ABSTRACT: A 19-year-old construction worker from Virginia who had traveled in Bolivia had sporotrichoid lesions on the left arm. Only after unsuccessful therapy for sporotrichosis was a diagnosis of cutaneous leishmaniasis considered. Biopsies revealed necrotizing granulomatous changes, and culture of the biopsy specimens grew Leishmania (Viannia) braziliensis. The sporotrichoid pattern…
ABSTRACT: A patient with a large paraesophageal hernia had a Nissen fundoplication via laparoscopy. He returned a year later with the transverse colon herniated into the chest. At operation, the hernia ostium was found to be the aortic hiatus. We believe that the original ostium was missed because of the…
ABSTRACT: A radiographic hallmark in pulmonary agenesis is opacification of the ipsilateral hemithorax with displacement of the mediastinum in the direction of the agenetic lung. We believe this case report is the first in which the mediastinum was not displaced; instead, the liver and intact hemidiaphragm were displaced cephalad, preventing…
ABSTRACT: Dermatomyositis (DM) has been associated with gastrointestinal malignancy but not with polyps or adenoma. We report a case of villous adenoma associated with DM. An 80-year-old white woman was referred for a rash of 2 months' duration that was suggestive of DM. On examination, Gottron's papules and heliotrope rash…
ABSTRACT: Diagnosis of vertically acquired human immunodeficiency virus (HIV) infection is often difficult because of transplacentally acquired maternal antibodies. The polymerase chain reaction (PCR) test is commercially available and has high sensitivity and specificity. To evaluate the usefulness of PCR testing in the early diagnosis of perinatally acquired HIV infection,…
ABSTRACT: During a period of 7 years at our institution, four girls and one boy with Down's syndrome, ages 9 to 16 years, were examined and treated for hyperthyroidism. Two patients had Graves' disease and they responded to propylthiouracil (PTU) with a predictable clinical course resulting in remission within 4…
ABSTRACT: Eagle's syndrome occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. In adults, the styloid process is approximately 2.5 cm long, and…
ABSTRACT: Elderly patients with community-acquired pneumonia may not have a systemic inflammatory response characterized by fever and leukocytosis. We compared lack of fever and leukocytosis with mortality in elderly patients with community-acquired pneumonia. Patients with fever and leukocytosis (group A, 47 patients) were compared with those without fever and leukocytosis…
ABSTRACT: Hepatic adenoma is an unusual complication of pregnancy. Most of these lesions are solitary and associated with hormonal contraceptives. We believe ours is the first case of successful resection of multifocal hepatic adenoma during pregnancy in a patient with no history of oral contraceptive use.
ABSTRACT: Hepatitis due to herpes simplex virus (HSV) is unusual in healthy individuals. To date, only 56 cases of HSV hepatitis in adult patients have been reported, including 21 pregnant patients. We describe a 25-year-old white woman in her 30th week of gestation who had progressive acute hepatitis. Histologic examination…
ABSTRACT: Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern encountered by orthopaedic surgeons. We review 11 cases of this fracture pattern. Treatment was by reduction and stabilization of the femoral neck fracture with one or more cannulated screws, followed by fixation of the femoral shaft using…
ABSTRACT: Mucormycosis historically has caused substantial morbidity with high mortality in renal transplant patients with disseminated and/or rhinocerebral infection and in patients with gastrointestinal illness regardless of predisposing conditions. We report the first successful treatment of gastric mucormycosis in a renal transplant recipient and review presumed pathogenic mechanisms of mucormycosis…
ABSTRACT: The Diabetes Control and Complications Trial has conclusively established that intensive control of insulin-dependent diabetes mellitus in persons aged 19 to 26 years (almost exclusively white, normotensive, nondyslipidemic, of normal weight, and insulin sensitive) reduces by ± 50% the likelihood of retinopathy, nephropathy, and neuropathy. In contrast, persons with…
ABSTRACT: This study compares the rate of mental disorders in children and adolescents with sickle cell disease with the rate in a corresponding control population. Using the clinical interview, a diagnosis based on DSM-III-R criteria for the presence of 13 mental disorders common to childhood was considered in a sequential…
ABSTRACT: To assay and profile chronic neurobehavioral impairment associated with chlordane exposure in symptomatic patients, consecutive evaluations of nine patients were done with sensitive neurophysiologic and neuropsychologic tests for neurobehavioral function. Their visual fields, balance, reaction time, blink, color discrimination, grip strength, cognitive function, recall, memory, and perceptual motor speed…
ABSTRACT: To define the role of ambulatory pH monitoring in evaluating chronic cough, we studied esophageal pH values of patients referred to a gastroenterology laboratory. Chronic cough was evaluated in 31 patients, who were grouped based on response to treatments; 11 patients (35.5%) had gastroesophageal reflux (GER)-related cough, 11 (35.5%)…
ABSTRACT: Transjugular intrahepatic portosystemic shunt (TIPS) is a recently introduced angiographic technique for achieving portal decompression. New invasive radiographic procedures such as TIPS can result in radiation exposure equal to that received by patients during radiation therapy. With these high doses of radiation, patients are at increased risk for radiodermatitis…
ABSTRACT: We recently encountered a case of recurrent non-Hodgkin's lymphoma manifested after a long period of quiescence as bilateral involvement of the breasts. This 37-year-old woman had stage IVA nodular poorly differentiated lymphocytic lymphoma diagnosed 9 years previously and was followed up without treatment. She was lost to follow-up after…
ABSTRACT: We report a case of symptomatic pleural collection of cerebrospinal fluid caused by a ventriculopleural shunt in a 4-year-old child. Since ventriculopleural shunts are not commonly used in the management of hydrocephalus, primary physicians must be aware of this potential complication.
ABSTRACT: With increasing evidence of the effectiveness of mass screening in reducing mortality from both cervical and breast cancer, we began to study the rates of cervical cytology and mammography in 1994 for its impact on increased efforts to gain participation among its target population, the Sioux Indian women. Data…
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