6,699 results match your criteria Connecticut medicine[Journal]


Ham Sandwiches and Medical Malpractice: Time for a Change.

Authors:
Michael M Deren

Conn Med 2017 May;81(5):309-311

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May 2017
4 Reads

Bisphosphonates and the Role of Calcium Plus Vitamin D in Osteoporosis.

Conn Med 2017 May;81(5):299-305

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May 2017
3 Reads

Screening and Treatment Rates for Latent Tuberculosis Among Newly-Arrived Refugees in an Urban Facility in Connecticut.

Conn Med 2017 May;81(5):291-298

There is a high prevalence of latent tuberculosis infection (LTBI) and risk of reactivation among refugees. This study describes LTBI prevalence, treatment initiation, and completion rates in refugee patients seen at one urban Connecticut hospital. This retrospective chart review includes 248 adult refugee patients screened between January 2009 and April 2012. Read More

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May 2017
5 Reads

Refractory Psoriatic Arthritis and Polyarteritis Nodosa: Co-occurrence in a Patient with Undiagnosed HIV.

Conn Med 2017 May;81(5):285-289

Human immunodeficiency virus (HIV) infection can result in several autoimmune illnesses, including psoriasis, psoriatic arthritis (PsA), and polyarteritis nodosa (PAN). We describe a patient who presented with PsA refractory to both synthetic and biologic disease-modifying antirheumatic drugs (DMARDs), who then developed PAN while on antitumor necrosis factor (TNF) therapy. The onset ofvasculitic disease led to the discovery of the HIV infection, and manifestations of both PsA and PAN remitted with the introduction of highly active antiretroviral therapy. Read More

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May 2017
5 Reads

Intravascular Lymphoma: A Diagnostic Challenge.

Conn Med 2017 May;81(5):281-284

Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma that selectively affects small and medium-sized bloodvessels in the absence oflymph-adenopathy. The central nervous system (CNS) and skin are the organs most commonly affected. We describe the case of a 64-year-old male who presented to the emergency department (ED) complaining of asthenia and bilateral lower extremity edema that progressed rapidly to anasarca. Read More

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May 2017
4 Reads

Changes in Hospital Utilization Among Seriously Mentally Ill Patients Following Enrollment in an Integrated Primary and Behavioral Health Care Program.

Conn Med 2017 May;81(5):271-279

Objectives: Integrated primary and behavioral health care models are emerging to improve access to care; however, the effect they have on utilization and expenditure has yet to be studied.

Methods: A retrospective, longitudinal review of all patients (N = 343; 97% Medicaid) enrolled in our primary and behavioral health care program looked at hospital utilization up to a year before and after enrollment and estimated spending from Medicaid reimbursement data.

Results: There was a significant decrease in emergency department (ED) visits per person before enrollment vs after enrollment (2. Read More

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May 2017
2 Reads

The Unsustainable Cost of Medicaid: Insights from a Hospital-Based Academic Dermatology Practice.

Conn Med 2017 May;81(5):267-269

Objective: To investigate the lost revenue associated with Medicaid patients in a university-based dermatology practice over a one-year period compared to non-Medicaid patients. Specifically, the goal was to investigate the change in revenue if Medicaid visits were associated with a range of copayments.

Results: The total billed across all encounters for the 2014 -2015 fiscal year was $31017159, of which $3715393 (13. Read More

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May 2017
2 Reads

When Things Go Wrong: Examining the Frequency and Aftermath of Critical Incidents Among OBGYN Residents.

Conn Med 2017 May;81(5):261-266

Objective: To examine the frequency with which obstetrics and gynecology (OBGYN) residents experience critical incidents (CIs) during residency and participate in postincident debriefing.

Methods: A survey was conducted to examine the frequency of CIs during training, abilities of residents to cope with CIs, and the impact of postincident debriefing.

Results: Among the 27 residents who responded (93. Read More

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May 2017
7 Reads

Bilateral Giant Cell Arteritis Presenting as Bilateral Sudden Vision Loss.

Conn Med 2017 Apr;81(4):235-236

Giant cell arteritis (GCA) is the most common form of primary vasculitis and it mainly involves large to medium sized vessels. It is also referred to as temporal arteritis as it primarily affects the temporal artery. Ocular involvement frequently occurs in GCA; if not promptly diagnosed, it can cause devastating ocular complications including complete vision loss and permanent blindness. Read More

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April 2017
4 Reads

Pseudo-Atrial Flutter Secondary to a Chest Wall Percussion Device.

