Case Report

Persistent Pain Associated With Long-term Intrathecal Morphine Administration

ABSTRACT: A 32-year-old man with chronic intractable right lower extremity pain unresponsive to multiple neurosurgical and pharmacologic treatments, including intrathecal morphine administration, was successfully treated with sciatic nerve block, discontinuance of opioid therapy, and psychologic interventions. Plasma and urine ratios of morphine metabolites morphine-3-glucuronide and morphine-6-glucuronide were analyzed at the…

Case Report

Spontaneous Resolution of a Lung Mass Due to Infection With Mycobacterium terrae

ABSTRACT: A 61-year-old smoker had a large right lung mass suggestive of bronchogenic carcinoma. Bronchoscopy showed what appeared to be tumor occlusion of a right middle lobe subsegment. Biopsies were nondiagnostic for malignancy. A scheduled percutaneous needle aspiration biopsy 1 week later was canceled because of a significant reduction in…

Case Report

Renal Cell Carcinoma and Autoimmune Hemolytic Anemia

ABSTRACT: A previously healthy man who became bedridden because of malaise, fatigue, and weakness was found to have an autoimmune hemolytic anemia (AIHA). In the course of his evaluation for the AIHA, he was found, coincidentally, to have a renal cell carcinoma. The AIHA was marginally responsive to therapy with…

Case Report

Probable Transfusion-Associated Graft-Versus-Host Disease in a Patient With Tuberous Sclerosis

ABSTRACT: Acute transfusion-associated graft-versus-host disease (TA-GVHD) is rare but often fatal. Graft-versus-host disease that occurs as a complication of bone marrow transplantation is more common but has lower mortality. Features of TA-GVHD are nonspecific and can be confused with viral infections and drug reactions. We present a case of probable…

Case Report

The Oldest Reported Patient With Fibromuscular Dysplasia of the Renal Artery

ABSTRACT: An 80-year-old woman was brought to the emergency department with accelerated hypertension. Multiple medical regimens failed, including an angiotensin-converting enzyme inhibitor, which caused acute renal failure. Results of a renal scan for captopril were negative; renal arteriogram revealed fibromuscular dysplasia of the right renal artery. Percutaneous transluminal angioplasty was…

Primary Article

Ingestion of Angel’s Trumpet: An increasingly Common Source of Toxicity

ABSTRACT: Angel's trumpet is a hallucinogenic plant commonly cultivated as an ornamental in the southeastern United States. Consumption of any part of the plant may result in severe anticholinergic toxicity. In past years, toxicity has largely resulted from accidental ingestion, but in 1994 there was a ten-fold increase in the…

Case Report

Wegener’s Granulomatosis Mimicking a Sternal Abscess

ABSTRACT: Bone destruction as a manifestation of Wegener's granulomatosis has been reported, but these cases were limited to the head and face. We present a case in which a sternal abscess was the initial manifestation of Wegener's granulomatosis. We believe this is the first reported case of bone destruction due…

Primary Article

Established Adult Respiratory Distress Syndrome Successfully Treated With Corticosteroids

ABSTRACT: In 1990, we described the treatment of established adult respiratory distress syndrome (ARDS) with a sustained course of adrenocortical steroids (ACS). This report updates our experience with an uncontrolled prospective series. Patients with ARDS of more than 3 days' duration were initially given ACS in intravenous dosages of 125…

Primary Article

Autopsy Evaluation of Asbestos Exposure Retrospective Study of 135 Cases With Quantitation of Ferruginous Bodies in Digested Lung Tissue

ABSTRACT: In recent years, there has been increased interest in documenting asbestos exposure. The pathologic sine qua non of asbestos exposure has been the presence of “asbestos bodies” in lung parenchyma. In this retrospective study of 135 autopsies done to determine asbestos exposure, ferruginous bodies in digested lung tissue were…

Primary Article

Firearm-Related Hunting Fatalities in North Carolina: Impact of the ‘Hunter Orange’ Law

ABSTRACT: In the decade spanning 1983 through 1992, 68 people were killed by firearms while hunting in North Carolina (average of 1.66 fatalities/100,000 licenses issued). Of these, 58 deaths involved two parties, a shooter and a victim. In 22% of the incidents the victims were mistaken for game. During the…

Case Report

Laryngoceles and Saccular Cysts

ABSTRACT: Laryngoceles and saccular cysts are related, benign abnormalities of the larynx. The pathophysiology of both lesions can involve congenital as well as acquired factors, and the appearance of both may range from incidental findings on laryngoscopy to symptoms such as hoarseness, dysphagia, dyspnea, and laryngeal discomfort. The surgical techniques…

Primary Article

Optimization of Radiation Dose and Image Quality in Mammography: A Clinical Evaluation of Rhodium Versus Molybdenum

ABSTRACT: Mammography was done with a conventional molybdenum anode/filter combination and either a molybdenum/rhodium (Mo/Rh) or rhodium/rhodium (Rh/Rh) combination to compare the contrast characteristics and penetrating ability of the different techniques. Each pair was rated as being equal, one slightly better than the other, or one much better than the…

