As the non-ST segment elevation acute coronary syndromes (NSTEACS) include unstable angina pectoris (UAP) and the non-ST segment elevation myocardial infarction (NSTEMI), acute diagnosis and risk stratification can often prove challenging. This review will cover guidelines and strategies for risk assessment, contemporary approaches to acute patient management as well as…
Background: Nonparasitic benign hepatic cysts are relatively rare, and are usually detected fortuitously while investigating a patient for some other illness. However, they may reach huge proportions and present as an upper abdominal mass. With the advent of laparoscopy, a minimally invasive technique is available to manage these cases, which…
Introduction: The purpose of this study was to examine the efficacy of stellate ganglion blockade (SGB) in patients with complex regional pain syndromes (CRPS I) of their hands. Methods: After IRB approval and patient informed consent, 25 subjects, with a clinical diagnosis of CRPS I of one hand as defined…
Cryptococcal skeletal infections can lead to significant morbidity and mortality and should be considered in the differential diagnosis of lytic osseous lesions. Clinical and radiological similarities to various disorders may lead to delay in initiation of antifungal treatment. This report describes a case of cryptococcal osteomyelitis of humeral bone in…
Objective: Erythropoietin (EPO) is commonly used in very low birth weight neonates to minimize blood transfusions during hospitalization. Data are limited comparing the use of EPO along with a restricted transfusion schedule versus a restricted transfusion schedule alone. We compared the effects of a restricted transfusion schedule with EPO versus…
Gastric MALT lymphoma is almost exclusively a sequelae of Helicobacter pylori infection and rarely presents with profuse bleeding. Gastric mucosa is not normally thought to contain lymphoid tissue, yet in the presence of H pylori reactive lymphoid follicles form which are possibly throught to predispose the patient to developing lymphoma….
One of the reasons for shunt infection is valve erosion through the skin. In such cases, it is common practice to instantly relocate the shunt to avoid infection. We present a 77-year-old female patient with a 15-month history of hydrocephalus valve extrusion. Despite her poor mental status, clinical condition and…
Abstract:A previously healthy 29-year-old patient presented with new onset congestive heart failure. Based on findings on transthoracic echocardiogram (TTE) and cardiac magnetic resonance imaging (MRI) at an outside center, the patient was diagnosed as having a dilated cardiomyopathy with structural abnormalities in the ventricular septum and left ventricular (LV) apex…
Cleft lip with or without a cleft palate (CLP) and cleft palate alone (CPA) are common birth defects, with a combined birth prevalence of about 1 to 2/1,000.1 Affected children have a number of medical issues and potential complications, and therefore require a wide variety of healthcare specialists beyond plastic…
Polyneuropathy is a rare association of normal pressure hydrocephalus (NPH) and may complicate the diagnosis of both diseases. We describe a patient with NPH who presented with acute polyneuropathy. The patient was initially thought to have Guillain-Barré disease (GBS). Early consideration of NPH in patients presenting with acute polyneuropathy could…
Osteomyelitis of the skull base is a rare disorder, and even more so when the etiology is noninfectious. Symptoms are noisome and include headache and cranial nerve deficits. Because of the possibility of neoplasia, thorough evaluation, accurate diagnosis, and effective treatment are mandatory. In the case reported herein, a 58-year-old…
Objective: To provide a succinct and updated discussion on common ear, nose, and throat (ENT) disorders encountered by primary care physicians. Methods: Review of recent and pertinent literature. Results: Recent data was identified via a PubMed search as well as commonly utilized texts in otolaryngology. Discussion: While it is impossible…
Cutaneous metastasis of rectal carcinoma is a rare event. It occurs in fewer than 4% of all patients with rectal cancer. Although skin metastasis of rectal cancer is usually detected around surgical scars or on the abdominal wall, especially in the periumbilical region, it rarely presents at other sites. The…
Objectives: This study was performed to evaluate serum leptin levels in rheumatoid arthritis (RA) patients and investigate the correlation with serum tumor necrosis factor alpha (TNF-α) levels and clinical and laboratory parameters of disease activity. Methods: Fifty patients with RA and 34 control subjects were included. Disease activity score 28…
Background: Peripherally inserted central catheters (PICC) are common venous access devices. Clinical conditions and therapies that increase the risk of PICC-associated thrombosis have not been studied. Methods: We performed a retrospective case-control analysis of all adult patients who underwent placement of a PICC at our hospital over a three-year period…
In the article entitled, “Long-term air-exposed functioning hydrocephalus valve with no infection,” the authors describe an interesting case of an elderly patient whose ventriculoperitoneal shunt valve has eroded through the skin without a resulting shunt infection or malfunction.1 For any practitioner who takes care of patients with cerebrospinal fluid (CSF)…
Noncompaction of the ventricular myocardium is currently listed as an unclassified cardiomyopathy.1 This relatively new entity, first described in 1990,2 poses a problem of differential diagnosis in patients presenting with heart failure.Left ventricular noncompaction (LVNC) is characterized by multiple, prominent trabeculations of the left ventricular endocardium and deep intertrabecular recesses,…
Non-ST elevation (NSTE) acute coronary syndrome (ACS) is a common cardiovascular diagnosis and includes a range of presentations with myocardial ischemia from unstable angina (UA) to NSTE acute myocardial infarction (AMI). Recent statistics give a conservative estimate of more than 1.5 million hospital discharges with a primary or secondary diagnosis…
Normal Pressure Hydrocephalus (NPH) is a treatable form of dementia and therefore important. It was described by Hakim and coworkers in 1965 as a clinical syndrome occurring in patients with idiopathic or “occult” hydrocephalus with normal IC pressure (ICP) who could benefit from shunt surgery. NPH is characterized by the…