Conn Med 2017 Apr;81(4):231-233

Pseudo-atrial flutter is an EKG artifact that mimics a true atrial flutter. We report a case of pseudo-atrial flutter in a 67-year-old male with quadriplegia and ventilator dependence due to amyotrophic lateral sclerosis (ALS) who was hospitalized for respite care. Ihe pseudo-atrial flutterwas found to be due to percussions from a built-in chest wall percussion device in a hospital mattress used for chest physiotherapy. Read More

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April 2017
3 Reads

Tragus Piercing Presenting as a Novel Risk Factor with Magnetic Resonance Imaging.

Conn Med 2017 Apr;81(4):227-229

Although magnetic resonance imaging (MRI) excels in a number of medical imaging utilities, one of its particular attraction is the lack of ionizing radiation. However, MRI scans are associated with their own unique safety concerns. We encountered two cases of lost tragus piercings presenting as a novel risk factor in MRI safety. Read More

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April 2017
7 Reads

Durable Complete Response of Primary CNS Lymphoma in an 80-Year-Old Patient with Retroviral Infection.

Conn Med 2017 Apr;81(4):223-226

People aging with human immunodeficiencyvirus (HIV) present a unique set of challenges for their providers. Cardiovascular, metabolic, neurodegenerative, and renal disorders, and certain cancers are more common in this cohort, which is attributed to elevated rates of inflammation. Although survival remains compromised, integration of efficacious antiretrovirals and high-dose methotrexate (HD-MTX) was shown to improve clinical results in HIV-infected patients with primary central nervous system lymphoma (PCNSL). Read More

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April 2017
4 Reads

Injuries Associated with Subdural Hematoma: A Study of the National Trauma Data Bank.

Conn Med 2017 Apr;81(4):215-222

Of 92030 patients with subdural hematoma (SDH) in the National Trauma Data Bank (NTDB), 55729 had fall mechanisms of injury (61%), while 36301 had other traumatic mechanisms (nonfall, 39%). For nonfall mechanisms, the three associated injuries with the highest incidence were: skull fractures (43.3%), rib/sternum injuries (25. Read More

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April 2017
11 Reads

Peripheral Tibial Nerve Stimulation for Overactive Bladder Syndrome: Treatment Success and Patient Satisfaction.

Conn Med 2017 Apr;81(4):209-213

Objective: To evaluate the success rate and patient satisfaction ofperipheral tibial nerve stimulation (PTNS) therapy.

Method: Retrospective cohort study assessing PTNS treatment success and patient satisfaction.

Results: Data from 34 women were included. Read More

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April 2017
3 Reads

Pectus Carinatum: Factors That Contribute to Success and Failure of Nonoperative Treatment.

Conn Med 2017 Apr;81(4):203-208

Background: Pectus carinatum is a congenital chest wall deformity characterized by protrusion ofthe sternum and ribs. External bracing has been the gold standard treatment for this condition for the past 20 years.

Purpose: The primary purpose of the study was to identify factors that contribute to treatment success of bracing for patients with pectus carinatum. Read More

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April 2017
4 Reads

Effect of an Educational Intervention on the Accuracy of Data Submitted to a National Quality Registry.

Conn Med 2017 Apr;81(4):197-202

Background: We hypothesize that data-entry errors within the National Cardiovascular Data Registry® (NCDR) ICD Registry™ may be an important reason behind labeling many cases as nonevidence-based.

Objective: To describethe frequency of data-entry errors in implantable cardioverter-defibrillator (lCD) implant data from our institution and develop a plan for quality improvement using the Deming cycle.

Methods And Results: We assessed data of patient report forms from2007to 2010 and compared these data with forms submitted from 2011 to 2012 after implementation of a continuous multicomponent staff education and training program. Read More

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April 2017
3 Reads

Overview of Various Birth Control Options.

Conn Med 2017 Mar;81(3):173-179

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March 2017
3 Reads

Hemodilution Then Hemoconcentration after Resuscitation of Patients with Severe Sepsis or Septic Shock.

Conn Med 2017 Mar;81(3):169-171

Background: The impact of fluid ri suscitation on hematologic parameters and function has been well studied in hemorrhagic shock. Similar research has not been conducted in resuscitation of septic shock.

Hypothesis: In the absence of accompanying hemorrhage, resuscitation of patients with sepsis should be marked by hemodilution, followed by hemoconcentration during recovery. Read More

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March 2017
5 Reads

Recurrent Vulvar Carcinoma in a Skin Graft: A Case Reiort and Review of the Literature.

