Book Review

Drug Eruption Reference Manual 2000

Case Report

Massive Pelvic Hemangioma in a Patient With Blue Rubber Bleb Nevus Syndrome

ABSTRACT: &NA; Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by gastrointestinal and cutaneous hemangiomas. Patients typically present with gastrointestinal bleeding and anemia. Management of gastrointestinal bleeding may be challenging, since these lesions may be diffusely distributed throughout the gastrointestinal tract. The most common location is the…

Case Report

Bilateral External Iliac and Common Femoral Artery Disruptions After Blunt Trauma

ABSTRACT: &NA; Blunt trauma to the external iliac or common femoral artery is relatively rare. Since its original description as the “motor‐scooter handlebar syndrome,” this type of injury has been hypothesized as resulting from compression of the artery by the inguinal ligament. We report a case of mirror‐image arterial injuries…

Case Report

Idiopathic Colonic Varices as a Cause of Lower Gastrointestinal Bleeding

ABSTRACT: &NA; Idiopathic varices of the colon are rare, only 22 cases having been reported in the literature. This case report describes a 27‐year‐old man with gastrointestinal bleeding from idiopathic colonic varices. The diagnosis was made angiographically. The patient was treated conservatively without surgery and had no recurrence of bleeding…

Case Report

Antiphospholipid Antibody Syndrome Manifested as a Postoperative Cerebrovascular Event in a Child

ABSTRACT: &NA; Perioperative cerebrovascular events are exceedingly uncommon in pediatric patients. The etiology of such problems includes emboli from intracardiac thrombi, sickle cell disease, vascular anomalies, vasculitis affecting the cerebral vasculature, and prothrombotic states. We describe a 6‐year‐old boy who had right‐sided hemiparesis on the second postoperative day after an…

Case Report

Bronchostenosis Due to Childhood Tuberculosis and Manifested as an Asymptomatic Mass

ABSTRACT: &NA; We report a case of bronchostenosis manifested as an asymptomatic mass on preoperative chest roentgenogram. Bronchoscopic biopsy inadvertently led to drainage of the obstructed bronchus. The various pathogenic origins of bronchostenosis are discussed, with the most likely cause in this case being previous tuberculosis.

Case Report

Ventricular Thrombosis in Sipple’s Syndrome

ABSTRACT: &NA; An 18‐year‐old girl with multiple endocrine neoplasia type 2 (Sipple's syndrome) had a large intraventricular mass that proved to be a thrombus. She had no apparent precipitating factor for intracavitory thrombus formation. This is the first reported case of multiple endocrine neoplasia associated with ventricular thrombus. A hypercoagulable…

Case Report

Chronic Granulomatous Meningitis With Multiple Cranial Nerve Lesions, Hydrocephalus, Stroke, Sinus Thrombosis, and Epilepsy

ABSTRACT: &NA; Most frequently, chronic granulomatous meningitis (CGM) is caused by infectious agents. However, in some cases the cause of CGM remains undetermined. It is unclear whether antimicrobial agents, including antituberculous drugs, are helpful in such cases. We describe a 61‐year‐old man who had multiple cranial nerve lesions, epilepsy, sinus…

Case Report

Necrotizing Fasciitis and Toxic Shock-like Syndrome Caused by Group B Streptococcus

ABSTRACT: &NA; A recent increase in reports of necrotizing fasciitis resulting from group B streptococcus has alerted physicians to a possible concomitant increase of toxic shock‐like syndrome. We report the second case of group B streptococcus causing necrotizing fasciitis and toxic shock‐like syndrome. A black woman, aged 52 years, with…

Case Report

Catastrophic Medical Complication in Psychogenic Excoriation

Compulsive skin picking generally has limited potential health consequences. We describe a case with severe neurologic sequelae and review the literature to assess factors that likely contributed to the failure to prevent this severe outcome. Despite efforts to integrate treatment, our patient had severe medical complications, an epidural abscess and…