Skull base osteomyelitis may develop as a complication of paranasal sinusitis or other regional infectious process or as an unfortunate sequelae of iatrogenic injury or trauma. Afflicted patients generally have some form of systemic immunocompromise, most often diabetes, or a history of external beam radiotherapy for a head and neck…
Expired CME Article Questions: Common ENT Disorders
CME Topic: Healthcare Disparities. South Med J 2006;99:932, 965.On pages 932 of the September CME section, the date of original release was incorrectly listed as August 1, 2006. It should have read September 1, 2006. The date the credit expires was incorrectly listed as August 1, 2007. This should have…
Expired CME Credit Submission and Evaluation Form – Common ENT Disorders
We report on a patient who experienced vomiting, diarrhea and abdominal pain shortly after ingestion of sildenafil and was found to have aortic dissection upon admission to the hospital. To our knowledge, this has not been previously reported. Vomiting and diarrhea are not known manifestations of aortic dissection.
Nontoxigenic Corynebacterium diphtheriae is an unusual cause of deep infections such as endocarditis. We encountered a cluster of three deep infections caused by nontoxigenic C diphtheriae during a ten week period in Oakland, California. A 42-year-old, homeless, alcoholic male presented on May 14, 1999, complaining of chills, cough, weight loss,…
Acute mesenteric ischemia occurs in 1 of 1000 hospital admissions, and a nonocclusive mechanism makes up about 20% of these cases.1 Nonocclusive mesenteric ischemia (NOMI) is a condition where the macrovasculature is patent, but the microvascular blood flow is inadequate to meet intestinal tissue demands leading to gangrene and disastrous…
We report on a 64-year-old male with a past medical history of hepatocellular carcinoma partially resected at an outside institution, who presented with recurrent tumor in the left lobe of the liver for a scheduled transarterial chemoembolization (TACE). He demonstrated marked scrotal edema, lower body edema and extensive ascites consistent…
We wish to report the case of a 68-year-old male who presented with a gluteal mass and hypercalcemia. Although gluteal masses have been described in advanced Hodgkin disease,1 in our patient, the gluteal mass was the presenting sign. Similarly, although hypercalcemia may develop during the course of lung cancer, multiple…
Multiple myeloma is a clonal B cell malignancy characterized by accumulation of plasma cells.1 It can result in bone destruction leading to pain, hypercalcemia, osteopenia, pathologic fractures and spinal cord compression. Skeletal manifestations are not only due to deposition of plasma cells in the bones, but also secondary to increased…
One of the primary purposes of presenting research at scientific meetings is to disseminate important research findings as soon as possible. However, the validity of research presented at scientific meetings has been a concern.1–2 Those who have studied the fate of abstracts from scientific meetings have used the study’s subsequent…
As most readers are aware, factitious disorder (FD) involves a person’s feigning or producing physical or psychological ailments that can range from infection and fever of unknown origin to bereavement and psychosis. The goal in FD has historically been viewed as the sick role,1 with its attendant attention, nurturance, and…
Metformin, a biguanide antidiabetic drug, has been implicated as a cause of lactic acidosis, usually in a setting of renal failure, IV contrast administration, shock, sepsis, hypoxemia, heart failure, or liver disease. Although metformin can cause mild lactic acidemia in type 2 diabetes mellitus patients with normal renal function,1,2 there…
Early diagnosis and combined modality of treatment have significantly improved the survival of breast cancer patients. Most patients will die of etiologies other than breast cancer, which may include second primary malignancies (SPM). We report here two patients who developed squamous cell carcinoma of the oral cavity following treatment of…
Anatomic anomalies are supported by an underlying embryological basis and manifest their clinical impact. The external jugular vein is used as venous manometer, while both the external and internal jugular veins are used for IV catheterization to conduct diagnostic procedures or IV therapies. The variations are important for interventional radiologists…
Psychiatric Grand Rounds http://www.mentalhealth.ucla.edu/opce/gr.html is a feature of the Neuropsychiatric Institute, UCLA, in association with the Department of Psychiatry and Behavioral Sciences. The lectures are presented at 11 am every Tuesday and can be viewed live or accessed via the 2005/2006 archive. The lectures are listed in reverse chronological order…
Many ear, nose, and throat (ENT) disorders are easily diagnosed and treated by primary care physicians (PCP). Some problems, however, require a visit to an ENT specialist (otolaryngologist). If you or your child experience problems with the ear, nose, or throat which require a visit to a physician, understanding the…
When the SMA was founded in 1906, the discoveries of x-rays by Röntgen in 1895, and radioactivity by Becquerel in 1896, were virtually current events. That first era for radiation oncology was one of curiosity, experimentation, and empiricism. Early physicians merely applied exposure to radiation to “see what happened” and…
Mrs. Bennett is a 58-year-old African-American female with metastatic cervical cancer, diagnosed two years ago. She initially underwent radical hysterectomy, chemotherapy and radiotherapy. She did well until six months ago when liver metastases were detected. She then entered a Phase II clinical trial, but the cancer continued to progress. She…
These notes are most sharply constructed for the non-Jewish physician who tends to a Jewish patient and who operates with the assumption that religion is of therapeutic value, having the potential to guide, comfort and motivate.The physician should know that in Judaism, formally speaking, life is carried and guided by…
Research suggests that religious involvement favors health and longevity. Studies are beginning to show that religious involvement may also benefit cognitive functioning in late life. This article reviews and discusses research on religion, spirituality, and healthy cognitive aging.
