Case Report

Reactive Airways Dysfunction Syndrome: Occurrence After Exposure to a Refractory Ceramic Fiber—Phosphoric Acid Binder Mixture

ABSRACT:A previously healthy, 47-year-old millwright was exposed to high airborne levels of a refractory ceramic fiber-phosphoric acid binder mixture; after acute bronchospasm, he required hospitalization. During the next 4 years, he had recurrent acute bronchospasm requiring emergency department visits and three hospitalizations. Review of the patient's medical and occupational history…

Case Report

Problems in Assessment of Acute Melatonin Overdose

ABSRACT:Melatonin is sold in the United States as a dietary supplement and is promoted primarily as an aid for insomnia, stress, jet lag, and aging. Cases of acute poisoning have not been reported, partially because of problems in assessment of toxicity. We report the case of a 66-year-old man who…

Case Report

Wandering Spleen: A Challenging Diagnosis

ABSRACT:Wandering spleen is rare, particularly in children, and diagnosis is difficult. It usually occurs at 20 to 40 years of age, and most cases are seen in women. Diagnosis is difficult because of lack of symptoms, unless splenic torsion has occurred. Patients usually have an asymptomatic abdominal mass, an acute…

Case Report

Bilateral Persistent Trigeminal Arteries Associated With Cerebral Aneurysms and Aortic Arch Vessel Anomaly

ABSRACT:We present the case of a patient with headache who, on computed tomography, was found to have subarachnoid hemorrhage. Angiography revealed bilateral persistent trigeminal arteries, anterior communicating artery and left pericallosal artery aneurysms, and an absent left vertebral artery. An anomalous right subclavian artery, originating at a common trunk with…

Case Report

Chronic Diarrhea Associated With Thymoma and Hypogammaglobulinemia (Good’s Syndrome)

ABSRACT:We report the case of a patient with severe diarrhea and malabsorption who was subsequently found to have hypogammaglobulinemia and thymoma (Good's syndrome). The mechanism by which hypogammaglobulinemia and/or thymoma causes diarrhea is unclear. It may be related to malabsorption caused by a mucosal lesion resembling villous atrophy, which may…

Case Report

Sarcoidosis Associated With Recurrent Pancreatitis

ABSTRACT: A 56-year-old previously healthy man had two episodes of unexplained pancreatitis in the setting of constitutional symptoms, recurrent palsy of the right seventh cranial nerve, and bilateral parotitis. Chest radiography revealed marked bilateral hilar lymphadenopathy, and sarcoidosis was diagnosed by bronchoscopy with transbronchial biopsy showing noncaseating granulomas. The pancreatitis…

Case Report

Primary Angiosarcoma of the Rib

ABSTRACT: A 64-year-old man had a lytic rib lesion that dramatically increased in size in 4 weeks. A bone scan showed a corresponding photopenic focus. Biopsy revealed a malignant tumor with sarcomatous areas suggestive of angiosarcoma. Review of the literature shows that angiosarcoma is rarely seen as a primary rib…

Current Concepts

Anserine Bursitis: A Brief Review

ABSTRACT: A commonly missed malady of older patients' knees is anserine bursitis, which often accompanies osteoarthritis. I briefly review the condition and discuss physical examination, epidemiology, imaging, differential diagnosis, and treatment.

Primary Article

Videoscopically Assisted Fascia Lata Harvest for the Correction of Recurrent Ventral Hernia

ABSTRACT: Autologous fascia lata tissue transfer is a feasible alternative to reconstruction of the abdominal wall in selected patients. We describe a new technique using minimally invasive technology that allows harvest of the fascia lata graft without the traditional large thigh incision.

Primary Article

Unexpected Opportunities: Incidental Findings Detected During Impairment Evaluations for Coal Workers’ Pneumoconiosis

ABSTRACT: Coal workers' pneumoconiosis impairment evaluations for 374 miners, predominately from eastern Kentucky, were conducted by our department between January 1, 1989, and June 30, 1992. During a review of the cases, potentially significant findings not directly related to any detected pneumoconiosis were recorded. Sixty-five (17.4%) of the men had…

Current Concepts

Current and Investigational Therapies Used to Alter the Course of Disease in Multiple Sclerosis

ABSTRACT: Extensive research is under way to develop pharmacotherapeutic agents that will prevent the exacerbations and the progression of neurologic disability associated with multiple sclerosis (MS). The most intensive research strategy has involved agents intended to limit demyelination by reducing inflammation and modifying the immune response. In this category are…

