Nonsteroidal anti-inflammatory drug induced duodenal web.

Duodenal webs represent an unusual cause of intestinal obstruction in adults. These anomalies are generally considered to be congenital in origin and usually present in infancy. However, they occasionally become symptomatic in adulthood.

Delayed presentation of splenic trauma following colonoscopy.

Splenic trauma is a rare complication of colonoscopy, and diagnosis of such an injury is often delayed and made only at laparotomy. Although computerized tomography may be helpful, a knowledge of this complication is the best tool to aid in early diagnosis. In this article, a case of splenic trauma is presented that was associated with a flexible fiberoptic colonoscopy and required an urgent splenectomy five days after the procedure.

Dieulafoy lesion as a cause of massive gastrointestinal bleeding.

The Dieulafoy lesion, also referred to as exulceratio simplex, caliber-persistent artery anomaly, or cirsoid aneurysm, is a relatively rare, yet possibly fatal cause of gastrointestinal bleeding. Recent journal articles suggest that this pathological entity is not as uncommon as once thought. Advances in endoscopic technique and esophagogastroduodenoscopy (EGD) have greatly assisted in earlier diagnosis and added options to the treatment regimen for this lesion.

The child with attention deficit hyperactivity disorder and learning disability.

The following case is presented to demonstrate the difficulties associated with treatment of Attention Deficit Hyperactivity Disorder (ADHD) when it is comorbid with a learning disability (LD). These two disorders exist simultaneously in about 30% of those diagnosed with ADHD. It is often difficult to separate the effects of one condition from those of the other.

The Objective Structured Clinical Examination (OSCE) in the clinical clerkship: an overview.

The Objective Structured Clinical Examination (OSCE) for student assessment is well established, with an extensive body of research documenting that this is a valid means to assess clinical skills that are fundamental to the practice of medicine. The OSCE consists of a circuit of stations which tests a range of skills and learning to assess undergraduate medical students. A well-constructed OSCE provides important information about candidate performance and the quality of training.

Bilateral seventh nerve palsy: a report of two cases and a review.

The onset of bilateral face weakness is uncommon. Two cases are presented, followed by a discussion of a differential diagnosis.

Alternative/complementary therapies.

The national trends and our regional experience of the utilization of complementary therapies suggest that a significant number of our patients will continue to employ remedies that are outside the mainstream of what has been defined as conventional Western medicine. The data obtained from our survey is very consistent with the national survey published in 1993. Indeed the national interest in alternative/complementary therapies seems to be growing.

State of South Dakota's child: 1996.

The trend of decreasing annual births in South Dakota continued with a decline to 10,470 live births in 1995. The state's infant mortality rate (IMR) of 9.5 per 1,000 live births for 1995 decreased from 9.

Improving rural health care in South Dakota.

This study was designed to find ways to improve the quality of health care in rural settings. The study includes three components: a telephone survey of a rural community, a patient quiz, and interviews with ten rural family practice doctors in the southeast corner of South Dakota. This study was conducted in a rural community of about 1,500 people.

Ovulation induction for infertility is it safe or not?

Case reports of ovarian tumors in women undergoing fertility treatment have raised questions about the potential neoplastic effects of ovulation-induction agents used in the treatment of infertility. This has been the subject of much debate, media coverage and patient alarm. An increased risk of malignant epithelial ovarian cancer, borderline epithelial ovarian tumors, and nonepithelial ovarian cancer have been reported in association with the use of fertility drugs.

Pine Ridge Indian Health Service Primary Care Resident Rotation: a summary.

The Pine Ridge Indian Health Service Primary Care Resident Rotation was officially established in January 1992 and operated through May 1996. Sponsored by an Indian Health Service grant, the rotation was conceived in an effort to help address the problem of recruitment and retention of physicians at Pin Ridge in the long term, while offering a unique educational experience for residents. Fifty-eight residents from 40 Family Practice, General Internal Medicine and General Pediatric Residency Programs in 18 states completed the rotation.

Clonidine: a practical guide for usage in children.

Clonidine, oral and patch, has been used in adults for the treatment of hypertension and Tourette's Syndrome. Recently clinicians have begun to employ it in several oft label usages in children, especially behavioral syndromes. This article is a guide to its usage in children and includes discussion of its indications, contraindications, pre-treatment laboratory studies, dosing and drug interactions.

Familial breast cancer risk assessment.

