&NA; Treatment of craniofacial hyperhidrosis currently consists of thoracic sympathectomy, which is not widely available. Oral anticholinergic agents and &bgr;‐blockers may be effective but also carry significant side effects. We describe a healthy, active 27‐year‐old male resident physician who had excessive facial sweating with minimal exertion or stress. The sweating…
&NA; Empyema necessitatis is a collection of inflammatory tissue that ruptures spontaneously through a weakness in the chest wall into surrounding soft tissues. Although empyema necessitatis can be caused by a number of infectious agents, mycobacteria are the most frequently implicated. Empyema was a much more common complication of pulmonary…
&NA; Nonsecretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM) and accounts for 1% to 5% of all cases of MM. The clinical presentation and radiographic findings of NSMM and MM are the same. The diagnosis of MM requires the detection of a…
&NA; Excluding laryngeal papillomas, neoplasms of the hypopharynx rarely cause sudden asphyxial death in adults. We describe the first such death from a carcinoma and review the literature for similar cases since 1966. A high clinical index of suspicion and early laryngoscopy in individuals with symptoms suggestive of hypopharyngeal neoplasia…
&NA; Although spinal epidural abscess is uncommon, its incidence is likely to rise with increasing use of epidural injections for the control of lower back pain. We report a case of spinal epidural abscess after epidural steroid injection. The abscess resolved with conservative medical management.
&NA; Beals‐Hecht syndrome, also known as congenital contractural arachnodactyly, is caused by a defect in fibrillin as in Marfan syndrome. This syndrome is characterized by a multitude of clinical findings including arachnodactyly, narrow body habitus, scoliosis, congenital contractures, and external ear deformities. Restrictive lung disease may be associated with the…
&NA; Acetaminophen (paracetamol) is a widely prescribed analgesic‐antipyretic drug. Adverse allergic reactions to this drug are rare. We report a case of anaphylactic shock due to acetaminophen. Results of skin prick tests and intradermal tests were negative. Oral rechallenge resulted in generalized urticaria associated with an increased plasma level of…
&NA; Thin‐glomerular‐basement‐membrane (TGBM) nephropathy is among the most common causes of isolated hematuria. This autosomal dominant disorder is characterized by diffuse thinning of the GBM and is diagnosed by electron microscopic examination of renal biopsy tissue. A study of an affected kindred has revealed a mutation in the &agr; chain…
Background. Preceptorships with community physicians have been incorporated into medical curricula to foster interest in generalist careers. An evaluation of our preceptorship program was undertaken to determine this influence.
Background. The prevalence of smoking in the general US population has declined significantly over the past few decades. Despite this, few studies have examined changes in cigarette attributes perceived by less educated, rural, or southern populations.
Background. Clostridium difficile—associated diarrhea (CDAD) is a common cause of mortality and morbidity in hospitalized patients. Some case reports have implicated renal failure as a risk factor for CDAD. The aim of this study was to assess whether chronic renal insufficiency is a risk factor for CDAD and whether it…
Background. Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications
Background. Underutilization of left ventricular function (LVF) evaluation in older patients with heart failure has been well documented, but age‐related variation in the use of LVF evaluation has not been.
Background. The extent to which age plays a role in the underutilization of angiotensin‐converting enzyme (ACE) inhibitors in heart failure patients has not been well studied.
Background. The human leukocyte antigens (HLA) are associated with susceptibility to systemic lupus erythematosus (SLE) and manifestations of SLE in different ethnic groups.
Background. Before conjugated Haemophilus influenzae type b (Hib) vaccination, a syndrome known as buccal cellulitis, usually caused by Hib and often accompanied by bacteremia, was seen. We investigated the incidence and cause of facial cellulitis at our hospital during the 10 years before and the 10 years after introduction of…
Background. Hyperinfective strongyloidiasis is rare, but the mortality rate is very high. It occurs most commonly in immunocompromised patients. We reviewed the clinical presentation and mortality rate of cases managed in our facility.
Background. Obesity has reached epidemic proportions over the past 20 years.
&NA; Attention‐deficit/hyperactivity disorder, a syndrome involving inattention, impulsivity, and hyperactivity, was originally thought to occur only in children. It is now a recognized condition throughout life in some individuals. For a valid diagnosis, the onset of symptoms should occur before age 7. Dysfunction of catecholamine neurotransmission is implied by the…
Background. Pfiesteria piscicida and look‐alike dinoflagellates are collectively known as Pfiesteria complex organisms (PCOs). The purposes of this paper are to evaluate the threat that PCOs pose to human health and to clarify some common misconceptions concerning these organisms.
