Showing papers in "Maryland medical journal in 1999"

Postural instability in Parkinson's disease.

Abstract: Persons with Parkinson's disease are at great risk of suffering traumatic injuries from falls. Intervention with physical therapy and the use of assistive devices are helpful in preventing falls. Unfortunately, many patients are not referred for these interventions until they have already suffered traumatic injury. A simple measure of balance, which can easily be performed in an office setting, is the functional reach. This measure has been shown to be predictive of falls in the elderly. In this study, the functional reach was measured in patients with idiopathic Parkinson's disease during each visit over at least one year. Patients deemed at risk of falling were referred for physical therapy and possibly assistive devices. Those patients subsequently suffering falls were noncompliant with the recommendations.

Long-term functional results after manipulation of the frozen shoulder.

Abstract: The use of shoulder manipulation in the treatment of frozen shoulder syndrome remains controversial. Opponents cite the risk of dislocation, fracture, nerve palsy, and rotator cuff tearing as limiting the usefulness of manipulation. A retrospective study of 38 shoulder manipulations in 32 patients was performed. These patients were followed for an average time of 58 months. The patients were examined in follow up for combined shoulder range of motion, external and internal rotation strength, and status of the long head of the biceps. Manipulation was performed in all patients by the senior author and supervised physical therapy was begun within 24 hours of the manipulation. The average recovery time was 13 weeks. In this series, 97% of patients had relief of pain and recovery of near complete range of motion, although 8% required a second manipulation to obtain a successful result. Mild weakness to manual muscle testing was present in 5.3% of patients in external rotation and 10.5% of patients in internal rotation. There was no deterioration of shoulder function with time. In fact, most patients improved with passage of time, even more. There was no evidence of biceps tendon rupture or rotator cuff insufficiency at the time of follow up in any of the patients. No fractures, dislocations or nerve palsies were observed, although one patient who had no premanipulation arthrogram was found to have a rotator cuff tear a few months after failed manipulation. Manipulation of the shoulder can therefore be offered to reduce the pain and period of disability in patients who fail conservative treatment of frozen shoulder syndrome.

Fat embolism syndrome in a case of abdominal lipectomy with liposuction.

Abstract: Fat embolism syndrome is reported in a patient who underwent abdominoplasty and suction lipectomy for body contouring. Within 48 hours after surgery, she experienced adult respiratory distress syndrome, secondary to fat embolism syndrome. This was proven on bronchoscopy by evidence of fat laden macrophages. Aggressive respiratory support over 12 days resulted in patient survival.

Laparoscopic spinal fusion.

Abstract: We have reviewed the history of laparoscopic fusions and our results over the past two years, utilizing a femoral ring allograft and bone graft in 51 patients The rate of fusion in this series is nearly 100%, with relief of radicular pain in about 90% The average hospital stay is approximately two days and return to work is about six weeks Minimally invasive techniques for spinal surgery will evolve with time and will become the standard of care in the near future

Spinal subdural hematoma : a rare complication of lumbar puncture : case report and review of the literature

Abstract: Spinal subdural hematoma, though rare, is an established complication of lumbar puncture. A young man with persistent back and neck pain after a traumatic lumbar puncture for the diagnosis of lymphocytic meningitis is presented. A diagnosis of spinal subdural hematoma at T2 to T8 levels without significant spinal cord compression was confirmed by magnetic resonance imaging. Symptoms resolved after one month of analgesics and muscle relaxants.

Seroprevalence study of Hantavirus infection in the community based population.

