Southern medical journal
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Southern medical journal · Oct 1997
Case ReportsPresentation and treatment of spontaneous aortocaval fistula.
Spontaneous rupture of abdominal aortic aneurysm into the inferior vena cava is rare. The clinical presentation is highly variable, and the diagnosis can be difficult, often being made only at operation. The aortocaval fistula results in a large left-to-right shunt, which can cause cardiac failure. Once the diagnosis is made, treatment is by surgical closure of the fistula and repair of the aneurysm with a graft. ⋯ Spontaneous aortocaval fistulas are uncommon, and their preoperative recognition is difficult. Hematuria in association with an abdominal aortic aneurysm should raise the suspicion of an aortocaval fistula. Surgical correction is possible, with survival rates comparable to those associated with rupture of aneurysms into the retroperitoneum. Early operative control of the fistula is important to optimize the preload to the heart.
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Southern medical journal · Oct 1997
Case ReportsAcute colonic pseudo-obstruction complicated by cecal perforation in a patient with Parkinson's disease.
Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by physical examination and radiologic findings indicative of mechanical obstruction but in which no physical obstructive process can be found. Many factors have been associated with this syndrome which include electrolyte imbalance, systemic infection, drugs, and occasionally, neurologic disease. Reported here is a case of acute colonic pseudo-obstruction which developed in a patient with known Parkinson's disease and was complicated by cecal perforation, yet had a favorable outcome.
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Southern medical journal · Sep 1997
Case ReportsTongue involvement in a patient with granulomatous myositis.
A 64-year-old woman had difficulty swallowing and talking, weakness of the tongue, and progressive muscle weakness that was proven to be caused by a granulomatous myopathy. This case resembled a motor neuron disease, indicating that granulomatous myopathy should be considered in patients with similar presentations, since it is a treatable condition with a more benign prognosis.
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Southern medical journal · Sep 1997
Review Case ReportsMethemoglobinemia caused by benzocaine topical spray.
Acute methemoglobinemia is a medical emergency that can rapidly become fatal. A substantial number of drugs, including topical preparations, can precipitate this condition. I report a rare example of severe, acute methemoglobinemia caused by oropharyngeal anesthesia with topical benzocaine spray for orogastric intubation. The pathophysiology, diagnosis, and treatment of methemoglobinemia are reviewed briefly.
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Southern medical journal · Sep 1997
Review Case ReportsIsolated colonic neurofibroma manifested by massive lower gastrointestinal bleeding and intussusception.
We report a case of rare solitary neurofibroma of the transverse colon in a patient without neurofibromatosis. The patient was found to have an intussuscepting tumor prolapsing transanally, with massive lower gastrointestinal bleeding. This case represents only the second documented report of an isolated colonic neurofibroma.