WMJ : official publication of the State Medical Society of Wisconsin最新文献

Introduction: The recreational use of nitrous oxide is surging in popularity, with nearly 13 million Americans aged 12 and older reported to have misused it, according to a 2019 survey by the Substance Abuse and Mental Health Services Administration. Prolonged use has been linked to significant neurological deficits, potentially leading to lifelong issues if not treated early.

Case presentation: We present a case of a 38-year-old male with significant neurologic deficits attributed to prolonged nitrous oxide abuse, resulting in subacute combined degeneration of the spinal cord. This condition is characterized by demyelination of dorsal and lateral columns.

Discussion/conclusions: The growing recreational use of nitrous oxide, facilitated by its easy availability and lack of regulation, highlights the importance of clinician vigilance in managing associated risks. Neurological symptoms from vitamin B12 deficiency are particularly worrisome. Early intervention is crucial to prevent potential long-term consequences.

Introduction: Climate change is the greatest global public health threat of this century, increasing respiratory, cardiovascular, and vector-borne diseases; mental health effects; and premature deaths. The US health care sector is responsible for 8% to 10% of the nation's greenhouse gas emissions; therefore, engaging health care systems in emissions reduction could improve health for all communities.

Methods: A 10-question survey was emailed to a convenience sample consisting of 211 faculty physicians, nurse practitioners, and physician assistants and an unknown number of other staff employed at 21 UW Health family medicine clinics. The survey measured knowledge of health care greenhouse gas emissions and included 2 open-ended questions to solicit opinions on sustainability priorities and barriers to waste reduction. Each clinic also received a 15-minute presentation on health care climate impact during one of their regularly scheduled meetings.

Results: Of the 130 survey respondents, 34% knew the health care sector is responsible for 8% to 10% of the US carbon emissions and 9% of non-greenhouse air pollutants. Only 26% knew that most of these emissions come from purchasing and transportation. However, 92% thought environmental sustainability should be incorporated into all clinical operations, and 74% wanted to know how to affect purchasing to reduce emissions. Top priorities were identified as investing in renewable energy, increasing recycling, and reducing waste (eg, single-use instruments). Top barriers to waste reduction were thought to be cost, complacency, and time.

Conclusions: Despite lack of knowledge of the health care sector's contribution to US greenhouse gas emissions, most surveyed health care workers wanted their health care system to incorporate environmental sustainability into all clinic operations. Additional research identifying knowledge gaps and soliciting opinions of other medical specialties and health care systems on health care greenhouse gas emissions may increase awareness of health care emissions, inform health care leaders, and lead to emissions reduction.

Introduction: While prostatic abscess formation is often mitigated by initiating antibiotics for prostatitis, early recognition and treatment are important to avoid risk of sepsis and death.

Case presentation: A 79-year-old male presented with milky-white penile discharge during bowel movements. He had no fever, dysuria, or perineal pain. The discharge culture grew multidrug resistant Escherichia coli. Computed tomography of abdomen/pelvis showed a heterogenous, enlarged prostate leading to diagnosis of a prostatic abscess. The abscess was treated successfully with cystourethroscopy, transurethral unroofing, and a course of intravenous ertapenem.

Discussion: Previous research shows patients with prostatic abscesses present with perineal pain, dysuria, and fever. This case demonstrates the importance of considering a prostatic abscess in a patient with penile discharge alone.

Conclusions: We report a unique presentation of prostate abscess to educate and improve clinical suspicion of a rare, yet potentially fatal urological complication.

Introduction: People experiencing homelessness are more likely than the general population to have chronic health conditions and often encounter significant barriers to health care access. Many of these barriers can be affected by community-based factors, such as availability of reliable transportation, past experiences with health care systems, and community attitudes toward the unhoused population. This project aims to assess the needs and barriers to health care identified by people experiencing homelessness in a rural Midwestern city.

Methods: The survey used was adapted from a survey previously conducted to assess the needs of the homeless population in Milwaukee, Wisconsin. Surveys were distributed during outreach around the city of Wausau, Wisconsin. Data were transcribed and reviewed, and descriptive statistics were calculated.

Results: A total of 45 surveys were completed. Most participants identified as White, non-Hispanic males (n = 24, 53%) and were 46 to 55 years old (n = 14, 31%). Barriers to health care included lack of housing, cost, transportation, lack of a mailing address, inadequate hours, and disrespectful care. Eighty-six percent of participants (n = 38) reported having a mental health diagnosis, yet only 26% (n = 12) stated that they see a mental health professional.

Conclusions: Individuals experiencing homelessness in a rural community have broad and complex barriers to accessing health care. Given limited resources in smaller communities, innovative and holistic solutions should be considered when aiming to make care more equitable.

