Southern medical journal
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Southern medical journal · Aug 2006
Case ReportsA case of early onset normotensive scleroderma renal crisis in a patient with diffuse cutaneous systemic sclerosis.
Scleroderma renal crisis (SRC) has classically been defined as a new onset of accelerated arterial hypertension associated with a rapid increase in serum creatinine concentration and/or microangiopathic hemolytic anemia. SRC occurs in approximately 20% of patients with systemic sclerosis who have diffuse cutaneous manifestations. In addition, 10% of reported cases of SRC with diffuse cutaneous involvement have normal blood pressures; in the majority of these cases, SRC occurs after treatment with corticosteroids. We describe a patient who presented with an early onset SRC in the setting of diffuse cutaneous systemic sclerosis in evolution without prior accelerated arterial hypertension or corticosteroid use.
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Southern medical journal · Jul 2006
Case ReportsPositive C-ANCA and cavitary lung lesion: recurrence of Wegener granulomatosis or aspergillosis?
A case of a cavitary lung lesion in the right middle lobe of a 34-year-old woman who presented with hemoptysis is presented. The patient had a 2-year history of Wegener granulomatosis that had been treated with cyclophosphamide and corticosteroids. Although the patient gradually achieved remission of her disease, she developed new pulmonary symptoms and a cavitary lesion in her right lung. ⋯ Pulmonary aspergillosis was felt to be the cause of both the hemoptysis and the cavitary lesion. We postulate that C-ANCA and P-ANCA were falsely positive in this case. Although rare, false positive C-ANCA and P-ANCA have been reported in pulmonary fungal infections.
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Gastroesophageal reflux disease is the most common and expensive digestive disease with complex and multi-factorial pathophysiologic mechanisms. Transient inappropriate relaxation of the lower esophageal sphincter is the predominant mechanism in the majority of patients with mild to moderate disease. Hiatal hernias and a reduced lower esophageal sphincter pressure have a significant role in patients with moderate to severe disease. ⋯ Barrett esophagus is a major risk factor for esophageal adenocarcinoma, and upper endoscopy with surveillance biopsies is recommended for patients with Barrett esophagus. Medical therapy with anti-secretory agents (H2 blockers and proton pump inhibitors) is effective for most patients with gastroesophageal reflux disease. Surgical fundoplications and endoscopic treatment modalities are mechanical treatment options for patients with gastroesophageal reflux disease.
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Southern medical journal · Jun 2006
Case ReportsManagement of a circumferential lower extremity degloving injury with the use of vacuum-assisted closure.
A 58-year-old male presented with a large circumferential degloving injury and was immediately taken to the operating room for further assessment of his wound. At that time, a plastic surgeon was consulted to manage the wound due to its size and significant soft tissue loss. ⋯ The patient underwent a successful split thickness skin graft on hospital Day 23 and was discharged home. Follow-up visits revealed no scar contracture or functional limitations.
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Chaplaincy is organized in Europe in various ways, depending on the cultural, religious, social and governmental aspects which shape healthcare. One of the uniting forces in bringing national chaplaincies together into one united body has been the European Network of Health Care Chaplaincy (ENHCC). ⋯ These difficulties are described and note is given to how the ENHCC is dealing with them. Finally, special attention is given to how chaplaincy in Europe and the medical community interact and what is needed to bridge the gap between the two worlds of science and faith.