Objectives: We sought to evaluate whether there is a sex difference in the analgesic response to μ versus κ opioids in the management of acute moderate to severe pain of injury in the emergency department. Methods: The study was a randomized, double-blind, clinical trial comparing the prototypical μ-receptor agonist, morphine…
Background: Intralesional therapies provide an alternative to surgical treatment of Peyronie’s disease (PD). This study examines the efficacy of intraplaque injections of interferon-α-2B (IFN-α-2B) in the treatment of PD. Methods: Twenty-five patients were enrolled in the study with 21 completing the study. The average age of the study participants was…
Munchausen syndrome is a rare condition in which the patient repeatedly seeks medical care for factitious illnesses. Cardiac Munchausen syndrome was first reported in 1953 and later referred to as cardiopathia fantastica. It is characterized by clinical manifestations of acute cardiac disease that are feigned and recurrent. Cardiopathia fantastica can…
CME Credit—January 2004 Featured CME Topic: Cardiopathia Fantastica: Expired CME Credit Submission and Evaluation Form
Vasectomy is one of the most reliable and cost-effective permanent methods of contraception. Despite its popularity, certain issues pertaining to the procedure remain unresolved. Appropriate selection of candidates for vasectomy requires thorough counseling and screening, though a foolproof method of eliminating dissatisfaction and regret remains a mystery. Debate continues over…
The involvement of the cerebellum in Legionnaires’ disease has been noted in occasional case reports, but there have been no reviews on this subject to date. We report a previously healthy patient who contracted Legionella pneumonia and developed profound cerebellar dysfunction during his illness. He was treated with antibiotics with…
Patients with depersonalization disorder experience episodes in which they have a feeling of detachment from themselves. Symptoms of depersonalization may occur in individuals who have other mental disorders, or who have various medical conditions, or who have taken certain medications. A woman developed depersonalization symptoms after initiation of minocycline therapy….
Salmonella septic arthritis in healthy individuals is a rare phenomenon in the United States. This case report chronicles the clinical course of a 41-year-old male farmworker who presented with a 3-week history of fever, chills, night sweats with pain, and swelling and redness of his left ankle. He had an…
This report describes a 9-year-old girl with pigmented villonodular synovitis of the right knee. She presented with a chronic bloody effusion of the knee. The diagnosis of pigmented villonodular synovitis was suggested by the findings on magnetic resonance imaging and confirmed at the time of arthroscopic synovectomy. This report emphasizes…
Patients presenting with neck complaints, such as pain or stiffness, are not uncommon in the Emergency Department. Complaints of neck instability, however, are unusual. We report the case of a 30-year-old woman who presented with multiple neck complaints that included having a “wobbly” sensation of her neck on flexion, feeling…
A 74-year-old woman had a history over 25 years of endarterectomy of both renal arteries, iliac venous thrombosis, pulmonary embolism, left internal carotid artery endarterectomy, coronary angioplasty, aortocoronary bypass grafting, occlusion of the right axillary artery, lower-limb claudication due to common iliac artery aneurysm, external iliac artery stenosis, multiple femoral…
A woman with previously undiagnosed common variable immunodeficiency presented with diarrhea and volume depletion. Biopsies from upper and lower endoscopy revealed atrophic gastritis, villous atrophy, and an inflammatory bowel disease-like chronic colitis, with absence of plasma cells in all sites. Cytomegalovirus inclusions were demonstrated in the colon and small bowel…
Hyalinizing spindle and epithelioid cell nevus (Spitz nevus) is an uncommon melanocytic lesion. The histologic features of this benign tumor can mimic those of certain benign (dermatofibroma and desmoplastic cellular blue nevus) and malignant (metastatic carcinoma and malignant melanoma) neoplasms. We report a woman with a hyalinizing Spitz nevus and…
Background: Little is known about co-medical illnesses in black and white patients with probable Alzheimer’s disease (AD). Methods: To address this question, we used two methods. In the first (Group I), black and white probable AD patients were matched on age at presentation to the clinic, age of onset of…
Background: Achalasia is a primary motility disorder of the esophagus characterized by poor mid-esophageal motility and failure of the lower esophageal sphincter to properly relax. The optimal treatment of the disease would improve esophageal peristalsis and promote lower esophageal sphincter relaxation. Currently, such therapy is not possible, so treatment of…
Tonsillectomy remains one of the most common surgical procedures performed worldwide. Recent advancements in equipment technology have ushered in several new tonsillectomy techniques. Among these is the Colorado tip electromicrodissection needle. In this report, we describe the technical aspects of this modality and report our results in a prospective study…
Objective: We sought to calculate the sensitivity, specificity, negative predictive value, and positive predictive value of a limited sinus computed tomographic (CT) scan for sinus disease. Methods: We conducted a retrospective case series. Inclusion criteria included a sinus CT scan obtained between April 1999 and November 2000. From the complete…
Background: We used transcutaneous (TC) carbon dioxide (CO2) monitoring to prospectively evaluate changes in respiratory status after interscalene anesthesia in 45 adults (40 successful and 5 unsuccessful blocks). Methods: TC-CO2 oxygen saturation and respiratory rate were recorded every minute for 5 minutes before block and every 2 minutes for a…
Objective: It has been reported that patients with fibromyalgia syndrome (FMS) have lower maximal respiratory pressures than healthy subjects, indicating reduced pulmonary muscle strength. It has also been reported that patients with FMS have reduced grip strength. In this study, we aimed to examine the possible relationship between handgrip strength…
Background: Occult celiac disease has been reported in 0 to 6% of adults presenting with iron-deficiency anemia. Most prior studies have been retrospective or screened only a selected population of patients with small bowel biopsies. To more accurately define the true prevalence of this disorder in patients presenting with iron-deficiency…
Capgras syndrome, the delusion that identical-appearing impostors have replaced familiar people, is an unusual phenomenon usually seen in schizophrenia or dementia. We recently cared for a 78 year old man who seemed to develop Capgras syndrome as an adverse reaction to diazepam. An iatrogenic cause should be considered in the…
In typical cases of Munchausen by proxy maltreatment, a mother feigns or produces illness in her child. Her primary goal is to accrue emotional gratification, and no mental disorder better accounts for the behavior. We present the first published case in which the principal manufactured ailment was celiac sprue. In…
Chryseobacterium meningosepticum is a Gram-negative bacillus historically associated with meningitis and sepsis in premature neonates. Clinicians should suspect this organism when Gram-negative bacilli are seen on Gram-stain and culture, particularly in immunocompromised patients, and in cases of disrupted host tissue integrity. We report the first case of septic arthritis due…
This report describes three cases of foreign body ingestion incorrectly diagnosed as asthma and/or upper respiratory tract infection. These cases demonstrate the need for further clinical investigations in any child who does not improve with adequate therapy. Many of our patients had symptoms of asthma and/or respiratory tract infection for…
A sentence stood out in the letter: “I will not allow you to examine me unless you promise not to, under any circumstance, disclose my diagnosis without my prior consent.” The author of the letter wanted to find out whether our Clinic could help her. The letter was succinct: only…
As the practice of medicine becomes more technical, specialized, and firmly anchored in evidence-based data, clinicians may be tempted to concentrate on diseased organs and neglect the patient as an individual who interacts with a community. Often the patient’s psychosocioeconomic background modulates the predisposition to diseases, the clinical presentation, and…
Glaucoma is well recognized but often misunderstood by the medical and lay communities. The National Eye Institute estimates that 2.2 million Americans older than 40 years of age have been diagnosed with glaucoma and that another 2 million do not know that they have the disease. This underscores a major…
It is unfortunate that in American society, more than 90 million lawsuits are filed each year. Regrettably, many of these lawsuits are not the result of the individual’s actions but are filed as a result of acts of omission because the individual who is sued did not take appropriate actions…
There is good news and bad news as far as human immunodeficiency virus (HIV) infection is concerned. The bad news is that there is an increase in the number of patients with HIV infection. The good news is that for many patients, HIV infection is now a treatable chronic medical…
The events triggered by the September 11, 2001, destruction of the World Trade Center in New York City have had profound effects on the concept of the individual’s freedom and the relationship between the individual and society. Independence, liberty, freedom of belief and expression, and freedom of choice were held…
In the present socioeconomic climate, physicians may become the target of lawsuits and may find that jury verdicts often far exceed the lifetime earnings of the entire practice group. Excessive malpractice claims and exorbitant insurance premiums have forced many physicians to leave their favorite state and to either change specialty…
The disciplines of endocrinology and psychiatry have a strong historical link. The description of Myxedema madness by Richard Asher is one striking example. Thyroid function tests are routinely ordered in patients admitted to psychiatry services. The book Psychoneuroendocrinology by Drs. Wolkowitz and Rothschild attempts to bridge the disciplines of neuroendocrinology…
The diversity of the U.S. population is expected to increase significantly within the next few decades. It is projected that by 2050, compared with the year 2000, the white, non-Hispanic population will decrease from 71.8 to 52.8%, that the Hispanic population will increase from 11.4 to 24.5%, and that the…
This 128-page book truly fulfills the expectations of its title. There are more pictures than text, and the photographs are mostly self-explanatory. The text merely emphasizes specific points. The book is divided into four chapters: general principles, upper extremities, spine and gait, and lower extremities. In addition, a section on…
Clinicians who provide primary care are expected to be knowledgeable about a wide variety of medical problems and to make diagnostic and therapeutic decisions within a relatively short period of time. During the past few decades, the corpus of medical knowledge has expanded to such a degree that it is…
The practice of medicine has changed significantly during the past few decades. The enormous increase in the corpus of knowledge makes it virtually impossible for any one physician to be fully knowledgeable about all aspects of one’s primary specialty. Objective, sophisticated tests with high specificity and high sensitivity relentlessly replace,…
With the increasing use of bone density testing for diagnosing osteoporosis and establishing fracture risk, inconsistencies have arisen in the way in which bone densitometry is performed and the results interpreted. Differences in indications for bone mass testing, acquisition techniques, interpretation of results for different ages, genders, and ethnicity, quality…
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