Since its development in the 1950s, vancomycin has had a prominent role in the treatment of staphylococcal infections. Soon after its debut, the first cases of methicillin-resistant Staphylococcus aureus (MRSA) were reported (1961),1 but remained a rarity until the late 1970s.2
Muscle overlying the intramyocardial segment of an epicardial coronary artery is defined as a myocardial bridge, and the artery coursing within the myocardium is known as a tunneled artery. It is an inborn coronary abnormality that was recognized at autopsy by Reyman1 in 1737 and first identified angiographically by Portmann…
Pyomyositis is an acute endemic infection, initially seen in tropical areas. Over the last several years, however, more cases have been reported in temperate areas, especially among patients with immunodeficiency. This increase could reflect the use of more advanced imaging techniques, but also corresponds to a rising number of immunocompromised…
Background: Oxybutynin is a tertiary amine and has chemical similarities like protamine sulfate. Protamine sulfate’s effect on bacterial viability has been shown in some studies; however, there is scanty data regarding the effect of oxybutynin on bacterial viability. Accordingly, the aim of the present study was to investigate the effect…
Objective: This study proposed to assess the relationship between power Doppler ultrasound examination and spectral Doppler analysis of hand joints with clinical and laboratory parameters in rheumatoid arthritis. Methods: Patients receiving disease-modifying antirheumatic drugs or biologics (infliximab) underwent joint examination and were assessed by a Health Assessment Questionnaire, Duruoz’s Hand…
Background: Transient ischemic attack (TIA) is presumed to be of cardiovascular origin. The aim of the study was to evaluate the electrocardiographic, echocardiographic, and clinical signs for predicting TIA recurrence. Methods: A total of 100 consecutive patients presenting with a first episode of TIA without atrial fibrillation, previous stroke, and…
Background: The purpose of this study was to examine: (a) the extent to which patients report having used conventional and nonconventional treatments for osteoarthritis in family medicine settings and (b) how patient characteristics are related to the use of these treatments. Methods: A survey was sent to 2,178 patients with…
Objectives: Adverse behavioral profiles, particularly depression and hostility, increase the risk of coronary artery disease (CAD) and affect recovery after CAD events. We sought to determine the effects of outpatient phase II cardiac rehabilitation and exercise training (CRET) programs in CAD patients with high levels of psychological distress. Methods: We…
Atherothrombosis describes the superimposition of a thrombus on a ruptured atherosclerotic plaque, and is the primary cause of acute ischemic events. Atherothrombosis is a generalized and progressive process with an inflammatory component. Patients with disease in one vascular bed are at risk of disease in another, a concept known as…
The increase in vancomycin use in the 1980s to treat antibiotic-associated colitis and methicillin-resistant Staphylococcus aureus (MRSA) is largely responsible for the appearance of vancomycin-resistant enterococcus, which in turn spawned isolated cases of vancomycin-resistant S. aureus. Perhaps most worrisome to clinicians are strains of MRSA that are heteroresistant to vancomycin;…
Cladophialophora bantiana, a dematiaceous fungus, is an uncommon pathogenic organism originally thought to more commonly affect immunocompetent patients. Increasing numbers of reports, however, describe the organism affecting immunocompromised patients. Like all dematiaceous fungi, Cladophialophora can be recognized in histopathologic sections by the golden-brown coloration in the walls of the hyphae….
Surgical tracheostomy was first described in 1909. Since then, it has become a standard procedure for patients requiring prolonged mechanical ventilation. More recently, bedside percutaneous tracheostomy has been shown to be as safe and effective as the surgical technique, but with the added advantage of also being technically straightforward and…
Isolated involvement of the sternum with tuberculosis is rare. Only a few cases of sternal tuberculosis have been reported in literature. Tubercular sternal osteomyelitis presenting as multiple cutaneous sinuses over the anterior chest wall is extremely rare. We present a patient with sternal tuberculosis presenting as multiple cutaneous sinuses over…
Chest pain continues to be one of the leading emergency department presentations. Acute coronary syndrome is the most dreaded chest pain scenario, as “time is myocardium” in this situation. Numerous benign and less life-threatening diseases like early repolarization, acute pericarditis, and vasospastic angina can present with a similar clinical picture….
