Missouri medicine
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The combination of neurosurgical and otological skull base techniques has allowed new avenues to the resection of tumors of the medial petrous bone. Three cases are presented illustrating the surgical options available.
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Review
Substance abuse and dependence in physicians: an overview of the effects of alcohol and drug abuse.
Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. Early intervention followed by appropriate treatment can often help return physicians to healthy personal and professional lives. Current scientific evidence suggests the prevalence of substance abuse or dependence among the medical profession over a lifetime is approximately 10-15%, slightly in excess of the general population. The initiation of intervention is critical and ultimately may be lifesaving.
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For over 25 years many clinicians and others working in health-related fields have envisioned the day when physicians will use a computer on their desk or at the bedside to enter and retrieve the medical records and other information needed to care for their patients. Pioneers in medical informatics have been working during this time to develop the concepts and systems to make this possible, but so far, with only a few exceptions, this has been still mostly a dream. However, we may now be on the threshold of the time when these systems will be implemented on a large scale and become an integral part of the practice of clinical medicine, making the vision no longer a dream but a reality.
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Although small and relatively protected, an accessory spleen can be the cause of acute intraabdominal symptoms following minimal trauma. Although a splenic fracture or laceration may not be apparent on by CT scan, the scan cannot rule out the possibility. The diagnosis of splenic injury should be entertained in light of appropriate history and physical findings. The case we present and prior similar cases are a useful review of isolated accessory splenic rupture due to blunt trauma.