Most enterocutaneous fistulas are caused by complications of abdominal surgery that may result from anastomotic failure, poor blood supply, or iatrogenic bowel injuries. Mortality rates are high when associated sepsis and malnutrition are uncontrolled. Fistulas that occur late and those that recur spontaneously present more difficulty and may close spontaneously…
We report a case of hepatotoxicity in a 2‐month‐old baby after a camphor‐containing cold remedy was applied dermally. Liver function tests returned to normal after the application of the cold remedy was discontinued. Ingestion of camphor can cause severe liver and central nervous system injury, and neurotoxicity has been observed…
Patients with common variable immunodeficiency (CVID) are occasionally recognized to have a concurrent noncaseating granulomatous disease. The granulomatous disease (GD) associated with CVID shares many clinical properties typical of sarcoidosis. Some investigators speculate that the GD‐CVID is actually sarcoidosis that is expressed atypically because of the patient’s immunodeficiency. Clinical differences,…
ABSTRACT &NA; Cholangiocarcinoma is one of the most common malignancies of the biliary tree. Most cases are perihilar. Cholangiocarcinoma usually has an indolent, slowly progressive course and is associated with a high mortality rate. In this article, we discuss the management of perihilar cholangiocarcinoma by radiation therapy and chemotherapy in…
ABSTRACT &NA; We report the case of a boy with achondroplasia and i(21q) Down syndrome. Besides craniofacial features typical in Down syndrome, the skeletal findings of achondroplasia dominate the clinical picture. The diagnosis of Down syndrome was based on clinical features and the cytogenetic finding of i(21q) trisomy 21. The…
ABSTRACT &NA; Intracanalicular meningiomas are extremely rare and difficult to differentiate from intracanalicular vestibular schwannomas. We report an unusual case of a posterior fossa meningioma in the proximal internal auditory canal that was originally diagnosed as a vestibular schwannoma due to its appearance on magnetic resonance imaging. However, closer inspection…
ABSTRACT &NA; Spontaneous rupture of the spleen is a rare complication of acute Q fever infection. Only two cases have been reported, both in Europe. This is the first reported case of spontaneous rupture of the spleen caused by acute Q fever in the United States.
ABSTRACT &NA; We describe a patient who had a coronary arteriovenous fistula (CAVF) and whose mitral valve papillary muscle ruptured from chronic ischemia due to a coronary steal phenomenon. He was treated surgically with ligation of the CAVF (left circumflex to coronary sinus), coronary artery bypass grafting, and mitral valve…
ABSTRACT &NA; A 41‐year‐old woman had fever of 3 days' duration. She had had pancreas transplantation 2 years previously and had recently completed a course of antirejection medication. Temperature spikes occurred during treatment with broad spectrum antibiotics. No obvious cause for the fever was found. The patient's condition worsened, with…
ABSTRACT &NA; Certain medications, such as the phenothiazines, may cause side effects that result in neck stiffness and may actually mimic the presentation of meningitis, especially in children. Despite the controversial use of antiemetics, they continue to be used in children with viral gastroenteritis. I describe the case of a…
ABSTRACT &NA; Superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction, most frequently occurring in patients who have had rapid weight loss. Identification of this syndrome can be a diagnostic dilemma and is frequently made by exclusion. The most characteristic symptoms are postprandial epigastric pain, eructation,…
We report the case of a patient who was treated with fluoxetine hydrochloride (Prozac) for depression. Approximately 8 weeks into the treatment, an eosinophilic pleural effusion and serum eosinophilia developed. An extensive workup for the etiology of eosinophilic pleural effusion was unrevealing. Pleural biopsy showed a nonspecific inflammatory reaction and…
ABSTRACT &NA; Peliosis hepatis is an unusual disorder associated with a variety of diseases and treatments. This is the first report of peliosis hepatis associated with administration of 2‐chloro‐3′‐deoxyadenosine. The literature is reviewed.
