The Journal of the American Osteopathic Association
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J Am Osteopath Assoc · Feb 1996
Case ReportsParaneoplastic intestinal pseudo-obstruction, mononeuritis multiplex, and sensory neuropathy/neuronopathy.
A patient with diffuse intestinal pseudo-obstruction consisting of gastric paresis and impaired small and large bowel motility, mononeuropathy multiplex, and sensory neuropathy/neuronopathy was found to have small-cell carcinoma of the lung. The clinical symptoms were thought to be consistent with paraneoplastic neuropathy, and high antineuronal and anti-calcium channel antibodies led to the diagnosis of small-cell carcinoma of the lung. Identification of paraneoplastic neuropathy is important, because early treatment may halt the progression of the underlying carcinoma.
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J Am Osteopath Assoc · Jan 1996
Chronic fatigue complaints in primary care: incidence and diagnostic patterns.
The complaint of chronic fatigue is ubiquitous in the primary care setting. Because of the nonspecific nature of chronic fatigue, practitioners do not focus on this complaint. Furthermore, most physicians use a problem-based approach. ⋯ From these data, the investigators conclude that the workup for chronic fatigue is often incomplete or lacks documentation. This oversight is likely due to a problem focus not directed at the chronic fatigue complaints. Also complicating the evaluation process are the multiple associated disorders, the prevalence of the complaint, and cost/benefit issues facing the primary care physician.
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Each year, more than 1 million children and adolescents begin smoking, and an average of 24% of high school students report smoking, despite existing laws that prohibit the sale of tobacco to minors. In this study, the authors observed an 11-year-old boy attempt to purchase cigarettes at 57 retail establishments in western Pennsylvania to determine if the existing laws do, indeed, limit children's access to buy cigarettes. This study took place between August 15, 1993, and October 2, 1993. ⋯ In 30 of the 57 attempts (53%), the 11-year-old student would have been able to purchase cigarettes. Of these attempts, 53% would have sold them on his first request, while 47% would have sold them to him if he indicated that the cigarettes were for his dad. Only 3 of the 57 establishments (5.2%) posted the law, and 54 of the 57 clerks (95%) were aware of the cigarette law.
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J Am Osteopath Assoc · Oct 1995
Occurrence and impact of suspected delirium in hospitalized elderly patients.
The records of 95 consecutive people older than 65 years and admitted to a community hospital were retrospectively reviewed to determine the prevalence of undiagnosed delirium in hospitalized elderly patients. Chart review focused on identification of patients with documented diagnosed delirium according to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria and patients with unrecognized delirium. Unrecognized delirium was considered present when information contained in a patient's chart met some or all criteria for delirium as described in DSM-III-R, but the physician's progress notes failed to indicate delirium as a diagnosed clinical entity. ⋯ Thirty-six percent of the patients were suspected of having unrecognized delirium. The mean length of hospital stay and the rate of mortality were significantly higher for patients with suspected delirium than for non-delirious patients. The findings of this study suggest that unrecognized delirium in the hospitalized elderly may occur frequently and is associated with an increased length of hospital stay and increased mortality.
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J Am Osteopath Assoc · Oct 1995
Case ReportsAdult Arnold-Chiari malformation: a postpartum case presentation.
Adult Arnold-Chiari malformation, also known as Chiari malformation type I, typically occurs in women during early adulthood and can be a cause of unexplained headaches, as well as associated syringomyelocele. In this unique case report, a 32-year-old, postpartum woman with posturally induced headache from Chiari malformation type I had symptoms occur for the first time during pregnancy. Magnetic resonance imaging of the brain confirmed the diagnosis and is the neuroimaging study of choice in such cases. Neurosurgical decompression, when performed early, is highly successful in symptomatic individuals.