Introduction: Causes of nipple pain include trauma, vasospasm, malignancy, Paget's disease, inflammation secondary to blockage of the ducts, infection, and medications. Raynaud's phenomenon (RP) of the nipple is reported more often in women and typically presents bilaterally.

Case presentation: A 63-year-old man presented with episodic, stabbing pain and blanching of the left nipple, worsening over 3 years. Symptoms began insidiously during military service. Examination revealed no abnormalities, but blanching was observed during a painful episode. Laboratory and imaging studies were unremarkable. Conservative measures and pharmacologic agents, including nitroglycerin ointment and amlodipine, provided minimal relief. Intercostal nerve blocks and cervical sympathetic blocks did not provide lasting relief. Ultrasound-guided paravertebral sympathetic block with local anesthetic provided temporary relief lasting week. Botulinum toxin injection around the areola resulted in sustained pain relief lasting more than month.

Discussion: The patient's presentation is consistent with primary RP of the nipple, a rare and underrecognized condition. While it typically affects distal extremities, it can involve other areas, including the nipple. Diagnosis is clinical, often requiring documentation during episodes. Management is challenging and largely anecdotal. Botulinum toxin has shown promise in RP, though evidence remains mixed.

Conclusions: This case highlights a rare presentation of unilateral, vasospastic nipple pain resembling primary RP, with partial response to botulinum toxin injection.

Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare critical outcome of breast implantation that typically presents 8 to 10 years after textured-implant placement with periprosthetic seroma. Treatment consists of implant removal and capsulectomy, which is typically curative. But in rare case, malignant infiltration through the capsule results in disseminated disease, necessitating aggressive treatment with systemic chemotherapy. Sarcoidosis, a chronic systemic granulomatous disease characterized by noncaseating granulomas, is another rare cause of periprosthetic seroma.

Case presentation: A 61-year-old female with a history of invasive ductal carcinoma of the breast status post textured implant-based reconstruction presented with late periprosthetic seroma and overlying rash. Cytology of seroma aspirate was suggestive of BIA-ALCL, and positron emission tomography-computed tomography was concerning for invasive disease. Surgical specimen pathology of the implant-capsule complex and skin punch biopsy of the overlying rash revealed only granulomatous inflammation. The patient was diagnosed with sarcoidosis and spared systemic chemotherapy treatment for disseminated BIA-ALCL.

Conclusions: BIA-ALCL should be ruled out in all cases of late periprosthetic seroma. Definitive surgical pathology is necessary to prevent misdiagnosis and inappropriate treatment of masquerading entities, such as sarcoidosis.

Background: Alcohol use is increasing in Wisconsin. We aimed to improve a state public health campaign around youth drinking to increase awareness of alcohol as a carcinogen.

Methods: The campaign was expanded and distributed via targeted social media advertisements and a directed campaign in a Wisconsin county with high rates of alcohol consumption.

Results: The media campaign outperformed benchmarks by 23.6%, delivering 1.65 million impressions. Total billboard impressions exceeded expectations by 46%. Across all digital tactics, there was a collective click-through rate of 0.42%. Facebook had the largest audience with over 128 000 total impressions, exceeding expectations by 28%. Cancer-specific related messaging engaged slightly higher click-through rates among Facebook audiences than impact messaging (0.47% vs 0.36%).

Discussion: Adding cancer-related messaging was effective in this expanded Wisconsin state youth drinking campaign.

Introduction: Academic medicine literature has reported hesitation from clinical teaching physicians to use questions when teaching medical students due to its negative connotation of "pimping." However, newer literature suggests that most students prefer questions, while only a small minority are less welcoming. Some teaching physicians, however, have concerns about using questions due to the risk of humiliating or embarrassing medical students in clinical settings.

Methods: Medical students who completed core clerkship rotations at a public medical school in the Midwest were invited to participate in 1 of 4 virtual focus groups. Students were asked to reflect on 3 clinical teaching vignettes. Inductive thematic qualitative analysis was performed to create a codebook. The transcripts were coded by 2 independent coders for emerging themes.

Results: Twenty-six students participated across 4 groups. Four major themes were identified that demonstrate positive student reception of teaching physicians and their questions: teaching physicians (1) engaging students, (2) setting clear expectations, (3) empathizing with the medical student experience, and (4) asking questions to teach rather than evaluate. Thematic coding of the 3 vignettes resulted in initial intercoder reliabilities of 85.4%, 87%, and 79%, prior to achieving 100% consensus. Students described the ideal teaching physician to be patient, engaged, and respectful.

Conclusions: By engaging medical students, setting clear expectations early on, empathizing with the medical student experience, and asking questions with the purpose of teaching, teaching physicians can be less hesitant about upsetting medical students when utilizing questions as a teaching tool.