Volume 93, Issue 7

The differential diagnosis of fasting hyperglycemia in type I diabetes includes the Somogyi effect, the dawn phenomenon, and insufficient insulin administration. To determine the causes of fasting hyperglycemia and their effect on subsequent daytime blood glucose control, the authors retrospectively reviewed blood glucose profiles of 126 patients with type I diabetes. The Somogyi effect accounted for 12.6% of all instances of fasting hyperglycemia, the dawn phenomenon, 24.1%, and poor control, 63.3%. Measurement of 3 AM and 5 AM blood glucose values is the key to making a correct diagnosis. Once a patient's fasting hyperglycemia is placed in one of these groups, appropriate treatment can be started.

Five patients who underwent cardiac catheterization at three separate institutions during a period of 6 years were found to have anomalous inferior vena cava with azygos continuation. Although it is not uncommon to detect this defect in pediatric patients with congenital heart disease, it may be an unusual finding for an angiographer who works primarily with adults. This article serves as a reminder of the existence of this potentially confusing anomaly, usually associated with other congenital cardiac abnormalities.

Lateral epicondylitis, one of the most common lesions of the arm, affects some 50% of tennis players. This condition poses a problem in clinical management because treatment is dependent not only on proper medical therapy but also on correction of the improper on-court biomechanics. The most common flaw is a late contact on the backhand groundstroke, forcing the player to extend the wrist with the extensor muscles. This action predisposes to trauma of the tendon fibers at the lateral epicondyle. Understanding the biomechanics will better prepare the physician to advise the patient and to communicate with a tennis teaching professional to facilitate long-term relief.

Graduate medical education traditionally has emphasized the teaching of biomedical knowledge and technical skills. However, physicians-in-training also need opportunities to explore their emotional reactions that occur during the process of patient care and medical training. The promotion of personal growth and self-awareness should be important components of graduate medical education. Easily implemented, a resident support , group is one forum that addresses this obvious gap in medical education. This article reviews the goals and structure of support groups, with the hope that more training programs will implement them.

A comatose patient arrived at the emergency room with apnea and in shock after a grand mal seizure. A maculopapular rash, not initially observed, led to a diagnosis of cutaneous mastocytosis. Degranulation of the mast cells with massive histamine release had resulted in cardiovascular collapse. The authors follow a detailed report of this case history with a discussion of the diagnosis and treatment of the acute systemic stage of this potentially life-threatening illness.

Immunomodulatory agents for the treatment of certain oncologic disorders are rapidly moving from the research laboratory into clinical practice. These agents may not be void of potential neuropsychiatric sequelae. The following clinical report concerns a previously nondepressed patient with no history of psychiatric disorders who became depressed and killed himself while being treated with interleukin-2. It is important that consulting psychiatrists be sensitive to acute emotional changes in cancer patients taking immunomodulatory agents.