The Journal of the Kentucky Medical Association
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Metastatic squamous cell carcinoma presenting in the neck from an unknown primary site represetns 2% to 6% of head and neck cancers. Optimal management of these cases remains controversial and continues to evolve with experience. We performed a retrospective analysis involving patients treated for unknown primary squamous cell carcinomas with metastases to cervical lymph nodes who presented to either the University of Kentucky or the Veterans Affairs Hospital of Lexington, Kentucky, from 1990 to 2000. ⋯ The presence of extracapsular spread, increased number of positive lymph nodes, and eventual discovery of a primary tumor did not significantly decrease survival in this series. The mean follow-up period for patients in this study was 54.8 months. We continue to refine our diagnostic and treatment strategies in this group of patients in an effort to improve long-term survival and reduce patient morbidity.
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Dementia with Lewy bodies (DLB) is the second most common neurodegenerative cause of dementia of the elderly following Alzheimer's disease. The significant clinical features include: fluctuating cognition with pronounced variations in attention and alertness, recurrent visual hallucinations, and spontaneous motor features of parkinsonism. As an alpha-synucleinopathy, DLB is characterized by Lewy bodies of both classical and cortical types with neuritic degeneration. This report describes an autopsy of an elderly woman with DLB and reviews the clinical and pathologic features of dementia with Lewy bodies.
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Clinical forensic medicine (CFM) is "the application of appropriate forensic practices and principles, heretofore reserved for use by the pathologist at autopsy, to living patients in a clinical setting." "Living forensic" patients include survivors of trauma and potentially catastrophic experiences resulting in injury. CFM arose from "clinically" affirming that not all abuse or assault victims sustain fatal injuries. Appropriate medical documentation and interpretation of physical findings may aid law enforcement and/or social services in the legal evaluation of a case or situation. Additionally, timely collection of pertinent evidence may be performed as the case necessitates.
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In recent years, epidemics of Methicillin-Resistant Staphylococcus aureus (MRSA) infections in patients not associated with the health care system have been reported in several states. This community-acquired MRSA (CA-MRSA) is microbiologically distinct from hospital-acquired MRSA (HA-MRSA) and has a predilection to cause severe skin and soft tissue infections and a particularly virulent necrotizing pneumonia. Many patients have suffered serious morbidity and mortality because of thefailure to recognize CA-MRSA as the pathogen in these infections. ⋯ Here we report 15 cases of CA-MRSA infections managed by the Infectious Diseases Division at the University of Louisville and offer guidelines for diagnosis, treatment, and infection control based on our experience. Primary care and emergency physicians as well as infection control professionals need to be aware that there is an emerging epidemic of CA-MRSA infections in the state of Kentucky. Several of our current practices regarding treatment and isolation will need to be modified to prevent the morbidity and possibly mortality associated with some CA-MRSA infections.