Case Report

Massive Asymmetric Virginal Breast Hypertrophy

ABSTRACT: Massive unilateral virginal breast hypertrophy in a 13-year-old girl was treated by right breast reduction, with removal of 2,968 g of breast tissue. A year later, the patient had enlargement of the left breast, and contralateral reduction mammoplasty was done. Two-year follow-up has shown no further enlargement. This case…

Primary Article

Headache Prevention in Retrosigmoid Vestibular Nerve Section

ABSTRACT: Most disorders of the inner ear resulting in vertigo can be managed medically with good results. Meniere's disease, one of the more common causes of recurring vertigo, does not respond adequately to medical management in 5% of the cases. These patients become candidates for surgical management. Selective vestibular nerve…

Primary Article

Low Incidence of Hemodynamic Instability in Patients With Gastrointestinal Hemorrhage

ABSTRACT: Patients with gastrointestinal hemorrhage are frequently admitted to critical care units, in large part to be observed for signs of hemodynamic instability. All patients admitted with gastrointestinal bleeding to our medical intensive care unit over a 1-year period (n = 108) were retrospectively reviewed to determine the incidence of…

Case Report

Pneumocystis carinii Pneumonia With an Atypical Granulomatous Response

ABSTRACT: Pneumonia due to Pneumocystis carinii may present atypical radiographic and pathologic findings. We report the case of a 32-year-old man with acquired immune deficiency syndrome (AIDS) whose chest roentgenogram showed a bilateral diffuse nodular pattern suggestive of miliary tuberculosis. Diagnosis ultimately required open lung biopsy, which showed evidence of…

Case Report

Early Recognition of Risk Factors for Persistent Effects of Vecuronium

ABSTRACT: Renal failure and hepatic failure are important risk factors for persistent effects of vecuronium. We report a case in which vecuronium therapy after cardiac arrest led to prolonged paralysis due to severe renal and hepatic dysfunction not apparent until after vecuronium therapy. Biochemical and electrophysiologic examinations confirmed that neuromuscular…

Primary Article

Causes of Gastrointestinal Hemorrhage in Neonates and Children

ABSTRACT: The causes of gastrointestinal hemorrhage in children were detailed in 1964 by Spencer. We investigated the causes of gastrointestinal hemorrhage in 165 children seen at our institution over a 13-year period. The most common causes of gastrointestinal hemorrhage in the hospitalized patients were necrotizing enterocolitis (44%), anal fissures (23%),…

Case Report

Coxsackievirus-Associated Pancreatitis Mimicking Metastatic Carcinoma

ABSTRACT: The origin of idiopathic acute pancreatitis has not been well defined. Several enteroviruses, including coxsackievirus, have been implicated. We report the case of a 21-year-old woman with severe, acute pancreatitis with no classic risk factors. Initial evaluation failed to show choledocholithiasis. Her condition improved with conservative treatment, but symptoms…

Primary Article

Diagnostic Value of Clinical Examination and Various Imaging Techniques for Breast Implant Rupture as Determined in 81 Patients Having Implant Removal

ABSTRACT: To determine sensitivity and specificity of magnetic resonance imaging (MRI) and ultrasonography (US) in the detection of breast implant rupture, and also to determine the relative merits of clinical examination and mammography, we studied 81 patients (160 implants). All patients had implants removed, thus allowing confirmation of the presence…

Case Report

Chronic Myeloid Leukemia Manifested During Megakaryoblastic Crisis

ABSTRACT: We describe a 38-year-old man with a chronic myeloproliferative syndrome characterized by elevated white blood cell and platelet counts and increased blasts in the peripheral blood. Bone marrow aspiration was a “dry tap” and the biopsy specimen was hypercellular 'with numerous blasts, atypical megakaryocytes, and increased reticulin fibrosis. The…

Case Report

Successful Double Bypass Grafting in a Child With Coronary Artery Obstruction Due to Kawasaki Disease

ABSTRACT: We describe the clinical evaluation and surgical treatment of a 7-year-old child who had severe coronary artery obstructions that occurred as a sequela of previously diagnosed Kawasaki disease.

Case Report

Cutaneous Lesions Due to Pleurophoma (Phoma) Complex

ABSTRACT: We report a case of striking and disfiguring facial mycosis due to an organism belonging to the Pleurophoma complex of Coelomycetes. This condition was likely acquired through repeated contact with infected soil and exacerbated by prolonged application of topical corticosteroid preparations. Antifungal drug susceptibility testing was used to direct…

Correspondence

“False-Positive” Factitious Disorder by Proxy

Editorial

ADULT RESPIRATORY DISTRESS SYNDROME LEARNING LESSONS FROM THE PAST

Correspondence

Poorly Differentiated Adenocarcinoma in a Gastric Hyperplastic Polyp