A family, with a strong history of dominant breast and ovarian cancer, is described. Using highly polymorphic microsatellite markers within the BRCA1 breast cancer gene on chromosome 17q21; three affected sisters, their father and a paternal second cousin once removed, are shown to share the same "abnormal" haplotype. Because of this informative linkage, the carrier status of the unaffected siblings can be established by determining whether they inherited their father's "normal" or "abnormal" haplotype.

Supernumerary nipples and accessory breast tissue.

Supernumerary nipples and supernumerary breast tissue are often dismissed as cosmetic curiosities. These structures have the potential for pathologic degeneration and may be associated with significant congenital abnormalities. In a prospective comparison of 100 Native American women to 100 non-Native American women, these accessory organs were found much more commonly in Native American women.

Improving job satisfaction of rural South Dakota mental health providers through education: a pilot study.

Many underserved rural areas of South Dakota are plagued by high turnover of mental health providers, and need to develop retention strategies through improving job satisfaction. A major source of job dissatisfaction in rural areas is professional isolation (lack of continuing education opportunities and inadequate number of peers available for professional interaction). The authors developed and implemented interdisciplinary educational programs to improve job satisfaction (and possibly job retention) of rural mental health providers (RMHPs) through reduced professional isolation.

Dr. T. F. Riggs and the Johns Hopkins connection: an early graduate medical experience in South Dakota.

Theodore F. Riggs, MD was born to missionary parents in Dakota Territory in 1874. His early education was a mixture of a mission school with Indian children and more conventional elementary schools in eastern communities.

State of South Dakota's child: 1995.

The total number of births in South Dakota declined again in 1994 to 10,504 with a .6% decrease in white babies and a 11% decrease in American Indian babies. The percent of low birth weight (LBW) newborns in South Dakota is lower than that observed nationally yet, increased in 1994 to 5.

"Video lottery" and treatment for pathological gambling. A natural experiment in South Dakota.

Four agencies which offer specialized treatment for pathological gambling provided data on the number of inquiries about gambling treatment and the actual number of gamblers treated before, during, and after the shutdown of video lottery in the state of South Dakota. A marked decrease in the number of inquiries and number of gamblers treated was seen during the time the machines were turned off as compared to the time periods when video lottery gambling was available. The results suggest that the accessibility and availability of video lottery machines is an important factor in the number of people being adversely impacted by gambling.

Pheochromocytoma associated with polycythemia: case report.

Secondary polycythemia has been noted in association with various neoplasms. An erythropoiesis stimulating factor (erythropoietin) has been demonstrated in the fluid or tissues obtained from most of these neoplasms and erythropoietin levels were found to be elevated in the serum and returned to normal after resection of these tumors. Recently, the potential of pheochromocytoma to produce a wide variety of hormones and neurotransmitters such as growth hormone, motilin, ACTH, atrial natriuretic factor (ANF) and others has been shown.

Gonadotropin control of follicle and oocyte maturation: implications for ovulation induction.

Development and maturation of follicles and oocytes during the menstrual cycle are complex processes that are poorly understood. Current gonadotropin therapy for ovulation induction/IVF may result in the production of suboptimal oocytes. As we learn more about the interdependency of follicle and oocyte in natural cycles, we should enhance our ability to produce better quality oocytes in artificial cycles.

Ethics of alternative therapies.

As people seek alternative therapies, the responsibility of the primary caretaker grows. This article addresses why people seek alternative therapies and discusses the ethics and challenges of the physician.

Augmentation cystoplasty after cesarean hysterectomy for placenta previa-percreta.

We report a case of a 38-year old woman with placenta previa-percreta and urinary bladder invasion. Resection of the bladder wall during cesarean hysterectomy was complicated by a postoperative vesico-vaginal fistula and small-capacity bladder. A reconstructive augmentation cystoplasty utilizing the ileum was successful in improving the bladder capacity.

An experience in missionary obstetrics and gynecology.

An extended visit at a small community hospital in Thailand provided an opportunity to observe and learn about rural health care in an emerging nation. Several aspects of gynecologic and obstetric care are compared.

The state of South Dakota's child: 1994.

This annual report reviews natality and infant mortality data and also reviews teenage pregnancy in South Dakota. Data for 1993 again document a declining rate of birth for South Dakota with a 3% decline in the number of births since 1990 and an 18% decline since 1980. An identical number of infants (102) died in 1993 as 1992 with neonatal mortality slightly declining and post neonatal mortality slightly increasing for the state.