Background: Computer-assisted instruction in medicine appears rofacilitare learning, but it has not been compared prospectively to more traditional reaching methods. Purpose: To compare the efficacy of computer-assisted instruction to a more…
For the first time, we report Klebsiella pneumoniae as an enteroinvasive food-borne pathogen transmitted from a hamburger. A 28-year-old previously healthy African-American male ingested a portion of a hamburger from a fast food chain. Symptoms of…
OBJECTIVE: To describe a case of warfarin resistance apparently caused by malabsorption and to review the literature regarding warfarin resistance. CASE SUMMARY: A 28-year-old renal transplant patient with systemic lupus erythematosus was admitted…
The interpretation of acid-base data can be greatly facilitated by applying five rules: (1) use the blood gas to identify acidemia or alkalemia, (2) determine whether the underlying cause of acidemia or alkalemia is respiratory or metabolic, (3)…
Thorough investigation of complex cases of acid-base disturbances indudes verification of pH, determination of respiratory and metabolic components, calculation of the anion gap, assessment of the degree of compensation; and analysis of the…
Acquired hemophilia (antibodies or inhibitors to factor VIII) is the most common acquired disease affecting clotting factors. It has been described in association with autoimmune disease, malignancy, dermatologic disorders, in the postpartum period,…
This article demonstrated a systematic approach to acid-base problem solving through the application of the so-called "Rules of Five." This technique was compared with other options for acid-base problem solving, namely, clinicians' use of gestalt or…
CONTEXT: An estimated 60 million Americans use some from of complementary and alternative medicine, though approximately 70% do not tell their physicians about this use. Open communication between conventional medical providers and patients in this…
When a patient's total serum calcium level drops below 8.9 mg/dL, first determine whether the hypocalcemia is real. Measure the serum level of ionized calcium or (because 40% of calcium is bound to protein) adjust the total serum calcium level for…
A controlled randomized double-blind study was done to determine the frequency and severity of leg cramps in 40 patients on dialysis with a history of leg cramps. All patients entered a 2 month placebo washout and were randomized into a 2 month…
A 52-year-old white male presented for evaluation of moderate azotemia (blood urea nitrogen (BUN) 52 mg/dl and creatinine 5.4 mg/dl). Renal history was positive for hypertension (156/100), nocturia, and polyuria. There was a 10-year history of an…
Drug-induced acute tubular necrosis is a primary cause of acute renal failure (ARF); it may result from the use of such agents as aminoglycosides, amphotericin B, and radilocontrast media. To reduce the risk of aminoglycoside toxicity, prescribe the…
Angiotensin-converting enzyme (ACE) inhibitors and NSAIDs are among the drugs most commonly associated with acute renal failure (ARF). Patients at risk for ACE inhibitor-induced ARF include those with congestive heart failure (CHF) or compromised…
Enterovesical fistula is a rare complication of a variety of inflammatory and neoplastic diseases. It usually presents with pneumaturia, fecaluria, urinary tract infections, or irritable bladder symptoms in the setting of either diverticulitis or…
In elderly individuals, serum creatinine may remain normal as glomerular filtration rate (gfr) declines. Therefore, the estimation of glomerular filtration utilizing mathematical models incorporates age as an important variable. In order to adjust…
A 68-year-old man with coronary artery disease was admitted for chest pain and ventricular tachycardia, After electric cardioversion, therapeutic heparinization was started for myocardial ischemia and nontransmural infarction, On day 3, headache and…
Precipitants of hyperkalemia include diabetes, certain medications (eg, NSAIDs, ACE inhibitors), tissue injury, and hormonal abnormalities. Hyperkalemia alters the extracellular to intracellular potassium gradient, which decreases the resting…
Four cases histories illustrate the process of defining the cause of hyponatremia: Categorize the patient's volume status; determine kidney function and kidney's response to volume stimulus; measure urine osmolality; consider other factors, including…
Abnormalities that increase water reabsorption can lead to hyponatremia, and the resulting water retention presents the threat of CNS volume changes. Avoid overcorrection of hyponatremia, however, as this causes similar changes. Also, be aware of…
Early detection and careful management of kidney disease can help slow or halt progression to renal failure. Early diagnosis is based on a history and physical examination, urinalysis (with dipstick testing for protein, blood, and pH), and…
Hypomagnesemia may be caused by renal losses (often related to drugs or diabetes), inadequate intake or inadequate intestinal absorption. Manifestations may include arrhythmias, particularly during myocardial ischemia or with digitalis use, and such…
Decisions which determine the duration and outcome of terminal care should be influenced by patient autonomy. Studies suggest, however, that end-of-life decision-making is more complex than a single principle and that physicians may be responsible…
Autosomal dominant polycystic kidney disease (ADPKD), the most common inherited disorder in this country, is more than just a renal disease. Major extrarenal sites are the cardiovascular system, liver, and GI tract. The most devastating…
Pylephlebitis or septic thrombophlebitis of the portal vein, a precursor of hepatic abscesses, is an extremely rare and frequently fatal complication of diverticulitis. The following report describes a patient presenting with pylephlebitis and…
OBJECTIVE: To make clinically relevant recommendations for electrocardiogram (ECG) testing among psychiatric patients, the study examined the practice of ordering ECGs for this population. METHODS: The records of 4,045 patients consecutively admitted…
Percutaneous transluminal angioplasty and renal artery bypass surgery are the most effective means of treating renal vascular disease and the hypertension it causes. Selection of the most appropriate treatment depends on the nature of the underlying…
Detection of renal vascular disease offers the opportunity to cure a patient with hypertension as well as to avert severe renal damage and lifelong dependence on dialysis. The crucial first step is to suspect renovascular lesions. Clues include the…
Trichophyton verrucosum infection, which is acquired from the hide of dairy cattle, is the cause of tinea barbae, a severe pustular eruption on the face and neck, We present the cases of five patients, three of whom had severe pustular tinea barbae…