Annals of internal medicine
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A case of a patient with angina who was considered for coronary bypass surgery illustrates the issue of informed consent. Ethical and legal aspects and the inherent limitations of achieving consent must be considered. ⋯ The patient's desire to defer the decision to the physician raises the question of whether such requested paternalism violates patient self-determination and invalidates consent or is an exercise of the patient's right to have his physician decide. The case presented exemplifies the patient-physician interaction needed for responsible paternalism.
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Case Reports
Gastric and small intestinal myoelectric dysrhythmia associated with chronic intractable nausea and vomiting.
We describe a patient with symptoms of severe nausea, vomiting, epigastric bloating and pain, and marked weight loss due to a gastrointestinal motility disturbance. Motility abnormalities were characterized by uncoordinated high pressure (as high as 300 mm Hg) contractions and uncoordinated interdigestive motor complexes in the duodenum and small intestine, and tachygastria often associated with tachyarrhythmia in the gastric myoelectric activity recordings. Uncoordinated interdigestive myoelectric complexes again were found in the duodenum and small intestine. ⋯ Thus, the motility abnormality found in the study appears to be responsible for the symptoms described. This is probably a new clinical entity. The importance of manometric and myoelectric study of a gastrointestinal motility for unexplained nausea and vomiting is emphasized.
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Haemophilus ducreyi was isolated with an enriched chocolate agar containing vancomycin from seven patients with clinical evidence of chancroid. Four cases were imported from outside the United States; the other three cases were acquired in the United States from one of the imported cases. ⋯ Plasmid molecular weights were identical for isolates from the epidemiologically linked cases and differed according to the geographic origins of the strains. Findings of this study confirm that H. ducreyi is sexually transmitted and suggest that clinical chancroid develops frequently after acquisition of H. ducreyi.
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The body of knowledge pertinent to the care of the elderly lies largely within internal medicine and its subspecialties. A growing number of elderly persons have great need for medical and social services. ⋯ The FCIM opposes the creation of separate medical school departments and favors inclusion of an administrative mechanism for geriatrics within the department of medicine, preferably linked to the division or section of general internal medicine. The FCIM encourages the American Board of Internal Medicine to continue to explore forms of recognition of advanced training and particular competence in geriatric medicine but opposes the creation of a separate certifying board for geriatrics.