SMJ // April 2006, Volume 99 - Issue 4

Case Report

Treatment of Extramammary Paget Disease with Topical Imiquimod Cream: Case Report and Literature Review

Abstract:Extramammary Paget disease is an uncommon cutaneous neoplasm that presents as erythematous plaques most frequently located in the anogenital region. Management of patients with extramammary Paget disease involves evaluation of the individual for: (1) a disease-associated, unsuspected, visceral malignancy and (2) secondary adenocarcinoma in the underlying dermis or regional lymph…

Case Report

Amiodarone-induced Alveolar Hemorrhage

Abstract:Amiodarone is increasingly prescribed for patients with ventricular and supraventricular tachyarrhythmias. Many adverse effects have been reported due to this drug and include injury to the liver, thyroid, cornea, skin, and neuromuscular system. Pulmonary toxicity is one of the more serious side effects of this anti-arrhythmic drug and is potentially…

Review Article

Easy Bruisability

Abstract:Physicians often see patients who complain of “easy bruising.” The skill of the clinician is to identify those patients likely to have a potentially serious underlying disorder from those who do not. A detailed history often provides sufficient information. A comprehensive physical examination and possibly some baseline laboratory studies can…

Case Report

Conversion Disorder Presenting as Hemiplegia and Hemianesthesia with Loss of Neurologic Reflexes: A Case Report

Abstract:Conversion disorders can present with a variety of sensorimotor signs and symptoms. We present the case of a young woman who presented with sudden onset hemiplegia and hemianesthesia including unilateral loss of deep tendon reflexes, Babinski reflex, and loss of rectal tone with bladder incontinence. The loss of rectal tone,…

Original Article

Adverse Outcomes in Younger Rib Fracture Patients

Background:Recent studies on the impact of rib fractures after blunt trauma have shown a linear relationship between age, increasing number of rib fractures, and complications, including mortality. Others have documented that age-related morbidity increases before age 65 in trauma patients. We hypothesize that patients as young as age 45 demonstrate…

Original Article

Descriptive Epidemiology of Hepatitis C Virus Among Male Heroin Abusers in Taiwan

Background:The purpose of this study was to explore the epidemiology of hepatitis C virus (HCV) infection and to determine the risk factors for HCV infection among heroin abusers in Taiwan. Methods:This was a cross-sectional study. From November 2004 to February 2005, 577 subjects, including 423 subjects (73.3%) using injectable heroin…

Original Article

Heat Illness Symptom Index (HISI): A Novel Instrument for the Assessment of Heat Illness in Athletes

Background:Heatstroke is the third leading cause of death in athletics, and an important cause of morbidity and mortality in exercising athletes. There is no current method, however, for identifying milder forms of heat illness. In this pilot study, we sought to develop and provide initial validation for a Heat Illness…

Original Article

Pounds of Cure: Chart Weight as a Measure of Service Intensity

Abstract:Intensity of hospital services is often estimated by length of stay (LOS). Increasing demands for documentation in the medical record suggested to us an alternate method: weighing the chart. In a retrospective study, we compared LOS and chart weight as predictors of actual hospital costs at a community teaching hospital….

Case Report

An Unrecognized Cause of Recurrent Hypercalcemia: Immobilization

Abstract:We report a 66-year-old Chinese man with chronic renal insufficiency (creatinine 1.7 mg/dL) and gout suffering from slurred speech and right hemiplegia for 3 days. Acute cerebral infarction was confirmed by computed tomography. Conscious disturbance occurred on the tenth hospital day without significant changes on imaging study when compared with…

Case Report

New Anticonvulsants-New Adverse Effects

Abstract:Ongoing refinements in pharmacology continue to provide new medications for the treatment of seizure disorders and other neurologic conditions. The authors present the cases of two children who developed relatively uncommon adverse effects to new anticonvulsant medications, including metabolic acidosis with topiramate and hyponatremia with oxcarbazepine. In one of our…

Case Report

Primary Tuberculous Liver Abscess: A Case Report and Review of the Literature

Abstract:A 48-year-old diabetic man was admitted to our hospital with abdominal pain in the right upper quadrant, weight loss, night sweats, fatigue, and anorexia. Ultrasonography, computed tomography, and magnetic resonance imaging of the abdomen revealed multiple hemangiomas and a hypodense mass lesion in the posterior segment of the right hepatic…

Case Report

Paradoxically Developed Optochiasmatic Tuberculoma and Tuberculous Lymphadenitis: A Case Report with 18-Month Follow up by MRI

Abstract:We report the first case of extracranial tuberculous lymphadenitis which paradoxically developed during treatment of intracranial tuberculoma. Our patient, a 15-year-old girl who initially presented with meningitis and intracranial tuberculomas, developed extracranial tuberculomas during treatment for central nervous system tuberculosis. She was followed clinically with cerebrospinal fluid (CSF) studies and…

