Article

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Current Concepts

Chemoprevention of Breast Cancer

We critically examined the literature regarding tamoxifen and raloxifene for breast cancer chemoprevention, a controversial topic of interest to all providers of health care services for women. The National Surgical Adjuvant Breast and Bowel Project showed that tamoxifen decreased the incidence of breast cancer in women at increased risk. Two…

Primary Article

Early Experience With Laparoscopic Antireflux Surgery in the Rural Setting

Abstract Background. Gastroesophageal reflux (GERD) affects a significant portion of the population, and refractory or untreated disease can have serious long‐term complications. Antireflux procedures are now done more frequently because of advances in laparoscopic technique. It has been reported in the literature that the quality of care is better in…

Case Report

Echolalia as a Novel Manifestation of Neuropsychiatric Systemic Lupus Erythematosus

ABSTRACT: &NA; “That tongue of yours, by which I have been tricked, shall have its power curtailed and enjoy the briefest use of speech.” With these words, Hera, of Greek mythology, deprived the nymph Echo of spontaneous speech, constraining her instead to merely repeating the words of others. Echolalia, which…

Current Concepts

Evolutionary Approach to Medicine

ABSTRACT: &NA; A new discipline in the medical field, called Darwinian (or evolutionary) Medicine, has arisen to study how natural selection could shape a machine as complex as the human body without eliminating its vulnerability to diseases. It asserts that systems and organs that form our bodies result from millions…

Current Concepts

Generic Substitution: Issues for Problematic Drugs

ABSTRACT: &NA; The methodology and criteria for bioequivalence testing have been firmly established by the Food and Drug Administration (FDA). For certain drugs with a narrow therapeutic index (eg, digoxin, levothyroxine, warfarin), generic substitution may not be advisable or even allowable, depending on the substitution laws of individual states. Digoxin…

Case Report

Influenza A Pneumonia With Rhabdomyolysis

ABSTRACT: &NA; Influenza A pneumonia accounts for a significant number of the community‐acquired pneumonias in the United States. While myalgia is a common complaint in influenza A infection, few cases of rhabdomyolysis associated with this virus have been described. Although it has been recently recognized that rhabdomyolysis complicating certain bacterial…

Current Concepts

Information About Age-Related Macular Degeneration on the Internet

Abstract Background. A great deal of health information has become available on the Internet over the past several years. Some of this information is inaccurate or misleading to patients. We attempted to determine the accuracy of information on the Internet concerning age‐related macular degeneration (ARMD). Methods. The term “macular degeneration”…

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Primary Article

Multicenter Trial of Prolonged Infusions of Rocuronium Bromide in Critically Ill Patients: Effects of Multiple Organ Failure

Abstract Background. This study was done to determine the safety, efficacy, dosing requirements, and spontaneous recovery profiles of prolonged infusions of rocuronium bromide in the critically ill. Methods. This multicenter, prospective, nonrandomized, open label trial enrolled 32 patients at two university‐based medical centers. Patients who were determined to require neuromuscular…

News Potpourri

News Potpourri

Case Report

Pancreatitis Due to Ascaris lumbricoides: Second Occurrence After 2 Years

ABSTRACT: &NA; Pancreatitis is a common disease in the United States, with the most likely etiologies being biliary tract disease and alcohol use. Infections with parasites such as Ascaris lumbricoides comprise a small percentage of pancreatitis cases in the United States, but they are a common etiology in developing countries….

Commentary

Physicians, Firearm Counseling, and Legal Liability

ABSTRACT: &NA; To explore the potential legal consequences to physicians of counseling their patients about gun violence, I consider the question: If a patient divests herself of a firearm upon the advice of her physician and is subsequently the victim of a rape, robbery, aggravated assault, or homicide, could she…

Expired CME Article

Psoas Abscess: A Primer for the Internist

ABSTRACT: &NA; Psoas abscess is a rare condition with vague clinical presentation. In this article, its epidemiology, etiology, bacteriology, diagnosis, and treatment are discussed. Common diseases that may be erroneously diagnosed in patients with psoas abscess are presented.

Case Report

Sarcoidosis and Opportunistic Infections

ABSTRACT: &NA; Two patients receiving steroid therapy for sarcoidosis had a potentially fatal opportunistic infection that was difficult to differentiate from the underlying illness, but was successfully treated after the diagnosis was made. The effects of sarcoidosis on the immune system and the additional effects of steroid therapy on cell‐mediated…

Abstract

Selected Abstracts

Primary Article

Sexually Transmitted Diseases During Pregnancy: Screening, Diagnostic, and Treatment Practices Among Prenatal Care Providers in Georgia

Abstract Background. Sexually transmitted diseases (STD) during pregnancy are associated with adverse outcomes. We conducted a prenatal care provider survey to determine STD screening, diagnosis, and treatment practices. Methods. Standard questionnaires were mailed to Georgia‐licensed obstetrician/gynecologists, family practitioners, and nurse‐midwives (N = 3,082) in 1998. Results. Of the 1,300 care…

Case Report

Strangulated Obturator Hernia: Still Deadly

ABSTRACT: &NA; The case of an elderly, emaciated female patient with recurrent lower abdominal and hip pain associated with nausea and vomiting due to an incarcerated obturator hernia is described. The presence of a Howship‐Romberg sign and a tender mass on digital rectal examination in this thin, elderly woman with…

Case Report

Transvaginal Ultrasonographic Identification of Appendicitis in a Setting of Chronic Pelvic Pain and Endometriosis

Our patient had a history of chronic endometriosis and pelvic pain and complained of recent onset of right-sided abdominal pain, nausea, and vomiting. Transvaginal ultrasonography revealed a thick-walled mass superior and medial to the right ovary, which was thought to be an inflamed appendix. The woman was not pregnant, and…

Primary Article

Ultrasound Detection of Free Intraperitoneal Fluid Associated With Hepatic and Splenic Injuries

Abstract Background. The objective of this study was to compare the sensitivity and specificity of 5 abdominal views for detecting free intraperitoneal fluid in trauma patients later diagnosed with hepatic or splenic injuries. Methods. This retrospective study conducted over a 17‐month period enrolled patients with trauma. A Focused Abdominal Sonogram…

Case Report

Ventriculitis Due to Cryptococcus uniguttulatus

ABSTRACT: &NA; Infections due to non‐neoformans cryptococci are rare. We report the first case of a human infection caused by Cryptococcus uniguttulatus. Ventriculitis caused by this organism developed in a 65‐year‐old woman who had had repair of an internal carotid aneurysm. In vitro sensitivity testing showed the Cryptococcus species sensitive…

Primary Article

Vitamin D: Balancing Cutaneous and Systemic Considerations

Abstract Background. Vitamin D insufficiency may lead to various health problems. By encouraging sun protection to prevent skin cancer, physicians may be limiting a major source of vitamin D for many individuals. Methods. We did a literature review on issues related to vitamin D inadequacy, particularly those relevant to various…