As medicine has become more and more subspecialized, many physicians have developed a shortsighted approach to patient care. Our view narrows down to focus only on our subspecialty area, sometimes to the exclusion of conditions that need treatment. The article in this issue that evaluates the prevalence of diabetic conditions…
As a boy, I could hardly wait until autumn, when I could see the new automobile models for the coming year. Although my father was a Ford man, and I had an instilled bias toward the cars built in Dearborn, I nevertheless waited anxiously to see the new offerings from…
Leprosy appears to have originated in the region of eastern Africa and was spread around the world with the movement of human populations. The disease was not present in the “New World” before the immigration of European settlers, but early case reports suggest that it was well established in North…
The non-“textbook” clinical presentation of leprosy is more common today, as illustrated by the cases reported by Abide et al1 in this issue of the Journal. Patients seldom attempt to conceal this illness today, because effective treatment is now available. As a result, patients frequently present with early lesions—small macules…
Objective: The aim of this study was to evaluate the safety and effectiveness of percutaneous cholecystostomy without interval cholecystectomy as definitive treatment for acute cholecystitis in elderly or critically ill patients with various coexisting diseases who were unfit for surgery under general anesthesia. Design: Between July 2004 and June 2006,…
Objectives: Adhesive capsulitis is characterized by a progressive and painful loss of shoulder motion of unknown etiology. Previous studies have found the prevalence of adhesive capsulitis to be slightly greater than 2% in the general population. However, the relationship between adhesive capsulitis and diabetes mellitus (DM) is well documented, with…
Objective: To study the adverse outcomes and its predictors during anticoagulant therapy in patients with venous thromboembolic disease (VTD) from a rural population. Methods: This is a prospective observational study of 94 consecutive patients. The patients were diagnosed in a first-level hospital from a rural Spanish area using objective methods…
Objectives: Type 2 diabetics are at higher risk for cardiovascular disease. To reduce this risk, the American Diabetes Association recommends traditional cardiovascular disease risk factor modification, reducing hemoglobin A1c (HbA1c), and the use of aspirin for patients over 30 years of age. The goal of this study was to analyze…
Depression accelerates the development and progression of cardiovascular disease and confers an increased risk of mortality. Platelets share biochemical similarity with the central nervous system, particularly in the uptake, storage, and metabolism of serotonin. Given this similarity, and considering the central role of platelets in the biology of cardiovascular disease,…
Abstract:Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder that can lead to serious central nervous system complications including hemorrhage, ischemia, and infection. Symptoms can be mild, making diagnosis problematic. Fifty-three prior cases of HHT and brain abscess are described, in addition to two new cases. The clinical manifestations…
Over the past 25 years, the Joint Commission for the Accreditation of Healthcare Organizations has changed its guidelines regarding religious/spiritual care of hospitalized patients to increase attention concerning this aspect of hospital-based care. Little empirical evidence assesses the extent to which hospitals relied on hospital chaplains as care providers during…
Restless legs syndrome (RLS) is a chronic neurologic disorder, with a prevalence rate in the general population of 5% to 10%. The diagnosis of RLS is straightforward; it is based on symptom history alone and uses the four essential diagnostic criteria for RLS. Owing to the heterogeneity of the disorder,…
Three native-born patients from the Mississippi Delta presented with leprosy over a 13-month period. None had a history of foreign travel, contact with each other, or known leprosy patients. Two patients’ lesions lacked anesthesia, and all had a history of armadillo exposure. These cases add to the association of armadillo…
The pathogenesis of Brunner gland hamartoma of the duodenum is unknown. This case report describes the chronology of the development of Brunner gland hamartoma from Brunner gland hyperplasia over a 12-year interval. The study subject, a 64-year-old man with chronic iron deficiency anemia, underwent serial upper endoscopies during this period….
The pathogenesis of Brunner gland hamartoma of the duodenum is unknown. This case report describes the chronology of the development of Brunner gland hamartoma from Brunner gland hyperplasia over a 12-year interval. The study subject, a 64-year-old man with chronic iron deficiency anemia, underwent serial upper endoscopies during this period….
Persistent lip swelling can be a diagnostic challenge. We report an unusual case of lip edema in the setting of lip surgery 30 years before presentation and because of retained foreign material. This case highlights the importance of accurate historical information and aggressive diagnostic methods in assessing persistent lip swelling….
