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R M Fincher

Publications and source records attributed to R M Fincher.

At least 37 records · Page 2Linked to original sources
PubMed1993

Case report: malignant pericardial effusion as the initial manifestation of malignancy.

Although malignant pericardial effusion is a common complication of malignancy, it is rarely the initial manifestation. A case of a nonsmoking 36-year-old woman who had pericardial tamponade due to malignant pericardial effusion as the initial manifestation of malignancy is presented. Case reports of patients with malignant pericardial effusion as the initial manifestation of malignancy published since 1974 are reviewed. The clinical presentation, histology, and survival of these patients is compared with those cases published prior to 1974. Survival of patients with primary malignancy in the lung who present with malignant pericardial effusion has not improved.

Adenocarcinoma↗
PubMed1993

Relationships of interns' performances to their self-assessments of their preparedness for internship and to their academic performances in medical school.

This study addressed the questions of whether medical students' cumulative grade-point averages (GPAs) correlate with the performance assessments (overall and in specific areas of competency) that they receive as interns from their internship program directors, and whether the students' self-assessments of preparedness for internship correlate with their internship directors' overall assessments. A questionnaire to assess interns' competencies was developed and sent to the directors of the internship programs of the 283 1990 and 1991 graduates of the Medical College of Georgia School of Medicine who consented to participate in the study (82% of the graduates). Eighty percent of the program directors responded. A similar questionnaire was sent to all 342 of the 1990 and 1991 graduates; 38% provided self-assessments of their competencies and also stated their views on how well prepared they were for their internships. Considering the classes as a group, the mean ratings of the interns' overall competencies by the program directors ranged from 3.7 to 4.3 on a five-point Likert scale (1, unsatisfactory, to 5, outstanding), whereas the interns' ratings of how well they were prepared for their internships (that is, their sense of overall competency) were somewhat lower, ranging from 3.4 to 4.0. The correlations of GPAs with the specific areas of competencies ranged from .28 to .51. The correlation between the mean ratings of the program directors and the mean self-ratings of the interns was .58. The data support the conclusions that medical school academic performance relates significantly to performance in internship and that interns do not rate themselves as highly as their program directors do.

Achievement↗
PubMed1993

Cryptococcal pneumonia occurring as an infiltrative mass simulating carcinoma in an immunocompetent host: plain film, CT, and MRI findings.

Cryptococcosis, a potentially fatal pulmonary infection, rarely occurs in advanced form in immunocompetent individuals. Radiographic findings are variable and include single and multiple mass-like infiltrates, nodules, and segmental infiltrates. MRI manifestations of pulmonary cryptococcosis have not been reported previously. We have compared MRI, CT, and plain film radiographic findings in a case of multisegmental cryptococcal pneumonia occurring as a mass simulating carcinoma in an immunocompetent individual; we have also discussed the differential radiographic evaluation of pulmonary cryptococcosis.

Cryptococcosis↗
PubMed1993

Holt-Oram syndrome associated with hypoplastic peripheral vasculature and midsystolic click.

Holt-Oram syndrome is a rare, autosomal dominant syndrome characterized by upper extremity skeletal abnormalities and cardiac defects. The most common skeletal anomalies involve the thumbs and range from minor radiographic abnormalities to phocomelia. The most common cardiovascular abnormality is ostium secundum ASD, followed by ventriculo-septal defect and ostium primum ASD. MVP and hypoplastic peripheral vasculature of the upper extremities have been reported only rarely. We have reported the case of a patient with HOS who has both hypoplastic peripheral upper extremity vasculature and evidence of MVP.

Abnormalities, Multiple↗
PubMed1993

Specialty choice: development of a questionnaire.

