Southern medical journal
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Southern medical journal · Oct 1996
Review Case ReportsAscites associated with antibiotic-associated pseudomembranous colitis.
We report the case of an elderly patient who had ascites due to pseudomembranous colitis and associated hypoalbuminemia. Computed tomography showed diffuse colonic wall thickening. An indium-111 scan to localize the site of infection showed abnormal localization of 111In throughout the colon. ⋯ To study the cause of ascites in patients with pseudomembranous colitis, we reviewed our institutions' experience with ascites in association with Clostridium difficile colitis, identifying 16 cases over a 1-year period (which included our case). In most of the other cases, the ascites could be attributed primarily to another mechanism, including portal hypertension, congestive heart failure, and sepsis (intra-abdominal and systemic). We also reviewed the literature regarding the association of ascites with C difficile colitis.
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Southern medical journal · Aug 1996
Case ReportsSting of the puss caterpillar: an unusual cause of acute abdominal pain.
We report the case of a 41-year-old man with abdominal pain after envenomization by a puss caterpillar. The patient's medical history and physical examination revealed classic symptoms, leading to the correct diagnosis and appropriate therapy with intravenous calcium gluconate. Although severe, local reactions to puss caterpillar envenomization have been previously described, to our knowledge this is the first report of a patient with severe, acute abdominal pain caused by a puss caterpillar's sting.
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Southern medical journal · Aug 1996
Patient understanding of emergency department discharge instructions.
Patients were interviewed immediately after discharge outside the emergency department to determine whether they could read their discharge instructions and recall their diagnosis and treatment plan. The association between frequency of correct responses and various characteristics of the patients was assessed. Of the patients completing the interview, 72% could read the discharge instructions. ⋯ Overall, 37% of patients answered all questions correctly and 8% answered all questions incorrectly. No association was found between frequency of correct responses and variables examined. Miscommunication of discharge information occurs frequently; illiteracy does not completely account for the observed low rates of recall.
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We report the case of a patient with recurrent admissions for congestive heart failure who was subsequently diagnosed with apical hypertrophic cardiomyopathy. The major physiologic characteristic of patients with apical hypertrophic cardiomyopathy is diastolic dysfunction due to abnormal stiffness of the left ventricle during diastole, with resultant impaired ventricular filling. In these patients, as in all patients with hypertrophic cardiomyopathy, the main pathology is inadequate relaxation of the ventricle; therefore, a regimen of diuretics and inotropic agents can actually worsen the clinical picture. We emphasize the need to consider hypertrophic cardiomyopathy in evaluating cases of congestive heart failure.
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The laryngeal mask airway (LMA), developed in 1983, is a new device to assist in the management of the pediatric and adult airway. In 1991, the Food and Drug Administration gave its approval for use of the LMA in the United States. ⋯ Its role in management of the difficult airway and the traumatic airway is still evolving. This review will introduce the LMA to the nonanesthesiologist and review for the anesthesiologist the origins of the LMA, its physical structure, the technical aspects of insertion, problems with aspiration, its role in the difficult airway, and experience with the pediatric population.