1/5. patients with delusional and bizarre thinking.patients with delusional or other types of bizarre thinking are often incorrectly labeled as schizophrenic. This error has significant medical and social implications to the patient. Delusional thinking has been linked with a variety of nonschizophrenic problems including the use of licit and illicit drugs, a wide variety of medical diseases, and nonschizophrenic psychiatric disturbances. A series of case studies in which the diagnosis of schizophrenia was incorrectly made elucidates the problem and helps the physician consider the alternatives.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Norplant: systemic immunological complications--case report.The Norplant* system is composed of a set of six Silastic* (silicone polydimethysiloxane) capsules measuring 34 mm by 2.4 mm, each containing 36 mg of levonorgestrel and sealed at either end with a medical grade silicone elastomer adhesive. levonorgestrel is a synthetic progestin, widely used in combination oral contraceptives and in single-agent "mini-pills". In a procedure completed in less than 15 minutes by an experienced physician, the six capsules are surgically implanted subdermally, most commonly on the inside of the left upper arm. The levonorgestrel diffuses through the Silastic material into the blood stream and is carried to the target organs. ovulation is suppressed in the majority of the cycles during the first years of use, and cervical mucus is thickened, inhibiting sperm penetration. During use, the effective delivery of levonorgestrel is about 30 mcg/day from day 500 to day 2300. Recently, we have seen patients with complications from Norplant, and we describe here a patient who presented with systemic complications resulting from both the endocrinological aspects of Norplant and the immunological aspects of the Silastic implants. To our knowledge this is the first case report in the western medical literature describing systemic immunological complications as a result of a failed Norplant device.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. life-threatening conditions associated with male infertility.Most urologists' clinical experience is that infertility is a rare presenting sign of life-threatening medical disorders in men. Considering the current practice of infertile couples presenting to the gynecologist for initial evaluation and the popularity of assisted reproductive technology, many men are evaluated with a semen analysis alone and treatment instituted without urologic consultation. This may cause a delay in the diagnosis of a significant medical illness or misdiagnosis of a potentially treatable cause of male factor infertility. We reviewed the records of 1236 new male infertility patients presenting to Bowman Gray School of medicine and Baylor Medical College in an attempt to determine the frequency of significant medical disease in men presenting with infertility and whether any pattern of semen analysis findings was predictive of these disorders. Thirteen men, or 1.1% of the total population, were found to have a significant medical illness upon full urologic evaluation (Table 5). Testicular tumors were found in six, spinal cord tumor in one, brain tumors in three, genitourinary malformation in two, and a chromosomal abnormality in one. Interestingly, one of these patients was a physician with bilateral testicular cancer who had an abnormal semen analysis and had undergone multiple cycles of intrauterine insemination before referral. We could not identify a pathognomonic pattern on semen analysis that would allow us to predict the presence of medical illnesses in these 13 patients. Sperm counts ranged from azoospermic to almost normal semen parameters.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Assessment of neuroendocrine dysfunction following traumatic brain injury.Posttraumatic neuroendocrine pathology may be a clinically significant complication following traumatic brain injury (TBI). Metabolic abnormalities are described after TBI in two cases. A 21 year old male injured in a motor vehicle accident admitted in a minimally responsive condition presented with fluctuating high sodium levels, undetectable serum testosterone, and depressed cortisol and thyroid function. Imaging revealed near complete avulsion of the pituitary stalk leading to panhypopituitarism. A 38 year old male admitted for occipital skull fractures and brain contusions presented with hyponatremia and low serum testosterone. Both patients required hormonal replacement and correction of electrolyte abnormalities. A screening protocol adapted for selected patients at risk for endocrine problems is described. While neuroendocrine screening is not advocated in all TBI patients, physicians should be aware of the importance of neuroendocrine dysfunction following TBI.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Marital sexual dysfunction: erectile dysfunction.All clinicians are occasionally consulted by men complaining of impotence. The history is the most important step in the differential diagnostic process for this symptom. Answers to four basic questions enable the physician to recognize classic psychologic and organic patterns. In addition, these questions provide clues as to the cause of the dysfunction. Physical and laboratory examinations are usually required to identify the specific organic cause. Traditional prevalence figures for impotence may no longer be valid. This topic awaits epidemiologic data that reflect current diagnostic sophistication. Individual treatment approaches to both organic and psychologic impotence must counteract the adverse influence of performance anxiety.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |