ABSTRACT:Neither carisoprodol (Soma) nor tramadol (Ultram) is a controlled substance at the federal level. However, evidence indicates that these medications may have abuse potential, particularly in patients with a history of substance abuse. We report three cases in which a combination of carisoprodol and tramadol was used illicitly to obtain…
AbstractBackground.There is increasing need to examine the effectiveness of acupuncture and other alternative therapies for common conditions. However, little attention has focused on the variability in acupuncturists' assessment, diagnosis, and treatment patterns. Methods.Seven office-based acupuncturists practicing Traditional Chinese Medicine evaluated the same patient with chronic low back pain and provided…
ABSTRACT:This is the first reported case of cerebral blastomycosis successfully treated with amphotericin B lipid complex.
ABSTRACT:Tuberculosis has been increasing in incidence in recent years. Pericardial involvement and pericardial effusions are well-documented and may result in pericardial tamponade. Despite this, large pericardial effusions are uncommon, and manifestation as cardiac tamponade is rare. We report two cases of tuberculous pericarditis in which the initial feature was tamponade….
ABSTRACT:Most patients with intestinal obstruction have had previous surgery. Rarely, the development of adhesions and resulting small bowel obstruction is attributed to previous intra-abdominal trauma. We present the case of a young man, without a history of surgery, who had been a restrained driver in a motor vehicle crash. Seven…
ABSTRACT:Delusions of parasitosis, though uncommon, are an important cause of distress for affected patients and frequently of frustration for their physicians. They occur primarily in middle-aged or older women, who have the delusional belief that they are infested with parasites. Although the vast majority of cases involve dermatologic manifestations, some…
AbstractBackground.Variations in referral rates among primary care physicians have implications for cost and quality of care, as well as primary care training. Dermatology referral rates of residents and faculty from an academic family medicine clinic are described. Methods.Using a computerized referral tracking system, all dermatology referrals from January to March…
ABSTRACT:A 26-year-old man had a gunshot wound in the right posterolateral aspect of the chest. A chest radiograph showed the bullet in the region of the cardiac silhouette. The patient was hemodynamically stable and had no complaints of dyspnea or abdominal pain. Echocardiography and computed tomography identified the bullet in…
ABSTRACT:This report presents the development of endometrial adenocarcinoma after diagnosis of polycystic ovary syndrome (PCOS) in three premenopausal women. Such cases illustrate the increased potential for endometrial hyperplasia and malignancy in the setting of chronic anovulation associated with PCOS and underscore the need for prompt identification and treatment. Attention to…
ABSTRACT:A quadriplegic patient with severe spasticity, treated with dantrolene (400 mg daily) for 5 years, had dyspnea, orthopnea, hypoxia, and right-sided opacity of the chest on radiograph. At thoracentesis, an exudative effusion containing 64% eosinophils was documented, with simultaneous peripheral eosinophilia of 11%. An allergic reaction to dantrolene was postulated….
AbstractBackground.Primary care providers (PCPs) have limited training in recognizing common skin disorders, and additional emphasis may be placed on laboratory evaluation, including skin biopsies. Methods.Primary care providers in Miami, Fla, were surveyed regarding skin biopsy and excision practices and histologic interpretation. They then participated in an examination, using 20 high-quality…
ABSTRACT:“Mimickers” of vasculitis are well-documented in the literature. We report a case of intravenous drug abuse manifesting with signs and symptoms suggestive of vasculitis. This case highlights the need for diagnostic precision in the evaluation of suspected vasculitis.
AbstractBackground.Castleman's disease (CD) is a distinctive type of atypical lymph node hyperplasia that is often clonal. In a previously reported series of CD, clonal populations of plasma cells were detected by immunohistology in 4 of 39 cases (10%, [H9261] restricted), and immunoglobulin gene rearrangements were detected by paraffin polymerase chain…
AbstractBackground.We examined the role of social networks and marijuana smoking in a community outbreak of infections due to Neisseria meningitidis. Methods.We interviewed all patients and their contacts. Isolates were tested by pulsed field electrophoresis and multilocus enzyme electrophoresis. Results.Nine cases of meningococcal disease occurred in the outbreak; isolates from seven…
AbstractBackground.Risk factors for and management of intrauterine fetal demise (IUFD) have been investigated, but the maternal morbidity has not been evaluated. Methods.Over a 60-month interval, all cases of IUFD after 20 weeks' gestation were reviewed for maternal trauma and maternal postpartum complications. Results.In this retrospective analysis, 498 singleton and 24…
ABSTRACT:Anemia is common in patients with disseminated carcinoma and is usually due to bleeding, infection, or marrow suppression from chemotherapy or metastatic infiltration. However, microangiopathic hemolytic anemia is rarely seen in such patients. We report a case in which microangiopathic hemolytic anemia was the initial finding in lung adenocarcinoma.
