Upper-extremity deep vein thrombosis (UEDVT) was an understudied disease until recently. Previously thought of as benign, UEDVT has been shown in recent studies to pose a significant risk for pulmonary embolus and death. This article reviews the epidemiology, risk factors, clinical features, diagnostic tests, treatment options, complications, and prevention strategies…
Expired CME Credit Submission and Evaluation Form – Upper-extremity Deep Vein Thrombosis
A 71-year-old black woman was admitted to the hospital with a 2-month history of a nonhealing leg ulcer. Her medical history included diabetes mellitus type 2, congestive heart failure, allergic rhinitis, and asthma. The patient’s asthma was labile and steroid-dependent until 2 years before admission, at which time zafirlukast therapy…
Chronic myelomonocytic leukemia (CMML) is a relatively rare, heterogeneous syndrome classified as a myelodysplastic syndrome according to the French-American-British classification system. The patient’s presenting symptom was a pigmented skin nodule that, although common for cases of acute monoblastic leukemia, is peculiar for CMML. This case should increase awareness of the…
Mycobacterium avium-intracellulare (MAI) rarely causes disease of the spine in healthy individuals. We describe an elderly woman who had isolated skeletal involvement with MAI, mimicking Pott’s disease. She responded well to surgical excision of the inflamed tissue and antibiotic therapy. Osteomyelitis due to MAI must be differentiated from that due…
In obese patients, lymphodystrophic tissue can create large masses that are microscopically indistinguishable from chronic lymphedema. This tissue can be disabling, especially in the lower extremities. The tissue is refractory to conservative therapy and is prone to cellulitis and abscess formation. The patients are regarded as being at high risk…
A 65-year-old man with a 3-month history of intractable back pain had previously received cytotoxic curative chemotherapy for non-Hodgkin’s lymphoma. His postchemotherapy course had been complicated by febrile neutropenia, recurrent coagulase-negative staphylococcal bacteremia, and gastrostomy site infections. He was admitted with severe intractable lower back pain requiring high doses of…
A 27-year-old man with no history of cardiopulmonary disease presented with progressive shortness of breath. He was significantly tachypneic and hypoxic, with inspiratory and expiratory wheezing. Evaluation of the chest with computed tomography revealed a large anterior mediastinal mass and interstitial thickening consistent with lymphangitic spread. Plasma β-human chorionic gonadotropin…
The neighbors were concerned. They insisted on seeing me before I saw the patient. “Something has to be done!” they said several times. “It is not fair to let Aunt Liz,” as Mrs. Elizabeth Brown is known to them, “live on her own any longer. Doctor, you must convince her…
Systemic lupus erythematosus is a chronic autoimmune disease of unknown etiology with multisystem involvement. Pulmonary hemorrhage is a major life-threatening manifestation in children and adolescents with systemic lupus erythematosus, as well as in adults. Treatment has traditionally been with high-dose corticosteroids, with or without the addition of cytotoxic agents. We…
We describe the first two cases of percutaneous cryoablation under magnetic resonance imaging guidance. To date, this minimally invasive procedure has been used for the treatment of renal cell tumors in patients who cannot tolerate or refuse surgical nephrectomy. The two patients described showed no evidence of recurrence or complications…
Musical hallucinations are poorly understood auditory hallucinations that occur in patients with otologic or neurologic diseases. We report the first cases of musical hallucinations in two patients with neurologic Lyme disease. Both subjects were women with clinical and laboratory evidence of chronic Lyme disease, progressive neurologic dysfunction, and abnormal magnetic…
We report an unusual case of a 51-year-old woman with inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura. We propose that the presence of all three disorders together suggests that they may share an interrelated immune mechanism.
Background: Nineteen hydrogen sulfide (H2S)-exposed patients were compared with 202 unexposed subjects. This 1997-to-2001 case-referent series was compared with 16 previous (1991–1996) case-referent patients.
Background: Physicians who offer firearms counseling may increase their legal liability, depending on the attitudes of their medical malpractice insurance carriers.
Background: Although the beach is a high-risk environment for ultraviolet light exposure and subsequent skin damage, little is known about beachgoer tanning habits outside the beach setting. Our purpose was to evaluate indoor tanning and additional, nonbeach sunlight exposure in a beachgoing population.
Background: Increasing supplies of dermatologists and family physicians have been associated with earlier detection of malignant melanoma. We investigated whether physician supply was similarly related to incidence and mortality rates of malignant melanoma.
