The Mount Sinai journal of medicine, New York
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Olanzapine is an atypical antipsychotic drug approved for acute and long-term treatment of bipolar disorder. Although relatively safe as compared to other classical antipsychotic medications, there are a number of uncommon adverse effects of olanzapine such as oral cavity lesions. In addition to the relatively common side effect of dry mouth, several articles have reported an association between olanzapine treatment and the development of oral lesions such as apthous stomatitis, pharyngitis, glossitis and oral ulceration. ⋯ In the present case, xerostomia (dry mouth), which is an adverse reaction of both olanzapine and lithium, may have played a role in the development of black hairy tongue. All agents with a possible side effect of xerostomia may predispose patients to black hairy tongue, especially when they are administered in combination. To preclude the development of this complication with such drugs, extra time and effort should be given to improving oral hygiene.
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Patients presenting with chest pain and nondiagnostic electrocardiograms (ECG) in the emergency department (ED) often pose a challenge to physicians. QT dispersion (QTD) is an electrocardiographic marker of myocardial ischemia due to nonhomogenous ventricular repolarization. We hypothesized that QTD could accurately identify patients with acute coronary syndrome (ACS) who presented with chest pain and nondiagnostic initial ECGs. ⋯ For patients with chest pain and nondiagnostic initial ECG, ACS risk is high if QTD and QTcD values are greater than 40 ms. Therefore, QTD and QTcD can help identify patients with acute coronary syndrome who present with chest pain and a nondiagnostic initial ECG. However, poor operator characteristics of QT dispersion could limit its value as a diagnostic test in the clinical setting.
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Gastrointestinal manifestations of both Behçet's disease and intestinal tuberculosis include the signs and symptoms of abdominal pain, weight loss, fever, vomiting, diarrhea and palpable mass in the right lower quadrant. We report the case of a male patient with Behçet's disease who had multiple ileal perforations due to miliary tuberculosis. It was suspected that the perforations were due to intestinal manifestation of Behçet's disease, but the final pathology report and chest X-ray one week after surgery demonstrated the presence of miliary tuberculosis. To our knowledge, this is the first reported case of Behçet's disease with intestinal perforation due to miliary tuberculosis.
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Laboratory tests comprise a significant portion of hospital expenditure. Attempts to reduce their use have had mixed results. ⋯ The intervention developed here produced significant and sustained reduction of financial savings in the number of laboratory tests ordered, without negatively impacting diagnostic capability or patient care.
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Case Reports
Pulsed radiofrequency for the treatment of ilioinguinal neuralgia after inguinal herniorrhaphy.
Ilioinguinal neuralgia secondary to inguinal hernia repair is frequently a chronic, debilitating pain. It is most often due to destruction or entrapment of nerve tissue from staples, sutures, or direct surgical trauma. Treatment modalities, including oral analgesics, nerve blocks, mesh excision, and surgical neurectomy, have varied success rates. Pulsed radiofrequency (PRF) has recently been described as a successful method of treating chronic groin pain. Unlike conventional radiofrequency, PRF is non-neurodestructive and therefore less painful and without the potential complications of neuritis-like reactions and neuroma formation. Although the mechanism is unknown, it appears that the interaction of an electromagnetic field and c-fos proteins may alter normal transmission of painful impulses. Our study examines five patients treated with PRF for ilioinguinal neuralgia secondary to inguinal herniorrhaphy. ⋯ Ilioinguinal neuralgia is challenging to treat. We have demonstrated the successful use of PRF for four out of five patients seen in our office.