SMJ // October 2000, Volume 93 - Issue 10
Case Report
Positive Findings on Bone Scan in Multiple Myeloma
ABSTRACT &NA; We report a case of multiple myeloma in which the bone lesions showed high uptake of technetium Tc 99m methylene diphosphonate on a bone scan. A review of the literature comparing the usefulness of conventional skeletal radiography and bone scans in diagnosing the osteolytic lesions of myeloma shows…
Case Report
Factor XI Deficiency-Related Spontaneous Primary Intraventricular Hemorrhage
ABSTRACT &NA; Factor XI deficiency (plasma thromboplastin antecedent deficiency) is a rare autosomal‐dominant disorder. Neurologic complications in factor XI deficiency are even rarer. We propose that the factor XI deficiency in our patient contributed to a primary intraventricular hemorrhage.
Case Report
Utility of an HIV-1 RNA Assay in the Diagnosis of Acute Retroviral Syndrome
ABSTRACT &NA; Highly active antiretroviral therapy (HAART) begun during primary infection with human immunodeficiency virus type 1 (HIV‐1) can preserve immune function and may alter the long‐term clinical course of HIV‐1 infection. To diagnose primary HIV‐1 infection (PHI) early, when screening serologies may yield negative or indeterminate results, the Department…
Case Report
Spontaneous Internal Carotid Artery Dissection
ABSTRACT &NA; Once considered uncommon, spontaneous dissection of the carotid artery is an increasingly recognized cause of stroke, headache, cranial nerve palsy, or ophthalmologic events, especially in young adults. Even in the presence of existing signs and symptoms, the diagnosis can be missed by experienced physicians of all specialties. We…
Case Report
Human Extrapulmonary Dirofilariasis in Texas
ABSTRACT &NA; Human pulmonary infection due to the dog heartworm, Dirofilaria immitis, has been reported in the medical literature for many decades. Extrapulmonary infection due to this pathogen is less widely reported, including only nine cases in North America. We report a case of extrapulmonary dirofilariasis manifested as asymptomatic nodular…
Case Report
Valproate-Induced Tinnitus Misinterpreted as Psychotic Symptoms
ABSTRACT &NA; Valproate sodium is an anticonvulsant medication, which has also been shown to be effective in the treatment of bipolar disorder. We report a case of valproate‐induced tinnitus that was initially misinterpreted as increasing psychotic symptoms, which began approximately 2 days after initiation of valproate therapy. Tinnitus worsened during…
Case Report
Sandifer’s Syndrome in a Child With Asthma and Cerebral Palsy
ABSTRACT &NA; Gastroesophageal reflux is a common problem in infancy and childhood. However, it may be overlooked as a cause or complication of respiratory disease and/or neurobehavioral problems. In this report of a 5‐year‐old child with cerebral palsy, severe developmental delay, and asthma, Sandifer's syndrome was diagnosed after she was…
Case Report
Resolution of Syndrome X After Eradication of Virulent CagA-Positive Helicobacter pylori
ABSTRACT &NA; A 42‐year‐old man with chest pain was found to have ST depression in leads V1 through V4. The coronary arteries appeared normal on angiography. Positive results of ventricular pacing and acetylcholine test led to a diagnosis of syndrome X. Other studies revealed gastritis due to CagA‐positive Helicobacter pylori….
Case Report
Thyrotoxic Periodic Paralysis
ABSTRACT &NA; Thyrotoxic periodic paralysis is a thyroid‐related disorder that is manifested as recurrent episodes of hypokalemia and muscle weakness lasting from hours to days. The periodic paralysis has been associated with thyrotoxicosis from various etiologies. Although the incidence of the disorder is relatively higher among Asians, it has been…
Case Report
Lymphoepithelioma-Like Carcinoma of the Uterine Cervix
ABSTRACT &NA; We describe two rare cervical tumors having morphologic features closely resembling those of the nasopharyngeal lymphoepithelioma. This entity has historically been classified as a subtype of squamous cell carcinoma, but after reviewing the literature and the two cases presented here, we propose that this tumor is a distinct…
Current Concepts
The Painful Truth Physicians Are Not Invincible
ABSTRACT &NA; Physicians are not immune to psychosocial problems but may face unique impediments to attending to them. Self‐care among physicians is not a topic generally included as a part of professional training, nor is it a topic that readily receives consideration in professional practice. The stresses of professional practice…
Current Concepts
Relative Efficacy of Sildenafil Compared to Other Treatment Options for Erectile Dysfunction
Abstract Objective. We examined and compared the efficacy of sildenafil in patients previously using other agents or devices for erectile dysfunction (ED) treatment. Methods. We identified 47 patients with organic ED who had tried other therapies (intracavernosal injection therapy [ICIT], intraurethral prostaglandin suppositories [IPS], vacuum erection devices [VEDs], or yohimbine)…
