The West Virginia medical journal
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Case Reports
Treatment of giant intracranial aneurysm with carotid ligation, saphenous vein bypass graft.
Giant intracranial aneurysms pose difficult problems for neurosurgeons. This article describes the technique of extracranial-intracranial saphenous vein bypass graft and carotid artery ligation as treatment to remove a giant intracranial aneurysm.
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The distribution of mammography machines and related resources in West Virginia, along with the distribution of breast cancer screen-eligible women, are examined using county-specific data. This data placed on a state map shows that it is not necessary to cross more than one county line anywhere within West Virginia in order to visit a mammography facility. The overall density of these machines is 20 per 100,000 women over 45, almost double the capacity needed for screening mammography. ⋯ If mammography machines were placed in all the counties without machines, the cost in those countries would be around $140 per exam. It would be cheaper to provide a travel allowance to women in rural counties than to install machines in these areas. Machines that are accredited by the American College of Radiologists, the most available indicator of quality mammography, are located only in densely populated areas of the state.
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Heparin-induced thrombocytopenia with thrombotic complications is a serious clinical problem. The diagnosis is confirmed by a positive heparin-induced platelet aggregation test and/or detection of white clots upon pathological exam after a presumptive diagnosis based on these criteria: (1) Development of thrombocytopenia of less than 100,000 mm3 while receiving heparin therapy; (2) Normalization of the platelet count after an interruption in heparin therapy; (3) The presence of thrombotic complications; and (4) Exclusion of other causes of thrombocytopenia. Eight patients with heparin-induced thrombocytopenia were encountered at the Charleston Area Medical Center, Memorial Division, in a recent 20-month period. ⋯ The mortality rate was 25 percent and the morbidity rate was 38 percent. In conclusion, an initial platelet count should be obtained on all patients prior to receiving heparin, followed by repeat platelet counts every two to three days. Once thrombocytopenia or thrombosis is diagnosed, heparin should be discontinued and other therapeutic modalities considered.
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West Virginia, it would seem, is an unlikely place for physicians to encounter patients with poisonous marine envenomations. To the contrary, West Virginias who vacation at the beach may be envenomated and require further evaluation and treatment when they return home. ⋯ Such underwater sea creatures can cause local and systemic toxic or allergic reactions which potentially can be serious. This article describes these possible toxic encounters as well as first aid and medical management.
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Accidental hypothermia due to exposure is an infrequent cause of circulatory arrest. A premature diagnosis of clinical death must be avoided in these patients and vigorous attempts at active rewarming are indicated. Extracorporeal circulation in the form of partial cardiopulmonary bypass has been reported as an effective means of rapid, even core rewarming. We wish to report a recent case at Ruby Memorial Hospital in which extracorporeal circulation was used successfully in resuscitating a profoundly hypothermic multi-trauma victim.