests,…
ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for analgesic, anti-inflammatory, and antithrombotic indications. Such use carries the risk of significant side effects on nontarget organs, especially the gut. Some of these effects may be serious, especially among the elderly, whose NSAID use is proportionately greatest. Upper gastrointestinal mucosal lesions…
ABSTRACT: Recurrent intracranial meningioma with multiple pulmonary metastases is rare. In this case, the initial tumor had been diagnosed and removed 10 years earlier, and subsequent locally recurrent tumors were removed three times. Nine pulmonary metastases were discovered and resected recently. The metastatic lesion was confirmed as meningioma or arachnoidocytoma…
ABSTRACT: Superior mesenteric artery (SMA) syndrome is a form of small-bowel obstruction due to vascular compression of the duodenum. We describe a case of SMA syndrome in an intravenous drug abuser who had rapid weight loss during a 2-week drug binge. Radiographic studies are necessary to confirm the diagnosis, and…
ABSTRACT: The increased resistance, intolerance, or allergy to trimethoprim/sulfamethoxazole (TMP/SMX) has brought much attention to alternative treatment of pneumonia caused by Pneumocystis carinii (PCP). Pentamidine is considered when there is documented allergy or intolerance to TMP/SMX. Similarly, either dapsone/trimethoprim or clindamycin/primaquine is effective in the treatment of mild to moderate…
ABSTRACT: The transverse thoracosternotomy provides excellent exposure for repair of lesions involving the entire thoracic aorta. This approach has been made more feasible by other recent technical advances, such as retrograde perfusion of the brain during circulatory arrest, allowing single-stage replacement of the ascending and descending aorta and aortic arch….
ABSTRACT: Thoracobiliary communications in the form of either pleurobiliary or bronchobiliary fistulas are reported complications of many diseases. A strong suspicion in the appropriate clinical setting is necessary to recognize this problem. Bilioptysis is the sine qua non of a bronchobiliary fistula. Diagnostic imaging studies are useful to identify the…
ABSTRACT: We describe a case of acute human immunodeficiency virus infection that initially appeared to be bacterial sepsis. A marked increase in band forms was seen in the peripheral blood of our patient, with no increase in atypical lymphocytes. Having reviewed the most recent literature, we find this to be…
ABSTRACT: We modified a European questionnaire, the Standard Shiftwork Index, in syntax and length for application to workers of an American continuous operations petrochemical company in southeast Texas. Three groups of male employees—147 day workers, 107 8-hour backward rotating shift workers, and 107 12-hour shift workers—were surveyed for sleep quality,…
ABSTRACT: We report a case of eosinophilic enteritis associated with an ill-defined connective tissue disorder. The case was complicated by intestinal perforation and managed successfully without surgical intervention. No peripheral blood eosinophilia was present. Histologic examination of an intestinal biopsy revealed bands of eosinophils and mast cells at the base…
ABSTRACT: We report the case of an 18-year-old man with hemolytic-uremic syndrome (HUS) having a classic clinical presentation and diagnostic renal pathology without evidence of microangiopathic hemolytic anemia (MAHA) by peripheral blood smear. Indirect evidence of hemolysis was suggested by mild anemia, elevation of serum lactate dehydrogenase, and examination of…
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