Conn Med 2017 Mar;81(3):165-167

In recentyears, theincidence ofvul- var carcinoma has increased over 400%, specifically in the population of young women. We present a patient with an extensive history of recurrent vulvar carcinoma in situ who underwent multiple surgi- cal procedures and subsequent reconstruction with a skin graft, who then returned with a rare recur- rence in the graft. Multiple hypotheses have been proposedto explain the recurrence ofthis type ofcar- cinoma; however, none provides a solid explanation. Read More

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March 2017
3 Reads

First, Do No Legislative Harm.

Authors:
Matthew C Katz

Conn Med 2017 Mar;81(3):187-189

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March 2017
2 Reads

Remembering the Basics.

Authors:
Jeffrey A Gordon

Conn Med 2017 Mar;81(3):185-186

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March 2017
2 Reads

The Quality-Industrial Complex: Paying the Piper.

Authors:
Michael M Deren

Conn Med 2017 Mar;81(3):181-183

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March 2017
2 Reads

High Titer of Circulating Antiglutamic Acid Decarboxylase Antibodies in a Patient with Cerebellar Ataxia and Type 1 Diabetes.

Conn Med 2017 Mar;81(3):161-164

A 24-year-old female who was recently diagnosed with Type 1 diabetes mellitus (TiD) presented with a five-year history of visible gait disturbance and slurred speech. Her neurologic examination was remarkable for dysarthria, bilateral nystagmus, dysdiadochokinesia, finger-nose incoordination, heel-knee incoordination, and ataxic gait. A brain MRI disclosed diffuse cerebellar atrophy. Read More

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March 2017
3 Reads

Paraneoplastic Erythema Nodosum as a Prelude to Hodgkin Lymphoma.

Conn Med 2017 Mar;81(3):157-160

Erythema nodosum is currently thought to represent a delayed hypersensitivity reac- tion to deposition of circulating immune complexes, followed by neutrophilic infiltration of the septa in the subcutaneous tissue. We describe a patient with advanced Hodgkin lymphoma with B symptoms, preceded by erythema nodosum of the left shin by 12 weeks. This dermatologic entity cleared after the treatment for Hodgkin lymphoma, suggesting a true paraneoplastic reaction. Read More

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March 2017
3 Reads

Widespread Systemic and Peripheral Embolization of Left Atrial Myxoma Following Blunt Chest Trauma.

Conn Med 2017 Mar;81(3):153-156

Cardiacmyxomas arethemostcom- mon benign primary cardiac neoplasms, typically arising from the interatrial septum at the border of the fossa ovalis.'Ihey are generally divided into two anatomic types - ovoid and papillary myxomas -the latter ofwhich are less common but more frequently associated with embolic events. Despite their high embolic potential, however, widespread systemic and peripheral embolization, particularly to the lower extremities, is still uncommon. Read More

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March 2017
3 Reads

Partial Denervation and Anterior Release of the Hip Joint Capsule to Relieve Pain and Improve Function at Five Years Follow-up.

Conn Med 2017 Mar;81(3):145-151

Traditionally, patients with significant hip pain due to degenerative hip disease, who are not surgical candidates for a total hip arthroplasty (THA), or are wary of the procedure, have been managed with various modalities with variable effectiveness.

Objectives: We have recently developed an anterior release of the contracted hip capsule along with par- tial denervation ofthe hip joint performed on an out- patient basis to relieve pain and improve function.

Study Design: A case series of 24 patients. Read More

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March 2017
4 Reads

Otologic Pathology and Hearing Loss in Children with Down Syndrome, 6 - 18 Years Old.

Authors:
Scott R Schoem

Conn Med 2017 Mar;81(3):141-143

Ihis article is a retrospective, sin- gle-center, single-surgeon review of all patients with Down syndrome (Trisomy 21) seen at a free- standing children's hospital between January 2000 and December 2011. The aim was to assess for un- recognized otologic pathology and hearing impair- ment in all new patients between six and 18 years old. Two-hundred-nine patients were seen during the study time frame. Read More

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March 2017
2 Reads

Uncertainty Among Acute Care Surgery Providers Does Not Change with Experience.

Conn Med 2017 Mar;81(3):133-139

Background: Acute care surgery (ACS) is a demanding profession that is by its na- ture unpredictable and requires practitioners to routinely deal with uncertainty and stress. We hy- pothesized that the field attracts people who are comfortable working in such an environment and that their comfort with uncertainty increases with experience. A surgeon's stress with uncertainty can be assessed usingthe previouslyvalidated Physician Reaction to Uncertainty Scale (PRU scale). Read More

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March 2017
2 Reads

The History and Genealogy of Obamacare.

Authors:
Michael M Deren

Conn Med 2017 Feb;81(2):119-121

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February 2017
2 Reads

Value of Upright X-Rays in Diagnosis ofACJoint Injuries in Polytrauma Patients.

Conn Med 2017 Feb;81(2):111-115

Acromioclavicular (AC)jointinjury is a common orthopaedic problem that can occur following trauma, but may be underdiagnosed in patients with multiple injuries. In the polytrauma patient, X-rays are commonly done in the supine position, which leads to an underestimation of the amount of displacement of the AC joint. When suspecting an AC joint separation, upright or standing images are needed, without support of the injured arm, in order to classify the injury and guide further management. Read More

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February 2017
2 Reads

Unusual Breast Calcifications: Complete Replacement of Fibroglandular Tissue with Dystrophic Calcifications in End-Stage Renal Disease.

Conn Med 2017 Feb;81(2):107-110

We present a rare case of breast calcifications in a patient with end-stage renal disease (ESRD) who was noncompliant with peritoneal dialysis. She presented with rapid onset of a palpable breast mass. Breast ultrasound (US) demonstrated ill-defined areas of dense tissue in the breasts bilaterally. Read More

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February 2017
2 Reads

Acute Disseminated Encephalomyelitis Following Meningococcal Vaccination: Case Report and Review of the Literature.

Conn Med 2017 Feb;81(2):103-106

A 17-year-old female presentedwith acute disseminated encephalomyelitis (ADEM), a demyelinating disease ofthe central nervous system, fourweeks after receiving a meningococcalvaccination. The report highlights a rare but known presen- tation following routine vaccination that requires a high degree ofsuspicion in recognition and management. Early initiation of steroid therapy, followed by a steroid taper over one month resulted in a favorable outcome of complete neurological recovery. Read More

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February 2017
5 Reads

Anticoagulation in Cardiobacterium hominis Prosthetic Valve Endocarditis in a Patient with Hypercoagulability: A Clinical Dilemma.

Conn Med 2017 Feb;81(2):99-101

Cardiobacterium hominis is an uncommon cause of prosthetic valve endocarditis (PVE) and often presents insidiously. In comparison, prosthetic valve thrombosis (PVT) is a rare, but life-threatening condition that commonly occurs due to inadequate anticoagulation. Anticoagulation is relatively contraindicated in patients with endocarditis as it may prove to be lethal due to increased risk of cerebral hemorrhage. Read More

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February 2017
2 Reads

Levamisole-Adulterated Cocaine-Induced Skin Lesions: A Case Report and Literature Review.

Conn Med 2017 Feb;81(2):95-98

Levamisole is used as an agent to increase the total weight of street cocaine. We report the case of a 28-year-old female who presented with multiple painful, ulcerating lesions. She tested positive for cocaine and levamisole. Read More

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February 2017
2 Reads

Brucellar Vertebral Osteomyelitis: A Case Report and Brief Review of the Literature.

Conn Med 2017 Feb;81(2):91-94

Brucellosis is the most common worldwide zoonosis which continues to remain a significant worldwide health problem and burden. Transmission usually occurs secondary to direct or indirect exposure to certain animals, but a major mode of transmission is the ingestion ofunpasteurized milk or milk products from infected animals. 'Ihe disease has a geographic distribution including the Mediterranean basin and Arabian Peninsula, India, Mexico, and parts of Central and South America. Read More

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February 2017
2 Reads

Unicompartmental Knee Arthroplasty: Indications, Outcomes, and Complications.

Conn Med 2017 Feb;81(2):87-90

Unicompartmental knee arthroplasty (UKA) is a surgical option which is indicated in a special subset of osteoarthritis patients. Although it is often technically challenging, out-comes are positive when indications are followed as operative criteria. Benefits compared to total knee arthroplasty (TKA) include lower morbidity and a shorter recovery time. Read More

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February 2017
4 Reads

The Role of Patient History and Body Site Surveillance Cultures as Predictors of Colonization in a Long-Term Acute Care Hospital Setting.

Conn Med 2017 Feb;81(2):81-85

Background: Long-term acute care hospitals (LTACHs) have high rates of antibiotic and device use, hospital-acquired infections, and antibiotic resistance. Admission surveillance cultures are controversial.

Objective: Evaluate the significance of patienthistory and multiple body site admission surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Read More

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February 2017
2 Reads

Immediate Tube Feeding after Percutaneous Endoscopic Gastrostomy: Early Return to Goal Tube Feeds without Added Complications.

Conn Med 2017 Feb;81(2):75-79

Background: Percutaneous endoscopic gastrostomy (PEG) is frequently performed for delivery of nonoral enteral nutrition (EN) in critically ill patients. Tube-based supplement initiation is often delayed for a variety of reasons despite evidence that EN interruption results in worse outcomes.

Objective: To determine if early initiation of EN after PEG placement is safe and well-tolerated in critically ill patients and if early initiation of EN results in more goal-accomplished days of EN. Read More

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February 2017
2 Reads

Number of Consults and Response Times to ED: Effects on Patient Flow and Outcomes.

Conn Med 2017 Feb;81(2):69-73

Objectives: 'he number of consults and response times to our Emergency Department (ED) were tracked to understand the effects on patient flow and outcomes.

Study Design: We conducted a prospective observational study using convenience samples.

Methods: There were 992 requests for physician consultations or logistical services (bed manager, transport, or room cleaning) logged during ED shifts from January through July, 2014 at the VA CT Healthcare System West Haven Campus (VACHS). Read More

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February 2017
3 Reads

A Day of the Old, the New and the Future: What is Best, Like All, a Part of Each.

Conn Med 2017 Jan;81(1):53

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January 2017
2 Reads

Connecticut Chapter of the American College of Surgeons Annual Scientific Meeting.

Authors:
Philip R Corvo

Conn Med 2017 Jan;81(1):47-52

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January 2017
2 Reads

If There Were A Vaccine Against Cancer...

Authors:
Raul Pino

Conn Med 2017 Jan;81(1):45-46

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January 2017
6 Reads

Development of the Yale Gender Center: An Early Progress Report.

Conn Med 2017 Jan;81(1):41-44

As the need for comprehensive, affirmative health care for transgender and gender nonconforming youth has increased in recent years, clinical practice has struggled to catch up with evolving standards of care. The Yale Gender Center is an example of an interdisciplinary model of care that addresses not only clinical needs, but also ancillary needs for patients and training opportunities for students across several health disciplines. In this article, we discuss our clinical and training models, lessons learned, and our proposed directions to expand care. Read More

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January 2017
2 Reads

A Guideline Update of Out-of-Hospital Cardiac Arrest in Adults.

Conn Med 2017 Jan;81(1):35-39

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January 2017
2 Reads

Longitudinal Stress Fracture of the Femur: A Rare Entity.

Conn Med 2017 Jan;81(1):31-33

Exercise-induced stress reactions and stress fractures are common causes of pain in athletes. Although most stress fractures are trans- verse in orientation, rarely longitudinal stress fractures may occur in the tibia and femur. Early detection is important to start prompt and appropriate treatment to prevent complications. Read More

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January 2017
4 Reads

Leiomyosarcoma of the Innominate Vein: A Smooth Muscle Criminal.

Conn Med 2017 Jan;81(1):27-29

Leiomyosarcomas of vascular origin are extremely rare malignant tumors that can present a diagnostic challenge when they present as a mediastinal mass. Although they portend a poor prognosis with both aggressive local symptoms and metastatic disease, we present a rare case in which surgical en bloc resection of the tumor was curative. Read More

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January 2017
3 Reads

Portal Vein Thrombosis After a Right Hemicolectomy: A Case Report.

Conn Med 2017 Jan;81(1):23-26

The patient, a 43-year-old male, underwent uneventful laparoscopic right-sided hemicolectomy for a benign polyp, too large to be removed by colonoscopy. His postoperative course was uneventful; however, he returned 16 days after discharge with vague abdominal pain. A CT scan of his abdomen and pelvis showed extensive acute thrombus in portal, superior mesenteric, and splenic veins. Read More

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January 2017
3 Reads

Solitary Pleural Fibroma: A Case Report and Review of Literature.

Conn Med 2017 Jan;81(1):19-22

Solitary fibrous tumors ofthe pleura (SFTP) are uncommon. They tend to be discovered incidentally or during workup for unexplained cough or paraneoplastic effects. It is important to recognize the entityand perform a surgical excision because of the possibility of subsequent malignant transformation and local compressive effects. Read More

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January 2017
2 Reads

Clinical Implications of Emotion Dysregulation in ADHD.

Conn Med 2017 Jan;81(1):13-18

Emotion dysregulation is com- mon in patients with attention-deficit/hyperactive disorder (ADHD) and contributes substantially to ADHD related impairments and comorbidi- ties. The high prevalence of emotional dysregulation (ED) in individuals with ADHD highlights the need to understand the clinical implications of this association, neurobiological correlates, and potential treatment modalities. ED contributes significantly to ADHD adverse outcomes, such as occupational, driving, and legal consequences, and is associated with the development of psychiatric comorbidities. Read More

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January 2017
2 Reads