Southern medical journal
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Southern medical journal · Oct 1989
Case ReportsAdenoid cystic carcinoma metastasizing before detection of the primary lesion.
Although adenoid cystic carcinomas are occasionally manifested in atypical ways, metastatic disease preceding detection of the primary tumor has not been previously reported. We have described a patient in whom multiple pulmonary metastatic nodules were found one year before identification of primary adenoid cystic carcinoma of the maxilla. This case illustrates the need to include adenoid cystic carcinoma in the differential diagnosis of patients with metastatic disease and an unknown primary lesion. The use of special stains and electron microscopy can be helpful in confirming a diagnosis of adenoid cystic carcinoma.
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Southern medical journal · Oct 1989
Letter Case ReportsShoulder pain in a trial of labor after cesarean delivery.
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Southern medical journal · Sep 1989
Tracheostomy in the intensive care unit: a safe alternative to the operating room.
Severely injured patients frequently require endotracheal intubation, either by the nasotracheal (NT) or orotracheal (OT) route, for airway control and/or ventilatory support. If intubation is required for more than two to four weeks, an elective tracheostomy is usually indicated. Transferring these patients to the operating room is difficult, and it impairs their continued monitoring and care. ⋯ There were no complications specifically attributed to the performance of tracheostomy in the ICU, though one patient each suffered tracheitis, tracheostomy tube dislodgement, and tracheomalacia. Tracheostomy in the ICU avoids the risks of moving these patients with all their monitoring and infusion lines, and saves operating room time and charges. Trained surgical personnel using adequate instruments and lighting can safely perform a tracheostomy in the intensive care unit.
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Southern medical journal · Sep 1989
Free rectus abdominis muscle flap: advantages in lower extremity reconstruction.
Major soft tissue losses of the distal portion of the leg usually require free tissue transfer for reconstruction. We have recently treated seven patients with free rectus abdominis muscle flaps. The rectus abdominis has several advantages over other muscles; these advantages simplify such reconstructions. ⋯ There have been two complications in this series, one intraoperative flap failure, and one case of recurrent osteomyelitis. There has been no donor site morbidity. We recommend the free rectus abdominis muscle flap for the reconstruction of many complex wounds of the distal portion of the leg.
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Southern medical journal · Aug 1989
Case ReportsListeriosis as an obstetric complication in an immunocompromised patient.
We have reported a case of maternal death associated with Listeria monocytogenes septicemia in a woman who was being treated with immunosuppressive drugs for lupus nephritis. This report, coupled with a previous case of L monocytogenes sepsis in a pregnant patient with AIDS, emphasizes that L monocytogenes infection may be an important, unrecognized pathogen in pregnant women with impaired immunity.