&NA; Attention deficit hyperactivity disorder (ADHD) persists into adulthood in up to 60% of cases with childhood onset. A childhood history of ADHD is a prerequisite for making the ADHD diagnosis in an adult. The Utah, Copeland, and Brown self‐rating scales are useful in helping the primary care physician confirm…
&NA; Certain medical ailments occur with increased frequency among musicians and can affect musicians of all ages and ability. These maladies range in severity from incidental, asymptomatic findings among casual and occasional players to serious injuries that significantly disable professional musicians from practicing or performing. The most prevalent problems involve…
Nonsecretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM) and accounts for 1% to 5% of all cases of MM. The clinical presentation and radiographic findings of NSMM and MM are the same. The diagnosis of MM requires the detection of a monoclonal…
Empyema necessitatis is a collection of inflammatory tissue that ruptures spontaneously through a weakness in the chest wall into surrounding soft tissues. Although empyema necessitatis can be caused by a number of infectious agents, mycobacteria are the most frequently implicated. Empyema was a much more common complication of pulmonary tuberculosis…
Although spinal epidural abscess is uncommon, its incidence is likely to rise with increasing use of epidural injections for the control of lower back pain. We report a case of spinal epidural abscess after epidural steroid injection. The abscess resolved with conservative medical management.
Beals-Hecht syndrome, also known as congenital contractural arachnodactyly, is caused by a defect in fibrillin as in Marfan syndrome. This syndrome is characterized by a multitude of clinical findings including arachnodactyly, narrow body habitus, scoliosis, congenital contractures, and external ear deformities. Restrictive lung disease may be associated with the severe…
Excluding laryngeal papillomas, neoplasms of the hypopharynx rarely cause sudden asphyxial death in adults. We describe the first such death from a carcinoma and review the literature for similar cases since 1966. A high clinical index of suspicion and early laryngoscopy in individuals with symptoms suggestive of hypopharyngeal neoplasia are…
Treatment of craniofacial hyperhidrosis currently consists of thoracic sympathectomy, which is not widely available. Oral anticholinergic agents and [H9252]-blockers may be effective but also carry significant side effects. We describe a healthy, active 27-year-old male resident physician who had excessive facial sweating with minimal exertion or stress. The sweating was…
Acetaminophen (paracetamol) is a widely prescribed analgesic-antipyretic drug. Adverse allergic reactions to this drug are rare. We report a case of anaphylactic shock due to acetaminophen. Results of skin prick tests and intradermal tests were negative. Oral rechallenge resulted in generalized urticaria associated with an increased plasma level of histamine….
Thin-glomerular-basement-membrane (TGBM) nephropathy is among the most common causes of isolated hematuria. This autosomal dominant disorder is characterized by diffuse thinning of the GBM and is diagnosed by electron microscopic examination of renal biopsy tissue. A study of an affected kindred has revealed a mutation in the &agr; chain of…
Background.The human leukocyte antigens (HLA) are associated with susceptibility to systemic lupus erythematosus (SLE) and manifestations of SLE in different ethnic groups.
Background.Clostridium difficile–associated diarrhea (CDAD) is a common cause of mortality and morbidity in hospitalized patients. Some case reports have implicated renal failure as a risk factor for CDAD. The aim of this study was to assess whether chronic renal insufficiency is a risk factor for CDAD and whether it increases…
Background.The prevalence of smoking in the general US population has declined significantly over the past few decades. Despite this, few studies have examined changes in cigarette attributes perceived by less educated, rural, or southern populations.
Background.Underutilization of left ventricular function (LVF) evaluation in older patients with heart failure has been well documented, but age-related variation in the use of LVF evaluation has not been.
Background.Obesity has reached epidemic proportions over the past 20 years.
Background.Before conjugated Haemophilus influenzae type b (Hib) vaccination, a syndrome known as buccal cellulitis, usually caused by Hib and often accompanied by bacteremia, was seen. We investigated the incidence and cause of facial cellulitis at our hospital during the 10 years before and the 10 years after introduction of the…
Background.The extent to which age plays a role in the underutilization of angiotensin-converting enzyme (ACE) inhibitors in heart failure patients has not been well studied.
Background.Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications
Background.Hyperinfective strongyloidiasis is rare, but the mortality rate is very high. It occurs most commonly in immunocompromised patients. We reviewed the clinical presentation and mortality rate of cases managed in our facility.
Background.Preceptorships with community physicians have been incorporated into medical curricula to foster interest in generalist careers. An evaluation of our preceptorship program was undertaken to determine this influence.
Attention-deficit/hyperactivity disorder, a syndrome involving inattention, impulsivity, and hyperactivity, was originally thought to occur only in children. It is now a recognized condition throughout life in some individuals. For a valid diagnosis, the onset of symptoms should occur before age 7. Dysfunction of catecholamine neurotransmission is implied by the clinical…
Attention deficit hyperactivity disorder (ADHD) persists into adulthood in up to 60% of cases with childhood onset. A childhood history of ADHD is a prerequisite for making the ADHD diagnosis in an adult. The Utah, Copeland, and Brown self-rating scales are useful in helping the primary care physician confirm the…
Certain medical ailments occur with increased frequency among musicians and can affect musicians of all ages and ability. These maladies range in severity from incidental, asymptomatic findings among casual and occasional players to serious injuries that significantly disable professional musicians from practicing or performing. The most prevalent problems involve overuse…
Background.Pfiesteria piscicida and look-alike dinoflagellates are collectively known as Pfiesteria complex organisms (PCOs). The purposes of this paper are to evaluate the threat that PCOs pose to human health and to clarify some common misconceptions concerning these organisms.
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