Case Report

Recurrent Pericarditis After Thoracic Surgery

ABSTRACT: &NA; Acute pericarditis is a frequent complication after cardiac and/or thoracic surgery. Recurrent acute pericarditis with multiple episodes is an uncommon phenomenon, however. Patients typically have chest pain and/or pericardial inflammation as shown by electrocardiography and echocardiography. Treatment presents a clinical challenge due to the condition's rarity and lack…

Current Concepts

Renal Tubular Acidosis Syndromes*

ABSTRACT: &NA; Renal tubular acidosis is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. This report relates clinical disorders of acidification to the underlying defective mechanisms…

Current Concepts

Advanced Germ Cell Tumors in Male Patients

ABSTRACT: &NA; Germ cell tumors (GCTs) in male patients are particularly important in oncology because the impact of a cure in the young patient population is significant. Patients with poor‐risk tumors by the international classification system have about a 50% likelihood of long‐term survival. No randomized trial has proved a…

Editorial

A FEW THOUGHTS ABOUT PROFESSIONALISM

Editorial

WHAT TO DO IF I AM DEAD OR DISABLED

Editorial

EDITOR'S REPORT

Primary Article

Mardi Gras Eye Injury Survey, 1998‐1999*

Abstract Background. We studied the nature of associated ocular trauma during the 1998 and 1999 New Orleans parade seasons and whether trends were observable from previous surveys. Methods. A prospective survey and retrospective analysis included 18 emergency rooms (ERs) in the New Orleans area. Results. Sixteen surveys representing eight ERs…

Primary Article

Portable Cushioned Operating Table Siderails An Adjunct To Pediatric Surgery

Abstract Background. In an effort to prevent falls of pediatric surgical patients from the operating table, a set of portable cushioned operating table siderails was developed. Methods. A set of portable cushioned operating table siderails was used in the operating room over a 5‐year period in more than 2,550 cases….

Primary Article

Prevalence of Penicillin‐Nonsusceptible Pneumococcal Bacteremia in a Staten Island Community Hospital

Abstract Background. Although the first reports of infection due to penicillin‐nonsusceptible Streptococcus pneumoniae in the United States were in children, these strains have circulated widely in recent years, with the prevalence increasing dramatically among the elderly. Regional surveillance of pneumococcal susceptibility profiles may assist clinicians in management decisions, increase awareness…

Primary Article

Newly Identified Hyperglycemia Among Hospitalized Patients

Abstract Background. Earlier diagnosis and treatment of diabetes mellitus is desirable. We studied the prevalence of newly identified diabetes among hospital inpatients. Methods. We did a prospective observational study in a community teaching hospital. Results. Thirty‐six patients had hyperglycemia on at least 2 days and were considered to have newly…

Primary Article

Prothrombin Gene Mutation Uncommon in Pulmonary Embolism

Abstract Background. Venous thrombosis followed by pulmonary embolism is one of the most common causes of sudden death among middle‐aged adults. Several inherited polymorphisms are associated with heightened risk of venous thrombosis, including mutation at position 20210 of the prothrombin gene and mutation at codon 506 of the factor V…

Primary Article

Clarithromycin for Safe and Cost‐Effective Reduction of Cyclosporine Doses in Lung Allograft Recipients*

Abstract Background. This study was done to analyze the economic effect of clarithromycin on the daily dosing of cyclosporine in lung transplantation. Methods. Nine consecutive patients (mean age ± SEM, 34.6 ± 5.2 years) had transplantation from June 1995 to June 1996. Median follow‐up time was 649 days (range, 431…

Trauma Rounds

Traumatic Lumbar Hernia

ABSTRACT: &NA; Lumbar hernias occur infrequently; however, after trauma, they can present challenging problems in management. Unlike congenital or primary acquired lumbar hernias, posttraumatic lumbar hernias result from a disruption in normal anatomic boundaries and may require extensive reconstruction. We describe a case of lumbar hernia in a patient who…

