Primary Article

Attitudes and Knowledge Regarding Breast-feeding: A Survey of Obstetric Residents in Metropolitan Areas of South Korea

ABSTRACT: A 15-minute, 6-page questionnaire on breast-feeding was administered to the obstetric residents in four metropolitan academic training programs in Korea to assess their attitudes toward and knowledge about breast-feeding and their confidence in managing breast-feeding problems. The questionnaires were self-administered and confidential, and the participation rate was 84% (n=76)….

Case Report

Periorbital Varicella Gangrenosa Necessitating Orbital Exenteration in a Previously Healthy Adult

ABSTRACT: A previously healthy 31-year-old man had profound neurologic compromise and necrotizing periorbital infection due to a complication of varicella infection. Despite aggressive treatment, he required orbital exenteration and radical debridement of the involved tissues. He survived in a vegetative state for almost 1 year before succumbing to progressive neurologic…

Case Report

Antiphospholipid Syndrome Associated With Seizures

ABSTRACT: Antiphospholipid antibodies have been associated with thrombosis, fetal wasting, and thrombocytopenia. We discuss a case of antiphospholipid syndrome with the rarely recognized presentation of generalized tonic-clonic seizure during pregnancy. This case emphasizes the need for evaluation of possible hypercoagulable states in young adults with cerebrovascular events or newly diagnosed…

Case Report

Management of Catheter Emboli

ABSTRACT: Catheter emboli are a significant risk to patient well-being. With a 49% complication rate for indwelling catheter emboli, the consensus is that these foreign bodies should be removed. Preferably, the emboli are removed by percutaneous extraction; however, if the emboli are in the heart or central vasculature and percutaneous…

Current Concepts

Normal Sinus Heart Rate: Appropriate Rate Thresholds for Sinus Tachycardia and Bradycardia

ABSTRACT: Conventional rate limits for sinus rhythm—100/min as the tachycardia threshold and 60/min as the bradycardia threshold—were established by consensus and never formally examined. Because clinical experience indicated that both figures were too high, we investigated this formally in 500 normal individuals. Results were consistent with normal data from the…

Case Report

Fatal Cytomegalovirus Pneumonia in a Patient Receiving Corticosteroids and Methotrexate for Mixed Connective Tissue Disease

ABSTRACT: Cytomegalovirus (CMV) pneumonia is a serious illness that may occur in severely immunocompromised patients such as those with bone marrow transplants. A strong association between this condition and immunosuppressive therapy for collagen vascular diseases has not been described. We describe a patient who had CMV pneumonia while receiving methotrexate…

Case Report

Fatal Disseminated Herpes Simplex in Pregnancy With Maternal and Neonatal Death

ABSTRACT: Disseminated herpes is rare in the adult and usually occurs in the immunocompromised. Twenty-one cases have been reported in which healthy women contracted life-threatening disseminated herpes simplex virus (HSV) infections in the third trimester of pregnancy. Most of these patients had nonspecific symptoms, and many did not have mucocutaneous…

Primary Article

Changes in Employee Smoking Behavior After Implementation of Restrictive Smoking Policies

ABSTRACT: How do restrictive smoking policies affect the smoking behavior of employees? At two federal hospitals, 2,700 employees completed written surveys after implementation of restrictive smoking policies. At one hospital, smokers reported less smoking at work (down 2.0 cigarettes a day at 6 months, 1.7 at 12) without compensatory smoking….

Primary Article

Postoperative Pulmonary Changes After Laparoscopic Cholecystectomy

ABSTRACT: Laparoscopic cholecystectomy (LC) has been widely used in recent years because of short postoperative hospital stays and low morbidity. In this study, 24 patients were prospectively evaluated with preoperative and postoperative spirometry, arterial blood gas determinations, and chest radiographs to quantitate the magnitude of postoperative pulmonary changes after LC….

