- Amphetamine Toxicity
Author: Neal Handly, MD, MS, MSc, Associate Research Director, Department of Emergency Medicine, Hahnemann Hospital; Assistant Professor of Emergency Medicine, Drexel University College of Medicine
Amphetamines are a class of compounds increasingly abused in regions of the world such as the western United States, Australasia, and Europe. Synthetic amphetamine compounds commonly are produced in clandestine laboratories and vary in purity and potency. Other potentials for amphetamine abuse include prescription medications and various over-the-counter diet pills. Clinical effects of amphetamine abuse are significant and commonly observed in EDs. The ED physician's ability to recognize and treat amphetamine intoxication is very important.
- Imaging in Child Abuse
Author: Evan Geller, MD, Assistant Professor, Department of Radiologic Sciences, Drexel University College of Medicine; Section Chief of Nuclear Medicine, Department of Radiology, St Christopher's Hospital for Children
Caffey's landmark article of 1946 noted an association between healing long-bone fractures and chronic subdural hematomas in infancy, and it was the first to draw attention to physical abuse as a unifying etiology. In 1962, Caffey and Kempe et al proposed manhandling and violent shaking as mechanisms of injury and emphasized the acute and long-term sequelae of abuse as serious public health problems.
- Childhood HIV Disease
Author: Mark Abdelmalek, MD, Chief, Division of Laser and Dermatologic Surgery, Assistant Professor, Department of Dermatology, Drexel University College of Medicine
The World Health Organization (WHO) estimates that approximately 2.1 million children are living with the human immunodeficiency virus (HIV) as of 2007. In 2007 alone, 370,000 children were newly infected, an improvement from the 530,000 newly infected in 2006; however, in 2008, the WHO reported an increase to 430,000. Not only are the children themselves ravaged by disease, but their primary caregivers have also often succumbed to acquired immune deficiency syndrome (AIDS).
- Hemorrhoidectomy
Coauthor: David E Stein, MD, Chief, Division of Colorectal Surgery, Associate Professor, Department of Surgery, Director, Mini-Medical School Program, Drexel University College of Medicine; Chief, Division of Colorectal Surgery, Department of Surgery, Hahneman University Hospital; Consultant, Merck; Consultant, Ethicon Endo-Surgery; Consultant, Health Partners; Consultant, Cook Surgical
Anal vascular cushions are present in everyone and are believed to contribute, in small part, to overall anal continence. The term hemorrhoids is used to refer to these cushions when they become enlarged and symptomatic. These anal cushions are composed of plexuses of vessels within the anal canal that connect arterioles to veins without intervening capillaries.
- Intestinal Fistulas
Coauthor: Asyia S Ahmad, MD, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Associate Program Director, Gastroenterology and Hepatology Fellowship Training Program, Drexel University College of Medicine
Fistula is derived from the Latin word that means "pipe." A fistula is an abnormal connection between two epithelialized surfaces. It usually involves the gut and another hollow organ, such as the bladder, urethra, vagina, or other regions of the GI tract. Fistulas may also form between the gut and the skin or between the gut and an abscess cavity. Rarely, fistulas arise between a vessel and the gut, resulting in profound GI bleeding, which is a surgical emergency.
- Shigellosis
Author: Joyann A Kroser, MD, Clinical Associate Professor of Medicine, Gastroenterology, and Hepatology, Drexel University College of Medicine
Shigella organisms cause bacillary dysentery, a disease that has been described since early recorded history. Shigella species (eg, Shigella dysenteriae, Shigella flexneri, Shigella sonnei, Shigella boydii) are aerobic, nonmotile, glucose-fermenting, gram-negative rods that are highly contagious, causing diarrhea after ingestion of as few as 180 organisms. Shigella species cause damage by 2 mechanisms, as follows: (1) invasion of the colonic epithelium, which is dependent on a plasmid-mediated virulence factor, and (2) production of enterotoxin, which is not essential for colitis but enhances virulence.
- Quinolizidine and Isoquinoline Poisoning
Coauthor: Richard J Hamilton, MD, FAAEM, FACMT, Professor and Chair, Department of Emergency Medicine, Drexel University College of Medicine
Alkaloids are alkali-like compounds that form salts with acids and contain nitrogen, generally in heterocyclic and/or ring structures. Found in a wide variety of plants, animals, and fungi, many alkaloids have medicinal and toxic properties. Quinolizidine and isoquinoline alkaloids are a widely distributed, heterogeneous group of alkaloids with members of each group having known toxicity to humans and domestic animals.