The West Virginia medical journal
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Pancreatic injuries secondary to blunt trauma are challenging to diagnose. In many cases, the diagnosis is missed or delayed due to the subtle symptoms and signs of pancreatic injury. Blunt pancreatic injuries may evolve over a period of time and can be a source of extensive morbidity and mortality. ⋯ The pertinent CT findings and utility of CT as a diagnostic tool in these three cases of blunt pancreatic injuries are reviewed. Abdominal CT scanning can accurately identify pancreatic injuries secondary to blunt trauma, allowing expeditious surgical intervention. A high index of suspicion for pancreatic injury combined with careful interpretation of abdominal CT scans can provide valuable information about pancreatic injury during the initial trauma assessment.
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Ignorance of medical charges by decision-makers could handicap cost control programs. By written survey, we determined the ability and confidence of 267 adults, including 85 health care workers, to estimate four medical charges: epidural anesthesia for childbirth, outpatient hernia surgery, dipyridamole-thallium heart stress test, and a one month supply of nicotine drug patches. ⋯ Respondents rated medical charges significantly more difficult to estimate than non-medical. Seventy percent of respondents felt that most physicians do not know enough about medical charges to give good advice and 92% felt that they did not know enough about medical charges to make satisfactory choices.
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During a five-week interval which began May 1991, 19 patients presented to a community health center in a rural West Virginia community with a painful dermatitis. The dermatitis was caused by exposure to a single species of caterpillar, Hemileuca maia, larva of the buck moth. ⋯ Epidemics of caterpillar stings rarely have been reported. No previous epidemics of stings by the buck moth caterpillar have appeared in the literature.
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Case Reports
Coronary artery bypass in two patients with immune thrombocytopenic purpura without preoperative splenectomy.
Two patients with severe coronary artery disease and idiopathic thrombocytopenic purpura underwent coronary artery bypass grafting without preoperative splenectomy. The patients' thrombocytopenia and bleeding were controlled with platelet transfusion alone. This report indicates that the use of cardiopulmonary bypass in patients with immune thrombocytopenia does not invariably mandate splenectomy, particularly in those in whom performance of a splenectomy may be associated with an increased risk of intraoperative cardiac morbidity.
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Case Reports
Cardiopulmonary arrest in pregnancy: the role of caesarean section in the resuscitative protocol.
A 36-year-old black multipara at 32 weeks gestation was referred with apparent peripartal cardiomyopathy. Upon arrival, she was found to be in pulmonary edema; and shortly thereafter developed cardiopulmonary arrest. She failed to respond to initial attempts at cardiopulmonary resuscitation but subsequently responded after Caesarean section and pericardiocentesis. This case exemplifies the unique aspects of performing cardiopulmonary resuscitation on a gravid female in the latter part of pregnancy and that Caesarean section should be considered an integral part of the resuscitative protocol when standard protocols fail.