May 2007, Volume 100 - Issue 5

Perioperative Cardiac Evaluation: Novel Interventions and Clinical Challenges

Donna L. Mercado, MD, David Y. Ling, MD, Gerald W. Smetana, MD

Abstract: Cardiac complications are one of the most important sources of morbidity and mortality after noncardiac surgery. In this review, we discuss the pathophysiology of postoperative cardiac complications and published risk indices and guidelines that allow an estimation of...

(pp 486-492)

Recognizing the Link Between CKD and CVD in the Primary Care Setting: Accurate and Early Diagnosis for Timely and Appropriate Intervention

Jan N. Basile, MD

Abstract: Chronic kidney disease (CKD), which is becoming increasingly prevalent in the US and worldwide, eventually progresses to end-stage renal disease (ESRD), requiring renal replacement therapy. Diabetes and hypertension, the two leading causes of CKD, are themselves reaching...

(pp 499-505)

Bacteroides fragilis Vertebral Osteomyelitis: Case Report and a Review of the Literature

Hesham Elgouhari, MD, Mohamed Othman, MD, Wendy H. Gerstein, MD

Abstract: Background: To review the presentation of Bacteroides fragilis (B fragilis) spondylodiscitis. Methods: Two investigators independently searched the published English, Spanish and French languages literature through September 2005 using MEDLINE (1966–2005). We included all...

(pp 506-511)

Overlapping Features of Thrombotic Thrombocytopenic Purpura and Systemic Lupus Erythematosus

James N. George, MD, Sara K. Vesely, PhD, Judith A. James, MD, PhD

Abstract: Although thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) are distinct entities, they may appear as overlapping clinical syndromes from multiple perspectives: pathogenesis, patient demographics, clinical features, and management (Table). Our...

(pp 512-514)

Dual Perinephric and Prostatic Abscesses from Methacillin-resistant Staphylococcus aureus

Aaron A. R. Tobian, MD, PhD, Scott K. Ober, MD, MBA

Abstract: Perinephric and prostatic abscesses may present with protean symptoms and often arise from ascending urinary tract infections. Both abscesses are often caused by uropathogens, and only on rare occasions is the etiology due to methacillin-resistant Staphylococcus aureus...

(pp 515-516)

Coccidioidomycosis Pneumonia in a Nonendemic Area Associated with Infliximab

Mahmood Dweik, MD, Bruce A. Baethge, MD, Alexander G. Duarte, MD

Abstract: Tumor necrosis factor (TNF) inhibitors, such as infliximab, are highly effective in the management of rheumatoid arthritis; however, these agents are associated with an increased risk of infectious complications. Individuals developing coccidiomycosis pneumonia frequently...

(pp 517-518)

Urinothorax: A Rapidly Accumulating Transudative Pleural Effusion in a 64-year-old Man

Samuel Deel, MS-4, BS, Emory Robinette Jr, MD, FCCP

Abstract: We report the case of a 64-year-old man who developed a rapid, right-sided pleural effusion. On initial presentation to the emergency room, the patient had fever and flank pain consistent with a ureteral obstruction (due to a bladder tumor) and associated hydronephrosis...

(pp 519-521)

Buerger Disease in an Elderly Man

Hassan M. Ismail, MD, MPH, FACP

Abstract: Buerger disease is characterized by progressive distal extremity ischemia in persons with recent tobacco consumption. Typically, affected persons are young men. There have been case reports of Buerger disease in older men. Almost all of the reported cases were characterized...

(pp 522-524)

Coincidental Consort Clear Cell Cutaneous Carcinom: Facial Squamous Cell Carcinoma In Situ Containing Human Papillomavirus and Cancer Cells with Clear Cytoplasm in an Octogenarian Couple

Philip R. Cohen, MD, Keith E. Schulze, MD, Peter L. Rady, MD, PhD, Stephen K. Tyring, MD, PhD, MBA, Qin He, MD, Paul T. Martinelli, MD, Bruce R. Nelson, MD

Abstract: Clear cell squamous cell carcinoma in situ, also referred to as pagetoid or clear cell Bowen disease, is a rare pathologic variant of this neoplasm. It is characterized by neoplastic cells with clear or pale cytoplasm. An octogenarian husband and wife concurrently developed...

(pp 525-530)

Spontaneous Cholesterol Crystal Embolization to Bone Marrow

Matthew D. Reuter, MD, Paula J. Chor, MD, Amanda Dehlendorf, MD, Martin A. Alpert, MD

Abstract: Cholesterol crystal embolization is a well-established complication of arterial trauma and anticoagulation which may involve multiple organs including the skin and muscle, producing clinical features such as livedo reticularis, cyanosis and gangrene of the toes and intense...

(pp 533-536)

Squamous Cell Carcinoma In Situ in a Female Urethral Diverticulum

Diane Young, MD, Seth Bilello, MD, Alex Gomelsky, MD

Abstract: There have been less than 100 reported cases of carcinoma in a female urethral diverticulum, with only 10 of these cases being squamous cell carcinoma (SCC). The course of this disease is frequently aggressive, despite multimodality treatment, and most patients die within 2...