A 45-year-old Costa Rican woman was seen for a jejunostomy tube malfunction. There was no evidence of tube malposition or intestinal obstruction. During endoscopy, a long worm was retrieved from the distal duodenum; it was later confirmed to be Ascaris lumbricoides. After treatment with mebendazole, no further episodes of tube…
Prostate cancer metastasizing to the mandible is a rare occurrence. This case describes a patient whose presenting symptom was a painless swelling of the left mandible. Radiological investigation demonstrated a lesion within the left mandibular ramus, and subsequent biopsy confirmed the diagnosis of metastatic prostate cancer. Key Points * Metastatic…
To the Editor: Right atrial thrombus is a serious complication of long-term central vein catheter placement.1 Management may include thrombectomy, anticoagulation, and removal of the catheter. However, removing the catheter alone is reportedly associated with a higher mortality than thrombectomy.2
To the Editor: Pancytopenia, or aplastic anemia (AA), is an often idiopathic autoimmune disorder affecting the hematopoietic cells. Severe pancytopenia is also a rare but serious complication of thyrotoxicosis. Nevertheless, most of the cases of pancytopenia and AA in Graves disease (GD) are seen as a complication of antithyroid drugs…
Although a highly effective medication, the usage of clozapine is limited mostly by its 2.7% incidence of neutropenia. It is often a treatment of last resort for patients with severe psychiatric illnesses, and therefore often the only medication to which a patient has responded. There has thus been a great…
A 35-year-old woman was admitted to the intensive care unit with heart failure and chest pain. Echocardiography had shown dilated cardiomyopathy, with a preponderance of right heart findings and pulmonary hypertension. In a woman with multiple prior uncomplicated pregnancies and deliveries, and no other known risk factors of developing pulmonary…
New episodes of bipolar illness can be mitigated or prevented with medication.1 Mood stabilizer medications, such as lithium and anticonvulsive drugs, have a demonstrated efficacy for treatment and prevention of manic episodes. Although interventions such as electroconvulsive therapy2 and psychotherapy3 are often used, all atypical antipsychotic medications have an indication…
Cystic fibrosis (CF) is the most common life-shortening genetic disease in whites. Recent progress has resulted in improvement in median survival for patients in the Cystic Fibrosis Foundation Registry from 16 years in 1970 to 36.5 in 2005.1 In the early years, it was thought that the disease was mainly…
Percutaneous cholecystostomy is an alternative treatment to cholecystectomy for acute cholecystitis in patients who are either critically ill or at high risk. Performed under local anesthesia, it allows bacteriologic studies that are useful for selected antibiotic therapy, and it appears to be safer than gallbladder puncture because of the effective…
Objectives: This article provides strategies for health care delivery for the Oglala Lakota on the Pine Ridge reservation of South Dakota. Methods: Both authors relied on their field experience as well as health care literature for constructing this article. Stella Iron Cloud is a member of the Oglala Sioux Tribe….
This article examines the nature of Lakota health and healing in its traditional form, how the Lakota both adapted to and resisted western medicine, and the state of contemporary healthcare, traditional and western, on the Pine Ridge Reservation and among the Lakota people of South Dakota.
Sleepless Nights and Restless Legs Syndrome It’s nighttime, and you’re finally able to unwind and go to bed. But right before you fall asleep, you feel it—an uncontrollable, irresistible urge to move your legs. The feeling is maddening; the best way to describe it is “creepy.” It only goes away…
Sex and the Heart: More to Know About Sexual Dysfunction in Patients with Heart Failure The prevalence of erectile dysfunction in male patients with coronary atherosclerotic diseases has been well documented. Although much research has been done on male erectile dysfunction and the heart, much remains to be conducted on…
Gender Differences in Mortality After Myocardial Infarction: Are There Any Differences? Many studies have suggested that female gender is a modest independent predictor of adverse outcome after myocardial infarction (MI). In the recent issue of Heart, Radovanovic et al examined the relationship between gender and in-hospital mortality after MI and…
Folic Acid Fortification and the Risk of Masked Vitamin B12 Deficiency In January 1998, folic acid fortification of cereals was implemented by the United States Food and Drug Administration in an attempt to increase dietary folic acid intake. However, there is a risk of masking or precipitating clinical manifestations related…
Exercise and Aging This study demonstrates the importance of fitness and regular physical activity to ongoing health in the elderly. It also shows that an overweight active elderly person is likely to be healthier than a thin, inactive one.
