Objective: To assess the level of training, awareness and attitude about psychocutaneous disorders among psychiatrists. Methods: A mail-in survey was sent to all members of the Washington State Psychiatric Association and the Washington State Council on Child and Adolescent Psychiatry. Survey respondents were asked about demographic variables, level of training,…
A dejected, overweight young woman with excoriations on her face and arms sits in my examination room. Her intake form says “pimples and itching.” Every few months I see similar patients, almost all women. They’ve been to their primary care providers, seen therapists, and often consulted other dermatologists. It is…
Acute hepatitis A or B infection can be lethal in patients with chronic liver disease. Safe and effective vaccines are currently available to prevent hepatitis A and B. Despite wide availability of vaccines, most patients with chronic liver disease are not immunized, in part due to nonuniform and inconsistent current…
Preparing the surgeon of the future is a formidable task with which most training institutions are struggling. In this issue of the SMJ, Page addresses several contentious contemporary issues in general surgical residency training.1 Training hours restrictions, which was thought would decrease attrition rates amongst the general residents, has had…
Stress ulcer prophylaxis (SUP) in noncritically ill patients has been a topic of debate for many years. Significant physiologic stress has been shown to cause gastritis and peptic ulcers. In 1998, the American Society of Health-System Pharmacists (ASHP) set forth a set of guidelines for SUP. These guidelines were created…
Autosomal dominant hyperimmunoglobulin E syndrome (HIES, or Job syndrome) is a rare primary immunodeficiency characterized by elevated immunoglobulin E (IgE), eosinophilia, recurrent skin and pulmonary infections, dermatitis, and connective tissue and skeletal abnormalities. A 26-year-old male with known HIES presented with abdominal pain and diarrhea. Imaging showed sigmoid diverticulitis without…
Interest in the relevance of spirituality to medical practice continues to grow, owing in part to greater awareness of the importance of cultural competence, the inclusion of spiritual care among the goals of palliative medicine, and requirements by organizations such as the Joint Commission on Accreditation of Healthcare Organizations to…
To the Editor: Splenomegaly is rather common in patients with liver disease. Alternatively, various cytopenias are not infrequently identified in subjects with various degrees of liver dysfunction. Cytopenias have long been attributed to sequestration and/or destruction of the blood cells in the enlarged spleen, leading to the term “hypersplenism.” The…
Papillary renal cell carcinoma in the horseshoe kidney is uncommon. We report a case of papillary renal cell carcinoma in the horseshoe kidney and discuss its incidence, diagnosis, and treatment.
We report the case of a 61-year-old female with ulcerative colitis on therapy with prednisone and azathioprine. The patient presented with fever, dry cough, a swollen lower extremity, and nodules on the right wrist and the scalp. Computed tomography scans of the head, chest, abdomen, and pelvis revealed multiple lesions….
Paget disease of bone (PD) is a common skeletal disease. It is usually polyostotic and most frequently involves the pelvis, femur, spine, skull, and tibia. The bones of the upper extremity in poly- or monostotic PD are rarely affected. A patient with PD involving the third left metacarpal bone and…
To the Editor: Sarcoidosis is an immune-mediated condition affecting multiple organs, especially the lungs, lymph nodes, skin, and eyes. Infections are considered to be a rare complication of sarcoidosis; in two retrospective clinical series of 122 and 197 patients with sarcoidosis, infections have been reported in 2.5% and 0% of…
Rhabdomyosarcoma and schwannoma are two of the rarer tumors seen in the surgical setting, and it is rarer still to see these tumors originate in the breast. Rhabdomyosarcoma has an incidence of only 250 cases a year in the United States; of these, more than 90% are seen in individuals…
In patients who have surgically-altered upper gastrointestinal anatomy, postoperative endoscopic enteral nutrition options can be limited by issues such as bowel stenosis and/or acute angulation. This report details the use of an endoscopic triangulation method combining per-oral and percutaneous transgastric approaches to overcome an efferent gastrojejunostomy limb stenosis, to successfully…
To the Editor: The point is well made that ST elevation on electrocardiography (ECG) may be absent within the first two hours of the onset of symptoms of acute in-stent coronary thrombosis,1 thereby mandating a high index of clinical suspicion for this complication in patients with intracoronary stents. Such was…