Primary Article

The Value of Preoperative Mammograms in Nononcologic Breast Surgery

ABSTRACT: It remains unclear whether preoperative mammograms are necessary in young patients having nononcologic breast surgery. Various authors have recommended mammography in all such cases, in conflict with guidelines from the American Cancer Society. We conducted a retrospective study to determine the utility of preoperative mammograms in young women. From…

Primary Article

Vitamin D Levels in Children With Cystic Fibrosis

ABSTRACT: Serum levels of the important hormone 1,25-dihydroxyvitamin D (1,25-diOHD, calcitriol) have not been extensively evaluated in patients with cystic fibrosis (CF) during the critical period of skeletal growth and development. This study was a cross-sectional, observational assessment of 25-hydroxyvitamin D (25-OHD, calcidiol) and 1,25-diOHD levels in 54 patients with…

Primary Article

Home Health Care: Pediatric Education in the Community

ABSTRACT: The purpose of this paper is to describe a curricular innovation involving a community home health care (HHC) experience for third-year medical students as an integral part of a pediatric clerkship. Students at George Washington University are required to participate in an afternoon of HHC visits, one of which…

Primary Article

Transverse Leukonychia in Patients Receiving Cancer Chemotherapy

ABSTRACT: Transverse white nail banding can be inherited or caused by a variety of diseases and medications, including cancer chemotherapeutic agents. We report three cases in which patients with cancer had antineoplastic therapy-induced transverse leukonychia and summarize previously published reports. There is no specific cancer chemotherapeutic drug, combination of drugs,…

Primary Article

Warthin’s Tumor and Cigarette Smoking

ABSTRACT: Warthin's tumor is a relatively uncommon salivary gland neoplasm, traditionally considered a disease of men. Recent reports have brought this assumption into question by identifying a substantial percentage of patients who are women. Furthermore, several reports have attempted to correlate cigarette smoking with development of Warthin's tumor. We retrospectively…

Case Report

Gastric Adenocarcinoma and Low-Grade B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue

ABSTRACT: We describe the synchronous occurrence of gastric signet-ring cell adenocarcinoma and low-grade B-cell lymphoma of mucosa-associated lymphoid tissue in a patient with chronic gastritis and intestinal metaplasia. Histologic features of the mucosal inflammation, a follicular gastritis, were suggestive of a chronic Helicobacter pylori infection. Previous hypotheses concerning the relationship…

Case Report

Asynchronous Bilateral Medullary Carcinoma of the Breast

ABSTRACT: We report a case of bilateral medullary carcinoma of the breast occurring asynchronously in a young woman and review the epidemiology of this form of breast cancer. Clinical and radiographic surveillance are necessary in the follow-up of all women with medullary carcinoma of the breast to ensure that further…

Primary Article

Surgical Morbidity and the Risk of Amputation Due to Infected Puncture Wounds in Diabetic Versus Nondiabetic Adults

ABSTRACT: We reviewed the hospital course of 77 diabetic and 69 nondiabetic subjects who had incision, drainage, and exploration of infected puncture wounds of the foot. Diabetics were 5 times more likely to have multiple operations and 46 times more likely to have a lower extremity amputation than nondiabetics. The…

Case Report

Mesenteric Tumor Emboli Manifested as Recurrent Abdominal Pain

ABSTRACT:Mesenteric tumor emboli have been rarely reported in the literature. Tumors associated with this phenomenon include aortic angiosarcomas, pulmonary neoplasms, Hodgkin's lymphoma, and renal cell carcinoma. In most cases, presentation is dramatic and death is rapid. We present a case of mesenteric tumor emboli from an aortic source that had…

Primary Article

Outcome in Medical Intensive Care Unit Patients Requiring Abdominal Surgery: Prospective Validation of a Risk Classification System

ABSTRACT:To prospectively validate a previously developed two-factor logistic regression model as a predictor of mortality, we studied its effectiveness in predicting outcome for patients in medical intensive care units (ICUs) who had surgical laparotomy. A high-risk classification was assigned to patients with an Organ System Failure Index (OSFI) ≥3 or…

Editorial

‘NATURAL REMEDIES,’ MEDICAL CARE, AND POLITICS

Correspondence

Ascites Associated With Antibiotic-Associated Pseudomembranous Colitis

Correspondence

Clinical Association of Helicobacter pylori Gastritis in Children

Correspondence

Clinical Association of Hellcobacter Pylori Gastritis in Children

Correspondence

Resistance to Gonadotropin-Releasing Hormone Agonist in a Patient With Metastatic Prostate Cancer