SMJ // September 1997, Volume 90 - Issue 9

Primary Article

Air Bags Alone Compared With the Combination of Mechanical Restraints and Air Bags: Implications for the Emergency Evaluation of Crash Victims

Abstract Background.Air bags (ABs) may be perceived by the public and physicians as protection for thoracoabdominal injuries. This study compares injury patterns when air bags are used alone with injury patterns when air bags plus mechanical restraints (MRs) are used. Methods.Patients treated over a 4-year period with emergency medical services-documented…

Primary Article

Is There an Anatomic Explanation for Chest Pain in Patients With Pulmonary Sarcoidosis?

Abstract Background.Chest pain (CP), its cause unknown, is a common and often prominent symptom of sarcoidosis. Methods.We determined the frequency and character of CP in patients with pulmonary sarcoidosis and examined its relationship with (1) length of time since diagnosis, (2) roentgenographic stage, and (3) radiographic abnormalities on spiral chest…

Clinical Review

Diagnosis, Prophylaxis, and Treatment of Headaches in the Athlete

Abstract Background.Headaches are a common entity in the ambulatory population. Physicians involved in sports medicine must be able to accurately diagnose headaches in athletes and whether they are exacerbated by exertion. Many medications have proven or theoretical negative effects on athletic performance. Thus, we should consider all aspects of medical…

Clinical Review

Chronic Hepatitis C

ABSTRACT Background.Infection with the hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide. Epidemiologic and natural history studies have helped to define the clinical impact of HCV infection, and molecular diagnostic assays have established clinical endpoints against which therapeutic regimens are currently tested. The absence of…

Primary Article

Oxidative Stress in Diabetic Macrovascular Disease: Does Homocysteine Play a Role?

Abstract Background.Non-insulin-dependent diabetes mellitus (NIDDM) and hyperhomocysteinemia are both associated with increased lipid peroxidation (oxidative stress). This may contribute to the accelerated vascular disease associated with these conditions. It is not known whether the coexistence of elevated homocysteine levels will stimulate oxidative stress further than that caused by diabetes alone….

Primary Article

Influence of Age on Optimal Daily Levothyroxine Dosage in Patients With Primary Hypothyroidism Grouped According to Etiology

Abstract Background.Optimal daily levothyroxine (LT4) dosage is reported to be significantly smaller in the elderly with primary hypothyroidism when compared with their younger counterparts. However, this finding has not been studied in different etiologic groups. Methods.This study assessed the influence of age on optimal daily LT4 dosage in 337 patients…

Primary Article

Comparison of Three Perineal Procedures for the Treatment of Rectal Prolapse

Abstract Background.The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to compare the short-term outcome of three perineal procedures in patients with rectal prolapse. Methods.Between April 1989 and April 1995, all consecutive patients who had Delorme's procedure, perineal…

Case Report

Respiratory Depression in a Child Unintentionally Exposed to Transdermal Fentanyl Patch

ABSTRACT: A 2-year-old boy was found unresponsive after sleeping in bed with his grandmother. After the patient was intubated and ventilated, paramedics discovered a transdermal fentanyl patch on the victim's back. Removal of the patch and treatment with naloxone resolved symptoms. This is the first reported case of secondary exposure…

Case Report

Squamous Cell Carcinoma Arising in an Unhealed Wound in Crohn's Disease

ABSTRACT: A 49-year-old black woman with a 23-year history of Crohn's disease came to our clinic; she had a squamous cell carcinoma arising in an unhealed perineal wound 16 years after abdominoperineal resection (APR). We report this case to show the potential for malignant degeneration in such wounds. This patient…

Case Report

Tongue Involvement in a Patient With Granulomatous Myositis

ABSTRACT: A 64-year-old woman had difficulty swallowing and talking, weakness of the tongue, and progressive muscle weakness that was proven to be caused by a granulomatous myopathy. This case resembled a motor neuron disease, indicating that granulomatous myopathy should be considered in patients with similar presentations, since it is a…

Case Report

Methemoglobinemia Caused by Benzocaine Topical Spray

ABSTRACT: Acute methemoglobinemia is a medical emergency that can rapidly become fatal. A substantial number of drugs, including topical preparations, can precipitate this condition. I report a rare example of severe, acute methemoglobinemia caused by oropharyngeal anesthesia with topical benzocaine spray for orogastric intubation. The pathophysiology, diagnosis, and treatment of…

Case Report

Autoimmune Thrombocytopenic Purpura Associated With Hyperthyroidism in a Single Individual

