Biomedical subjects
Publications and source records attributed to J D Haines.
Psoas abscess is most often caused by infection with Staphylococcus aureus. Classic symptoms are localized pain, persistent fever, and a limp or flexion problem of the hip. Diagnosis can be confirmed by ultrasound or computed tomographic scan. Appropriate treatment consists of drainage of the abscess and antibiotic therapy.
Despite an occasional temporal relationship between abdominal pain and menstruation, the clinical features of endometriosis are often nonspecific. Diagnostic tests are usually unrewarding, and diagnosis is most often made at surgery. Endometriosis is a progressive disease, and recurrence is common despite therapy. In the case described, a woman with symptoms mimicking acute appendicitis was found at exploratory laparotomy to have ileal endometriosis. Her symptoms coincided with menses.
Numerous causes of pneumothorax, pneumomediastinum, and pneumopericardium have been described in the literature. The authors report a unique case in which one or more causes may have contributed to the patient's condition.
The left ventricular-aortic conduit provides one solution to the problem of a congenital obstruction of the left ventricular outflow tract, which may result from a wide variety of conditions. The creation of a double-outlet left ventricle successfully relieves left ventricular hypertension and its sequelae. This case demonstrates one long-term complication of the left ventricular-aortic conduit--stenosis at the point of origin of the graft in the left ventricle due to endothelial proliferation, which necessitated replacement of the graft.
Broncholithiasis, a disease that is probably much more common than has been reported, is most often associated with pulmonary infections, for example, tuberculosis and histoplasmosis. Stones originate from calcified peribronchial lymph nodes that erode into the tracheobronchial tree, but lithoptysis occurs infrequently. The most common symptoms are persistent cough and hemoptysis, sometimes followed by findings of obstructive pneumonia (fever, chills, and purulent sputum). Physical findings are nonspecific, and radiologic findings are varied. Complications include formation of a fistula between the respiratory tract and the esophagus or aorta and obstructive pulmonary symptoms. Treatment ranges from conservative management (simple observation) to thoracotomy for patients in whom complications from stone erosion develop. The prognosis of patients with broncholithiasis is generally excellent.
Two cases of subclavian steal syndrome are reported. Symptoms included light-headedness or syncope, reflecting vertebrobasilar insufficiency, and in one case, numbness and tingling in the left upper extremity, reflecting ischemia. Many persons with this syndrome are asymptomatic. Key findings include unilaterally decreased pulses and a significant difference in blood pressure between the upper extremities. Arch aortography, the "gold standard" of diagnosis, must be performed before surgical intervention.
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Renal involvement in legionnaires' disease is a well-known, yet incompletely understood, complication. Manifestations of renal involvement include proteinuria, hematuria, pyuria, cylindruria, and azotemia. Previous cases of legionnaires' disease with renal involvement have shown pathophysiologic changes consistent with acute tubulointerstitial nephritis or acute tubular necrosis. A toxic metabolite produced by Legionella pneumophila has been theorized to produce a vasoconstrictive effect on the renal microvasculature, leading to ischemia and renal dysfunction. The case reported here is unique in that the patient presented with interstitial nephritis in the absence of pulmonary signs or symptoms.
Numerous factors must be taken into account in deciding when to allow an athlete to return to sports activities after having infectious mononucleosis. Factors such as length of illness, splenic size, and proper use of diagnostic testing have considerable bearing on this important decision. Splenic rupture is a potentially life-threatening complication of infectious mononucleosis, so extreme exercise and alcohol consumption should be avoided for a month after this infection.
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A 4-year-old boy experienced sudden fever, followed by a rash on the trunk and extremities and erythema of the pharynx. Five days later, the fever remained and erythema appeared on the oropharynx, tongue, and lips. The skin of the palms and soles became erythematous and indurated, and both conjunctivae became injected. Desquamation of the skin occurred on both thumbs and one finger, and an anterior cervical lymph node was found to be enlarged. The patient was diagnosed as having Kawasaki disease, and treatment with aspirin was started. The desquamation progressed to involve the entire surface of the palms and soles, and then symptoms resolved. Twenty years after recognition of Kawasaki disease, this enigmatic illness continues to defy attempts to understand its etiology and pathogenesis. Most experts agree that the cause is either an environmental toxin or an infectious agent, but other possible causative agents may need to be proposed and investigated.
A 64-year-old man with progressive swelling and erythema of his right calf preceded by dull aching in the right popliteal fossa was presumed to have deep vein thrombophlebitis. A venogram revealed normal circulation in the right lower leg, and an ultrasound examination of the right popliteal fossa revealed a 2 X 5-cm popliteal cyst. Fluid aspirated from the cyst confirmed the diagnosis of gout. Popliteal cysts associated with gout are rare, and those that rupture, leak, dissect, or enlarge can mimic thrombophlebitis (a phenomenon known as pseudothrombophlebitis). Thus, the primary care physician should consider the diagnosis of popliteal cyst in patients who appear to have deep vein thrombophlebitis.
Methanol poisoning is a relatively rare but extremely hazardous form of intoxication that can result in blindness or death. Most cases of poisoning occur by gastrointestinal absorption, but methanol (methyl alcohol) can also be absorbed into the body by respiratory and dermal routes. Methanol is produced from the destructive distillation of wood and is a common component of paints, varnishes, antifreeze solutions, and various solvents. A physician's awareness of the early symptoms, toxicology, and treatment of this condition and of settings in which poisoning often occurs can avert a disastrous outcome.
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A 46-year-old man experienced weakness, lassitude, and vague, aching abdominal pain in the right upper quadrant. Physical examination was notable for hepatomegaly and slight hyperpigmentation of the hands. Elevated levels were revealed on liver function tests, and massive iron deposition was shown on liver biopsy. The patient was started on a therapeutic regimen of 400-ml phlebotomies. Hereditary hemochromatosis is an iron-storage disease in which total body iron stores can reach incredibly high levels, leading to damage of the liver, heart, pancreas, and pituitary gland. The most specific screening test is measurement of the serum concentration of ferritin, and a transferrin saturation determination is also helpful in diagnosis. Phlebotomy is still the treatment of choice, although new ways of administering chelating agents are being investigated.