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Almost half of the 213 Hispanic women of the western North Carolina surveyed reported knowing about emergency contraception (EC) even if not by that name, and 12% reported use. Few (15%) had a moral objection to EC. Almost all said they would seek accurate information from their provider or health clinic, but only 21% reported discussing EC with a care provider. Of the 63 potential candidates for EC, 70% reported inconsistent use of birth control, 21% reported previous use of EC and 44% reported a willingness to use EC in the future.

Despite recent advances in neurosurgical techniques, the overall outcome following an aneurysmal subarachnoid hemorrhage remains poor. Knowing the possible risk factors and warning symptoms responsible for the event can lead to an earlier diagnosis and as a result, prevent subsequent complications.

This is a retrospective study using autopsy data to establish the prevalence and lifetime risk of intra-abdominal surgery. Over an 8-year period, 2,648 autopsy and clinical records from a public and private hospital were reviewed for evidence of intra-abdominal surgery. The lifetime risk of intra-abdominal surgery can be used to assess the utilization of health care among ethnic groups and in considering the role of incidental surgery.

Body weight is known to have an important effect on pulmonary functions. A number of studies have reported an inverse relation between respiratory function and various indices of obesity or fat distribution. Our findings are of clinical importance as they indicate that respiratory functions are affected even in mildly and moderately obese cases.

A review of 28 cases of hantavirus pulmonary syndrome (HPS) reported to the Texas Department of State Health Services from 1993 through 2006 is presented.

The aim of this study was to analyze our experience with stereotactic radiosurgery in the management of patients with brain metastases from radioresistant primary cancers. We have retrospectively reviewed the clinical record of those patients for the outcome measures. All data were coded and entered into multivariate regression analysis for studying the relationship between survival and other variables.

The question of whether or not partially removed atypical nevi should be re-excised with clear margins in order to prevent their evolution into melanoma remains unanswered. Although studies have shown that most atypical nevi will never progress into melanoma, re-excision, when biopsy margins are positive, is commonly practiced. We argue that re-excision in such cases is not necessary. The results of our study support observation as a safe alternative to re-excision for incompletely removed atypical nevi.

We review the clinical use of thiazolidinediones and the studies and controversies concerning complications attributed to this class of medications.

Extrapulmonary manifestations of Mycobacterium tuberculosis (MTB) in general, and tuberculous peritonitis (TBP) in particular, have posed complex diagnostic challenges for centuries. As the incidence of tuberculosis is declining in developed nations, clinicians may overlook the need to establish an early diagnosis and prompt therapy for this disorder.

Postprandial hyperglycemia is nearly universal in patients with uncontrolled diabetes, it is common in well-controlled patients, and it is associated with poor outcomes. The goal of this manuscript is to highlight the importance of postprandial glucose levels in diabetes management by describing the pathophysiology of postprandial hyperglycemia, the consequences of elevated postprandial glucose (PPG), the therapeutic interventions for controlling PPG, and the impact of agents targeting PPG on cardiovascular outcomes.

Insulin is the most efficacious therapy for diabetes, but its introduction to treatment regimens is often delayed. This delay results in worsened glycemic control, compromising the patient's long-term prognosis as a consequence of an increased propensity for complications. Earlier initiation of insulin can help minimize or even avoid these complications, and modern formulations and delivery devices can help make the adoption of insulin easier for patients.

Injuries resulting from high- and low-velocity projectiles as well as their initial management are well documented in the literature. Most of the described injuries involve gunshot wounds, some of which involve injuries to the hand and wrist. To our knowledge, there has not been a case described that involves a hollow arrow shaft with fragmentation. This paper presents a case report of such an injury through the wrist and hand. The report illustrates both the unique nature of the injury and describes the techniques and special considerations for surgical management.

A 37-year-old man presented with painful swelling in the left forearm muscle. The biopsy of muscle swelling disclosed the presence of the pulmonary adenocarcinoma. The diagnosis of skeletal muscle metatasis from lung cancer was made. The patient was treated with systemic chemotherapy and radiotherapy. Skeletal muscle metastasis due to primary lung cancer is rare.

