Tuberculous peritonitis: a case report and literature review.

We present a case of tuberculous peritonitis in the setting of alcoholic cirrhosis with ascites. A young American Indian male with alcoholic cirrhosis and ascites presented with low grade fever and weight loss. A diagnosis of tuberculous peritonitis was made by laparoscopic guided peritoneal biopsy.

Atlantoaxial instability in Down's syndrome: a case report and review.

Down's syndrome is the most common autosomal chromosomal abnormality in humans and is associated with a number of well known clinical findings. Atlantoaxial instability is a less recognized, yet potentially significant, manifestation of Down's that has gained importance because of the widespread participation of Down's syndrome individuals in athletic events. Early recognition and appropriate management of patients with atlantoaxial instability can significantly reduce the morbidity and mortality associated with this condition and guide patients and their parents toward continued safe participation in athletics.

Pine Ridge IHS Primary Care Resident Rotation.

With the support of the Oglala Sioux Tribe and the Aberdeen Area Indian Health Service, the University of South Dakota School of Medicine initiated development of a primary care resident rotation at the Pine Ridge IHS provider site. The rotation was conceived in an effort to help address the problem of recruitment and retention of physicians at Pine Ridge in the long term, while offering a unique educational experience for residents. It is a cooperative effort of four neighboring medical schools in South Dakota, North Dakota and Nebraska.

Odontoid fracture in the elderly: a case report of the screw fixation technique.

The case of a type II, highly unstable, odontoid fracture in a 92 year old patient is reported. This fracture was treated by a new technique for anterior odontoid screw fixation with excellent results. The authors discuss this technique and treatment options for odontoid fracture in the elderly.

Human genome project.

Genome n. [gene plus chromosome] the complete set of chromosomes containing all of the genes of an organism. For man this set of 46 per cell stretches to a 6 foot strand of DNA.

Neuropsychiatric manifestations of vitamin B12 deficiency in the absence of anemia or macrocytosis: a case report.

We describe an atypical case of a young adult who had the acute onset of neuropsychiatric symptoms consistent with vitamin B12 deficiency despite a normal hematocrit, a normal MCV, a normal peripheral blood smear, a normal bone marrow biopsy, a normal Schilling test but abnormally low serum vitamin B12 levels. The patient responded quickly to parenteral vitamin B12 therapy but had mild residual symptoms at the time of his last clinic visit.

HIV associated risk factors: a survey of a troubled adolescent population.

The incidence of Acquired Immunodeficiency Syndrome (AIDS) in young adults and the typical incubation period for AIDS suggest that exposure to this disease often occurs in adolescence, a period of life during which risk taking behavior is particularly common. The population of adolescents with mental or behavioral problems and substance abuse problems at the South Dakota Human Services Center were studied by questionnaire and by human immunodeficiency virus (HIV) screening to assess the current prevalence of seropositivity and the potential for HIV transmission in these troubled youths. Sexual behavior, number of partners, prior incarceration, history of sexual abuse, drug and alcohol use, and knowledge about HIV transmission were examined.

The Yankton Model Program.

Changes in medical education towards a student-centered, problem-based learning, with continuity care experience in ambulatory settings have been recommended. The University of South Dakota School of Medicine has developed such an educational model for third year medical students named the Yankton Model Program and is herein described.

Early detection of adolescent mood disorders.

Adolescent depression remains significantly underdiagnosed despite its official recognition since 1975 and its association with high morbidity and mortality. With the exception of teachers, physicians are the professionals most likely to see depressed youngsters. This article attempts to increase the physician's awareness of adolescent depression.

Splenic abscess: two case reports.

Two cases of splenic abscess are presented. Both patients presented similarly with fever and abdominal pain. Diagnostic and treatment approaches to splenic abscess are discussed.

Lithium induced renal toxicity--a review of the literature.

Lithium therapy is widely accepted as efficacious treatment for bipolar affective disorder. However, long term usage of lithium raises concern of side effects involving multiple organ systems, particularly renal function. A review of the literature indicates no significant effects on glomerular filtration rate.

Overwhelming postsplenectomy sepsis twenty-two years after operation risks management and prevention.

A new case of fatal postsplenectomy sepsis occurring 22 years after operation for splenic rupture is described. There are now 30 published cases in which this complication occurred 10 or more years after operation. The microorganism responsible for the vast majority of cases is Streptococcus pneumoniae.

Psychiatric side effects of non-psychiatric drugs.

Many drugs prescribed for somatic diseases are capable of causing psychiatric symptoms in patients, especially in the elderly, the demented and probably in those who already suffer from a mental illness. In this study a random sample of drugs listed in the PDR was reviewed. In 65% of the drugs the manufacturer lists potential psychiatric side effects.

Coexistence of hereditary spherocytosis and beta-thalassemia: case report of severe hemolytic anemia in an American black.

The first reported case of hereditary spherocytosis (HS) and beta-thalassemia in an American black is presented. The diagnosis rested on clinical presentation, family history and specialized laboratory findings. The tendency toward hemolysis of spherocytes and thalassemia red cells may explain the severity of anemia in this patient.

Port-A-Cath: a study of complication rates.

Venous access can be a difficult problem for patients receiving intravenous medications, such as chemotherapy, over long periods of time. Totally implanted venous access devices, such as the Port-A-Cath TM (Pharmacia Deltec, St. Paul, MN) have been introduced as a solution to the problem of venous access.

Pneumatosis cystoides intestinalis: a complication of colonoscopic polypectomy.

A 68-year old female underwent removal of a 3 cm transverse colon polyp, which contained adenocarcinoma, by means of endoscopic polypectomy. She tolerated the procedure well. Unfortunately, six hours later she returned to the hospital with vague abdominal complaints.

Hyperlipoproteinemias: part IV. Drug regimens.

The bile acid sequestrants and nicotinic acid are the agents of first choice for the treatment of hypercholesterolemia. Experts disagree as to the drug of choice for hypertriglyceridemia, although both nicotinic acid and gemfibrozil are effective. For combined hyperlipoproteinemia, single drug choices include nicotinic acid, lovastatin, and gemifibrozil.

Hyperlipoproteinemias: Part III. When to treat.

The recommended treatment goals for patients with hypercholesterolemia who do not have coronary heart disease or two additional risk factors, are a total cholesterol of less than 240 mg/dL and an LDL-cholesterol of less than 160 mg/dL. For patients with coronary heart or two additional risk factors, the goals are 200 mg/dL and 130 mg/dL respectively. The step-one diet is the initial therapy for hypercholesterolemia, followed by the more rigid step-two diet if response has been inadequate.

Hyperlipoproteinemias: Part II. Screening and patient classification.

The National Cholesterol Education Program recommends measuring the total nonfasting serum cholesterol in all individuals 20 years of age or older. By definition, a desirable level is less than 200 mg/dL, borderline-high is 200-239 mg/dL, and high is greater than or equal to 240 mg/dl. Subsequent classification is based on the LDL-cholesterol level with a value of less than 130 mg/dL considered to be desirable.

Pleural effusion with rheumatoid arthritis.

Pleural effusions complicating rheumatoid arthritis occur most commonly in middle-aged men. The majority of these individuals will be symptomatic with pleuritic chest pain and/or dyspnea. Rheumatoid pleural effusions have distinct chemical characteristics including elevated LDH, low glucose and low pH.

Hyperlipoproteinemias: Part I. Lipoprotein classification and abnormalities.

The hyperlipoproteinemias are disturbances in the metabolism of lipoproteins. Elevated levels of total and low density lipoprotein-cholesterol, and low levels of high density lipoprotein-cholesterol are proven risk factors for atherosclerosis. The significance of hypertriglyceridemia as an independent risk factor for atherosclerosis is controversial, however, at high levels triglycerides are a major risk factor for pancreatitis.

Superior mesenteric artery syndrome: an approach to the diagnosis and management of upper gastrointestinal obstruction of unclear etiology.

The differential diagnosis of upper intestinal obstruction includes mechanical obstruction, obstruction secondary to systemic disease, and idiopathic intestinal pseudo-obstruction. The causes of these are extensive; however, the majority of cases involve a mechanical etiology. Superior mesenteric artery syndrome (SMAS) is a rare and controversial form of mechanical obstruction with just over 300 well-defined cases described in literature.

Unilocular hydatid cyst disease: a challenging diagnosis.

Echinococcosis, a disease uncommon in the United States, is extremely rare in South Dakota, although it is endemic in several regions of the United States and prevalent in certain areas of the world. Due to the mobile state of the world's population, recognition of this disease is important. Echinococcosis carries the potential for significant morbidity and mortality which can be minimized by appropriate surgical management.