Current Concepts
Noninvasive Ventilation in Respiratory Failure Due to Cystic Fibrosis
Abstract Background. Noninvasive positive‐pressure ventilation (NIPPV) is increasingly used as an effective means of avoiding endotracheal intubation and mechanical ventilation in patients with respiratory insufficiency or failure. Methods. We retrospectively reviewed our experience with NIPPV to treat respiratory failure in five patients with cystic fibrosis (CF). Results. Despite chronic lung…
Expired CME Article
Chronic Pain and Its Management in Primary Care
Abstract Background. Chronic pain is commonly encountered in primary care, but it can be difficult to manage. Methods. The purpose of this article was to review the definition of chronic pain, general guidelines of management, pharmacologic and nonpharmacologic treatment, the role of pain clinics, and rehabilitation goals. Conclusions. Effective management…
Primary Article
Acute Electrocardiographic Changes After Pneumonectomy*
Abstract Background. Postpneumonectomy electrocardiographic (ECG) changes have not been well‐defined. Methods. We reviewed the clinical data and the preoperative and postpneumonectomy ECGs of 15 patients who had pneumonectomy. Results. All postpneumonectomy ECGs showed a higher heart rate and two (13%) showed diffuse ST elevation. Four patients (27%) had transient atrial…
Primary Article
Reevaluation of Anaerobic Blood Cultures in a Veteran Population
Abstract Background. Studies suggest that the selective use of anaerobic blood cultures may represent a more cost‐effective laboratory approach when anaerobic bacterial infection is suspected. Methods. A 5‐year retrospective study was done at a Veterans' Affairs hospital to determine the utility of routinely including anaerobic blood culture when sampling for…
Primary Article
African American Female Physicians in South Carolina Role Models and Career Satisfaction
Abstract Background. This study examined the factors that influenced African American women to select medicine as a career and their satisfaction with their career choice. Methods. Of 132 African American female physicians in South Carolina, 62 responded to a survey of open‐ended questions about why they chose medicine, what they…
Primary Article
Uninsured Under TennCare A Case Study of Public Health Clinic Users
Abstract Background. We characterized public health clinic users 4 years after implementation of a major public health insurance reform and identified barriers to health care access. Methods. We used face‐to‐face interviews and profile analysis of survey findings. Results. The typical public health client household is larger, poorer, and more likely…
Trauma Rounds
Occult Ligamentous Injury of the Cervical Spine
ABSTRACT &NA; Evaluating the cervical spine for injury is an essential part of the assessment of a traumatized patient. Clinical examination and radiographs are the traditional techniques used for this evaluation. Often, however, a reliable clinical examination is not possible because of head injury, altered mental status, or “distracting” injuries….
Case Report
Thyrotoxic Periodic Paralysis
ABSTRACT:Thyrotoxic periodic paralysis is a thyroid-related disorder that is manifested as recurrent episodes of hypokalemia and muscle weakness lasting from hours to days. The periodic paralysis has been associated with thyrotoxicosis from various etiologies. Although the incidence of the disorder is relatively higher among Asians, it has been reported in…
Current Concepts
Chronic Pain and Its Management in Primary Care
ABSTRACT>Background.Chronic pain is commonly encountered in primary care, but it can be difficult to manage. >Methods.The purpose of this article was to review the definition of chronic pain, general guidelines of management, pharmacologic and nonpharmacologic treatment, the role of pain clinics, and rehabilitation goals. Conclusions.Effective management of chronic pain is…
Current Concepts
The Painful Truth: Physicians Are Not Invincible
ABSTRACT:Physicians are not immune to psychosocial problems but may face unique impediments to attending to them. Self-care among physicians is not a topic generally included as a part of professional training, nor is it a topic that readily receives consideration in professional practice. The stresses of professional practice can exact…
Current Concepts
Relative Efficacy of Sildenafil Compared to Other Treatment Options for Erectile Dysfunction
ABSTRACT>Objective.We examined and compared the efficacy of sildenafil in patients previously using other agents or devices for erectile dysfunction (ED) treatment. >Methods.We identified 47 patients with organic ED who had tried other therapies (intracavernosal injection therapy [ICIT], intraurethral prostaglandin suppositories [IPS], vacuum erection devices [VEDs], or yohimbine) before using sildenafil….
