Original Article

Treatment of Persistently Leaking Post PEG Tube Gastrocutaneous Fistula in Elderly Patients with Combined Electrochemical Cautery and Endoscopic Clip Placement

Objectives:Persistent leakage from a gastrocutaneous fistula (GCF) created for the purpose of percutaneous endoscopic gastrostomy (PEG) tube placement is a common problem in elderly patients. Conservative methods often prove unsuccessful and surgical closure is usually not performed because of poor surgical risk. With advances in endoscopic technology, several nonsurgical approaches…

Original Article

Sustained Improvement in Cognitive and Emotional Status of Apneic Patients After Prolonged Treatment with Positive Airway Pressure

Background:Obstructive sleep apnea-hypopnea syndrome (OSAH) is associated with impairment of cognitive functions and disturbances in emotional status. The aim of this study was to objectively evaluate the benefits of prolonged and sustained treatment for OSAH at two sleep centers serving rural community hospitals.Methods:Fifty-six patients diagnosed with OSAH syndrome underwent Cognistat,…

Original Article

Use of the Internet for Health Information Among Primary Care Patients in Rural West Texas

Background:Little is known about how primary care patients in rural, remote or border areas use the internet for their health information. This study examined the factors related to internet use for medical information among primary care clinic patients in such areas of West Texas.Methods:A convenience sample was drawn from nine…

Original Article

The Effect of July Admission in the Process of Care of Patients with Acute Cardiovascular Conditions

Background:Little information is available to measure the impact of new trainees in the process of care and outcomes of patients with acute cardiovascular conditions. The objective of this investigation is to assess whether physicians' experience has an impact on the quality of health care delivery.Methods:Two cohorts of hospitalized patients with…

Review Article

Hantavirus Pulmonary Syndrome: A Concise Clinical Review

Abstract:In 1978, hantaviruses were first described as the etiological agent of hemorrhagic fever with renal syndrome (HFRS) in Korea. Since then, numerous related, enveloped, negative-stranded RNA viruses have been identified, forming the genus Hantavirus within the family Bunyaviridae. These pathogens are distributed worldwide and thus can be classified, on the…

Editorial

Prevention of Heat-Related Illness: A New Modality Offers New Insight

Heat-related illness poses a serious risk of morbidity and mortality for athletes and is the third leading cause of death in this population.1 The spectrum of health-related illness includes heat cramps (often self limiting) and the continuum of heat syncope, heat exhaustion, and exertional heat stoke (rectal temperature >104 F,…

Review Article

Management of Psoriasis

Abstract:Psoriasis is common, affecting about 2–3% of the population, and has major effects on patients’ quality of life. Psoriasis varies in its manifestations and in how patients perceive the condition. Successful treatment involves addressing the clinical, psychological, and social aspects of the disease. Treatment options include topical agents, phototherapy and…

Case Report

Infective Mycotic Aneurysm Presenting as Transient Acute Coronary Occlusion and Infectious Pericarditis

Abstract:Cardiac catheterization carries a negligible risk of bacteremia. Post coronary artery intervention (PCI) bacteremia occurs frequently (in approximately 30% of cases); however, clinical sequelae occur rarely in such cases. Percutaneous coronary intervention has a greater bacteremic potential, probably due to the lengthy procedure time and the repeated insertion of interventional…

Case Report

Bullosis Diabeticorum Associated with a Prediabetic State

Abstract:Bullosis diabeticorum, or diabetic bullae, is a non-inflammatory blistering condition that is virtually diagnostic of diabetes. Diabetic bullae most often present as painless, tense, superficial bullae that occur in an acral distribution and commonly heal in 2–6 weeks without scarring, but complications such as secondary bacterial infection or hemorrhage may…

Case Report

Disaster Management at the 1904 New Market, Tennessee Train Wreck: Role of a Surgeon

Abstract:Knowing the lessons of past disasters is necessary in disaster planning. Such knowledge paves the way for creating a plan that anticipates the patterns, as well as the impediments, of behavior and injuries encountered in most events. On September 4, 1904, a head-on “butting” collision of two Southern Railway passenger…

Case Report

Vitamin D as Adjunctive Therapy in Refractory Pulmonary Tuberculosis: A Case Report

Abstract:Vitamin D regulates calcium homeostasis in the body and may play a major role in regulating immune responses to tuberculosis (TB). Pilot studies suggest that vitamin D supplementation may improve outcomes in pulmonary TB (PTB), but clinical evidence using vitamin D in TB treatment is limited. We present a case…

Case Report

Adult Varicella Zoster Infection Complicated with Streptococcal Retrosternal Abscess

