Showing papers in "Maryland medical journal in 1991"

The history of lupus erythematosus.

Abstract: The history of lupus can be divided into the classical period which saw the description of the cutaneous disorder, the neoclassical period which saw the description of the systemic or disseminated manifestations of lupus, and the modern period which was heralded by the discovery of the lupus erythematosus cell in 1948.

Magnetic resonance imaging diagnosis of an intracranial metastasis of adenocarcinoma of the prostate: case report.

Abstract: Adenocarcinoma of the prostate is the second most common cancer of American males over age fifty. However, the reported instances of cerebral metastases have been exceedingly rare and are usually diagnosed at postmortem. This report describes an unusual case of brain metastasis from an occult adenocarcinoma of the prostate confirmed by craniotomy and tumor resection.

Calcitonin and the treatment of osteoporosis.

Abstract: Calcitonin, a potent inhibitor of bone resorption, is an important agent for the treatment of osteoporosis. An analgesic effect of salmon calcitonin has also been reported. The recent development of calcitonin nasal spray should eliminate the need for injections.

Mexiletine-associated left ventricular dysfunction: a case study.

Abstract: Mexiletine is a lidocaine analogue used in the treatment of symptomatic ventricular arrhythmias. However, in selected individuals with baseline diminished left ventricular function, it may possess clinically significant negative inotropic effects.

Insignificant blunt maternal trauma with lethal fetal outcome: a case report.

Abstract: We report a case of a twenty-nine-week breech fetus with skull fracture, intracranial bleeding, and liver laceration sustained in a vehicular accident. This case describes insignificant maternal trauma with poor fetal outcome.

Pregnancy and addiction: outcomes and interventions.

Abstract: Cocaine use by pregnant women has increased dramatically in recent years, resulting in well-documented consequences for mothers and offspring. However, even a once weekly peer-oriented intervention can have a positive impact on pregnancy outcome for drug-using women.

Study of the relationship between elevated maternal serum alpha-fetoprotein and adverse pregnancy outcome.

Abstract: In a study of 1,703 pregnancies, adverse clinical outcomes associated with unexplained elevated maternal serum alpha-fetoprotein (MSAFP) included intrauterine growth retardation (IUGR), prematurity, IUGR and prematurity, prematurity without IUGR, spontaneous abortion, and stillbirth. These findings have significant implications for careful obstetrical management of patients with elevated MSAFP.

Disseminated histoplasmosis in AIDS patients in Maryland.

Abstract: These patients demonstrate the difficulty in arriving at the diagnosis of disseminated histoplasmosis. The diagnosis in two of the three patients also served as the initial AIDS case-defining opportunistic infection. In each of these patients, the clinical presentations were atypical and in only one patient was a positive exposure history elicited. Recurrent bowel obstruction was the presenting complaint in the first patient and the diagnosis was made only on pathologic exam of the resected small bowel. The second patient's diagnosis was made on biopsy of the colon via colonoscopy. The third patient's diagnosis also eluded an extensive FUO workup; he was diagnosed by bone marrow culture and silver stain of a mediastinal lymph node biopsy, despite serial negative serologic tests for histoplasmosis. The first two patients had significant gastrointestinal disease which is a relatively unusual manifestation for disseminated histoplasmosis. The third patient illustrates the limited diagnostic usefulness of serologic testing in AIDS patients and the continued usefulness of bone marrow analysis in an FUO evaluation. In conclusion, these case presentations demonstrate that disseminated histoplasmosis in patients with HIV infection can present with unusual manifestations, outside of the typical endemic arca, without a positive exposure history or positive serologic test, and may be the initial AIDS case-defining opportunistic infection in these patients. Consequently, a disseminated histoplasmosis should be considered in all AIDS patients with perplexing clinical presentations.

Hypertension in blacks.