Background: The prevalence of congestive heart failure (CHF) in the United States is approximately 4 million, with associated annual health care expenditures exceeding $8 billion. Clinical pathways for CHF have been developed, but they have not been rigorously evaluated regarding efficacy and improvement in the quality of care. We sought…
We report a case of apotemnophilia, or “love of amputation,” in a man in his mid-20s. Apotemnophilia is defined as self-desired amputation driven by the patient’s erotic fantasy of possessing an amputated limb and overachieving despite being handicapped. The desire of a patient with apotemnophilia for amputation is obsessive, and…
Orally disintegrating olanzapine is a recently marketed form of olanzapine that dissolves rapidly on contact with saliva. We describe six demented patients resistant to treatment with common oral antipsychotic medications who were successfully treated with the formulation. The importance of these case reports is to make physicians aware that orally…
Ephedra, a psychoactive substance with stimulant properties, is found in many herbal products. Often perceived by the lay public as benign, the potential health-related dangers of using these products are beginning to be recognized. We review four cases associated with ephedra-containing herbal products and report three additional cases. Unlike the…
Impaired processing of perceptual information is often a prominent aspect of psychotic disorders. Physical symptoms such as pain or discomfort may be either incorrectly perceived or misinterpreted by psychotic patients. Presented here is a series of cases in which somatic symptoms occurred in psychotic patients and worsened their psychotic states…
A patient presented with scrotal cellulitis as a complication of infusing 900 ml saline into his scrotum. He had obtained a kit along with explicit instructions for performing the infusion through the Internet. This practice may be more widespread than expected. An Internet search revealed many references to this procedure,…
Upper-extremity deep vein thrombosis (DVT) is a fairly uncommon syndrome of complex etiology and varied presentation. Its incidence has recently grown, and it has become more widely recognized in diverse clinical settings. Clinical reviews and prospective studies have clarified some aspects of the clinical presentation and setting and have alerted…
Upper-extremity deep vein thrombosis (DVT) is a fairly uncommon syndrome of complex etiology and varied presentation. Its incidence has recently grown, and it has become more widely recognized in diverse clinical settings. Clinical reviews and prospective studies have clarified some aspects of the clinical presentation and setting and have alerted…
Despite the publication of several consensus guidelines that set forth recommendations for the transfusion of red cells, actual clinical practice continues to vary widely. Animal data and studies in human volunteers and patients support a red cell transfusion threshold of 7 to 8 g/dl in most patients. However, conflicting data,…
Bone densitometry is routinely used to assess the skeleton in patients who have diseases or conditions that can cause low bone mass. However, there are some areas of controversy related to the interpretation of bone densitometry results. To address these issues, the International Society for Clinical Densitometry (ISCD) convened a…
I and my coauthors thank Dr. Olson for his thoughtful letter 1 about our study. 2 As he so aptly put it, our patient exhibited three of the key diagnostic features of the Klüver-Bucy syndrome. With regard to outbursts of irritation, their presence does not exclude the diagnosis of this…
To the Editor:In patients with diagnostic pleurisy, it is important to examine which type of leukocytes in pleural effusion is predominantly increasing. For example, if neutrophils are predominantly present, bacterial infection is suggested. If lymphocytes are predominant, tuberculosis or malignancy is considered to be the cause. If an increase in…
Staphylococcal toxic shock syndrome (STSS) is defined as the occurrence of fever, rash, hypotension, multiple organ dysfunction, and desquamation. 1 It is caused by toxigenic strains of Staphylococcus aureus. 2 The main hematologic changes are usually thrombocytopenia and leukocytosis with left shift. We described eosinophilia for the first time in…
Carcinomatous meningitis is an underdiagnosed complication of solid tumors. Autopsy data suggest a prevalence of 20% in patients who die as a result of systemic cancer. 1 It is usually suspected in patients with widely disseminated disease who present with neurologic symptoms and in whom routine imaging studies fail to…
We thank Dr. Ash 1 for his observations and comments about our article. 2 Succinctly, the case report described a 39-year-old man who brought a live worm to the emergency department that he claimed to have voided recently through his urethra. Urinalysis revealed 5-10 WBC count, red blood cells too…
Several reports in the literature have associated treatment with atypical antipsychotic medications with the development of diabetes mellitus or related events. Infrequent case reports have described presentations with severe acute complications such as diabetic ketoacidosis. We recently saw a male patient with a history of bipolar disorder who developed the…
State medical boards are the primary vehicles by which medical practice is regulated in the United States. Their authority is established in state statutes, and their mandate is to protect the public through a system of 1) professional licensure to ensure that only qualified, competent physicians provide health care services…
In my opinion, the patient described in the article by Helft et al 1 had leukemia to start with, because the patient was in a pancytopenic state. In addition, trephine bone marrow biopsy was not performed, so the leukemia could have been missed, especially if the marrow was patchily hypoplastic….
n Reply:Dr. Moiz’s comments on the role of bone marrow biopsy are appropriate. Bilateral posterior iliac crest biopsies were performed and reviewed by the pathology department. The sections showed marked hypocellularity but did not show any evidence of acute lymphoblastic leukemia. Bone marrow aspirate, biopsy, and chromosomal studies of the…
Dr. Anderson’s article in the October 2002 issue of Southern Medical Journal1 contains notable omissions. Sir Arthur Conan Doyle (1859–1930) wrote about Dr. Watson, who assisted Sherlock Holmes in his detective work. Dr. Watson certainly was not incidental to the plots, and quite arguably he was a “physician-detective.” Although Conan…
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