Abstract: The genus Hantavirus, family Bunyaviridae, comprise at least 20 distinct viruses. Ten of these have been linked to specific human diseases. Hemorrhagic fever with renal syndrome has been recognized since the 1950s. Hantavirus pulmonary syndrome was recognized in the United States in 1993. Epizootiologic studies of Norway rats in the Baltimore area have shown that rodent infections with hantaviruses are common and geographically widespread with prevalence reaching 44% in tested rat populations. These viruses are antigenically related to the Seoul virus. Hantavirus infections in humans occur through transmission from a rodent reservoir, primarily by inhalation of virus laden rodent excreta. There is no evidence to support person-to-person transmission of any known Hantavirus. To establish the prevalence of Hantavirus infections in humans in the Baltimore area we collected sera from 1,212 persons attending a community based health care system. These were tested for antibodies against three reference Hantavirus strains: Hantaan (HTN), Seoul (SEO), and Convict Creek (HN017). HN017 was chosen to represent the SinNombre (SN-like) strains of Hantavirus. Sera from nine patients were positive to Hantavirus specific antibodies, HTN, and SEO by Enzyme Linked Imuno Sorbent Assay (ELISA). No sera were positive for HN017 antigen. All sera that were positive for HTN and SEO were tested by western blot for HTN. All nine sera were confirmed positive by western blot. This suggests that unrecognized infections with Hantaan or Seoul-like viruses occur in the Baltimore area in humans, although the prevalence rate in humans is low (0.74%). Epidemiologic monitoring may be warranted to establish the health implications of these infections.

Sexual practices of older adults in a high HIV prevalence environment.

Abstract: Based on recent epidemiologic evidence, AIDS in older persons (ages 55-79) in Maryland appears to be increasingly contracted heterosexually, particularly in women. Little is known about sexual practices or beliefs about HIV in older persons living in high HIV prevalence urban populations. The purpose of this study was to assess sexual practices, particularly high risk behavior, modifications of behavior including condom use, and perceptions of risk. A behavioral survey, containing 41 potential responses, was developed through modification of The National AIDS Behavioral Survey, focusing on heterosexual activity. The survey was administered to a convenience sample of 55 to 79 year olds attending the Union Memorial Hospital medical clinic. Sexual activity is common within the older population, especially among men. Multiple partners is not unusual in older men. Condoms are commonly used. Older individuals typically are aware of HIV heterosexual transmission risk and a proportion have modified sexual behavior because of perceived risks.

Incidence rates of Lyme disease in Maryland: 1993 through 1996.

Abstract: The incidence rate per 100,000 population by gender and age group was calculated for the 24 Maryland jurisdictions using 1,392 cases reported to the Lyme Disease Registry during 1993 to 1996. The overall incidence rate for the state was 7.0 cases per 100,000 inhabitants. Males (incidence rate = 7.7) were 1.2 times more affected than females (incidence rate = 6.2) (p < 0.001). The bimodal overall age distribution shows a peak in the 10 to 19 age category (incidence rate = 8.5) and in the 50 to 59 age group (incidence rate = 8.9), and in the 20 to 29 age group (incidence rate = 3.9). The incidence rate by jurisdiction ranged from 0.7 in Allegany County from Western Maryland to 88.3 in Kent County on the Upper Eastern Shore. Results from this study show that counties from the Upper Eastern Shore region had the highest specific incidence rate by age group/gender/jurisdiction while counties from Western Maryland had the lowest specific incidence rates and have not reported Lyme disease patients younger than 10 or older than 59 years of age. This difference might be explained primarily by the kind of outdoor activities in which the different age groups are involved and the relative abundance of Ixodes scapularis infected with the etiologic agent of Lyme disease, Borrelia burgdorferi, in these two regions.

Pneumomediastinum: the Valsalva crunch.

Abstract: The following case presentations illustrate the diverse clinical manifestations and benign self-limited course of spontaneous pneumomediastinum. The discussion includes the mechanisms involved, the symptoms, the radiographic findings, the potential complications, the exclusionary diagnosis, and the appropriate management of this condition.

Sentinel lymph node mapping for staging breast cancer: preliminary results of a prospective study.

