Contemporary Internal Medicine Clinical Case Studies

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A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.

Contemporary Internal Medicine Clinical Case Studies A collection of cases from The Ohio State University Hospitals discussed by faculty of the Department of Internal Medicine

Volume 2 Edited by

Juan Bowen, M.D., and Ernest L. Mazzaferri, M.D. The Ohio State University Columbus, Ohio

PLENUM MEDICAL BOOK COMPANY NEW YORK AND LONDON

The Library of Congress cataloged the first volume of this series as follows: Contemporary internal medicine. Includes bibliographies and index. 1. Internal medicine-Case studies. I. Bowen, Juan. II. Mazzaferri, Ernest L., 1936. [DNLM: 1. Internal Medicine-case studies. WB 115 C761] 616'.09 88-22379 RC66.C66 1988

ISBN-13: 978-1-4615-6718-9

e-ISBN-13: 978-1-4615-6716-5

DOl: 10.1007/978-1-4615-6716-5

© 1989 Plenum Publishing Corporation

Sof'tcover reprint of the hardcover 1st edition 1989 233 Spring Street, New York, N.Y. 10013 Plenum Medical Book Company is an imprint of Plenum Publishing Corporation All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

This volume is dedicated to our wives, Debbie and Florence, for their support and understanding.

Starling-Loving Hall By Robert L. Hummel

Contributors WILLIAM H. BAY, MD, Associate Professor of Medicine, The Ohio State University, Columbus, Ohio JUAN BOWEN, MD, Director of General Medicine, Assistant Professor of Medicine, The Ohio State University, Columbus, Ohio PAUL M. DORINSKY, MD, FACCP, Assistant Professor of Medicine, The Ohio State University, Columbus, Ohio BARRY M. FRIEDMAN, MD, Assistant Professor of Medicine, The Ohio State University, Columbus, Ohio JOHN J. FROMKES, MD, Associate Professor of Medicine, The Ohio State University, Columbus, Ohio REBECCA D. JACKSON, MD, Assistant Professor of Medicine, The Ohio State University, Columbus, Ohio ERIC H. KRAUT, MD, Associate Professor of Medicine, The Ohio State University, Columbus, Ohio CARL V. LEIER, MD, FACP, Director, Cardiology, Professor of Medicine, The Ohio State University, Columbus, Ohio DANIEL J. MAZANEC, MD, FACP, Assistant Professor of Clinical Medicine, The Ohio State University, Columbus, Ohio ERNEST L. MAZZAFERRI, MD, FACP, Chairman, Department of Internal Medicine, Professor of Medicine and Physiology, The Ohio State University, Columbus, Ohio N. STANLEY NAHMAN, JR., MD, Assistant Professor of Medicine, The Ohio State University, Columbus, Ohio KWAME OSEI, MD, FACP, Assistant Professor of Medicine, The Ohio State University, Columbus, Ohio JOHN PAP, MD, Assistant Clinical Professor of Medicine, The Ohio State University, Columbus, Ohio

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Contributors

MICHAEL F. PARA, MD, FACP, Associate Professor