Objective:Although video-assisted thoracic surgery (VATS) lobectomy has been demonstrated to be safe and technically feasible for nonsmall cell lung cancer, it is infrequently performed in most hospitals. As a result, there has been no clear long-term outcome regarding this procedure until recently.Methods:We retrospectively analyzed the results of patients suffering from…
Background:The objective of this study was to assess the etiology, microbiology and outcome of hospital-acquired thoracic empyema (HATE) in adults.Methods:From December 2001 to December 2006, 459 adult patients with a diagnosis of thoracic empyema in a tertiary hospital were screened for HATE. HATE was defined as a new pleural empyema…
Abstract:After atrial fibrillation, atrial flutter (AFL) is the most important and most common atrial tachyarrhythmia. Atrial flutter describes an electrocardiographic model of atrial tachycardia ≥240/min, with a uniform and regular continuous wave-form. There is classically a 2:1 conduction across the atrioventricular (AV) node; as a result, the ventricular rate is…
Abstract:Diffusion-weighted imaging (DWI) is a sophisticated magnetic resonance imaging (MRI) technique with rapid acquisition time and high sensitivity for depicting acute cerebral ischemia. It is currently part of the routine workup in most medical centers when ischemic stroke is in the differential diagnosis. DWI helps establish a diagnosis of acute…
Abstract:Complaints of loss of memory and lack of concentration have been reported by long-term survivors of breast cancer. This mild cognitive impairment (MCI), also called “chemobrain” or “chemofog,” has been the subject of a number of studies in the last few years. This cognitive impairment, although usually mild, must be…
Abstract:Allergic rhinitis (AR) and asthma are disorders of the airway characterized by inflammation of the respiratory mucosa. The presence of one disorder increases the likelihood that the other will also occur. As they are mechanistically intertwined, one can exacerbate the other when both conditions are present. In addition, comorbid AR…
Abstract:Emphysematous cystitis is a rare disorder that is usually associated with immunosuppression, poorly controlled diabetes mellitus, and other risk factors such as previous urinary tract infection and/or recent instrumentation of the urinary tract. The case of an 89-year-old woman with emphysematous cystitis who had no evidence of immunodeficiency or other…
Abstract:Traumatic pulmonary pseudocyst is a rare clinical event that may occur following chest trauma. This complication usually occurs as a result of blunt trauma and rarely, due to a penetrating injury. We report an unusual case of a 10-year-old boy who developed a left-sided pneumothorax along with a traumatic pulmonary…
Abstract:Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is rare in patients under the age of 40 in the absence of metabolic or familial predisposition. A high incidence of involvement of the transverse ligament of the atlas in CPPD deposition disease was reported. However, involvement of the craniocervical junction is rarely…
Abstract:We present a case of methicillin-sensitive Staphylococcus aureus metastatic endophthalmitis (SAME) that developed from a bacteremia. We compare this to a literature review of similar cases and report unique characteristics of SAME. We discuss important considerations in the work-up and treatment of endogenous endophthalmitis.
Abstract:A woman presented with chest pain following emotional stress. Investigations showed acute ST-segment elevation, myocardial infarction, and elevated serum troponin. Emergency heart catheterization showed left anterior descending artery myocardial bridging, apical ballooning consistent with takotsubo cardiomyopathy (TTC), and decreased ejection fraction. Two days later, echocardiogram demonstrated near normalization of ventricular…
Abstract:We describe a 37-year-old non-smoker who presented with dyspnea and a unilateral effusion secondary to Burkitt lymphoma (BL). The diagnosis was made by pleural tissue biopsy using video-assisted thoracoscopic surgery (VATS). Burkitt lymphoma is discussed.
Abstract:Bouveret syndrome is a rare complication of cholelithiasis occurring when a gallstone passes through a cholecystoduodenal or choledochoduodenal fistula and lodges in the pylorus or proximal duodenum causing a gastric outlet obstruction. The case of a 70-year-old male who developed Bouveret syndrome is presented, and the management of this presentation…
Abstract:A 66-year-old male presented with swelling of the neck and arms, which was limiting his daily activities. Serum muscle enzymes were increased. A detailed history revealed that the patient received 10 cycles of infrared heat and massage therapy approximately 1 month before his first visit to the outpatient clinic. The…
Abstract:An 86-year-old man presented with sudden onset of dyspnea during hospitalization. Initial electrocardiography (ECG) showed poor R-wave progression of precordial leads with elevation of troponin I. Tension pneumothorax was subsequently diagnosed and the ECG returned to normal after resolution of clinical compromise.
