Background We report the experience in managing intracranial aneurysms at our medical center. Methods We retrospectively analyzed 297 intracranial aneurysms managed during a 6-year period. Risk factors were analyzed with respect to their influence on outcome after surgery as measured by Glasgow Outcome Scale score. Results Fifty-eight patients had multiple…
Background Our objective was to test the hypotheses that trial attorneys have shorter lifespans than other attorneys, and that attorneys in general have a shortened lifespan compared with the general population. Methods Using obituaries from the Annual Report of the Virginia State Bar, we compared the lifespans of male trial…
Narcolepsy is a severely debilitating neurologic disease that is not as rare as many believe, affecting an estimated 140,000 Americans. Despite the sometimes debilitating nature of narcolepsy symptoms, the disease may go undiagnosed without an organized method for evaluating patients with sleep complaints. Many of the classic symptoms of narcolepsy,…
To receive a CME certificate for 1 hour in category 1 credit toward the AMA Physician's Recognition Award, complete all sections of this form and mail it with a check (payable to SMA) for $15 ($30 for nonmembers) to: Publications Department, SMA, PO Box 190088, Birmingham, AL 35219-0088. The completed…
A 7-year-old girl presented with a thyroid mass, elevated serum levels of calcitonin and carcinoembryonic antigen, as well as multiple mucosal nodules in the upper lip and tongue. Cytologic material obtained by fine-needle aspiration biopsy from the thyroid mass was diagnosed as medullary carcinoma and confirmed by immunohistochemical studies in…
Medical conditions predisposing to epidural abscess include diabetes, intravenous drug use, alcoholism, and other immunocompromised states. Although cirrhosis is associated with an increased risk of infection in general it has not previously been identified as a condition predisposing to epidural abscess. We describe two cirrhotic patients with spinal epidural abscesses….
Actinomycosis is an invasive, destructive infectious syndrome caused by Gram-positive, branching, filamentous bacteria in the order Actinomycetales. The principal agent of human infections is Actinomyces israelii. Actinomycosis typically involves four anatomic sites, resulting in cervicofacial, thoracic, abdominal, or pelvic infection. Occasionally, however, dissemination of organisms, coupled with desmoplastic tissue reactions,…
Thyroid abscess was a common condition in the era before antibiotics. In the current medical environment, however, it is a clinical entity that is seldom encountered. We report the case of a unique cause of thyroid abscess, the environmental Gram-negative bacterium Acinetobacter calcoaceticus. Review of the published causes of thyroid…
Five middle-aged women presented with unexplained chronic swelling at the medial clavicle. None of the patients recalled a history of trauma and none experienced pain or other symptoms associated with the swelling. In all cases, suspicion of tumor prompted referral to an orthopedic oncologist; two cases were biopsied before referral….
To the Editor: Patients with head and neck cancer (HNC) and trismus can be managed with surgery. 1 However, a poor outcome may result because of the difficulty in obtaining clear margins of resection. The resection involving the pterygoid (muscles) space is bloody because of the presence of large pterygoid…
To the Editor: Since their introduction, statins have revolutionized the treatment and prognosis of atherosclerotic vascular disease. Reductions in both cardiovascular and total mortality have been demonstrated in high-risk primary, 1 high-risk secondary, 2 and low-risk secondary 3,4 prevention trials. The first clinically available statin was lovastatin. When first introduced,…
To the Editor: We read with interest the case report by Al-Homaidhi et al. 1 We recently observed a case of acute hepatitis that occurred in a young woman and was correlated to therapy with amoxicillin/clavulanic acid, a combination of amoxicillin, a semisynthetic penicillin (eg, oxacillin), and an inhibitor of…
Objective Acute pancreatitis is a recognized complication of sphincter of Oddi manometry (SOM). Its frequency of occurrence has been reported in the range of 4 to 31%. In an earlier retrospective study performed at this institution, the incidence of pancreatitis was 9.3% in patients who only had SOM compared with…
Background Kikuchi-Fujimoto disease, also called histiocytic necrotizing lymphadenitis, is a self-limiting lymphadenopathy of unknown cause. The patient often presents with fever, malaise, and lymphadenopathy primarily involving the cervical lymph nodes. Laboratory findings are nonspecific, and the diagnosis is established by identifying characteristic pathologic features from lymph node biopsy. The etiologic…
Background The objective of this study was to evaluate the accuracy of digital imaging in the diagnosis of toddler's fractures. Methods Medical records for a 9.4-year period were reviewed to locate children whose initial radiographs were interpreted as normal by a pediatric radiologist and whose subsequent bone scans or follow-up…
Background An important risk factor for suicide is psychiatric illness, but only a limited amount of work has been directed at assessing the use of firearms and other weapons by select psychiatric populations at high risk for violent acts. Method Patients with combat-related posttraumatic stress disorder (PTSD), patients with schizophrenia,…
Background Dental plaque is considered by some to be a secondary reservoir for Helicobacter pylori and thus responsible for gastric reinfection. The aim of this study was to investigate whether testing dental plaque using a rapid urease test (CLOtest) can be used to determine gastric H. pylori status. Methods We…