Abstract:A 43-year-old lady with type 2 diabetes mellitus and bronchial asthma presented with varicella zoster infection, dyspnea, and neck fullness. An urgent computed tomography scan revealed a mediastinal abscess with superior vena cava thrombus. Blood, mediastinal pus, and swab from a vesiculopustule on the neck cultured group A beta hemolytic…

Case Report

“Ohio River Valley Fever” Presenting as Isolated Granulomatous Hepatitis: A Case Report

Abstract:Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any…

Case Report

Oncocytic Carcinoma Arising in the Submandibular Gland with Disseminated Bone Metastases

Abstract:Oncocytic carcinoma of the head and neck is a very rare neoplasm. It usually occurs in the parotid glands. Only 11 cases of oncocytic carcinoma of the submandibular gland have been reported, and no cases have shown distant bone metastasis. A 67-year-old man presented with a tingling sensation in both…

Case Report

Toe Hair-Thread Tourniquet Syndrome

Abstract:A 5-month-old boy presented with swelling and discoloration of the right third toe because of hair-thread tourniquet syndrome. This was treated by urgent surgical release of the constricting band, with a successful outcome. The authors stress the importance of recognizing this rare condition and of prompt, complete, surgical release.

Editorial

The Long Journey of Outpatient Parenteral Antibiotic Therapy in Infective Endocarditis: From Idea to Clinical Guidelines

Infective endocarditis (IE) is one of the bacterial infections which usually necessitates long-term antimicrobial treatment, 4 to 6 weeks, and in some situations, even longer. Classically, the IE patient is considered at risk for unexpected complications throughout the duration of therapy and remains hospitalized for this period, with high costs….

Case Report

Adrenal Insufficiency as a Presenting Manifestation of Nonsmall Cell Lung Cancer

Abstract:The adrenals are a common site of metastases for lung cancers; adrenal insufficiency, however, as a presenting feature of lung cancer, is extremely rare. We report a case of primary adrenal insufficiency secondary to metastases from adenocarcinoma of the lung. Our patient presented with hypotension, abdominal pain, and weight loss….

Special Sections: Letters to the Editor

Empyema in a Rheumatoid Patient

To the Editor:Elevated pleural adenosine deaminase (ADA) levels in rheumatoid patients treated with prednisolone are highly predictive of tuberculosis.1 We report the case of a rheumatoid arthritis patient who developed a nontuberculous empyema with an elevated pleural ADA level.The patient was a 66-year-old woman with a 20-year history of rheumatoid…

Special Sections: Letters to the Editor

Pseudofourth Nerve Palsy as Initial and Sole Presentation in Ocular Myasthenia

To the Editor:Ocular myasthenia (OM) is characterized by fluctuating ocular muscle weakness without generalized weakness. The combination of ophthalmoparesis, ptosis, and weak eye closure are typical symptoms of OM.1 We report a patient with OM in which the sole symptom resembled trochlear nerve palsy.A 54-year-old woman presented with a one-month…

Special Sections: Letters to the Editor

Doubled Left Ovary

To the Editor:Accessory and supernumerary ovaries are rare anomalies with an estimated incidence of 1:29,000- 700,000 gynecologic admissions.1 A supernumerary ovary is entirely separate from the normally placed ovary with no ligamentous or direct connection with the broad, utero-ovarian or infundibulopelvic ligament. We report on a 31-year-old, gravida 1, para…

Editorial

Is Hantavirus Important to Practitioners?

In this issue of the Journal, Vinh and Embil1 provide a short, well-written review of the hantavirus pulmonary syndrome (HPS). This clinical entity was first described in 1993 and last reviewed in this journal in 1996.2 Vinh and Embil's review emphasizes recent information regarding the virology and pathogenesis of the…

Editorial

The Infectious Diseases Society of America Lyme Guidelines: Poster Child for Guidelines Reform

In the era of managed healthcare, medical specialty societies have gained tremendous power over the practice of medicine. Specialty societies exert their power through clinical practice guidelines that dictate the standard of care for diagnosis and treatment in a given field, and compliance with these guidelines is considered mandatory by…

Original Article

Gastrointestinal Temperature Trends in Football Linemen During Physical Exertion Under Heat Stress

Context:Exertional heat stroke is the third leading cause of death in US athletes. Elevations in core temperature in the digestive tract (TGI) have correlated with core temperature and are possible indicators of those at increased risk of heat stroke.Objective:The primary objective was to compare a.m. vs. p.m. TGI variation in…

Original Article

Management of Infective Endocarditis in Outpatients: Clinical Experience with Outpatient Parenteral Antibiotic Therapy

Background:There is limited experience in treating infective endocarditis (IE) with outpatient parenteral antibiotic therapy (OPAT).Methods:Following institutional review board (IRB) approval, patients discharged from Baystate Medical Center with IE documented by modified Duke criteria treated with OPAT were identified. Data obtained included organisms implicated, indications of clinical stability, percentage of total…