AbstractBackground.This study evaluated the safety and effectiveness of a new polyethylene glycol (PEG) laxative (MiraLax, Braintree Laboratories Inc, Braintree, Mass) in 23 patients reporting a history of constipation. Methods.After a 7-day placebo control period, patients were randomized into a double crossover trial of placebo versus 17 g of PEG daily…
ABSTRACT:A 12-year-old female patient with atypical orbital and periorbital cellulitis was found to have an occult lymphangioma of the orbit. Recognition of this entity provided an explanation for the atypical features of the case and guided appropriate medical management.
ABSTRACT:Dermoid cysts containing dental elements are reported in the literature. We report the first case of eight well-formed teeth in a mandible-like structure found in a teratoma.
ABSTRACT:We report the case of a 28-year-old woman with a 3-month history of right upper quadrant abdominal pain. Medical history and physical examination were unremarkable. Abdominal ultrasonography showed a dilated gallbladder, suggestive of gallstones, without bile duct dilatation. Serum chemistry values were normal. Laparoscopic cholecystectomy was planned, and a mass…
ABSTRACT:We report a case of acute perforated appendicitis in an incarcerated inguinal hernia, termed an Amyand's hernia. Although perforated appendicitis within an incarcerated inguinal hernia is uncommon, with a published incidence of 0.13%, its clinical presentation varies considerably, depending on the extent of periappendicular inflammation and the presence or absence…
ABSTRACT:An illustrative case of a second traumatic brain injury in the same child raises the issue of the criteria by which protective helmets for disabled children should be prescribed. There is a dearth of data substantiating criteria for helmet prescription for special needs children and assessing potential adverse side effects…
ABSTRACT:Vitamin D deficiency is relatively common among older persons and those with spinal cord injuries. We report a case of proximal renal tubular acidosis in a 44-year-old quadriplegic nursing home resident who had limited sunlight exposure. Laboratory studies showed a low level of serum bicarbonate, a normal serum anion gap,…
AbstractBackground.Restorative proctocolectomy, a standard operation for ulcerative colitis and familial adenomatous polyposis has significant complications, even in experienced hands. Methods.We studied surgical outcome by retrospectively reviewing cases of restorative proctocolectomy done at Ochsner Foundation Hospital from 1982 to 1995. Demographic and clinical data from two periods (1982 to 1989 and…
ABSTRACT:Group B streptococcus (Streptococcus agalactiae) is a common etiology of bacteremia among adults. Pyomyoma is a rare infectious complication of uterine leiomyomas. We report the case of a diabetic postmenopausal woman with a giant pyomyoma simulating an ovarian cancer. It was associated with S agalactiae endocarditis and deep venous thrombosis…
ABSTRACT:We report a rare case of isolated thrombocytopenia due to a large hamartoma of the pulposal type, which resolved with splenectomy in a 46-year-old man. Although hamartomas are usually found incidentally, they may cause hematologic disturbances such as thrombocytopenia, anemia, or splenic rupture. The diagnosis of splenic hamartoma is difficult…
ABSTRACT:We report a case of sinoatrial node block associated with syncopal episodes that required a temporary pacemaker. Magnetic resonance imaging (MRI) of the brain showed lesions of both temporal lobes consistent with viral encephalitis, presumably due to herpes simplex virus (HSV). The patient quickly recovered with intravenous acyclovir (Zovirax) therapy….
Abstract Background. Risk factors for and management of intrauterine fetal demise (IUFD) have been investigated, but the maternal morbidity has not been evaluated. Methods. Over a 60‐month interval, all cases of IUFD after 20 weeks' gestation were reviewed for maternal trauma and maternal postpartum complications. Results. In this retrospective analysis,…
Abstract Background. This study evaluated the safety and effectiveness of a new polyethylene glycol (PEG) laxative (MiraLax, Braintree Laboratories Inc, Braintree, Mass) in 23 patients reporting a history of constipation. Methods. After a 7‐day placebo control period, patients were randomized into a double crossover trial of placebo versus 17 g…
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