Background The study objectives were to determine whether a community-based organization's intensive counseling intervention would reduce sexually transmitted disease (STD) acquisition among high-risk STD clinic patients and to determine whether a low-cost trial could be conducted in a community-based setting with passive follow-up. Methods Participants were randomly assigned to routine…
Introduction Palmaris hyperhidrosis is a disorder mediated by the sympathetic nervous system. It causes excessive sweating. This study evaluated the safety, efficacy, and outcome after thoracoscopic sympathectomy in patients with palmaris hyperhidrosis. Methods We reviewed the medical records of 18 patients (10 male) who underwent bilateral thoracoscopic sympathectomy between July…
Mitral regurgitation is usually tolerated well in pregnancy, mainly because of left ventricular unloading due to the physiologic decrease in systemic vascular resistance (SVR). We report the case of a patient with mitral regurgitation who had pulmonary edema soon after delivery, which likely was due to a sudden increase in…
Gonorrhea is a common sexually transmitted disease that may cause a disseminated infection. We present a case of disseminated gonococcal infection (DGI) associated with acute human immunodeficiency virus (HIV) infection. To our knowledge, this is the first report in the literature of this codiagnosis, but it may represent an underdiagnosed…
“Treatment of Patients with Lipid Disorders in the Primary Care Setting: New Treatment Guidelines and Their Implications”1 presents a thorough review of the lowering of lipid levels in patients with and without atherosclerosis. The author endorses the new National Cholesterol Expert Panel, Adult Treatment Panel III treatment recommendations targeting low-density…
If we were asked to think of one word to describe our world today, we would not be wrong in choosing “change.” The world around us has seen significant change. Similarly, the world of medicine has also changed. The art of practice and teaching medicine has changed. If we look…
To the Editor: I read with interest the article by Friedman et al 1 describing a serious and potentially fatal skin reaction in a patient treated with celecoxib, a cyclooxygenase-2 inhibitor. As the potential for therapeutic applications of the cyclooxygenase inhibitors continues to increase, vigilance for adverse reactions and interactions…
To the Editor: Although the benefits of addressing spiritual concerns of patients in the intensive care setting have been documented, less attention has been directed to patients in the non-intensive care unit setting. General medical patients also have significant spiritual concerns, but physicians rarely ask about spiritual matters. 1,2 Assessing…
In Reply: My colleagues and I appreciate Dr. Jaster’s interest in and comments regarding our recent case report. 1 We agree that the association between the sudden death and dietary changes may be temporal and not causal. Given the lack of other etiologic possibilities and the associated electrolytic disturbances, however,…
To the Editor: I read with interest the report of Stevens et al, 1 in which they described a 16-year-old girl who experienced cardiorespiratory arrest at school and died after a failed attempt at resuscitation. As is often the case in unexpected sudden death, many details of the final event…
To the Editor: Salim et al's 1 classification of their patient with a minor head injury as a case of Klüver-Bucy syndrome is open to question. Admittedly, their patient exhibited emotional blunting, excessive eating, and hypersexual behavior, three of the six essential features of Klüver-Bucy syndrome outlined by Lilly et…
To the Editor: Many vasculitides 1 and autoimmune conditions 2 have been associated with hairy cell leukemia, including polyarteritis nodosa, leukocytoclastic vasculitis, scleroderma, polymyositis and pyoderma gangrenosum. Likewise, Behçet's syndrome has been described in the setting of acute and chronic leukemia. 3–5 We encountered a patient with hairy cell leukemia…
To the Editor: I would like to add another case of possible spontaneous remission of chronic lymphocytic leukemia (CLL) to that reported by Upshaw and Callihan. 1 In September 1996, a 74-year-old woman presented with a white blood cell count of 23,300/&mgr;l with 57% lymphocytes. The bone marrow biopsy specimen…
To the Editor: Peripheral blood eosinophilia is a well-recognized but unusual manifestation of a variety of malignant conditions including acute leukemia, Hodgkin's disease, lymphoma, and several solid tumors such as carcinoma of the uterus, thyroid, kidney, stomach, lung, mesothelioma, and melanoma, 1–3 but few cases of hypereosinophilia associated with hepatocellular…
To the Editor: Head trauma is extremely common in the pediatric population; by a conservative estimate, it affects approximately 375,000 children annually in the United States. It is the leading cause of morbidity in children older than 1 year of age. Fortunately, the majority of these head injuries are minor…
To the Editor: Newsham et al 1 effectively demonstrated significant rectal temperature lag during controlled exertional hyperthermia, particularly during the recovery phase. As a result, they rightfully questioned the position of the American College of Sports Medicine regarding sole reliance on rectal temperature measurements during the evaluation and treatment of…
To the Editor: Since the Oath of Hippocrates and Hippocrates’ dictum, “If you cannot help, then do no harm,” or even before then, physicians have appreciated the sanctity of life. To do good (bene) and not to do bad (non male) became key ethical principles. The Renaissance gave rise to…
Despite the efforts of the healthcare community, health organizations and government bodies, coronary heart disease (CHD) remains a major cause of morbidity and mortality throughout North America. Data published by the American Heart Association (AHA) 1 suggest CHD affected approximately 12.6 million people in the USA during 1999. The AHA…
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