ABSTRACT: An association between thrombocytopenia and thyrotoxicosis has been previously documented. In addition, a familial association between thrombocytopenia and thyrotoxicosis has also been reported. Theories for etiology include a common immunologic cause, a thyrotoxic-induced decrease in platelet survival, and a genetic predisposition for underlying autoimmune disease. We report a case…

Case Report

Perforated Cecal Adenocarcinoma Presenting as a Thigh Abscess

ABSTRACT: Complicated colorectal carcinoma has several symptoms, the most common being bleeding and obstruction. Occasionally it will cause perforation, which carries a worse prognosis. We report a case of perforated adenocarcinoma of the cecum that presented as an abscess of the thigh. We also present a review of the literature…

Primary Article

Metastatic Crohn's Disease

ABSTRACT: Metastatic Crohn's disease is the term used for granulomatous lesions of Crohn's disease involving sites other than the gastrointestinal tract. Metastatic Crohn's disease has been considered uncommon, when in actuality it may simply be underdiagnosed or misdiagnosed since the clinical findings can be different. We report on three patients…

Case Report

Biventricular Assist Device as a Bridge to Cardiac Transplantation in the Treatment of Peripartum Cardiomyopathy

ABSTRACT: Peripartum cardiomyopathy is an unexpected complication of the puerperium with a high mortality rate. Appropriate therapy requires accurate identification of this disease, which is frequently difficult in a patient who has been previously healthy. Medical therapy using alteration of intravascular volume (to optimize ventricular preload), the addition of inotropic…

Case Report

Prostate Cancer Metastatic Only to the Penis

ABSTRACT: Prostate cancer metastatic to the penis is rare. We describe a patient who had a painful nodule in the corpora cavernosa during adjuvant radiotherapy after radical prostatectomy for prostate cancer. Biopsy of the nodule revealed a poorly differentiated adenocarcinoma. Immunohistochemical staining for prostate-specific antigen confirmed a prostatic origin for…

Current Concepts

Hepatitis B: Diagnosis and Treatment

ABSTRACT: The hepatitis B virus (HBV), a member of the Hepadnaviridae family, was discovered 30 years ago. Since that time, clinical and basic research has led to a clear understanding of the epidemiology and natural history of infection and the pathogenesis of the resulting liver injury. Physicians are now able…

Primary Article

Cervical Intraepithelial Neoplasia in HIV-Infected Women in a Southeastern US Population

ABSTRACT: The objectives of our study were to determine the prevalence of cervical intraepithelial neoplasia (CIN) in a southeastern human immunodeficiency virus (HIV)-positive population relative to an HIV-negative control group and to compare these findings with published reports from other geographic regions. Demographic, medical, and cytopathologic data were collected on…

Primary Article

Deep Venous Thrombosis: Prediction by D-Dimer?

ABSTRACT: The utility of D-dimer as an inexpensive, noninvasive method of diagnosing deep venous thrombosis (DVT) is debated. We sought to determine whether a qualitative D-dimer assay would have a high correlation with DVT in 65 hospitalized patients who were randomly referred for diagnosis of DVT by venous duplex and…

Primary Article

Stroke and Malpractice Claims

ABSTRACT: We describe 15 malpractice claims that were filed after the patients had strokes. Both embolic and thrombotic, sterile and infected strokes led to claims. Ten of the claims alleged physician failure to protect the patient, two alleged physician failure to react as called for by symptoms, and three were…

Case Report

The Great Imitator: Rocky Mountain Spotted Fever Occurring After Hospitalization for Unrelated Illnesses

ABSTRACT: We describe two patients who had Rocky Mountain spotted fever after they were admitted to the hospital for emergency and elective surgical procedures. We initially thought one patient had a hospital-acquired infection; the correct diagnosis was deduced from epidemiologic clues elicited by consultants. These two cases were also unusual…

Case Report

Isolated Colonic Neurofibroma Manifested by Massive Lower Gastrointestinal Bleeding and Intussusception

ABSTRACT: We report a case of rare solitary neurofibroma of the transverse colon in a patient without neurofibromatosis. The patient was found to have an intussuscepting tumor prolapsing transanally, with massive lower gastrointestinal bleeding. This case represents only the second documented report of an isolated colonic neurofibroma.

Primary Article

Clostridium difficile Infection in Obstetric and Gynecologic Patients

ABSTRACT: We reviewed hospital records of women on the obstetrics and gynecologic services with a diagnosis of antibiotic-associated diarrhea, pseudomembranous colitis, or Clostridium difficile infection to better characterize the incidence and course of women with C difficile infection. Cases were included if there was identification of C difficile by culture…

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