ABSTRACT &NA; In the past few years, drug‐facilitated sexual assaults have received widespread media coverage. In addition to alcohol, the most frequently used date‐rape drug, flunitrazepam (Rohypnol), a fast‐acting benzodiazepine, and &ggr;‐hydroxybutyrate (GHB) and its congeners are among the most popular drugs used for this purpose. The latter drug is…
Abstract Background. Antihypertensive monotherapy fails to control blood pressure in many patients. Methods. Data on the efficacy and tolerance of fixed dose angiotensin‐converting enzyme (ACE) inhibitor/calcium antagonist combinations were reviewed, since they are the most widely prescribed medications for hypertension. Results. A fixed‐dose combination of two drug classes is an…
Abstract Background. We studied whether recurrence of coagulopathy, defined as the return of a coagulation abnormality after initial normalization, occurred after the use of antivenin (Crotalidae) polyvalent. Methods. A retrospective, blinded, descriptive analysis of 354 consecutive cases of North American crotalid snake envenomation was done. Inclusion criteria were documented clinical…
Abstract Background. We evaluated adherence to medication usage by health care professionals to estimate the expected upper limit of adherence among the general population. Methods. In a self‐administered survey, physicians and nurses were asked about their use of prescribed medications for acute and chronic illnesses. The settings were a teaching…
Abstract Objective. We compared blood pressure (BP) in patients with sickle cell disease (SCD)‐related crises and black patients without SCD. Methods. We retrospectively reviewed charts of emergency department (ED) patients with SCD crises in a 2‐year period, recording BPs and demographic and SCD data. A cohort of consecutive black patients…
Abstract Background. More data are needed to assess lower extremity angioaccess sites for hemodialysis. Methods. We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996. Results. Lower extremity grafts accounted for 16% (134/843) of patients in this series….
Abstract Background. Abnormal uterine bleeding is commonly seen in emergency departments and gynecologic clinics. In a southern, inner‐city hospital, a seemingly large number of women are admitted with life‐threatening anemia of benign gynecologic origin. We examine its causes, review treatments and outcomes, and discuss optimization of therapy. Methods. A chart…
Abstract Background. Policies for excluding ill children from child care can affect parental absenteeism from the workplace and the utilization of pediatric health care resources. Methods. We surveyed a representative sample of 310 child care centers throughout Virginia to assess policies for excluding children with fever, common upper respiratory tract…
Abstract Objectives. We sought to determine the prevalence of daily smoking in Louisiana in grades 6 through 12 and to compare Louisiana students' daily smoking to that of national student and Louisiana adult rates. Methods. A statewide, randomized, stratified classroom‐based survey of 11,736 subjects was done for the school year…
ABSTRACT &NA; Penetrating neck trauma may be managed operatively or nonoperatively, depending on precise anatomic location. Conservative management of zone II injuries is currently an issue under debate. We present a brief case report followed by a description of the current strategies for operative exploration and diagnostic maneuvers in penetrating…
ABSTRACT:We report a case of hepatotoxicity in a 2-month-old baby after a camphor-containing cold remedy was applied dermally. Liver function tests returned to normal after the application of the cold remedy was discontinued. Ingestion of camphor can cause severe liver and central nervous system injury, and neurotoxicity has been observed…
ABSTRACT:Intracanalicular meningiomas are extremely rare and difficult to differentiate from intracanalicular vestibular schwannomas. We report an unusual case of a posterior fossa meningioma in the proximal internal auditory canal that was originally diagnosed as a vestibular schwannoma due to its appearance on magnetic resonance imaging. However, closer inspection of the…
ABSTRACT:Cholangiocarcinoma is one of the most common malignancies of the biliary tree. Most cases are perihilar. Cholangiocarcinoma usually has an indolent, slowly progressive course and is associated with a high mortality rate. In this article, we discuss the management of perihilar cholangiocarcinoma by radiation therapy and chemotherapy in a case…
ABSTRACT:Superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction, most frequently occurring in patients who have had rapid weight loss. Identification of this syndrome can be a diagnostic dilemma and is frequently made by exclusion. The most characteristic symptoms are postprandial epigastric pain, eructation, fullness, and…
ABSTRACT:Most enterocutaneous fistulas are caused by complications of abdominal surgery that may result from anastomotic failure, poor blood supply, or iatrogenic bowel injuries. Mortality rates are high when associated sepsis and malnutrition are uncontrolled. Fistulas that occur late and those that recur spontaneously present more difficulty and may close spontaneously…
ABSTRACT:We describe a patient who had a coronary arteriovenous fistula (CAVF) and whose mitral valve papillary muscle ruptured from chronic ischemia due to a coronary steal phenomenon. He was treated surgically with ligation of the CAVF (left circumflex to coronary sinus), coronary artery bypass grafting, and mitral valve replacement. This…
ABSTRACT:A 41-year-old woman had fever of 3 days' duration. She had had pancreas transplantation 2 years previously and had recently completed a course of antirejection medication. Temperature spikes occurred during treatment with broad spectrum antibiotics. No obvious cause for the fever was found. The patient's condition worsened, with development of…
ABSTRACT:Peliosis hepatis is an unusual disorder associated with a variety of diseases and treatments. This is the first report of peliosis hepatis associated with administration of 2-chloro-3′-deoxyadenosine. The literature is reviewed.
