Southern medical journal
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Southern medical journal · Jul 2003
Case ReportsAsthma associated with worsening leg ulcer: a case of vasculitis in primary care.
A 71-year-old black woman was admitted to the hospital with a 2-month history of a nonhealing leg ulcer. Her medical history included diabetes mellitus type 2, congestive heart failure, allergic rhinitis, and asthma. The patient's asthma was labile and steroid-dependent until 2 years before admission, at which time zafirlukast therapy was started. ⋯ A sural nerve biopsy showed vasculitis consistent with Churg-Strauss syndrome. One week after prednisone therapy was initiated, the patient's foot strength was nearly normal and her eosinophilia had resolved. Although Churg-Strauss syndrome is a rare disorder, in the setting of asthma and multiple disparate signs and symptoms, the broad diagnostic category of serious vasculitic illness should be considered.
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Southern medical journal · Jul 2003
Review Comparative StudyRed cell transfusion "trigger": a review.
Despite the publication of several consensus guidelines that set forth recommendations for the transfusion of red cells, actual clinical practice continues to vary widely. Animal data and studies in human volunteers and patients support a red cell transfusion threshold of 7 to 8 g/dl in most patients. However, conflicting data, particularly in cardiac patients and in the elderly, suggest that it may be impossible to define a single red cell "trigger" for all patients. A well-designed, randomized, controlled trial is still needed to establish a safe threshold for red cell transfusion in adults with coronary artery disease.
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A patient presented with scrotal cellulitis as a complication of infusing 900 ml saline into his scrotum. He had obtained a kit along with explicit instructions for performing the infusion through the Internet. ⋯ An Internet search revealed many references to this procedure, but a MEDLINE search showed virtually no information in the medical literature. Patients who are considering scrotal inflation, as it is called in the lay literature, should be warned of the potential complications of this procedure.
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Southern medical journal · Jul 2003
Firearm counseling by physicians: coverage under medical liability insurance policies.
Physicians who offer firearms counseling may increase their legal liability, depending on the attitudes of their medical malpractice insurance carriers. ⋯ A majority of responding insurers thought that physician firearm counseling would not be covered under their medical malpractice policies. Physicians wishing to counsel their patients about the risks and benefits of owning and using firearms are advised to seek assurance of medical malpractice insurance coverage from their insurers or the annexation of a rider to their current policies.