Abstract: The major differences that have been recognized between black and white hypertensives are primarily epidemiologic, with hypertension being more prevalent, having an earlier onset, and having more severe sequelae in the black population. The cause of the problem in both black and white people remains obscure, but it appears that a difference in sodium handling may contribute to the particular hemodynamic and hormonal profile of black hypertensives. Salt sensitivity, expanded plasma volume and low renin levels have been the hallmark of the black hypertensive. Complications such as stroke and left ventricular hypertrophy remain the major sequelae of this disease in blacks. Finally, a current study confirmed the improved efficacy of antihypertensive therapy in blacks to diuretics and calcium channel blockers and a somewhat lower efficacy profile to angiotensin converting enzyme inhibitors and beta blockers, although the latter classes of agents have shown better response in blacks than previously thought.

Preventive therapy for tuberculosis in Maryland.

Abstract: Maryland data substantiate the safety of isoniazid therapy in preventing tuberculosis. To eradicate tuberculosis in the U.S., private physicians must play an active role by offering preventive therapy to patients at high risk of developing the disease.

Metastatic basal cell carcinoma.

Abstract: Metastatic basal cell carcinomas of the skin are rare tumors. Early excision of the primary lesion remains the best method of treatment, although unresectable tumors can be controlled by radiation therapy. Patients with regional lymph node metastases can be managed by radical lymph node dissection, while those with systemic metastases can be palliated by a combination of chemotherapy, radiation therapy, and surgery.

Stroke in the young. Part II.

Abstract: We have discussed some of the more common etiologic categories found in young patients with stroke. Though many of the causes are rare, in the aggregate they account for many of the conditions leading to stroke. In Part II of this series (July 1991), we will explore some of the less common causes of stroke in the young and outline an approach to the patient.

Medical therapy for SLE.

Abstract: Today, the major therapeutic challenge in systemic lupus erythematosus is to preserve the gains provided by corticosteroids while reducing their side effects.

Inflammatory pseudotumor of the retroperitoneum.

Abstract: A child presenting with the findings of inflammatory disease was found to have a pseudotumor of the retroperitoneum. Following surgical removal, all signs of the systemic inflammatory process resolved. These rare, benign tumors of unknown etiology must not only be differentiated from locally invasive malignant lesions, but may present with findings suggesting a chronic inflammatory disorder.

Management of the pregnant lupus patient.

Abstract: Increased understanding of SLE as it relates to pregnancy has allowed for many women with lupus today to have a successful pregnancy. However, pregnancies are high risk with up to 25 percent ending in miscarriage and with a high frequency of preterm delivery.

The efficacy of amiodarone in the treatment of refractory nonsustained ventricular tachycardia.

Abstract: Amiodarone is very effective in suppressing refractory nonsustained ventricular tachycardia Efficacy can be assessed after one week of therapy with continued long-term response in the vast majority of patients

Maryland's cytology labs: 1989-90 proficiency testing results.

Abstract: In 1990, the Department of Health and Mental Hygiene provided proficiency-testing to seventy-three cytology laboratories, and 293 technical employees. Sixty-three of these labs, 132 of 154 pathologists, and 130 of 139 cytotechnologists passed without having to undergo retesting or retraining. Failing laboratories accounted for approximately 2 percent of the cervicovaginal slides diagnosed in 1989. Labs with the lowest passing rates were small ones operated by single pathologists not employing cytotechnologists. Eight pathologists either surrendered their state permit or were required to obtain additional training; no cytotechnologist required additional training.

Premenstrual syndrome update: 1991.

Abstract: Premenstrual syndrome (PMS) was first identified in 1931 and currently affects millions of women on a physical and emotional basis. However, Buspirone has been found to be a safe and markedly effective agent in the management of this condition.

Glaucoma treatment and the laser revolution.

Abstract: We are just beginning to see the potential uses of laser energy to treat glaucoma. Each of the lasers described here has technical problems that make them less then perfect, but it is only a matter of time before we will be able to predictably alter the internal structures of the eye to better control any type of glaucoma.

Vascular lesions in SLE.

Abstract: The confusing array of manifestations resulting from multisystem involvement in SLE is due, in part, to the widespread involvement of blood vessels.