Biomedical subjects
A J Smally
Publications and source records attributed to A J Smally.
Acute paraplegia in the absence of trauma.
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Extinguishing dangerous behaviour in hospital.
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Thrombophlebitis and pseudothrombophlebitis in the ED.
The patient presenting to the emergency department (ED) with a painful swollen lower extremity is considered to have deep venous thrombosis (DVT) until this diagnosis can be ruled out. This clinical presentation, however, is far from specific and the differential diagnosis includes symptomatic Baker's cyst, also known as pseudothrombophlebitis syndrome (PTP). This article presents two cases of PTP and reviews the literature relevant to diagnosis of DVT and PTP. Ultrasonography is now the diagnostic test of choice for both DVT and PTP, being safe, accurate, noninvasive, and rapid, and should ideally be available for use in the ED.
Primary non-Hodgkin's lymphoma of the cranial vault.
We present a case of primary B-cell, large-cell, lymphoma of the skull vault in a 50-year-old HIV-positive male, who presented with a history of unilateral headache and a swelling on the scalp. Primary non-Hodgkin's lymphoma of the skull is rare, with only ten such cases in adults previously described. We suggest that this is the second reported case in an HIV-positive individual.
Hyperkalemia and digoxin toxicity in a patient with kidney failure.
Hyperkalemia resulting from digoxin toxicity is a well-recognized phenomenon. We report a case in which hyperkalemia, bradycardia, and hypotension were unresponsive to standard therapy but appeared to respond to digoxin-specific antibodies (Fab). This case highlights the importance of a high index of suspicion for digoxin toxicity as a potential cause of refractory hyperkalemia.
Transient Campylobacter bacteremia in a healthy child.
A 7-month-old immunocompetent child was brought to the emergency department with fever and diarrhea. Blood and stool cultures grew Campylobacter species. Campylobacter bacteremia resolved without treatment.
Spontaneous temporomandibular joint dislocation in an 80-year-old man.
We report the case of an 80-year-old patient who suffered a spontaneous temporomandibular joint (TMJ) dislocation. To our knowledge, this is the oldest patient reported to have this condition in the English-language literature. Reduction of spontaneous jaw dislocation is a procedure that usually can be accomplished in the office without intravenous sedation by properly applying downward pressure on the mandible.
Seizure in a five-year-old.
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Gastrointestinal endoscopy.
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Alkaline chemical keratitis: eye injury from airbags.
Inflation of an automobile airbag is accomplished by converting sodium azide to nitrogen gas. The bags are vented so that nitrogen and residual byproducts of combustion, such as alkaline gas, are released into the passenger compartment. We report the case of a patient who incurred a chemical keratitis after the driver's-side airbag deployed. The importance of recognition and management is discussed.
Septic shock. When patients fail to respond to conventional therapy.
Patients in septic shock require rapid evaluation and prompt initiation of therapy with appropriate antibiotics and fluids. When fluids do not restore perfusion, dopamine (Dopastat, Inotropin) therapy is begun. Some patients who fail to respond to these measures will respond to a combination of low-dose dopamine and regulation of blood pressure with norepinephrine (Levophed).
A man with a rapid decline in ventilatory status.
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