Editorial

Adverse Drug Reaction Reporting and Pharmacovigilance of New Therapeutic Agents

Much media attention and public interest has been recently expressed with respect to major recalls of popular medications worldwide, the most pertinent being the rofecoxib withdrawal in 2004.1,2 Situations such as this have heightened both academic and clinical interest in the areas of medication safety and pharmacovigilance. Fortunately, not all…

Editorial

Age and Adverse Outcomes in Rib Fracture Patients

There are five principle determinants of outcome following serious injury: injury severity, age, pre-existing medical conditions, time from injury to definitive care, and quality of care. Increasing age increases mortality following trauma, and the only debatable point is the age at which the enhanced mortality risk becomes manifest. In the…

Editorial

Amiodarone-induced Pulmonary Hemorrhage

Amiodarone is a widely prescribed anti-arrhythmic for atrial and ventricular arrhythmias. The adverse effect profile of amiodarone is diverse, involving the cardiac, thyroid, pulmonary, hepatic, gastrointestinal, ocular, neurologic and dermatological systems.1 However, the most severe and potentially life threatening of these side effects is the development of pulmonary toxicity.

Editorial

Central Nervous System Tuberculosis and Paradoxical Response

Tuberculosis (TB) is the 7th leading cause of death and disability worldwide and has reached epidemic proportions in both developed and undeveloped nations. Approximately 5 to 10% of tuberculosis cases involve the brain and central nervous system. Tuberculomas account for 10 to 30% of intracranial (IC) masses in TB-endemic areas….

Editorial

Conversion Motor Paralysis Disorder

Hysteria was first documented 4,000 years ago by the Egyptians, who believed the symptoms originated from the uterus, hence the name (hysterus).1 “Hysterical” conditions included combinations of seizures, paralysis, and anesthesia. During the 17th and 18th centuries, a variety of disorders such as hypochondriasis, hysteria, dyspepsia, and “gas and spleen…

Editorial

Preventing Heat Illness in Athletes

Although not generally appreciated, heatstroke is the third leading cause of death in athletes.1 Fortunately, in the past few years there has been an increase in the awareness of heat-related illnesses in both the medical community and the population in general. This is likely due to the heat wave that…

Expired CME Article

CME Questions: Dysnatremias: Why Are Patients Still Dying?

Expired CME Article Questions: Dysnatremias: Why Are Patients Still Dying?

Expired CME Article

Dysnatremias: Why Are Patients Still Dying?

Expired CME Article – Dysnatremias: Why Are Patients Still Dying?

Expired CME Credit Submission and Evaluation Form

Credit – April 2006 CME Topic: Dysnatremias: Why Are Patients Still Dying?

Expired CME Credit Submission and Evaluation Form – Dysnatremias: Why Are Patients Still Dying?

Letter to the Editor

Newborn Screening for Cystic Fibrosis

To the Editor:Newborn screening is a well-established approach for identifying genetic diseases with a 40-year history of improving public health.1 The debate about justification for screening newborns for cystic fibrosis (CF) continues; however, the Centers for Disease Control and Prevention (CDC) recommends that individual states consider planning and implementing newborn…

Letter to the Editor

Pesticides Used in Homes and Farms in El Paso, Texas

To the Editor:Commercial and residential use of pesticides is common in El Paso, Texas, both inside and outside people’s homes, as well as in agricultural fields. Although pesticides offer benefits to users by keeping insects and rodents out of the house or the farmland, it has been shown that certain…

Letter to the Editor

Systemic Infections Can Decrease the Threshold of Statin-induced Muscle Injury

To the Editor:We read with interest the report of Finsterer and Zuntner1 describing the possible relationship between rhabdomyolysis, statin therapy and systemic infection. We report a similar occurrence in a patient with septicemia. There are various risk factors described which increase the likelihood of statin-induced muscle injury, but little is…

Medical Webwatch

Medical Webwatch

Oral Pathology http://www.usc.edu/hsc/dental/opfs/ from the University of Southern California School of Dentistry is a large library of images illuminating a variety of oral diseases. Each series offers gross pathology, x-ray plates, and histological slides. The enlargeable thumbnails are accompanied by succinct summaries that describe manifestation, exploration, diagnosis, treatment, etc. It…

Acknowledgment

Patient’s Page

April is National Child Abuse Prevention MonthHow To Prevent Child AbuseWhat is child abuse? We’ve all heard the term, but do you really know what it is? Is spanking your child abuse? Is walking away from a screaming infant neglect? What, exactly, constitutes abuse? And how is it prevented? There…

SMA Centennial

Pediatrics During the 20th Century

“One is often surprised that our medical forefathers knew so much. One is also surprised that they knew so little, and yet were undoubtedly useful members of society. They had the distinct advantage over us that each man if well trained, knew all of everything medical that there was to…

Spirituality/Medicine Interface Project

Case Discussion: Disease as Punishment

” A 62-year-old woman has sustained a left hemiplegia while recovering from elective hip replacement for osteoarthritis. She refuses all treatment including physical therapy. She tells you in confidence that she is being punished for having committed adultery about 25 years ago, and that she should not have had the…

Spirituality/Medicine Interface Project

Educating Physicians: Are We Doing Enough?

