Biomedical subjects
Publications and source records attributed to H M Adelman.
A 75-year-old man with seronegative rheumatoid arthritis presented with a three-day history of low-grade fever, new arthralgias, mouth sores, and bilateral cutaneous hand lesions. He had not had hand trauma.
Explore the source record for details and available documents.
A 53-year-old woman presented with a productive cough, fever, chills, and night sweats of one month's duration. She reported having had lightly blood-streaked sputum initially but then experiencing massive hemoptysis (> 200 mL/2 hr). Since the onset of symptoms, she had had malaise, body aches, and a 27-lb weight loss. For the last two weeks, she had also had increasing shortness of breath and pleuritic chest pain.
Explore the source record for details and available documents.
A 39-year-old woman presented with progressively severe, sharp abdominal pain of three days' duration. The pain originated in the right lower quadrant of the abdomen and radiated to the back and suprapubic area. It worsened on ambulation and was associated with nausea and loose stools.
Explore the source record for details and available documents.
A 48-year-old man presented to the emergency department complaining of fever, chills, myalgias, and diffuse abdominal discomfort of four days' duration. A nonpruritic rash had developed on his left palm, arms, legs, and buttocks on the fourth day. He had not had respiratory symptoms, nausea, vomiting, or diarrhea.
Explore the source record for details and available documents.
A 61-year-old former postal worker presented with progressive pain in his lower back, weakness in his right leg, and numbness in his left foot. In recent weeks, he had dragged his right leg in order to walk. He had also had intermittent diarrhea and dysuria but no hematuria or weight loss.
Explore the source record for details and available documents.
A 52-year-old woman was admitted to the hospital with a rash, periorbital edema, dysphagia, and muscle weakness. The rash had appeared on the back of her neck nine months earlier, and because she had recently returned from a wildlife preserve on Assateague Island, Maryland, she assumed that it was due to tick bites. Over the next two months, the rash spread to her forehead, back, chest, and upper extremities, and scaly lesions appeared over metacar-pophalangeal joints. Initial laboratory tests indicated that her creatine kinase level was elevated. She was given prednisone and the level decreased. The rash also improved, but in the next two months the muscle weakness worsened. She became feverish and increasingly fatigued, depressed, and irritable. These later symptoms were attributed to the medication, but when she was weaned from it, her rash, weakness, and dysphagia increased. Over the ensuing months, she was given intramuscular injections of methotrexate (up to 25 mg/wk), followed by oral doses of hydroxychloroquine and azathioprine, but the symptoms persisted.
Explore the source record for details and available documents.
There is a need to monitor anticoagulation accurately, inexpensively, and rapidly. The accuracy and precision of a simple fingerstick method was studied in a large outpatient anticoagulation clinic using the Coumatrak method. The Coumatrak apparatus has been studied in the home setting, and three recent reports suggest that it is practical, accurate, and possibly superior to the standard method. These results differ from recently published studies. This technique was found to be less than acceptable in precision and accuracy. This method requires further study before it can be recommended for wide-spread use in making decisions for patient care.
D-penicillamine, a drug used to treat rheumatoid arthritis, Wilson's disease, and cystinuria, can cause myasthenia gravis. Fortunately, the myasthenia typically resolves after discontinuation of the drug. The diagnosis may be missed if weakness is blamed on a patient's underlying disease(s), in particular, rheumatoid arthritis. Reported here are the cases of two patients with chronic obstructive lung disease who were taking D-penicillamine for rheumatoid arthritis, then experienced increasing respiratory failure. At first, their problem seemed to stem from chronic lung disease, but further evaluation revealed the cause of the hypoventilation to be D-penicillamine-induced myasthenia gravis.
As residency programs adapt to the need to promote primary care, the importance of quantitating qualitative issues increases. In this study, a questionnaire based on reported residency stressors was answered by 238 internal medicine residents. The Profile of Mood States (POMS) was also completed by 64. Factor analysis derived three scales reflecting emotional distress and satisfaction with the workload and learning environment. Emotional distress correlated positively with POMS scores indicating depression and dejection and was inversely related to workload. Workload satisfaction was significantly higher in programs with fewer admissions and lower in programs with greater patient loads. Responses did not differ by postgraduate year of training. Residents in different programs showed significant differences in emotional distress and workload but not learning environment. Residents in university programs indicated more stress and less satisfaction with workload than those in community programs. This study supports the validity of the three scales and provides insights into elements of the educational process that are difficult to quantitate.
Cutaneous vasculitis, secondary to drug reaction, infection or collagen vascular disease, is the most common identifiable cause of palpable purpura. Common causes of palpable purpura often can be identified during the patient's history and physical examination. When this condition occurs in a patient who has not had a known precipitating event, or when the cause is unclear from the history and physical examination, diagnosis may be based on findings of the laboratory investigations and skin biopsy. Many cases of palpable purpura are idiopathic and self-limited. When treatment is necessary, dapsone, colchicine or systemic corticosteroids are useful drugs.
Castleman disease, or angiofollicular lymph node hyperplasia, and POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes), are associated and can lead to a clinical conundrum. The physician caring for a patient with Castleman disease should be alert to the development of multiple endocrine deficiencies, including primary hypogonadism, diabetes mellitus, hypothyroidism, and adrenal insufficiency. Avoidance of treating hypothyroidism alone when there is concomitant subclinical adrenal insufficiency is important, to avoid precipitating an adrenal crisis. A better outcome may result from earlier recognition of the endocrinopathies of this syndrome. This article describes a patient with Castleman disease in whom the features of POEMS unfolded over the ensuing years.
Rheumatoid arthritis is a multi-system disease. Pulmonary manifestations and complications include pleural disease, pulmonary infections, pneumonitis and interstitial pulmonary fibrosis, bronchogenic carcinoma, arteritis with pulmonary hypertension, obliterative bronchiolitis, bronchiectasis, and amyloidosis. Pulmonary rheumatoid nodules, including rheumatoid pneumoconiosis (Caplan's Syndrome), can result in spontaneous pneumothorax. In this article, the authors present a patient with rheumatoid arthritis and recurrent spontaneous pneumothorax. Through investigation, a bronchopleural fistula caused by a rheumatoid nodule was revealed. The authors also discuss the potential pitfalls caused by a lung nodule in a patient with rheumatoid arthritis, including the overlap with bronchogenic carcinoma and confusion with tuberculosis.