Background Surgical airway intervention is occasionally necessary due to contraindicated or failed endotracheal intubation. In cricothyroidotomy patients, a choice exists between continued long-term ventilation via the cricothyroidotomy portal or conversion to tracheostomy. We examined whether conversion to tracheostomy reduces the risk of acute complications. Methods We retrospectively identified 46 patients…
Because of recent concerns about the long-term risks of estrogen replacement therapy in postmenopausal women, there is growing interest in a group of compounds known as selective estrogen receptor modulators (SERMs). The SERMs bind to estrogen receptors and have tissue-specific effects that allow them to function as estrogen agonists in…
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…
One-year vertebral fracture risk reduction from clinical trials in adults with postmenopausal or glucocorticoid-induced osteoporosis is reviewed. Data were obtained by conducting a literature search of osteoporosis medications using the MEDLINE database, bibliographies of selected citations, and recent meeting abstracts. The methodologic quality of the trials was assessed using recently…
The resistance to erythropoietin, which is used to treat normochromic, normocytic anemia in chronic renal failure, can develop in patients with conditions such as iron deficiency, aluminum toxicity, hyperparathyroidism, chronic inflammatory diseases, and primary hematological disorders. We found amyloidosis in the bone marrow of a woman without any other etiology…
We describe two patients who had tuberculomas that were initially misdiagnosed as neurosarcoidosis, leading to prolonged steroid therapy before initiation of antituberculous medications. Neither patient was infected with the human immunodeficiency virus, and one of the patients had a negative tuberculosis skin test.
Detection of acute renal infarction is often delayed or missed because of both the rarity of the disease and its nonspecific clinical presentation. Abrupt onset of low-back pain in a patient at high risk for a thromboembolic event may be the first indication of renal infarction. We report a case…
Isovaleric acidemia is a rare autosomal recessive inborn error of leucine catabolism caused by deficiency of isovaleryl coenzyme A dehydrogenase. This enzymatic deficiency leads to severe metabolic derangement, manifested clinically as vomiting, dehydration, and acidosis progressing to seizures, coma, and death. The two phenotypic expressions are the acute severe and…
Methemoglobinemia results from the oxidation of the ferrous iron in hemoglobin to the ferric iron state. Methemoglobin is incapable of carrying O2, and high levels may impact on O2 delivery to the tissues. Methemoglobinemia may result from congenital deficiencies of enzymes that normally convert methemoglobin to hemoglobin, alterations in the…
We report a case of pleural effusion from trapped lung secondary to sarcoidosis. The patient presented with dyspnea, right pleural effusion, left and right upper-lobe infiltrate and a widened mediastinum. The pleural effusion and dyspnea failed to respond to a course of oral corticosteroids but was relieved by decortication with…
We present the case of a woman with metastatic malignant gastric stromal tumor occurring four years following a partial gastrectomy and distal esophagectomy, which presented as atypical breast mass with synchronous occult gastrointestinal bleeding. A discussion of metastatic pattern is presented, with emphasis placed on the need for continued surveillance…
Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture, the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal…
Radiation pneumonitis is a well-described complication of chest radiotherapy administered to patients for mediastinal, breast, and lung tumors. Dyspnea, cough, and radiographic infiltrates within the field of radiation are typical symptoms and findings. Systemic corticosteroids are the traditionally accepted treatment, often with good clinical responses reported in a large number…
Yersinia enterocolitica is a well-known cause of enterocolitis. Although focal extraintestinal manifestations and disseminated disease have been described, usually in immunosuppressed patients, infection in the chest seems to be rare. We report the case of an alcoholic man who had spontaneous pleural empyema due to Y. enterocolitica.
Persistent left superior vena cava is a relatively rare vascular anomaly. It is, however, the most common variation in the thoracic venous system. The anomaly is typically detected on chest x-ray after the placement of a pulmonary artery catheter or pacemaker leads. This report describes a case of persistent left…
Background It has been shown that patients with thoracic kyphosis due to osteoporosis have diminished pulmonary function. The aim of this study was to determine the pulmonary function, respiratory muscle strength, and endurance of patients with osteoporosis who did not have compression fractures. Methods The patient group consisted of 88…
Background Patient comfort is an important part of laceration repair. Methods The study was a randomized single-blind cross-over trial in which each participant received 250 ml warmed and 250 ml room temperature saline irrigation in simple linear wounds after a local anesthetic was instilled. The solutions and the order of…
Background The Circulaire nebulizer (C-Neb) is marketed as superior to low-dose albuterol for acute bronchospasm. Methods This clinical trial design compared clinical and fiscal outcomes of patients treated with C-Neb and high-dose albuterol (HDA). Eligibility criteria included reactive airway disease, age >5 years, and asthma score (AS) of 2 to…
Background Osteoporosis in black women may result in increased disability, longer hospital stays, and higher mortality compared with white women. However, it is unknown whether osteoporosis treatment or bone mineral density (BMD) measurement is different in these women, particularly in those at highest risk. Methods To examine differences and determinants…
Background Research demonstrates that religious values clearly impact on the judgments made by physicians and their patients. One basic dichotomy—belief in ethical values that do not change (absolute values) versus belief in values that change depending on the situation (relative values)—has recently been experimentally associated with different ethical decision-making patterns….
Background Prevention is the most cost-effective means of managing osteoporosis. However, little is known about osteoporosis-related preventive practices in Mexican-American women. We examined factors that might influence women's decision to start preventive measures for osteoporosis. Methods Information was gathered through a cross-sectional survey of low-income Mexican-American women who were seen…
During the past year, the field of osteoporosis has witnessed many significant developments that are paving the way for great future advancements in the management of this condition. In July 2002, the National Institutes of Health announced unexpectedly that it was terminating the arm of the Women’s Health Initiative (WHI)…
In a recent issue of Southern Medical Journal, Gorospe et al 1 reported a case of a patient with aortic dissection who presented with persistent fever and other systemic symptoms. We describe a patient with a similar clinical presentation whose symptoms subsided after surgical correction of the aortic dissection.
The brown recluse spider (Loxosceles reclusa) exists in significant populations mainly in the midwestern United States. Although bites can cause significant harm, envenomation is infrequent, and cases are usually clinically insignificant. Proper knowledge of the spider's habitat and lifestyle as well as the signs and symptoms of loxoscelism are needed…
The question whether a physician should assist patients with an intolerable terminal condition to end their life has been debated since the practice of medicine began with Hippocrates. The debate surrounding physician-assisted death (PAD) and voluntary euthanasia is still alive. 1 In the United States, patients now generally have a…
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