Abstract:A 65-year-old female patient with glioblastoma multiforme (GBM) developed aplastic anemia following treatment with temozolomide. Following her diagnosis of GBM, the patient received standard treatment with surgery, concomitant radiation therapy and temozolomide followed by adjuvant temozolomide. On day 14 of her adjuvant treatment, she developed profound fatigue and spontaneous bruising…
I, like most former house staff, had received the classic teaching that a regular, narrow-complex tachycardia at 150 beats/minute was atrial flutter (AFL) with 2:1 atrial-ventricular conduction until proven otherwise. While previously considered a relatively unstable rhythm commonly degenerating into atrial fibrillation (AF), AFL is now recognized as an important…
Abstract:Mycobacterium szulgai is one of the nontuberculous mycobacteria (NTM) and rarely causes diseases in human beings, particularly in immunocompetent patients. Less than 1% of all cases of NTM infection are caused by M szulgai, but the incidence is continuously increasing. Although extrapulmonary infections have been reported, most M szulgai infections…
Abstract:Sternal osteomyelitis secondary to minor trauma occurs rarely. Only a handful of cases have been reported. A 24-year-old male patient who had history of intravenous drug abuse and recent minor sternal trauma presented with signs and symptoms of sternal infection. Imaging studies suggested osteomyelitis and the patient underwent sternal resection,…
To the Editor:An approximately 68-year-old healthy woman presented with paresthesia and numbness in her left foot. Her pain was sharp in quality, aggravated by sitting and standing, with relief upon lying flat. Upon follow up a month later, the patient’s symptoms had worsened and had come to involve her right…
To the Editor:Cystic echinococcosis, or hydatidosis, is an endemic disease caused by larval forms of the tapeworm Echinococcus granulosus. Hydatid cysts (HC) may develop in any organ of the human body, most frequently in the liver (60–70%) and the lungs (20–30%).1 Splenic HC generally develops by means of systemic dissemination…
The search for cardinal questions in neurology including, ‘Is there a lesion?,’ ‘Where is the lesion?’ and ‘What is the lesion?’ continues. This has resulted in a plethora of tests, including ever increasing magnetic resonance imaging (MRI) sequences. Still, it seems, whatever test you order, a good history remains the…
The article titled “Traumatic Pulmonary Pseudocyst,” in this month’s issue of the SMJ discusses this rare clinical event which may occur following chest trauma.1 The spectrum of lung parenchymal injury following blunt chest trauma ranges from simple contusions to lacerations. A pulmonary contusion is characterized by hemorrhagic edema into the…
Primary malignant melanoma of the esophagus is a rare disease. Only about 190 cases have been reported so far in the literature. Its incidence in esophageal cancer series ranges from 0.1–0.2%. How can such an entity exist, one may wonder, especially given that the esophagus is not a site where…
Background:In patients with atrial fibrillation (AF) and atrial flutter (AFL), the value of the 12-lead surface electrocardiogram (ECG) in predicting direct current cardioversion (DCCV) outcomes has not been thoroughly investigated. We sought to determine whether the type of atrial arrhythmia (AF versus AFL) and the characteristics of the atrial fibrillatory…
Objective:The effect of the apolipoprotein &egr;4 allele (ApoE &egr;4) on cognitive performance in patients with probable Alzheimer disease (AD) has been studied in primarily Caucasian samples. The aim of this exploratory study was to examine whether the presence of ApoE &egr;4 is associated with cognitive performance in African American AD…
Background:In 2000, the American College of Obstetricians/Gynecologists (ACOG) established the 5 A’s method of brief smoking cessation counseling (ask, advise, assess, assist, arrange) as a standard component of prenatal care. The purpose of this study was to describe use of the 5 A’s in prenatal care in Northeast Tennessee, where…
Objective:To compare preterm birth rate and neonatal outcome in twin gestations randomized to either 17 alpha-hydroxyprogesterone caproate (17P) or placebo.Materials and Methods:Women with twin gestations between 20–30 weeks were randomized to receive weekly injections of either 250mg 17P injection (Group I), or placebo (Group II). Maternal and neonatal outcome data…
Abstract:Chest pain is an extremely common presenting symptom that is usually related to a cardiac cause. This case illustrates an unusual presentation of multiple myeloma as a cause of atypical chest pain. This case presentation shows the importance of having a broad differential diagnosis while evaluating patients with atypical chest…
Abstract:Polyarteritis nodosa (PAN) is a necrotizing vasculitis and may affect multiple organ systems. Due to the rupture of microaneurysms, perirenal hematomas may occur in both kidneys. Spontaneous perirenal hematoma is an infrequent complication of isolated PAN. Also, involvement of the splenic arteries is a rare occurrence in polyarteritis nodosa. Perirenal…
Atrial fibrillation is the most common sustained cardiac arrhythmia in people. It is characterized by uncoordinated atrial activation associated with an irregular and often rapid ventricular response. Atrial flutter is a closely related supraventricular tachycardia. Atrial flutter, the second most common atrial arrhythmia, is a reentrant rhythm notable for an…
To the Editor:Optimizing diabetes management in older adults with advanced chronic kidney disease is a difficult endeavor because of contraindications to antidiabetic agents and lack of expertise in using complex insulin regimens.1–3 We evaluated the impact of comanagement of such patients by a nephrologist and a diabetes specialty team. Twenty…
To the Editor:The risk of venous thromboembolism (VTE) in women using oral contraceptive pills (OCP) is well known. Until 1995, it was generally thought that the progesterone component of OCP did not contribute to the development of VTE.1 While it appears that the new OCP Yasmin® (drospirenone and ethinylestradiol) might…
To the Editor:In a recent issue of the SMJ, Kotan and Aygul1 reported a highly interesting clinical case of familial idiopathic basal ganglia calcification (IBGC).Throughout the text, the authors use the terms “Fahr disease” and “Fahr syndrome” interchangeably; however, this last term should be reserved for cases in which the…
MJM Wardrounds http://wardround.blogspot.com/ is a medical blog written by Dr. Mike McMahon, a physician from Dumfries, Scotland, United Kingdom where his inpatient work is predominantly general internal medicine with a smattering of rheumatology and infectious diseases. Since August 2005, he has been publishing contemporaneous details about preparations for their weekly…
To the Editor:We read with interest the article by Kim et al1 in the May 2009 issue of the Journal on simultaneous adrenal pheochromocytoma and sarcoidosis. Our patient’s condition was similar to the one reported by Kim et al.1A 58-year-old male was admitted for abdominal pain in the right upper…
Current Concepts and Management Strategies in Atrial Flutter1. The following statement about atrial flutter (AFL) is false:A. Typical AFL is the most common type of macroreentrant atrial tachycardia.B. AFL requires anatomic or functional barriers to maintain its activation.C. AFL is usually a highly regular rhythm.D. AFL is usually a life-threatening…
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