Abstract: Axillary lymph node dissection is the gold standard for staging breast cancer, but it is associated with significant morbidity and complications. Sentinel lymph node mapping technique has demonstrated a successful detection of the node or nodes more likely to have metastasis. Two techniques are being used to detect sentinel lymph node-intraoperative use of gamma detecting probe after injection of radio tracer preoperatively and the injection of blue dye and lymphatic mapping intraoperatively. We used both techniques. Twenty-four patients underwent sentinel lymph node mapping. Blue dye and gamma detecting probe identified sentinel lymph nodes in 78% and 77% of patients, respectively. Overall, 23 of 24 patients had a sentinel lymph node identified (96%). Ten patients had metastatic disease in the axilla. Out of these ten patients the only positive node/nodes were the sentinel lymph node in six patients. The other four patients had positive non-sentinel lymph node along with positive sentinel lymph node. All of the patients who had metastatic disease in the axilla were detected by the sentinel lymph node mapping technique. Therefore, no patient had positive non-sentinel lymph node if the sentinel lymph node was negative. This technique was 100% predictive of the axillary status. Sentinel lymph node mapping technique will change the management of breast cancer and will allow two-thirds of the patients with breast cancer to be managed without axillary lymph node dissection with a resulting reduction in morbidity and cost.

The impact of a geriatrics evaluation and management unit compared to standard care in a community teaching hospital.

Abstract: A prospective, controlled trial was initiated to determine whether an acute inpatient geriatrics unit located in a community-based teaching hospital provides better care for frail elderly patients at less cost than conventional medical-surgical units.

Pentoxifylline treatment for microangiopathic hemolytic anemia caused by mechanical heart valves.

Abstract: The use of pentoxifylline increased the hematocrit and eliminated the transfusion requirement for a patient who had microangiopathic hemolytic anemia due to three prosthetic heart valves.

Adherence to the JNC VI guidelines for the treatment of hypertension in the resident clinic

Abstract: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) provided guidelines for the treatment of hypertension. This study examined the adherence to the JNC VI guidelines by a retrospective chart review of patients treated for hypertension in the internal medicine house staff practice at a university teaching hospital in the year after publication of the JNC VI.

Minimally invasive parathyroidectomy utilizing a gamma detecting probe intraoperatively.

Abstract: The most common pathologic finding in primary hyperparathyroidism is a single adenoma. Traditionally, all four glands have been explored during surgery for primary hyperparathyroidism. With the advent of accurate localizing diagnostic studies, such as the sestamibi scan, some surgeons are now recommending single-gland exploration. In addition, when a sestamibi scan is performed the day of surgery, a gamma detecting probe can be used intraoperatively to direct the dissection. Although an experienced surgeon will successfully locate the abnormal gland 95% of the time with the traditional approach, this new technique results in a smaller incision with better cosmetic results as well as decreased operative time. Our initial experience with eight cases utilizing this technique is presented.

Enhanced external counter pulsation: the Howard County experience in the first 18 patients.

Abstract: Enhanced external counter pulsation is a noninvasive therapy that uses sequentially inflated pneumatic cuffs on the lower extremities to enhance coronary artery diastolic flow and decrease left ventricular afterload. We studied its effect on 18 patients with persistent angina despite maximal medical, surgical and catheter-based interventions. After enhanced external counter pulsation all subjects improved their functional class. Treatment with enhanced external counter pulsation improved functional class significantly from baseline 3.1 +/- 0.6 to 1.6 +/- 0.5 (p < .001). These results are consistent with the national experience. Growing physician awareness, recent Medicare approval status, and subsequent reimbursement will hopefully increase the use of this therapy.

A community care initiative: Maryland and Hopkins students take to the streets in Baltimore City.

