Southern medical journal
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Southern medical journal · Jul 1999
Case ReportsIntramural anomalous left coronary artery from the right sinus of Valsalva supported with venoarterial extracorporeal membrane oxygenation.
We report the case of a 14-month-old girl with a wide complex dysrhythmia and cardiogenic shock due to abnormal coronary anatomy. She was kept alive for 20 days by full cardiocirculatory support, using venoarterial extracorporeal membrane oxygenation (VA ECMO). ⋯ The patient was listed for heart transplantation and received a donor heart 20 days after beginning VA ECMO. We discuss the unusual presentation and course of the coronary arteries and the use of VA ECMO to support this patient before heart transplantation.
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The companion animal population in the United States is both large in numbers and diverse in composition. Nearly 60% of households have one or more animals. Associated with this large and diverse group of animals are considerable risks for injuries and transmission of infections to humans. ⋯ Physicians, veterinarians, public health officials, and others need to work together to ensure that animal ownership is as risk free for people as possible.
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Among natural disasters, lightning is a leading cause of morbidity and mortality throughout the world. A well-informed bystander and an astute physician can make the difference between an outcome of death or lifelong disability versus complete or near-complete recovery. ⋯ This case report describes a young woman who was struck by lightning while talking on a cellular telephone at a mass gathering in an outdoor stadium. The discussion that follows the case centers on the pathophysiology of being struck by lightning and on issues unique to being struck in a stadium full of people.
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Southern medical journal · Jul 1999
Biography Historical ArticleTo end itself by death: suicide in Shakespeare's tragedies.
The tragedies of William Shakespeare make frequent use of suicide, some accomplished, some merely contemplated. Although his intent was their dramatic context, the Bard nonetheless clearly anticipated many features being discussed today, including assisted suicide, imitative ("copycat") suicide, and suicidal ideation by individuals with depression or disabilities. Recent debate over how often these factors influence the incidence of suicide rarely invokes their historical longevity. ⋯ Among the 13 overt suicides, at least 7 are depicted as being admirable under the circumstances at the time. Also, in various ways, 4 of these 13 were assisted, and at least 3 others contain an imitative element. Overall, the action of taking one's life is presented in a neutral or even favorable light, and the audience is left with a mingling of pity and admiration for the victim, not reproach.
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Southern medical journal · Jun 1999
Case ReportsRenal cell carcinoma in an intrathoracic kidney: radiographic findings and surgical considerations.
Ectopic intrathoracic kidney is a rare phenomenon and is usually an incidental finding on a chest radiograph. Of all intrathoracic kidneys, congenital ectopia is most often shown, with a traumatic etiology occurring much less frequently. ⋯ Management, which was based on current treatment recommendations for isolated renal masses, consisted of radical nephrectomy. The patient has been without evidence of disease recurrence for 36 months after surgery.