The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
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A 55-year-old African-American woman presents with progressive shortness of breath, non-productive cough, and muscle aches for two weeks. Her medical history is non-contributory. She is a current smoker with a 20-year history of smoking one pack per day. ⋯ Physical exam reveals crackles over the right middle lobe of her lung. The remainder of her physical exam is unremarkable. Blood tests demonstrate a mild leukocytosis.
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A muscular-appearing 50-year-old man was found down in his home by family members. Paramedics documented pulseless electrical activity and began cardiopulmonary resuscitation that included placement of an endotracheal tube. The resuscitation was continued in the hospital emergency department (ED), and after 20 minutes, an arterial pulse returned. ⋯ Meanwhile, a past history established that the patient was a personal trainer who seemed fit and healthy until 10 days earlier, when he came to the ED because he had begun to lose his balance and fall frequently. Computed tomography (CT) at that time revealed lytic lesions in the fifth lumbar vertebra and extensive retroperitoneal lymphadenopathy involving the aortic, iliac, and obturator chains and the perirectal region. Arrangements had then been made for outpatient workup of a presumed malignancy.
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Treatment of middle cerebral artery (MCA) aneurysms remains controversial because of their morphological characteristics. The aim of our study was to analyze the morbidity, mortality, and outcome of patients who underwent clipping of MCA aneurysms and compare with that of endovascular therapy. ⋯ The results of clipping of MCA aneurysms are superior to that of published endovascular therapy. Surgical clipping remains the standard of care for MCA aneurysms with good clinical and angiographic outcome.