Showing papers in "Tennessee medicine : journal of the Tennessee Medical Association in 1997"

The Health Insurance Portability and Accountability Act.

Abstract: The Health Insurance Portability and Accountability Act, also known as HIPAA, was first delivered to congress in 1996 and consisted of just two Titles. It was designed to protect health insurance coverage for workers and their families while between jobs. It establishes standards for electronic health care transactions and addresses the issues of privacy and security when dealing with Protected Health Information (PHI). HIPAA is applicable only in the United States of America.

Ehrlichiosis with systemic sepsis syndrome.

Abstract: The diversity of presenting symptoms with Ehrlichia infections makes diagnosis difficult. Rash is infrequent. A febrile illness in the summer with thrombocytopenia should arouse suspicion of possible ehrlichiosis.

Hypercalcemia and pulmonary tuberculosis in east Tennessee.

Abstract: In a study of 83 patients with active pulmonary tuberculosis who were treated in East Tennessee, only three developed hypercalcemia. The incidence of hypercalcemia in East Tennessee is markedly lower than that quoted in earlier studies performed in the United States. The explanation for the infrequent occurrence of elevated serum calcium in our population is probably multifactorial, but does not appear to be related to the selection of antituberculous agents.

Fibrous dysplasia of the rib: an unusual cause of chest pain

Abstract: We present a patient with left chest and neck pain due to fibrous dysplasia of the first rib. This condition was not considered as part of the differential diagnosis of chest discomfort, since it is typically painless. We believe this is the first patient described with fibrous dysplasia of the rib with left chest pain that mimicked angina pectoris.

Plasma fibrin D-dimer in pregnancies complicated by partial placental abruption.

Abstract: OBJECTIVE To evaluate the value of the plasma fibrin D-dimer test, a sensitive indicator of coagulation abnormalities, as a method of affirmation of partial placental abruption. METHODS Fibrin D-dimer studies were obtained on 25 healthy, normotensive gravidas with late second and third trimester uterine bleeding and a clinical diagnosis of partial placental abruption. The test was repeated 24 hours later if bleeding persisted. The results were compared with D-dimer tests done on 30 healthy, term gravidas. Postpartum, all placentas were evaluated for evidence of abruption, and those suspected of abruption were sent for pathologic evaluation. RESULTS Three of 34 D-dimer tests, performed on 25 women who had 28 bleeding episodes, were mildly elevated. At delivery, 12 of the 25 placentas showed evidence of abruption, and six had pathologic findings suggesting abruption. One of the 16 D-dimer tests done on these 12 women was mildly elevated, and 2 of the 18 tests done on the other 13 women, whose placentas appeared normal, were mildly elevated. All 30 D-dimer studies in the control group were normal. The difference between the study group and the controls' results was not significant (P = 0.3). CONCLUSION We did not find the fibrin D-dimer test to be of value in substantiating the diagnosis of partial placental abruption.

Traumatic asphyxia syndrome

Abstract: Although the craniofacial changes associated with TAS are usually not life threatening, the syndrome is not benign. The mechanism of injury needed to create TAS is sufficient to warrant extreme caution in the approach to these patients. It is vital for the physician to recognize the pathophysiology of the injury pattern and to remain cognizant of the high likelihood of potentially lethal associated injuries. Aggressive and directed management of the cardiopulmonary systems coupled with prompt recognition and treatment of associated injuries is essential for optimal patient outcome. Language: en

Adult-onset focal dystonias: presentation and treatment options

Abstract: Adult-onset focal dystonias (AFD) are common disorders that are often misdiagnosed and incorrectly treated. Their presentation is readily recognized, and botulinum toxin has become the agent of choice for treating these disorders. Most of the focal dystonias include cervical dystonia, blepharospasm, oromandibular dystonia, spasmodic dysphonia, and limb dystonia, specifically writer's cramp. Their onset is either idiopathic, familial, or post-traumatic, and the pathophysiology of the focal dystonias is not currently known. Local injections of botulinum toxin into the affected area result in chemical denervation of the muscle, resulting in a weakness of the muscles that are involved in the sustained contractions. This weakness alleviates the painful contraction of the dystonia. In this paper we present a case study of the most common type of focal dystonia, cervical dystonia. The etiology in this case was post-traumatic, and significant improvement resulted after treatment with botulinum toxin type A.

Hypothermia: impact on the trauma victim.

Abstract: Secondary hypothermia may present the clinician with an extraordinary set of challenging problems. Rapid rewarming using both passive and active techniques is essential to correct the many reversible changes associated with hypothermia. Despite aggressive management, secondary hypothermia continues to exact a large toll in terms of the mortality of trauma victims.