Original Article

RIFLE Criteria Accurately Identifies Renal Dysfunction and Renal Failure in Elderly Patients with Upper Gastrointestinal Hemorrhage: A Pilot Study

Background:The incidence of acute kidney injury (AKI) as a complication of acute upper gastrointestinal bleeding (AUGIB) is not known. Recently, RIFLE criteria were used widely in the medical research to identify patients with different degrees of renal insufficiency.Objectives:Our purpose is to determine the incidence, clinical presentations, endoscopic findings and outcomes…

CME Topic

Stair Design in the United States and Obesity: The Need for a Change

Background:Maintenance of healthy body weight is a function of total energy expenditure including household and workplace activity. Light to moderate physical activity has been found to be effective in motivating sedentary and obese individuals, and is at least as effective as structured exercise in lowering weight in some studies.Discussion:Stair use…

Case Report

Prone Ventilation in a United States Marine with Acute Respiratory Distress Syndrome and an Open Abdominal Injury

Abstract:A United States Marine with an open abdominal injury from a single gunshot wound to the chest and abdomen was placed in the prone position after suffering from acute respiratory distress syndrome (ARDS). Prone ventilation in traumatic injuries involving an open abdomen has been rarely reported or attempted because of…

CME Topic

Cardiac Complications after Smallpox Vaccination

Abstract:In 2002, the US Federal government initiated a campaign to vaccinate military personnel and members of the civilian population against smallpox to counter a possible bioterrorism attack. More than 1,200,000 military personnel and approximately 40,000 civilians have been vaccinated since that time. The incidence of myopericarditis in these vaccinees has…

Review Article

In the Lymelight: Law and Clinical Practice Guidelines

Abstract:Almost from the beginning, the Ixodes scapularis and I pacificus, adult deer ticks, have been a breeding ground not only for Lyme disease, but also for political dissent. Most recently, the battleground moved into the arena of clinical practice guidelines. Both camps in the “Lyme Wars”—the Infectious Diseases Society of…

Editorial

Another Reminder of Our Post – 9/11 World

The World Health Organization declared the potential biological weapon smallpox eradicated in 1979. However, smallpox vaccination was required for US military personnel until 1990, when it was discontinued. After the September 11, 2001 terrorist attacks and the 2001 anthrax cases, the US government reinstated smallpox vaccination for military personnel and…

Special Sections: Letters to the Editor

Duodenal Biopsy is Justified by Its Superior Diagnostic Accuracy

To the Editor:In the context of suspected celiac disease, complications of duodenal biopsy include not only retroperitoneal hemorrhage,1 but also intraduodenal hematoma2 and duodenal perforation.3 Nevertheless and contrary to Friedel,1 even where esophagogastroduodenoscopy (EGD) is performed for the work up of dyspepsia, there is merit in performing a duodenal biopsy…

Editorial

From DaNang Lung to Combat Trauma-Associated Acute Lung Injury—Closing the Loop

Acute lung injury (ALI) is a syndrome diagnosed by a combination of acute hypoxemic respiratory failure in the presence of bilateral radiographic lung infiltrates, which cannot be fully explained by hydrostatic pulmonary edema.1 The acute respiratory distress syndrome (ARDS) is considered a more severe subtype of ALI. Severe sepsis, aspiration…

Special Sections: Letters to the Editor

Transverse Myelitis Associated with Salmonella Nontyphi Infection

To the Editor:Salmonella infection remains common and is still associated with significant morbidity and mortality. Neurological manifestations are rare. We report a case of transverse myelitis associated with Salmonella nontyphi infection.A 35-year-old lady presented with a three-week history of progressive bilateral lower limb weakness. Her background history was relevant for…

Special Sections: Letters to the Editor

International Medical Graduates in America

To the Editor:International medical graduate (IMG) physicians play a substantial role in American health care.1 They constitute approximately one quarter of all physicians in this country and a similar percentage of house officers.1 Approximately 20% of American medical school faculty are medical graduates from other countries, in academic clinical medicine,…

Special Section

Medical Webwatch

This is the training resource for healthcare professionals from the National Obesity Forum (NOF) from the UK: http://www.nationalobesityforum.org.uk/training-resource-for-healthcare-professionals-mainmenu-133.html. It comprises a short list of PDFs that consider the problem of obesity under the headings: “Prevention,” “Primary care,” “Screening,” “Assessment,” and “Treatment.” Under the “Professionals” tab on the left menu are…

CME Topic

June 2009 CME Questions

Stair Design in the United States and Obesity: The Need for a Change1. The following statements about obesity and physical activity are correct except:A. In contrast to the cardiovascular and other health benefits attributed to moderate and vigorous activity, the maintenance of a healthy body weight is a function of…

CME Topic

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