Determination of factors which influence medical students' choice of a specialty is potentially important for decisions regarding medical school curricular changes that might influence students' specialty choice. Beginning in 1988, we developed and annually revised a specialty choice questionnaire which was administered to the senior class at the Medical College of Georgia School of Medicine from 1988 to 1991. This paper presents reliability and validity data regarding the questionnaire. Validation procedures involved driving a multiple discriminant function to determine the significance of relationships between a variable and choice of a primary care (PC) or non-primary care (NPC) specialty. Structure coefficients for the multiple discriminant functions that were statistically and practically significant were desire for longitudinal patient care opportunities and desire for monetary rewards. Estimates of internal consistency were derived using Cronbach's alpha. Cronbach's alpha coefficients for this item set were 0.71, 0.59 and 0.46 for 1988, 1989 and 1990 respectively. Test-retest coefficients for the 1991 12-item questionnaire ranged from 0.51 to 0.81.

Career Choice↗
PubMed1992

Case report: ainhum (spontaneous dactylolysis) in a 65-year-old American black man.

Ainhum is the spontaneous autoamputation of toes as a result of the formation of a constricting band. It usually affects the fifth toe bilaterally and predominantly affects blacks in tropical regions, but has been uncommonly reported in temperate regions as well, including the United States. Of the 29 cases identified in the American literature since 1960, only 6 were published in the internal medicine literature. Because of the rarity of ainhum and consequent lack of attention in the clinical literature, this condition may be relatively unknown and therefore unrecognized by practicing internists. A patient with ainhum is described and the clinical features of this rare disease are emphasized to facilitate recognition and appropriate management.

Aged↗
PubMed1992

Case report: cavernous hemangioma of the liver.

Although cavernous hemangioma is the most common benign tumor of the liver, controversy persists regarding diagnosis and management of these lesions. With the development of multiple noninvasive modalities to visualize the liver, hepatic cavernous hemangiomas are recognized with increased frequency. The authors report the unusual case of a post-menopausal woman on no exogenous estrogen therapy who had a cavernous hemangioma that remained stable for approximately 10 years before dramatically increasing in size. This patient illustrates the vague symptoms associated with cavernous hemangiomas and the unpredictability of growth. Although estrogens have been reported trophic, this patient had no exogenous or endogenous estrogen supply, yet her lesion reached massive proportions. Modalities necessary to assure accurate diagnosis and factors influential in management are discussed.

Adult↗
PubMed1992

Classification model that predicts medical students' choices of primary care or non-primary care specialties.

To identify factors that influence students to choose primary care or non-primary care specialties, the authors surveyed the 509 graduating students at the Medical College of Georgia School of Medicine in 1988, 1989, and 1990. Using a Likert-type scale, the 404 responding students rated potential influences on their specialty choices from 1, very negative, to 7, very positive. The students choosing primary care specialties were positively influenced significantly more often by their desire to keep options open (85% versus 58%, p less than .001) and their desire for longitudinal patient care opportunities (95% versus 54%, p less than .001). Those choosing non-primary care specialties were more often influenced by their desire for monetary rewards (69% versus 35%, p less than .001) and by their perceptions of lifestyle following residency (74% versus 60%, p less than .01) and prestige of the specialty (57% versus 36%, p less than .001). The authors used multiple discriminant analysis to derive a discriminant function that would permit classification of students into primary care and non-primary care groups. The potential influences of desire for longitudinal care opportunities and desire for monetary rewards were statistically and clinically significant for all three years. Using the discriminant function, the authors correctly classified 81%, 79%, and 78% of the students' specialty choices for 1988, 1989, and 1990, respectively. The authors suggest that addressing the issue of monetary rewards will be necessary before the primary care fields again become attractive to students.

Career Choice↗
PubMed1991

Musculoskeletal abnormalities in a patient with juvenile hypothyroidism.

Abnormalities in growth and development are the most striking clinical features of juvenile acquired hypothyroidism. Therefore, physicians should consider the diagnosis of hypothyroidism in any child with musculoskeletal growth dysfunction. Drs Kilpatrick and Fincher describe a case demonstrating the severe and potentially irreversible effects of prolonged, untreated hypothyroidism.

Adolescent↗
PubMed1991

Pericardial metastasis from testicular seminoma: appearance and disappearance by echocardiography.