ABSTRACT:We report the case of a boy with achondroplasia and i(21q) Down syndrome. Besides craniofacial features typical in Down syndrome, the skeletal findings of achondroplasia dominate the clinical picture. The diagnosis of Down syndrome was based on clinical features and the cytogenetic finding of i(21q) trisomy 21. The diagnosis of…
ABSTRACT:Patients with common variable immunodeficiency (CVID) are occasionally recognized to have a concurrent noncaseating granulomatous disease. The granulomatous disease (GD) associated with CVID shares many clinical properties typical of sarcoidosis. Some investigators speculate that the GD-CVID is actually sarcoidosis that is expressed atypically because of the patient's immunodeficiency. Clinical differences,…
ABSTRACT:Spontaneous rupture of the spleen is a rare complication of acute Q fever infection. Only two cases have been reported, both in Europe. This is the first reported case of spontaneous rupture of the spleen caused by acute Q fever in the United States.
ABSTRACT:Certain medications, such as the phenothiazines, may cause side effects that result in neck stiffness and may actually mimic the presentation of meningitis, especially in children. Despite the controversial use of antiemetics, they continue to be used in children with viral gastroenteritis. I describe the case of a child who…
ABSTRACT:We report the case of a patient who was treated with fluoxetine hydrochloride (Prozac) for depression. Approximately 8 weeks into the treatment, an eosinophilic pleural effusion and serum eosinophilia developed. An extensive workup for the etiology of eosinophilic pleural effusion was unrevealing. Pleural biopsy showed a nonspecific inflammatory reaction and…
AbstractBackground.Antihypertensive monotherapy fails to control blood pressure in many patients. Methods.Data on the efficacy and tolerance of fixed dose angiotensin-converting enzyme (ACE) inhibitor/calcium antagonist combinations were reviewed, since they are the most widely prescribed medications for hypertension. Results.A fixed-dose combination of two drug classes is an option for hypertension treatment….
ABSTRACT:In the past few years, drug-facilitated sexual assaults have received widespread media coverage. In addition to alcohol, the most frequently used date-rape drug, flunitrazepam (Rohypnol), a fast-acting benzodiazepine, and &ggr;-hydroxybutyrate (GHB) and its congeners are among the most popular drugs used for this purpose. The latter drug is easily procured…
AbstractBackground.We studied whether recurrence of coagulopathy, defined as the return of a coagulation abnormality after initial normalization, occurred after the use of antivenin (Crotalidae) polyvalent. Methods.A retrospective, blinded, descriptive analysis of 354 consecutive cases of North American crotalid snake envenomation was done. Inclusion criteria were documented clinical evidence of crotalid…
AbstractObjectives.We sought to determine the prevalence of daily smoking in Louisiana in grades 6 through 12 and to compare Louisiana students' daily smoking to that of national student and Louisiana adult rates. Methods.A statewide, randomized, stratified classroom-based survey of 11,736 subjects was done for the school year 1996-1997. Results.We found…
AbstractBackground.We evaluated adherence to medication usage by health care professionals to estimate the expected upper limit of adherence among the general population. Methods.In a self-administered survey, physicians and nurses were asked about their use of prescribed medications for acute and chronic illnesses. The settings were a teaching hospital, employee health…
AbstractBackground.More data are needed to assess lower extremity angioaccess sites for hemodialysis. Methods.We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996. Results.Lower extremity grafts accounted for 16% (134/843) of patients in this series. Complications occurred in 58…
AbstractBackground.Abnormal uterine bleeding is commonly seen in emergency departments and gynecologic clinics. In a southern, inner-city hospital, a seemingly large number of women are admitted with life-threatening anemia of benign gynecologic origin. We examine its causes, review treatments and outcomes, and discuss optimization of therapy. Methods.A chart review of patients…
AbstractObjective.We compared blood pressure (BP) in patients with sickle cell disease (SCD)–related crises and black patients without SCD. Methods.We retrospectively reviewed charts of emergency department (ED) patients with SCD crises in a 2-year period, recording BPs and demographic and SCD data. A cohort of consecutive black patients without SCD was…
AbstractBackground.Policies for excluding ill children from child care can affect parental absenteeism from the workplace and the utilization of pediatric health care resources. Methods.We surveyed a representative sample of 310 child care centers throughout Virginia to assess policies for excluding children with fever, common upper respiratory tract illnesses, or head…
ABSTRACT:Penetrating neck trauma may be managed operatively or nonoperatively, depending on precise anatomic location. Conservative management of zone II injuries is currently an issue under debate. We present a brief case report followed by a description of the current strategies for operative exploration and diagnostic maneuvers in penetrating neck injuries….
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