Case Report

Marjolin’s Ulcer of the Foot Caused by Nonburn Trauma

ABSTRACT: Marjolin’s ulcers are malignancies that arise from previously traumatized, chronically inflamed, or scarred skin. We report a case of squamous cell carcinoma arising in a foot wound 42 years after the time of injury. The historical background, epidemiology, pathophysiology, diagnosis, treatment, and prognosis of Marjolin’s ulcer are reviewed. Diagnosis…

Current Concepts

Surgical Management of Malignant Tumors of the Adult Bony Spine

ABSTRACT: Modern diagnostic imaging techniques and new methods for anterior and posterior decompression and reconstruction of the bony spinal column have dramatically improved the surgeon’s ability to treat malignant tumors of the adult bony spine. The day of the laminectomy and Harrington rod reconstruction has passed, and an aggressive surgical…

Clinical Review

Hansen’s Disease

ABSTRACT: Physicians in the United States may encounter Hansen’s disease in immigrants and in patients from endemic areas such as Texas, Louisiana, Hawaii, and California. Exposure to infected armadillos may be one means of acquiring the disease. The Mycobacterium leprae bacillus has a predilection for nerves and skin in the…

Primary Article

Improvement in Oxygenation After Large Volume Paracentesis

ABSTRACT: Seventeen patients with biopsy-confirmed hepatic cirrhosis and tense ascites performed reproducible pulmonary functions and had arterial blood gas analysis before and after having a therapeutic large volume paracentesis. Each patient showed significant improvement in the static lung volumes as determined by helium dilution techniques. Dynamic airflow also improved as…

Primary Article

Laparoscopic Versus Open Appendectomy

ABSTRACT: This prospective clinical study was done because our initial retrospective review suggested that laparoscopic appendectomy (LA) offers no significant advantages over open appendectomy (OA) yet is significantly more expensive. From July 1992 to August 1993, 57 patients were approached preoperatively for randomization to either LA (n=19) or OA (n=18)….

Primary Article

Persistent Neurotoxicity From a Battery Fire: Is Cadmium the Culprit?

ABSTRACT: Two train conductors had chest tightness, painful breathing, muscle cramps, and nausea after fighting a fire in a battery box under a passenger coach. Shortly thereafter, they became anosmic and had excessive fatigue, persistent headaches, sleep disturbances, irritability, unstable moods, and hypertension. Urinary cadmium and nickel levels were elevated….

Primary Article

Prediction of Cure of Hypertension in Atherosclerotic Renal Artery Stenosis

ABSTRACT: We analyzed the outcome of 63 consecutive, adequate interventions for atherosclerotic renal artery stenosis and hypertension: 34 patients had percutaneous transluminal renal angioplasty, and 29 had surgical correction. Hypertension was cured in 21% of patients and improved in 47%, but 32% failed to respond. We analyzed clinical variables predictive…

Case Report

Infant Diabetic Ketoacidosis in the Emergency Department

ABSTRACT: We present the case of an infant brought to the emergency department with complaints commonly associated with a typical childhood illness. Surprisingly, he was found to have diabetes mellitus with ketoacidosis. The usual symptoms of polyuria, polydipsia, and weight loss attributed to diabetes mellitus were not observed. A fruity…

Case Report

Thyrotoxic Periodic Paralysis in a Black Man

ABSTRACT: We report a case of thyrotoxic hypokalemic periodic paralysis occurring in a black man. This previously healthy 41-year-old man had a 3-year history of recurrent paroxysmal episodes of paresis in the upper and lower extremities proximally, often occurring after heavy exercise. The patient had no history of hyperthyroidism, nor…

Case Report

Apical Hypertrophic Cardiomyopathy

ABSTRACT: We report the case of a patient with recurrent admissions for congestive heart failure who was subsequently diagnosed with apical hypertrophic cardiomyopathy. The major physiologic characteristic of patients with apical hypertrophic cardiomyopathy is diastolic dysfunction due to abnormal stiffness of the left ventricle during diastole, with resultant impaired ventricular…

Case Report

Disseminated Epidemic Kaposi’s Sarcoma Treated With Radiation and Chemotherapy

ABSTRACT: When a 40-year-old patient with end-stage acquired immunodeficiency syndrome (AIDS) had bloating and abdominal pain, a large epidemic Kaposi’s sarcoma (EKS) lesion was found obstructing the pylorus. Treatment consisted of single-agent chemotherapy for the disseminated lesions and external beam irradiation to the obstructing lesion. Within days of radiation therapy,…

Correspondence

Material Serum Amylase and Lipase Profiles in Pregnancy

Correspondence

Maternal Serum Amylase and Lipase Profiles in Pregnancy, Reply

Correspondence

Pulmonary Strongyloidiasis