Diabetic Cardiomyopathy Is Common, but How to Best Detect and Manage It Remains Unclear The main cause of death in diabetics is cardiovascular disease. Pathogenic factors are a combination of coronary artery disease causing myocardial ischemia; systemic hypertension; and diabetic cardiomyopathy (DCM) leading to global ventricular dysfunction. The research by…
Bowel Cancer and Body Weight: A Definitive Review of the Evidence In this systematic review, rigorous statistical and methodological criteria are used to identify 31 epidemiologic studies on the relationship between body weight and colorectal cancer. Although the association may be weaker than previously reported, we can now be confident…
Topiramate for Treatment of Alcohol Dependence Alcoholism is the third leading cause of preventable mortality and morbidity in the United States. Johnson et al have shown that topiramate can improve drinking outcomes among alcohol-dependent individuals. The mechanism is the latest in a series of efforts to translate the developing neuroscience…
Use of Magnesium for the Treatment of Acute Onset Atrial Fibrillation A common worldwide health problem is atrial fibrillation, being the most common arrhythmia treated in clinical practice. Recommended treatment for patients with severe atrial fibrillation includes the use of β-blockers and channel blockers to control the rate of the…
Heart Failure in the 21st Century This interesting article by Drs. Velagaleti and Vasan attempts to elucidate the contribution of hypertension and coronary artery disease to heart failure. The authors rightly conclude that there is considerable overlap between the two as etiologies for heart failure. Each can contribute to the…
To the Editor: We read with interest the article by Vadlamudi et al1 regarding the three cases of significant bleeding in patients concomitantly using warfarin and levofloxacin. The authors note that scant data even support a drug-drug interaction, let alone significant bleeding outcomes. Based on their report they recommend prudence…
To the Editor: Carbohydrate antigen (CA) 19-9 is the most commonly used tumor marker for identifying certain malignant conditions, including pancreatic cancer, cholangiocarcinoma, and other gastrointestinal malignancies. It is the most useful test in distinguishing between malignant and benign conditions of the pancreas.1 These tumor marker levels can also be…
To the Editor: With great interest, we read the excellent review article by Mercado et al,1 which provided a thorough overview of perioperative cardiac evaluation and postoperative cardiac complication risk reduction strategies. We agree with the authors1,2 that cardiac complications are a major cause of perioperative morbidity and mortality after…
To the Editor: We would like to present the case of a 50-year-old black male admitted for a T11-T12 spinal abscess debridement. The patient had three admissions during the prior year with similar symptoms. During these admissions, his blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA), and his minimum inhibitory concentration…
To the Editor: A 36-year-old hypertensive, diabetic male presented for a pancreatic transplant 2 years after receiving a kidney transplant. During abdominal exploration, a wide-based Meckel diverticulum with a palpable mass was found in the ileum. It was excised, and the site was used for duodenoenteric anastomosis for drainage of…
To the Editor: Isotretinoin is usually administered to patients with recalcitrant nodular acne who do not adequately respond to standard topical or systemic antibiotics,1 in subfoveal occult choroidal neovascularization,2 or for chemoprevention settings.3 To the best of our knowledge, although adverse reactions of isotretinoin affect most of the organs, including…
To the Editor: We would like to thank Dr. Glasheen and colleagues for their comments regarding our case series of bleeding complications encountered when levofloxacin and warfarin were combined. It appears that their important retrospective cohort study of the effect of the addition of antibiotics on the international normalized ratio…
To the Editor: A 42-year-old woman presented with fever, sore throat, and odynophagia lasting 7 days. She also developed pustules on her right hand after a minor laceration. Her medical history included Graves disease, for which methimazole was initiated 3 months prior. Physical examination revealed whitish patches over the oropharyngeal…
Discovering Lewis and Clark http://www.lewis-clark.org/ was conceived in 1993, and has been online since 1998. The “Lewis’s Medicines” page http://www.lewis-clark.org/content/content-channel.asp?ChannelID=352 gives clues to the diseases that the expedition expected to encounter and provides an insight into contemporary treatments. There are six well-illustrated pages with interactive graphics that list the botanics,…
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