Current Concepts
Noninvasive Ventilation in Respiratory Failure Due to Cystic Fibrosis
ABSTRACT>Background.Noninvasive positive-pressure ventilation (NIPPV) is increasingly used as an effective means of avoiding endotracheal intubation and mechanical ventilation in patients with respiratory insufficiency or failure. >Methods.We retrospectively reviewed our experience with NIPPV to treat respiratory failure in five patients with cystic fibrosis (CF). >Results.Despite chronic lung disease related to CF,…
Original Article
Resolution of Syndrome X After Eradication of Virulent CagA-Positive Helicobacter pylori
ABSTRACT:A 42-year-old man with chest pain was found to have ST depression in leads V1 through V4. The coronary arteries appeared normal on angiography. Positive results of ventricular pacing and acetylcholine test led to a diagnosis of syndrome X. Other studies revealed gastritis due to CagA-positive Helicobacter pylori. Classic therapy…
Original Article
Valproate-Induced Tinnitus Misinterpreted as Psychotic Symptoms
ABSTRACT:Valproate sodium is an anticonvulsant medication, which has also been shown to be effective in the treatment of bipolar disorder. We report a case of valproate-induced tinnitus that was initially misinterpreted as increasing psychotic symptoms, which began approximately 2 days after initiation of valproate therapy. Tinnitus worsened during the next…
Original Article
Serum Ionized Magnesium in Type 2 Diabetes
Original Article
Uninsured Under TennCare: A Case Study of Public Health Clinic Users
ABSTRACT>Background.We characterized public health clinic users 4 years after implementation of a major public health insurance reform and identified barriers to health care access. >Methods.We used face-to-face interviews and profile analysis of survey findings. >Results.The typical public health client household is larger, poorer, and more likely to be black than…
Original Article
Reply
Original Article
Lymphoepithelioma-Like Carcinoma of the Uterine Cervix
ABSTRACT:We describe two rare cervical tumors having morphologic features closely resembling those of the nasopharyngeal lymphoepithelioma. This entity has historically been classified as a subtype of squamous cell carcinoma, but after reviewing the literature and the two cases presented here, we propose that this tumor is a distinct carcinoma of…
Original Article
Acute Electrocardiographic Changes After Pneumonectomy*
ABSTRACT>Background.Postpneumonectomy electrocardiographic (ECG) changes have not been well- defined. >Methods.We reviewed the clinical data and the preoperative and postpneumonectomy ECGs of 15 patients who had pneumonectomy. >Results.All postpneumonectomy ECGs showed a higher heart rate and two (13%) showed diffuse ST elevation. Four patients (27%) had transient atrial arrhythmias. Five patients…
Original Article
Viagra and HAART
Original Article
African American Female Physicians in South Carolina: Role Models and Career Satisfaction
ABSTRACT>Background.This study examined the factors that influenced African American women to select medicine as a career and their satisfaction with their career choice. >Methods.Of 132 African American female physicians in South Carolina, 62 responded to a survey of open-ended questions about why they chose medicine, what they liked and disliked…
Original Article
Utility of an HIV-1 RNA Assay in the Diagnosis of Acute Retroviral Syndrome
ABSTRACT:Highly active antiretroviral therapy (HAART) begun during primary infection with human immunodeficiency virus type 1 (HIV-1) can preserve immune function and may alter the long-term clinical course of HIV-1 infection. To diagnose primary HIV-1 infection (PHI) early, when screening serologies may yield negative or indeterminate results, the Department of Health…
Original Article
Spontaneous Internal Carotid Artery Dissection
ABSTRACT:Once considered uncommon, spontaneous dissection of the carotid artery is an increasingly recognized cause of stroke, headache, cranial nerve palsy, or ophthalmologic events, especially in young adults. Even in the presence of existing signs and symptoms, the diagnosis can be missed by experienced physicians of all specialties. We report a…
Original Article
Sandifer’s Syndrome in a Child With Asthma and Cerebral Palsy
ABSTRACT:Gastroesophageal reflux is a common problem in infancy and childhood. However, it may be overlooked as a cause or complication of respiratory disease and/or neurobehavioral problems. In this report of a 5-year-old child with cerebral palsy, severe developmental delay, and asthma, Sandifer's syndrome was diagnosed after she was found to…
Original Article
Reevaluation of Anaerobic Blood Cultures in a Veteran Population
ABSTRACT>Background.Studies suggest that the selective use of anaerobic blood cultures may represent a more cost-effective laboratory approach when anaerobic bacterial infection is suspected. >Methods.A 5-year retrospective study was done at a Veterans' Affairs hospital to determine the utility of routinely including anaerobic blood culture when sampling for bacteremia. >Results.A total…
Original Article
Positive Findings on Bone Scan in Multiple Myeloma
ABSTRACT:We report a case of multiple myeloma in which the bone lesions showed high uptake of technetium Tc 99m methylene diphosphonate on a bone scan. A review of the literature comparing the usefulness of conventional skeletal radiography and bone scans in diagnosing the osteolytic lesions of myeloma shows that bone…
Original Article
Factor XI Deficiency–Related Spontaneous Primary Intraventricular Hemorrhage
ABSTRACT:Factor XI deficiency (plasma thromboplastin antecedent deficiency) is a rare autosomal-dominant disorder. Neurologic complications in factor XI deficiency are even rarer. We propose that the factor XI deficiency in our patient contributed to a primary intraventricular hemorrhage.
Original Article
Human Extrapulmonary Dirofilariasis in Texas
ABSTRACT:Human pulmonary infection due to the dog heartworm, Dirofilaria immitis, has been reported in the medical literature for many decades. Extrapulmonary infection due to this pathogen is less widely reported, including only nine cases in North America. We report a case of extrapulmonary dirofilariasis manifested as asymptomatic nodular lesions in…
Original Article
Gamma-hydroxybutyric Acid in the Right Hands
Trauma Rounds
Occult Ligamentous Injury of the Cervical Spine
ABSTRACT:Evaluating the cervical spine for injury is an essential part of the assessment of a traumatized patient. Clinical examination and radiographs are the traditional techniques used for this evaluation. Often, however, a reliable clinical examination is not possible because of head injury, altered mental status, or “distracting” injuries. In such…
