1/8. Lessons from the other side of the knife.The overall success or failure of knee arthroplasty is predicated on the successful combination of patient selection, meticulous surgical technique, and prosthetic design. Discussions regarding the outcome of knee arthroplasty frequently focus on the implants used and the surgical technique employed, with a less frequent focus on patient profile. However, the patient experience was further highlighted to me when I became the patient and experienced the consequences of knee arthroplasty firsthand. This experience offered me a greater insight into patient expectations, the importance of preoperative counseling, the severity of perioperative pain, and the issues involved in the rehabilitative period. Joint arthroplasty outcomes are dependent on the harmony existing between the patient's perioperative status, expectation level, motivational status, physician diagnostic and surgical skill, and the design characteristics of the prosthesis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Treatable complications of cancer patients referred to an in-patient hospice.This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as "imminently dying" by the referring physicians. The paper concludes that it would be beneficial for patients to receive examinations and a trial of medical treatment in their continuing treatment settings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Fulminant clostridium difficile colitis in a patient with spinal cord injury: case report.BACKGROUND: In certain patients with clostridium difficile colitis (CDC), a life-threatening systemic toxicity may develop despite appropriate and timely medical therapy. DESIGN: literature search and case report. FINDINGS: A 39-year-old man with T10 paraplegia presented with a distended, quiet abdomen following recent treatment with antibiotics for pneumonia. diarrhea was not present. Complete blood counts demonstrated a marked leukocytosis. A CT scan of the abdomen demonstrated a state of diffuse pancolonic inflammation with peritoneal fluid. The patient was taken to the operating room and underwent total abdominal colectomy with oversewing of the rectal stump and end ileostomy for treatment of the fulminant CDC. CONCLUSION: patients with spinal cord injury (SCI) often receive antibiotics for infections of the aerodigestive tree and urinary tract and for problems with skin integrity. A heightened awareness of the development of fulminant CDC remains essential in the care of patients with SCI. Any unexplained abdominal illness after recent antibiotic administration should alert the physician to CDC and its potential as a fulminant, potentially fatal illness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. life-threatening complications of empiric ceftriaxone therapy for 'seronegative lyme disease'.lyme disease, now the most common tick-borne illness in the united states, has recently received much media attention, due in part to its potentially serious sequelae in untreated patients. Because a rare patient with late illness may lack antibodies to the etiologic agent, borrelia burgdorferi, physicians may be tempted to give empiric antibiotics for illnesses that may not be lyme disease. We have described a patient who, despite negative laboratory evidence for late lyme disease, was treated for 3 weeks with intravenous ceftriaxone and sustained serious complications, including granulocytopenia, fever, hepatitis, and clostridium difficile-associated diarrhea. We caution physicians to weight carefully the risks of empiric treatment for ill-defined medical problems, and to recognize the hazards of even "safe" medications.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/8. Antineoplastic-associated colitis in Chulalongkorn University Hospital.clostridium difficile is well known for causing pseudomembranous colitis. Most cases are associated with the use of antimicrobial agents. Non-antibiotic associated colitis has rarely been reported. The causes of colitis are related to dietary changes, anesthesia, uremia, and various non-antibiotics medications, especially antineoplastic agents. Most responsible antineoplastics in previous reports are methotrexate and 5FU. From July 1993 to August 1994, 34 cancer patients developed acute diarrhea after chemotherapy. Six cases hd chemotherapy-associated colitis. All patients presented with moderate to severe diarrhea and demonstrable C.difficile toxin in fecal specimens and did not receive any antibiotics before the onset of diarrhea. Premier enzyme immunoassay (EIA) was used for toxin A assay because it is easy to perform and needs no special tissue culture laboratory facility. Data from multicenters studies have shown good sensitivity and specificity of the test. We found documented antineoplastics associated colitis, 7 episodes from 35 episodes of diarrhea (20.0%) that had been tested with EIA for toxin A. Five of 6 episodes were 5FU related. One patient had 2 episodes of antineoplastic associated colitis with the same chemotherapy regimen. The underlying malignancies were GI malignancies in 3 of 6 patients. In conclusion, moderate to severe diarrhea in cancer patients after chemotherapy should alert the physician to be aware of a potential fatal complication caused by C.difficile infection. True incidence has been undoubtedly masked by concomitant antimicrobial treatment and physician unawareness. Early recognition, discontinuation of chemotherapy and prompt treatment should be done to reduce morbidity and mortality of this disease.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/8. Unexpected death from enterocolitis after surgery for Hirschsprung's disease.Unanticipated death from enterocolitis occurred in five children 3 weeks to 20 months after uncomplicated reconstruction for Hirschsprung's disease. In each case the presenting symptoms of enterocolitis were mild and were misinterpreted by examining physicians. Within 2 to 12 days of onset of symptoms, unexpected death occurred. Although fatal enterocolitis is a well-known complication of Hirschsprung's disease, emphasis is usually placed on preoperative enterocolitis. Fatal postoperative enterocolitis is not a new entity associated with Hirschsprung's disease, but physician awareness of this possibility is obviously deficient. We strongly recommend extensive parent education and better postoperative communication between the surgeon and the referring physician.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
7/8. Another false alarm? apnea monitor activation in a Neonatal Intensive Care Unit graduate.Neonatal emergencies have become more common as increasingly sophisticated Neonatal intensive care units graduate lower birth-weight babies born at younger gestational ages. These patients present a number of challenges to emergency physicians. They are often discharged with apnea monitors, which generate a high number of false alarms. Neonatal Intensive Care Unit graduates, however, are predisposed to a number of conditions that can result in true episodes of apnea. We present such a case and will discuss the unusual underlying cause of apnea, the utility of apnea monitors, and the need for emergency physicians to be prepared to evaluate and treat these potentially complicated patients.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/8. clostridium difficile colitis associated with treatment of helicobacter pylori infection.helicobacter pylori infection of the stomach is being detected and treated more often now than ever before. This is likely to result in an increase in complications such as antibiotic-associated diarrhea. However, there is no literature on the incidence of such diarrhea, particularly clostridium difficile colitis, in patients treated for helicobacter pylori infection. We report the case of a patient who developed clostridium difficile colitis after treatment for helicobacter pylori infection with metronidazole, amoxicillin, H2 blockers, and bismuth subsalicylate. This patient presented with severe diarrhea that responded to a course of metronidazole with rapid disappearance of symptoms. The incidence of clostridium difficile colitis in patients treated for helicobacter pylori infection has not been studied. This unique association, although not unexpected, has not yet been reported in the literature. The increasing number of patients being diagnosed and treated for this infection requires a heightened awareness on the part of physicians, to assure early diagnosis and treatment of this treatable, yet potentially dangerous, complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |