Hawaii medical journal
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Hawaii medical journal · Apr 2011
Case ReportsGastric volvulus, Borchardt's Triad, and Endoscopy: A Rare Twist.
The authors describe a case of gastric volvulus, which is a rare cause of gastric outlet obstruction. An 85-year-old man presented with nausea, vomiting, and epigastric pain. Admission abdominal radiograph demonstrated a grossly distended stomach with air-fluid levels. ⋯ Endoscopy revealed a fluid-filled, tortuous stomach with a paraesophageal hernia, and the operator was unable to locate or pass the scope through the pylorus. Traditionally Borchardt's triad is believed to be diagnostic for acute gastric volvulus and consists of unproductive retching, epigastric pain and distention, and the inability to pass a nasogastric tube. The authors propose that the following features on endoscopy are highly suggestive of the most common type of volvulus (organoaxial): tortuous stomach, paraesophageal hernia, and inability to locate or pass the scope through the pylorus.
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Hawaii medical journal · Jan 2011
Case ReportsAn unusual cause of vertigo and syncope: a case report.
A 72-year-old woman with recurrent bouts of vertigo and syncope was found to have a glomus tympanicum tumor. Surgical removal of this tumor resulted in complete symptom resolution. This report summarizes the presentation, workup, treatment, and clinical significance of this case when dealing with these presenting symptoms.
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Hawaii medical journal · Nov 2010
Comparative StudyDiagnostic value of urine sodium concentration in hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion versus hypovolemia.
We are often left with the differential diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) versus hypovolemic hyponatremia. It is difficult to tell who will respond to isotonic saline infusion and who will not, if the urine sodium value is not completely suppressed (>10 mEq/L). ⋯ When the underlying cause is inconclusive between SIADH and hypovolemia, and when only basic laboratory results are available at the time of initial evaluation, the urine sodium alone will be adequate to guide initial fluid management. In contrast to traditional teaching, elevated urine sodium levels up to 50 mEq/L demonstrated clinically meaningful responses to isotonic saline infusion.
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Hawaii medical journal · Oct 2010
Risk factors for community-associated methicillin-resistant Staphylococcus aureus cellulitis--and the value of recognition.
To identify the risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) cellulitis. ⋯ The presence of abscesses and obesity were significantly associated with CA-MRSA cellulitis. Empiric therapy with antibiotics active against MRSA should be guided by these risk factors.
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Hawaii medical journal · Sep 2010
Case ReportsDiagnosis of appendicitis by a pediatric emergency medicine attending using Point-of-Care Ultrasound/ a case report.
Over the past decade Point/of/Care Ultrasound (POC US) is increasingly performed in adult emergency medicine for a variety of indications. Pediatric emergency medicine has been much slower to embrace POC US. ⋯ A diagnosis of appendicitis was made using real/time POC US by a pediatric emergency medicine attending. Knowledge of the sonographic characteristics of appendicitis can help the physician in the prompt diagnosis of this condition, thereby reducing morbidity and mortality that may result from a delay in diagnosis.