At the time of initial diagnosis, testicular malignancy is usually limited to the testicle and infradiaphragmatic lymph nodes. Metastases initially follow the retroperitoneal lymph channels and subsequently extend to the supradiphragmatic lymph nodes in the mediastinum and supraclavicular fossa. Testicular metastases to the pericardium are rare and usually asymptomatic. These lesions are most commonly identified at autopsy; therefore, the actual incidence is unknown. The authors report a 32-year-old man with testicular carcinoma, who developed asymptomatic pericardial metastases without concomitant supradiaphragmatic nodal or pulmonary metastases. They review the efficacy of echocardiography in diagnosis and follow up or pericardial metastasis.

Adult↗
PubMed1991

Improvement in sagittal sinus thrombosis by MRI.

A 33-year-old woman developed headaches, papilledema, and evanescent neurologic signs. MRI demonstrated thrombosis of the sagittal, transverse, and sigmoid sinuses. After initial heparinization and three months of oral anticoagulation therapy, papilledema was still present but the neurologic signs and symptoms had markedly improved. Repeat MRI scan revealed improvement in all dural thromboses.

Adult↗
PubMed1991

Association between third-year medical students' abilities to organize hypotheses about patients' problems and to order appropriate diagnostic tests.

The authors studied the abilities of three groups of third-year medical students (a total of 310) at two schools to order appropriate diagnostic tests and procedures for four cases studies. Each student was classified as "organized," "mixed," or "non-organized" based on the degree of organization of the approach the student used to list hypotheses for the two cases he or she was assigned. Analysis of variance revealed that the students in the organized and mixed groups spent significantly fewer dollars for inappropriate diagnostic evaluations than did the students in the non-organized group for three of the four cases (p less than .05). Analyses of the mean expenditures for all cases revealed that the students in the organized and mixed groups spent significantly fewer dollars for inappropriate evaluations than did the students in the non-organized group (p less than .05). The medical school that was teaching its students to organize hypotheses had more students in the organized group than expected for every case. The authors conclude that the ability of students to organize hypotheses is directly related to their ability to avoid increased expenditures for inappropriate diagnostic tests and procedures, and that organized thinking about patients' problems is a skill that can be taught.

Clinical Competence↗
PubMed1991

Infection due to the fungus Acremonium (cephalosporium).

Human infections due to fungi belonging to the genus Acremonium occur uncommonly, but unlike infections due to other filamentous fungi, usually affect immunocompetent individuals. Mycetoma, which usually develops following trauma, is the most common infection caused by Acremonium spp. Other sites of infection include the eye (generally following abrogation of ocular defenses), colonizing disease of the lung and gastrointestinal tract, as well as locally invasive infections such as osteomyelitis, sinusitis, arthritis, and peritonitis. Pneumonia and disseminated infections including meningitis, endocarditis, and cerebritis rarely have been reported. Optimal treatment of acremonium infections is not well defined both because infections due to these organisms are rare, and because many reports antedate effective antifungal therapy. In addition, susceptibility testing of filamentous fungi is poorly standardized, and in vitro sensitivity may not correlate with clinical response. Based on anecdotal reports, treatment of most invasive acremonium infections requires a combination of surgical intervention, when possible, and a regimen of amphotericin B. Some azoles also display inhibitory activity. Until more details are available regarding susceptibility of these organisms to antifungal agents, amphotericin B is recommended as initial therapy with the addition of either ketoconazole or fluconazole in infections of a life-threatening nature.

Acremonium↗
PubMed1990

Citrobacter freundii: a newly reported cause of pyomyositis.

Pyomyositis has been uncommonly reported in temperature climates, but is being recognized with increasing frequency. The most common etiologic agent is Staphylococcus aureus, although other pathogens have been rarely implicated. The authors describe the first case of pyomyositis caused by Citrobacter freundii. Because of the rarity of this disease in North America, it is often initially misdiagnosed. Neuromuscular sonography, a non-invasive imaging technique, identified the muscle abscess in this patient.

Aged↗