For two decades, published research has linked religious participation to various health outcomes. These include diminished risk according to overall and cause-specific morbidity and mortality and to indices of health status, symptomatology, and psychiatric illness, especially depression and anxiety. What may not be apparent to physicians exposed to this literature…
Faced ith medical illness, many people turn first to their faith for hope, comfort, strength, meaning, a sense of control, social support, and spiritual support. However, for a smaller but significant number of people, medical illnesses can signal the onset of a spiritual struggle that may presage declines in physical…
What do physicians need to know to help their patients deal with the impact that spirituality can have on their health and medical outcomes? The following special section in the SMJ addresses a variety of topics covering spirituality over the lifespan. Spiritual needs that are relevant to the patient’s health…
The role of spirituality in healthcare is an active and ongoing conversation with varied perspectives represented within the medical community. Whatever perspective one might bring to the conversation regarding spirituality and medicine in general, the particular relevance of spirituality for many patients at the end of life compels us to…
“There is an inescapably religious dimension to the caregiving experience. The self-sacrifice entailed in caregiving may be the closest brush with transcendence that most people will ever experience as we recognize the illusions of self-sufficiency and the realities of mutual dependence in a world of greater risks than the vast…
Of all influences religion may have on health, the most intuitively plausible and uncontroversial concerns patients’ health-related habits and behaviors. At least part of the epidemiologic association between religious involvement and mortality is accounted for by inverse associations between religious involvement and detrimental health behaviors and less consistent positive associations…
Spirituality refers to that essence which can bring meaning, courage, and hope to every human being’s existence no matter how old or sick or confused. It often expresses itself through beliefs or existential seeking, religious affiliation and community, or through a practice, such as prayer or meditation. It may engender…
The burden of depression will undoubtedly increase among the elderly. The increased burden of depression will be manifested by at least two factors: the increase in the absolute number of older people as the baby-boom generation enters later life, and the heavier burden of depression carried by the baby-boom generation…
Religious coping is the most widely used spiritual resource that older people utilize to deal with illness and stressful life events. Religious coping behaviors include two major dimensions, organizational and intrinsic.1,2 Organizational religiousness includes church attendance and religious group participation. Intrinsic religiousness includes faith in God, prayer, reading of scriptures,…
A personal connection to the Creator, often termed personal devotion, is the most robust protective factor identified to date in the research field of adolescent health and mental health. Adolescents who turn to God for guidance and direction in making daily choices have lower rates of morbidity with respect to…
Among the more impressive discoveries in spirituality and health research in the last two decades has been finding that certain aspects of spirituality are consistently associated with lower morbidity and mortality in adults. As a result of this knowledge, clinicians should incorporate an appreciation for the influence of spirituality and…
Mr. Jones is a retired 75-year-old building contractor who lives alone and has had few social contacts since he stopped attending church after his wife died. He is seeing his internist today for treatment of chronic leg pain, diabetes, and hypertension. Noncompliant for months on his diabetes regimen, his HgB…
Physicians are already overburdened with the amount of information they need to collect from patients. No doubt it is challenging to be told that one must screen patients for depression, social isolation, substance abuse, and unhealthy lifestyles, in addition to detecting covert physical disease and comprehensively addressing medical problems. Now…
There is growing recognition that persistent pain is a complex and multidimensional experience that can influence and be influenced by biologic, psychological, social and spiritual or religious factors.1–4 Individuals experiencing persistent pain often report they turn to their religion or spirituality to cope with pain. Religious pain coping techniques vary….
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