(pp 537-539)

Unilateral Shivering: A Result of Lateral Medullary Infarction

Gordon J. Gilbert, MD

Abstract: Shivering is mediated via the predominantly uncrossed reticulospinal tract. We report a case of a patient with left lateral medullary tract infarct involving the reticulospinal tract who displayed ipsilateral absence of shivering during a febrile episode. The physiology and...

(pp 540-541)

Parental Discipline of Young Children

Robert W. Block, MD, FAAP

Abstract: The authors of the article “A Longitudinal Study of Parental Discipline of Young Children” in this issue of the Southern Medical Journal correctly point out that the American Academy of Pediatrics strongly endorses parent education about discipline at all well child...

(pp 461)

Retroperitoneal Fibrosis as a Long-term Complication of Radiation Treatment for Prostate Cancer

Ranjeeta Mani, MD, Ashutosh Niraj, MD, MS, Radhika Sreedhar, MD, MS

Abstract: To the Editor: A 70-year-old gentlemen presented with a six week history of abdominal pain associated with generalized weakness and anorexia. The patient reported insidious onset, 5 to 6/10 aching, and mid-abdominal pain which was aggravated in the supine position with no...

(pp 545-547)

Electroconvulsive Therapy—An Outdated Treatment, or One Whose Time Has Come?

James N. Kimball, MD

Abstract: Depression, bipolar disorder, and other mental illnesses are being increasingly recognized in today’s medicine, with millions of people suffering from them. It is well known that people with mental illness utilize healthcare services more frequently than those without...

(pp 462-463)

Methicillin-resistant Staphylococcus aureus: An Established Pathogen with Emerging Infections

Wael E. Shams, MD

Abstract: Despite the general improvement in public health, the use of potent antimicrobial agents, and the strict application of hospital infection-control measures, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) continues to increase with multidrug resistance...

(pp 464-465)

The Impact of Bronchiectasis in Clinical Presentation of Asthma

I. Kivilcim Oguzulgen, MD, Firdevs Kervan, MD, Turkan Ozis, MD, Haluk Turktas, MD

Abstract: Background: Though asthma and bronchiectasis are two different diseases, their coexistence has been shown in many patients. The aim of this study was to evaluate the clinical features of asthmatics with bronchiectasis compared with pure asthmatics. Methods: We evaluated...

(pp 468-471)

A Longitudinal Study of Parental Discipline of Young Children

Rebecca R. S. Socolar, MD, MPH, Eric Savage, MA, Hughes Evans, MD, PhD

Abstract: Objective: To determine how discipline practices changed over time for young children. Methods: A cohort of parents with young children were interviewed in clinic about a broad array of disciplinary practices at two points in time. Results: A total of 182 parents were...

(pp 472-477)

Prevalence of Chlamydia trachomatis Among Active Duty Male Soldiers Reporting to a Troop Medical Clinic for Routine Health Care

Jeffery P. Greene, MD, Elisabeth Stafford, MD

Abstract: Objective: To determine the prevalence of chlamydia among young, male soldiers receiving routine healthcare and to measure risk factors associated with sexually transmitted infections (STI). Materials and Methods: Male soldiers between the ages of 18 to 25 years seeking...

(pp 478-481)

The Influence of Payer Mix and Visit Volume on NRMP Match Rates for Community-based Family Medicine Residency Programs

Robert Carlisle, MD, MPH, C. Ken Shannon, MD, PhD

Abstract: Background: With declining U.S. medical student interest in family medicine, it is important to study factors that may predict for individual residency program fill rates. Predictors of family medicine residency program match rates are few, with location by region of the...

(pp 482-485)

Lactobacillus Septic Arthritis

V. Chanet, MD, P. Brazille, S. Honore, M. Michel, A. Schaeffer, V. Zarrouk

Abstract: Lactobacillus is a Gram positive bacteria found in the mouth, gastrointestinal and female genital tract. Serious infections due to Lactobacillus are becoming increasingly common. We present a 49-year-old diabetic patient with Lactobacillus septic arthritis. To our...

(pp 531-532)

CME Questionnaire and Credit Form

NA

Abstract: CME Questionnaire and Credit...

(pp 493)

The Role of CT Scan in Reversible Airflow Obstruction

Anthony O’Regan, MD, FRCPI

Abstract: Computed tomography has had a dramatic impact on the diagnosis and management of respiratory disease.1 Traditionally used to characterize diffuse parenchymal lung disease, CT scaning also provides insights into airway diseases.1–5 In particular, the diagnostic sensitivity...

(pp 459-460)

Looking Back—Then Forward—at American Medicine

Gerald N. Weiss, MD, FACS, DABS, FICS, DACPE

Abstract: Does graduating from medical school at Tulane University on V-J Day, August 14, 1945 qualify one to look back over more than 60 years of American medical practice? Having practiced as an intern and resident in hospitals, done solo and group practice, served at a university,...