This case report describes a patient who developed anticonvulsant hypersensitivity syndrome (AHS) with fulminant hepatic failure two weeks after introduction of lamotrigine. Although hepatoxicity has been previously reported with lamotrigine, very few cases developed fulminant hepatic failure and to our knowledge, this report contains the lowest dosage at presentation and the slowest titration. This suggests that AHS may occur in a purely idiosyncratic manner, independent of dosage and titration.

Fahr syndrome refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcification. A 42-year-old woman presented with Fahr disease, but lacking extrapyramidal symptoms or a metabolic disorder. When screening other family members, we detected Fahr syndrome in two daughters and three brothers, revealing that the disease was an autosomal dominant trait. Fahr disease may be clinically asymptomatic, but have pronounced positive brain imaging findings. Computed tomographic scanning remains the most effective screening tool for adult relatives.

Cocaine use complicating acute painful episodes in patients with sickle cell anemia may be under recognized and may lead to multiorgan dysfunction. Enhanced surveillance is indicated if a history of cocaine abuse is elicited. Early evidence of organ failure should lead to consideration of aggressive interventions such as transfusion therapy. We report clinical outcomes in three patients in which cocaine use preceded a sickle cell pain episode.

Emphysematous cystitis is a rare condition usually seen in patients who are either diabetic or have other immunosuppressive diseases, or have had disruption of the bladder wall due to trauma or surgical instrumentation. We present a case of emphysematous cystitis in a patient with cystic fibrosis without any other underlying immunosuppressive conditions.

A case of adult-onset mastocytosis is presented to illustrate the classification, signs, symptoms, workup, treatment, and prognosis for this unusual condition. Although there is no cure for mastocytosis, symptoms of histamine release can be minimized with oral antihistamines. Ongoing surveillance of organ systems affected remains important. Our patient's mast cell disease predisposed him to bone loss, but there was no evidence of disease beyond the skin. He has done well with continued follow up monitoring his serum tryptase and oral antihistamine treatment.

Tuberculous peritonitis can present with a constellation of nonspecific signs and symptoms and may be easily misdiagnosed. This disease process is a rare cause of abdominal pain in the United States, and the diagnosis is entirely dependent upon the level of suspicion by the surgeon. In this case report, we present an example of a typical patient with tuberculous peritonitis, a diagnosis that was made only after laparotomy.

Lugol iodine solution staining of the cervix and vagina during colposcopy examination is known as a Schiller test and is routinely performed by colposcopists. Although iodine anaphylactic-like reactions are described in the literature, they are not reported during Lugol staining of the genital epithelia. This paper focuses on the latter possibility and describes an easy tool to treat it without using drugs.

The diagnosis of a ruptured dermoid cyst in a 58-year-old man with chronic psychiatric problems is described. The auditory and visual neuropsychiatric problems resulted from irritation of brain structures by cholesterol particles from the ruptured dermoid cyst. Extirpation of the cyst and it ruptured contents reversed two of the three chronic symptoms and both of the acute symptoms.

A middle-aged man was referred to our center with a history of progressive paraplegia over a period of three weeks. It was associated with multiple soft tissue swelling over the face, left rib and scapular area. He was initially treated in a peripheral hospital for sepsis with underlying cord compression secondary to metastatic disease. Further workup at our center revealed that he had primary plasma cell leukemia with multiple bony lesions and soft tissue infiltrations, complicated by paraplegia secondary to cord compression.

A 29-year-old female presented with chronic postpartum abdominal pain. CT scan was consistent with ovarian carcinoma, and biopsy yielded macrophages laden with eosinophilic bodies. Cultures, Histoplasma serologies, and Toxoplasma serologies were negative. A diagnosis of pelvic donovanosis was reached; the patient was treated with azithromycin resulting in clinical and radiographic resolution.

A 22-year-old woman had been suffering from episodes of epigastric pain and vomiting throughout her pregnancy and puerperium. After diagnosing pancreatitis, we discovered a trichobezoar in her stomach. In an emergent gastrotomy, the patient was found to have a gastric trichobezoar with a long tail extending down to her duodenum. This is one of the very few cases of Rapunzel syndrome complicated by pancreatitis; to our knowledge, it is the first to be reported postpartum.