Case Report

Chronic Granulomatous Meningitis With Multiple Cranial Nerve Lesions, Hydrocephalus, Stroke, Sinus Thrombosis, and Epilepsy

ABSTRACT:Most frequently, chronic granulomatous meningitis (CGM) is caused by infectious agents. However, in some cases the cause of CGM remains undetermined. It is unclear whether antimicrobial agents, including antituberculous drugs, are helpful in such cases. We describe a 61-year-old man who had multiple cranial nerve lesions, epilepsy, sinus thrombosis, stroke,…

Case Report

Ventricular Thrombosis in Sipple’s Syndrome

ABSTRACT:An 18-year-old girl with multiple endocrine neoplasia type 2 (Sipple's syndrome) had a large intraventricular mass that proved to be a thrombus. She had no apparent precipitating factor for intracavitory thrombus formation. This is the first reported case of multiple endocrine neoplasia associated with ventricular thrombus. A hypercoagulable state resulting…

Case Report

Recurrent Pericarditis After Thoracic Surgery

ABSTRACT:Acute pericarditis is a frequent complication after cardiac and/or thoracic surgery. Recurrent acute pericarditis with multiple episodes is an uncommon phenomenon, however. Patients typically have chest pain and/or pericardial inflammation as shown by electrocardiography and echocardiography. Treatment presents a clinical challenge due to the condition's rarity and lack of multicenter…

Case Report

Catastrophic Medical Complication in Psychogenic Excoriation

ABSTRACT:Compulsive skin picking generally has limited potential health consequences. We describe a case with severe neurologic sequelae and review the literature to assess factors that likely contributed to the failure to prevent this severe outcome. Despite efforts to integrate treatment, our patient had severe medical complications, an epidural abscess and…

Case Report

Massive Pelvic Hemangioma in a Patient With Blue Rubber Bleb Nevus Syndrome

ABSTRACT:Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by gastrointestinal and cutaneous hemangiomas. Patients typically present with gastrointestinal bleeding and anemia. Management of gastrointestinal bleeding may be challenging, since these lesions may be diffusely distributed throughout the gastrointestinal tract. The most common location is the small bowel,…

Case Report

Idiopathic Colonic Varices as a Cause of Lower Gastrointestinal Bleeding

ABSTRACT:Idiopathic varices of the colon are rare, only 22 cases having been reported in the literature. This case report describes a 27-year-old man with gastrointestinal bleeding from idiopathic colonic varices. The diagnosis was made angiographically. The patient was treated conservatively without surgery and had no recurrence of bleeding in 48…

Case Report

Necrotizing Fasciitis and Toxic Shock-like Syndrome Caused by Group B Streptococcus

ABSTRACT:A recent increase in reports of necrotizing fasciitis resulting from group B streptococcus has alerted physicians to a possible concomitant increase of toxic shock—like syndrome. We report the second case of group B streptococcus causing necrotizing fasciitis and toxic shock—like syndrome. A black woman, aged 52 years, with newly diagnosed…

Case Report

Antiphospholipid Antibody Syndrome Manifested as a Postoperative Cerebrovascular Event in a Child

ABSTRACT:Perioperative cerebrovascular events are exceedingly uncommon in pediatric patients. The etiology of such problems includes emboli from intracardiac thrombi, sickle cell disease, vascular anomalies, vasculitis affecting the cerebral vasculature, and prothrombotic states. We describe a 6-year-old boy who had right-sided hemiparesis on the second postoperative day after an uneventful patch…

Case Report

Bronchostenosis Due to Childhood Tuberculosis and Manifested as an Asymptomatic Mass

ABSTRACT:We report a case of bronchostenosis manifested as an asymptomatic mass on preoperative chest roentgenogram. Bronchoscopic biopsy inadvertently led to drainage of the obstructed bronchus. The various pathogenic origins of bronchostenosis are discussed, with the most likely cause in this case being previous tuberculosis.