The context for the above question is the Spirituality/Medicine Interface Project of this journal, ie, the humanistic aspects of becoming and being a physician. Taking the knowledge and skills aspects of professional competence for granted, I focus in this essay on the person of the physician, ie, professional identity, integrity…

Spirituality/Medicine Interface Project

Eye on Religion: Clinicians and Hinduism

Hinduism is as much a “way of life” as a religion and affects every aspect of life for Hindus from birth throughout their life. Hindus believe that as all streams and rivers lead to the same ocean, all genuine religious (spiritual) paths lead to the same goal; worship of every…

Spirituality/Medicine Interface Project

Face Transplantation: A Brave or Maverick Surgery?

On November 27, 2005 two French surgeons and their teams dropped a bombshell: they performed a partial face transplant on a 38-year old female patient whose face had been mauled by a dog in May of that year. Worldwide several teams had been working on the various technical, scientific and…

Spirituality/Medicine Interface Project

Face Transplantation: The View from Birmingham, England

The news that the world’s first partial face transplant had been performed in France on 27th November 2005 was greeted with a mixture of emotion by the medical profession and public alike. On the one hand this was a groundbreaking procedure with the potential to help many people, on the…

Spirituality/Medicine Interface Project

Face Transplantation: The View from Duke University and the University of Chicago

The partial face transplant performed in France last November 27, 2005, ushered a whole new arena of reconstructive surgery into the public eye. Unfortunately, this event has not been universally well received by the international community of reconstructive microsurgeons and medical ethicists. Early in 2005, the American Society for Reconstructive…

Spirituality/Medicine Interface Project

Face Transplantation: The View from Harvard Medical School

The era of composite tissue allotransplantation (CTA) began with the first hand transplant in 1963.1 Not surprisingly, given the novelty of the field of transplantation at the time, the graft was rejected after only three weeks. Over the next several decades, improvements in immunosuppression and surgical technique enabled successful transplantation…

Spirituality/Medicine Interface Project

Face Transplantation: The View from Paris, France

During the night of November 27, 2005, a 36-year-old woman disfigured by a dog was reconstructed by a transplantation of the lower part of the face including the nose and the lips. This first “facial transplantation” was a true medical performance. It answers the question that some had raised of…

Spirituality/Medicine Interface Project

Face Transplantation: The View from Vanderbilt University

In 1997 when Americans first saw the John Travolta and Nicholas Cage movie entitled “Face Off,” most assumed it was firmly rooted in the world of science fiction. In this movie an FBI agent played by Travolta, in order to infiltrate the inner circle of a nepharious criminal played by…

Spirituality/Medicine Interface Project

Face Transplants: Is the Genie Out of the Bottle?

In November 2005 a new world of reconstructive possibility opened up for people with severe facial disfigurement when oral and maxillofacial surgeon Bernard Devauchelle teamed up with Jean-Michel Dubenard to perform the first composite tissue allotransplant taking facial tissue from a brain dead donor and transferring it to a French…

Spirituality/Medicine Interface Project

Saving Face

Unlike those characteristics which describe the self, identity is not a static reality; rather, it is a construct perpetually in the process of being created and edited. Furthermore, although the editing may be done by the self, it is influenced as much by forces from without as by those from…

Spirituality/Medicine Interface Project

The English Position: Position Paper of the Royal College of Surgeons of England

To the reconstructive surgeon, facial transplantation would constitute a major breakthrough in restoration of a quality of life to those whose faces have been destroyed by accident or tumour. It is therefore worthy of study.

Spirituality/Medicine Interface Project

The French Position: Comité Consultatif National d’Ethique pour les sciences de la vie et de la sante’;: “L’allotransplantation de tissu composite (ATC) au niveau de la face (Greffe totale ou partielle d’un visage)”

L’expression « greffe du visage » doit être combattue. On ne greffe jamais un visage mais un tissu composite. Il faut donc combattre les fantasmes associés à une telle intervention qui reste une allogreffe de tissu composite destinée à réparer un visage déformé ou détruit. C’est pourquoi l’idée même de…

Spirituality/Medicine Interface Project

The French Position: Comite’; Consultatif National d’Ethique pour les sciences de la vie et de la sante’: “Composite Tissue Allograftransplantation of the Face (Total Or Partial Graft)”*

The term “face transplant” is misleading and should not be used: It is composite tissue, rather than an actual face, which is actually grafted. It therefore is necessary to oppose the fantastical images associated with an operation that takes a composite tissue allograft to repair a disfigured or destroyed face:…

Spirituality/Medicine Interface Project

The United States Position: Position Paper of the American Society for Reconstructive Microsurgery on Facial Transplantation

Composite tissue allotransplantation (CTA) has been performed on a limited basis clinically since 1992. Transplants of nerve, tendon, joint, larynx, tongue, hand, and, most recently, abdominal wall have been reported on just a few cases. The functional and aesthetic outcomes of these transplants have exhibited variable degrees of success. The…

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