(pp 466-467)

Errata

NA

Abstract: The answers to the March 2007 CME questions were incorrect as...

(pp 485)

Electroconvulsive Therapy: A Review of History, Patient Selection, Technique, and Medication Management

Stephen Taylor, MD

Abstract: Electroconvulsive therapy (ECT) is a safe and effective treatment for severe and persistent depression, bipolar disorder and schizophrenia. Though ECT is now over 60 years old, it remains an underutilized treatment today. History, patient selection, safety, and...

(pp 494-498)

Medical Webwatch

Jim Young

Abstract: Otolaryngology Houston http://www.ghorayeb.com/Pictures.html is authored by Bechara Y. Ghorayeb, MD and is a large A to Z photographic database of otolaryngology conditions. The galleries may also be perused by anatomical category. Most of the illustrations, including...

(pp 551)

Patient’s Page

Bridget Garland, MA

Abstract: Quick Quiz: What do the following movies have in common? As Good as it Gets (1997), Born on the Fourth of July (1989), Dr. T and the Women (2000), The Fisher King (1991), Girl, Interrupted (1999), Hamlet (2000), Secret Window (2004), Sybil (1976), When a Man Loves a Woman...

(pp 552)

Vitamin D: Deficiency or no Deficiency?

Mohsen Eledrisi, MD, FACP, FACE, Reem Alamoudi, MD, Buthina Alhaj, RN, Rifat Rehmani, MD

Abstract: To the Editor: Vitamin D deficiency is a common disorder that can have adverse effects on bone metabolism. There is no universal agreement on the levels of serum 25-hydroxyvitamin D that define vitamin D deficiency. Several cut-off points were suggested, including levels...

(pp 543-544)

Aspartame-induced Thrombocytopenia

H. J. Roberts, MD, FACP, FCCP

Abstract: To the Editor: The cause of thrombocytopenia is often not found. Owing to my interest in reactions to aspartame products,1 I have encountered four cases of thrombocytopenia which may be attributed to products containing aspartame, especially based on its recurrence on two...

(pp 543)

Classical Nodular Sclerosis Hodgkin Lymphoma Presenting with Central Nervous System Disease

Akshay K. Gupta, MD, Dennis Meisner, MD, Neetu Talreja, Ryan Smith, MD, Steven H. Swerdlow, MD

Abstract: To the Editor: The incidence of primary classical nodular sclerosis (CNS) lymphoma has increased significantly over the last 2 decades. Non-Hodgkin lymphomas (NHL) of B-cell origin account for the majority of these neoplasms. In contrast to NHL, CNS involvement by Hodgkin...

(pp 549-550)

Phytophotodermatitis Due to Puncture from Lime Tree Thorn

Lawrence M. Roth, MD, Elizabeth H. Levin, MD, Arthur H. Schwartz, MD, David J. Roth, BA

Abstract: To the Editor: Phytophotodermatitis is a cutaneous phototoxic inflammatory eruption due to exposure to light-sensitizing botanical substances and long-wave ultraviolet radiation that usually begins approximately 24 hours after exposure and peaks at 48 to 72 hours.1 The...

(pp 544-545)

Rhabdomyolysis Associated with Pulmonary Tuberculosis

Samer Zeayter, MD

Abstract: To the Editor: Rhabdomyolysis, a syndrome of muscle breakdown, is caused by a variety of infectious and noninfectious etiologies. To my knowledge, this is the first reported case of rhabdomyolysis caused by active pulmonary...

(pp 544)

Electrical Storm and Implanted Defibrillators

Charles P. Davis, MD, PhD

Abstract: To the Editor: As more patients obtain automatic implantable cardioverter defibrillators (AICDs), EMS personnel and emergency medical centers will be required to treat the unique situations that such patients present to emergency center personnel. One unique presentation is...

(pp 547-548)

Acute Pancreatitis Induced by Adult Precursor B-cell Acute Lymphoblastic Leukemia Associated with Complex Cytogenetics

Amr Hanbali, MD, Philip Kuriakose, MD, Ila Bansal, MD, Koichi Maeda, MD

Abstract: To the Editor: We report the case of a patient with precursor B-cell acute lymphoid leukemia and poor cytogenetics who presented with acute pancreatitis related to...

(pp 548-549)

Ilioinguinal-Inguinal Nerve Block for Hernia Repair

Richard K. Baumgarten, MD

Abstract: To the Editor: A recent article1 and editorial2 describing ilioinguinal-iliohypogastric nerve block (IHNB) for inguinal hernia repair, while thought provoking, is also troubling. The authors have performed a prospective randomized clinical trial (PRCT) and then presented...

(pp 542)

Response to Dr. Baumgarten’s Comments

Aysun Yilmazlar, MD

Abstract: To the Editor: In response to Dr. Richard K. Baumgarten’s letter, we would like to emphasize the following:First, our study is a retrospective one on 126 patients who had undergone inguinal hernia...

(pp 542-543)