Biomedical subjects
Publications and source records attributed to K B O'Dell.
A 24-year-old woman with a recent diagnosis of infectious mononucleosis presented with fever and left upper quadrant pain. Abdominal computed tomography revealed a splenic abscess that at laparotomy was found to have ruptured. This case illustrates a rare cause of splenic abscess and a rare complication of infectious mononucleosis.
We report the case of a 61-year-old man with a history of a Bilroth II procedure who presented to the emergency department after 12 hours of severe epigastric pain and one episode of coffee-ground emesis. Computed tomography and esophagogastroduodenoscopy revealed intussuscepted jejunum through a gastrojejunostomy that required emergency operative reduction. This case illustrates the rare complication of acute jejunogastric intussusception more than 20 years after a Bilroth II procedure.
A 77-year-old woman with an indwelling gastrostomy tube presented with a clinical picture of pneumonia and small bowel obstruction. During gastrostomy closure and performance of a feeding jejunostomy, inadvertent transmigration of the gastrostomy tube was found to be the etiology of the small intestinal obstruction. This case illustrates a rare complication of enteric feeding tubes.
Helicopter and fixed-wing air medical transportation provides an important role in the management of critically-ill patients. As the use of cardiac pacemakers continues to grow, knowledge of their expanding capabilities and sophistication is important. The environments of our "airborne intensive care units" are subject to many sources of electromagnetic and vibrational interference. Although pacemaker shielding mechanisms have become quite elaborate, further studies are needed to define their reliability in modern aircraft. Further, the possible effects of electromagnetic and vibrational interference upon inflight reprogramming require further study.
A 22-year-old man presented with a 12-hour history of acute epigastric pain associated with hematochezia. Emergency echocardiography and aortography were diagnostic of a bicuspid aortic valve and dissection of the thoracic aortic aneurysm. Surgical intervention included repair of the aneurysm, partial small bowel resection, and revascularizations of the superior mesenteric artery. An eventful hospital course ended in the patient's death on the eighth postoperative day. Dissecting aortic aneurysm is a rare condition in young adults. Prompt diagnosis with aggressive medical management and urgent surgical consultation affords the best outcome.
STUDY OBJECTIVES: This study was designed to establish the frequency, magnitude, and possible etiologies of the dysfunction of activity-sensing internal pacemakers during helicopter aeromedical transport. DESIGN: Two models of Medtronic Activitrax pacemakers were attached externally to healthy adult volunteers. Each volunteer then was loaded into the helicopter and subjected to a flight sequence. Pacemaker firing rates throughout this sequence were recorded. SETTING: On separate days, Aerospatiale Dauphin and Twinstar helicopters completed a total of 23 flights. TYPE OF PARTICIPANTS: Four healthy adult volunteers, two men and two women, participated. INTERVENTIONS: These included intra- and inter-flight threshold re-programming and external magnet application. RESULTS: The average preflight pacemaker rate of 65 beats per minute increased to an average in-flight rate of 105 beats per minute, which resolved to preflight rates on shutdown. This pattern was consistently extinguished with external magnet application. CONCLUSION: The effect of rotor motion and flight vibration on the rate-response of the Activitrax pacemaker is both predictable and easily preventable. Possible guidelines for the safe transport of these patients, using pacemaker reprogramming or external magnet application, are examined.
We discuss the case of a 59-year-old woman who presented to the emergency department with complaints of diplopia for five days. Physical examination disclosed an isolated complete right abducens nerve palsy. Angiography revealed a giant aneurysm from the postcavernous portion of the right internal carotid artery. This case illustrates an unusual etiology of a unilateral abducens nerve palsy.
We present two cases of intussusception in the adult. Both cases were secondary to a benign lipoma as the lead point. These cases represent typical cases of adult intussusception, a rare disease characterized by insidious onset, vague abdominal symptoms, and elusive diagnosis. A diagnostic and therapeutic approach to adult intussusception is suggested. The need to consider this rare entity in the differential diagnosis of chronic abdominal complaints in the adult is emphasized.