Abstract: Medical students from University of Maryland and Johns Hopkins University, with a grant from the Maryland Chapter of the American College of Physicians, held a free health fair in a Baltimore City neighborhood. The goals were to heighten awareness of common health problems, learn more about a medically underserved community, and increase access to primary care services in that community. The students planned booths to offer information and screening on 19 common health topics. Fair organizers worked with a local clinic, People's Community Health Center, and a neighborhood development organization, the Safe and Smart Center, to create an event that would engage and educate people on relevant issues. Approximately 100 medical students participated in the event and 350 people attended the fair. An optional survey filled out by fair participants revealed that a diverse group of people attended the event. Comments about the day from medical students and fair participants show that the event was enjoyable and offered a tremendous learning opportunity for both groups. This paper also discusses problems that arose during the planning stages as well as suggestions for those interested in planning a similar event.

A case of post-streptococcal reactive arthritis.

Abstract: Reactive arthritis is a term used to describe a sterile inflammatory arthritis occurring after a documented infection elsewhere in the body. Group A streptococcus is known to cause such an arthropathy in the setting of acute rheumatic fever. Friedberg first postulated that a reactive arthritis might occur in response to a streptococcal pharyngeal infection as a separate entity from rheumatic fever in the 1950s. Then, in the 1980s, other investigators began describing cases of reactive arthritis that were not characteristic of acute rheumatic fever based on certain observations and application of criteria. We present a patient whose clinical features are more consistent with post-streptococcal reactive arthritis than acute rheumatic fever.

Skin cancer detection and prevention: a community program promoting sun safe behaviors.

Abstract: New cases of skin cancer will be diagnosed over one million times in the United States in 1999. Basal and squamous cell types can cause significant cosmetic morbidity. Malignant melanoma can cause serious morbidity and mortality. Thus, early detection and prevention efforts are crucial for all skin cancers. Studies have identified genetic, hereditary, and environmental factors associated with increased risk of developing skin cancer. In this article, the incidence and risk factors are reviewed. The Howard County Skin Cancer Awareness Project, established in 1996, is presented as a community based program that aims to increase public awareness about the prevention and early detection of skin cancer. Future directions are also addressed.

Cat scratch encephalopathy.

Abstract: Cat scratch disease is usually a self-limited illness associated with tender lymph nodes, fever, malaise, and fatigue. Lymphadenopathy usually resolves spontaneously within three to four months. Cat scratch disease can be atypical as indicated by the presentation of our patient.

Hepatic hydrothorax: diagnosis and management. Case report and review of the literature.

Abstract: Current practice standards indicate the need for tube thoracostomy in the management of clinically significant recurrent pleural effusions. The following case presentation and review of the literature illustrate a contraindication to chest tube insertion with pleural effusions associated with portal hypertension (hepatic hydrothorax) and suggest alternative therapies.

Effect of a disease management tool on residents' compliance with American Diabetes Association standard of care for type 2 diabetes mellitus. American Diabetes Association.

Abstract: Diabetes mellitus is the fourth leading cause of death in the United States and a major cause of blindness and heart disease. Often, physicians do not comply with American Diabetes Association standards of practice. We report improved resident physicians' compliance with American Diabetes Association (ADA) standards of care for patients with Type 2 diabetes mellitus after the implementation of a disease management tool for diabetes mellitus.

Ultrasonic assisted liposuction.

Abstract: Ultrasonic assisted liposuction is a new and highly advanced technology that uses sound waves to emulsify body fat thereby allowing an efficient removal compared with the mechanical disruption of fat used in traditional liposuction. Safe application requires an exceptionally sophisticated plastic surgical, anesthetic, and operating room team. The media bombards patients with "magic wand" medical technology but seems less inclined to portray limitations, complications, and deaths. As with any emerging technology, ultrasonic assisted liposuction is producing its share of problems. This article provides an overview of this procedure and guidelines for patient selection. A conservative approach is emphasized for safety.

The health of merchant seamen in Baltimore and its history.

Abstract: This article provides the history of health care provisions for seamen in Baltimore and presents an analysis of the distribution of diseases of merchant seamen in baltimore in 1995.