The complexity of modern surgical practice and the cognitive and technical overload to which trainees are subjected places practitioners and residents alike in jeopardy of developing areas of incompetence. Inadequate exposure to essential operations during residency forces trainees to seek further expertise in fellowships. At the same time, practice burdens…
We present a case of concurrent diagnosis of acute myeloid leukemia (AML) with multiple myeloma with complex karyotype, which was successfully treated with allogeneic stem cell transplantation. A 51-year-old man with no past medical history presented with fatigue and anemia with blasts on peripheral smear. Bone marrow biopsy confirmed the…
Objective: Type 2 diabetes is a common disease, afflicting more than 20 million Americans. Psychiatric disorders, particularly depression, have been previously correlated with diabetes. Methods: The objectives of this study were to determine the frequency of psychiatric illnesses in a type 2 pediatric diabetic cohort and to examine if there…
Hussain M.A. Abbas, MD, MRCSI John M. Abide, MD Matthew Aboudara, MD Souvik Adhikari, MS Giridhar Adiga, MD, FACP Emmanuel Atta Agaba, MD, FRCS Neeraj Agnihotri, MD Regina T.P. Aguirre, PhD, LMSW-AP Sushil K. Ahlawat, MD Jatinder P. Ahluwalia, MD M. Akhtari, MD Tetsu Akimoto, MD Sercan Aksoy, MD Aamir…
Buried bumper syndrome (BBS) is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. This unusual phenomenon occurs when the internal bumper of a PEG tube erodes and migrates through the gastric wall and becomes lodged anywhere between the gastric wall and the skin. If not removed and treated…
To the Editor: A 45-year-old shepherd was admitted for fever, malaise, and loss of weight for a duration of 20 days. The physical examination revealed no remarkable findings; there was no organomegaly or adenopathy. Pancytopenia, mildly elevated liver enzymes, and polyclonal hypergammaglobulinemia were noticed. Bone marrow aspiration revealed no specific…
To the Editor: Familial forms comprise about a third of all idiopathic cardiomyopathies and are often associated with non-cardiac manifestation. Awareness of these manifestations is important for internists to successfully diagnose these conditions. A rare form of familial dilated cardiomyopathy associated with autosomal dominant sensorineural hearing loss has been described….
Objective: This Student Selected Component (SSC) was designed to equip United Kingdom (UK) medical students to engage in whole-person care. The aim was to explore students’ reactions to experiences provided, and consider potential benefits for future clinical practice. Methods: The SSC was delivered in the workplace. Active learning was encouraged…
The occurrence of pelvic endometriosis is not uncommon, but endometriosis of the gallbladder is extremely rare. To our knowledge, only one such case has previously been described in the literature. This report concerns another patient with gallbladder endometriosis, which formed two distinct lesions at the fundus of the organ. The…
We present the case of a patient with a history of hemorrhage following prior surgery whose pregnancy was complicated by plasminogen activator inhibitor type 1 deficiency. To our knowledge, this is the first reported case of a pregnancy complicated by plasminogen activator inhibitor type 1 (PAI-1) deficiency.
A nine-weeks pregnant, 27-year-old female was admitted for hypertension with a blood pressure of 213/110 mm Hg, headaches, palpitations, and anxiety. There was no previous history of hypertension or pre-eclampsia. She had elevated urinary normetanephrine, plasma-free normetanephrine, and plasma-free metanephrine concentrations. Phenoxybenzamine and labetalol were initiated for presumed pheochromocytoma. At…
The use of 90Yttrium microspheres to treat unresectable hepatoma is increasing worldwide. Therapeutically, 90Yttrium microspheres show promising increases in survival and tumor response, as well as acceptable toxicities. Here, we report on a 67-year-old man with hepatitis C-related advanced-stage hepatoma. This patient received selective internal radiation therapy (SIRT) using 90Yttrium…
Martin Buber’s concept of inclusion and Gabriel Marcel’s notion of availability are used to cast new light on the human dimension in medical care. Buber’s notion of inclusion indicates that clinical empathy should involve both cognitive and affective elements. It is argued that empathy is more than simply labeling a…
Nipple adenoma, a rare benign clinicopathologic entity also known as florid papillomatosis and papillary adenoma, is a tumor of the lactiferous ducts that develops in the superficial portion of the nipple. This lesion clinically mimics Paget disease of the nipple, and is often histologically misinterpreted as a ductal carcinoma.1 Herein,…
Objective: The problem of high body mass index (BMI) for age in the Head Start population in Texas is of great concern. The primarily Mexican American population is at high risk for diabetes and cardiovascular disease. This study examines the prevalence of elevated BMI for age in the Head Start…
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