Case Report

Bilateral External Iliac and Common Femoral Artery Disruptions After Blunt Trauma*

ABSTRACT:Blunt trauma to the external iliac or common femoral artery is relatively rare. Since its original description as the “motor-scooter handlebar syndrome,” this type of injury has been hypothesized as resulting from compression of the artery by the inguinal ligament. We report a case of mirror-image arterial injuries from blunt…

Current Concepts

Advanced Germ Cell Tumors in Male Patients

ABSTRACT:Germ cell tumors (GCTs) in male patients are particularly important in oncology because the impact of a cure in the young patient population is significant. Patients with poor- risk tumors by the international classification system have about a 50% likelihood of long-term survival. No randomized trial has proved a chemotherapy…

Current Concepts

Renal Tubular Acidosis Syndromes*

ABSTRACT:Renal tubular acidosis is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. This report relates clinical disorders of acidification to the underlying defective mechanisms responsible for…

Editorial

WHAT TO DO IF I AM DEAD OR DISABLED

Editorial

A FEW THOUGHTS ABOUT PROFESSIONALISM

Editorial

EDITOR’S REPORT

Primary Article

Portable Cushioned Operating Table Siderails: An Adjunct To Pediatric Surgery

AbstractBackground.In an effort to prevent falls of pediatric surgical patients from the operating table, a set of portable cushioned operating table siderails was developed. Methods.A set of portable cushioned operating table siderails was used in the operating room over a 5-year period in more than 2,550 cases. Results.The portable cushioned…

Primary Article

Prothrombin Gene Mutation Uncommon in Pulmonary Embolism

AbstractBackground.Venous thrombosis followed by pulmonary embolism is one of the most common causes of sudden death among middle-aged adults. Several inherited polymorphisms are associated with heightened risk of venous thrombosis, including mutation at position 20210 of the prothrombin gene and mutation at codon 506 of the factor V gene. Methods.We…

Primary Article

Newly Identified Hyperglycemia Among Hospitalized Patients

AbstractBackground.Earlier diagnosis and treatment of diabetes mellitus is desirable. We studied the prevalence of newly identified diabetes among hospital inpatients. Methods.We did a prospective observational study in a community teaching hospital. Results.Thirty-six patients had hyperglycemia on at least 2 days and were considered to have newly identified diabetes mellitus. They…

Primary Article

Clarithromycin for Safe and Cost-Effective Reduction of Cyclosporine Doses in Lung Allograft Recipients*

AbstractBackground.This study was done to analyze the economic effect of clarithromycin on the daily dosing of cyclosporine in lung transplantation. Methods.Nine consecutive patients (mean age ± SEM, 34.6 ± 5.2 years) had transplantation from June 1995 to June 1996. Median follow-up time was 649 days (range, 431 to 799 days)….

Primary Article

Prevalence of Penicillin-Nonsusceptible Pneumococcal Bacteremia in a Staten Island Community Hospital

AbstractBackground.Although the first reports of infection due to penicillin-nonsusceptible Streptococcus pneumoniae in the United States were in children, these strains have circulated widely in recent years, with the prevalence increasing dramatically among the elderly. Regional surveillance of pneumococcal susceptibility profiles may assist clinicians in management decisions, increase awareness of this…

Primary Article

Mardi Gras Eye Injury Survey, 1998-1999*

AbstractBackground.We studied the nature of associated ocular trauma during the 1998 and 1999 New Orleans parade seasons and whether trends were observable from previous surveys. Methods.A prospective survey and retrospective analysis included 18 emergency rooms (ERs) in the New Orleans area. Results.Sixteen surveys representing eight ERs were completed between February…

Trauma Rounds

Traumatic Lumbar Hernia

ABSTRACT:Lumbar hernias occur infrequently; however, after trauma, they can present challenging problems in management. Unlike congenital or primary acquired lumbar hernias, posttraumatic lumbar hernias result from a disruption in normal anatomic boundaries and may require extensive reconstruction. We describe a case of lumbar hernia in a patient who had been…