Four patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are described. Two patients presented with sustained ventricular tachycardia and two with cardiac arrest from which they were successfully resuscitated. All four patients had typical electrocardiographic and echocardiographic features and fulfilled the task force criteria for diagnosis of ARVD/C. All four patients…
Pyomyositis is a musculoskeletal infection with formation of an intramuscular abscess. Endemic in tropical climates, it is being reported with increasing frequency in temperate climates such as the United States. The most common causative organism is Staphylococcus aureus, present in greater than 90% of reported cases. Risk factors include underlying…
The hyalohyphomycetes (especially Fusarium sp.) have emerged as significant pathogens in severely immunocompromised patients. Human infections by Fusarium sp. can be superficial or limited to single organs in otherwise healthy patients. Such infections are rare and tend to respond well to therapy. By contrast, disseminated fusarial hylohyphomycosis affects the immunocompromised…
The case of a 38-year-old man with a history of chronic migraine is reported. Despite a 3 week history of changes in his migraine pattern, a normal neurologic examination led to conservative treatment. He later presented with worsening headaches and imbalance; tendon reflexes were increased on the right side, and…
Core competencies. Pay for performance. Physician, hospital, and health plan “report cards.” In medicine, we are growing accustomed to having our performance measured, rather than having it simply assumed. Society wants to be able to choose the best provider in the best system by evaluating objective evidence rather than just…
The article by Sarani et al1 published in this issue of the Southern Medical Journal illustrates how important it is to understand the different steps of the percutaneous techniques, the different potential complications, and the pitfalls of this operation. This is an article that will be beneficial both for surgeons…
&NA;Cardiac Rehabilitation Programs Markedly Improve High-Risk Profiles in Coronary Patients with High Psychological Distress (pages 262–267).1. Psychological stress has been: A. Associated with cardiovascular health, especially coronary events. B. Associated with major cardiovascular risk factors, including obesity, diabetes, dyslipidemia, and hypertension. C. Recently associated with inflammatory biomarkers. D. All of…
Objectives: Despite the availability of guidelines for the treatment of status epilepticus (SE), there may be variability in the initial stabilization, evaluation, and pharmacologic treatment of infants and children with SE. To improve the treatment of such patients, documentation of these problems is needed. The current study is a prospective…
Over the course of the millennia, cultures from around the world independently came to the same erroneous conclusion that emotions originate in the heart. Indeed, the words anger, angst, anguish, and angina all derived from the same Greek root word meaning constriction. Though emotions emanate from the brain, they resonate…
To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, Iervasi et al evaluated 3,121 cardiac patients with euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3). After mean follow-up of 32 months, there were 65 and 140 cardiac and…
Clinicians are often faced with the dilemma of how to treat osteoarthritis patients who are not completely satisfied with the conservative therapy outlined in the guidelines issued by the American College of Rheumatology and other organizations. Doctors and patients have hoped that glucosamine might be the answer for added pain…
Diastolic dysfunction occurs in up to 50% of patients with hypertension. Characterized by abnormalities of left ventricular (LV) filling, it is often associated with clinical heart failure. Antihypertensive agents that inhibit the renin–angiotensin-system (RAS) have been shown to improve diastolic function, but whether this is related to their blood pressure…
In a recent analysis of Framingham data, Dhingra et al1 demonstrate that baseline consumption of at least one soft drink a day is associated with an approximately 45% increase in the incidence and prevalence of the metabolic syndrome as defined by National Cholesterol Education Program (NCEP) guidelines, compared with subjects…
Cardiovascular diseases still represent the major cause of death in most developed countries and ultimately kill as many men as women.1 In the last decades, the management of a number of “traditional” risk factors (including obesity, diabetes, smoking, hypertension, and hypercholesterolemia) has led to a significant reduction in cardiovascular morbidity…
Seasonal epidemics of influenza and influenza-like illnesses continue to have a major impact upon the population of the United States, resulting in approximately 36,000 deaths and over 200,000 hospitalizations each year during recent decades.1,2 The Advisory Committee on Immunization Practices (ACIP)3 published its recommendations for the upcoming 2007–2008 influenza season…
Profiles in Science and Medicine http://profiles.nlm.nih.gov/browse/, from the National Library of Medicine, has profiles of 26 leaders in biomedical research and public health. Each of these multifaceted biographies expands to offer a selection from alphabetical listing, chronological presentation, or “Exhibit,” which is a standard format biography. There is a “What’s…
The Facts About MRSA There is a growing number of MRSA cases in the United States, with the infection appearing more and more frequently in hospitals, schools, and nursing homes. With this increase in outbreaks comes an increase in fear: what should I do to prevent this potentially deadly infection?…
To the Editor: The recent release of data regarding the cardiovascular (CV) safety of rosiglitazone (Avandia) raised major public concern. The author presents herein an updated summary of CV safety data of rosiglitazone and provides a rationale for avoiding its use outside the setting of clinical trials.
To the Editor: Inhaled adenosine is well known to produce bronchoconstriction in asthmatic patients. However, there have been few case reports and studies describing the airway effects of intravenous (IV) adenosine in the asthmatic population. Adenosine is a frequently used agent in pharmacologic cardiac stress testing, due to its effects…
To the Editor: Cytomegalovirus (CMV) infection is of major concern in transplant patients, and can mimic many diseases including gastric carcinoma, colon carcinoma, ischemic colitis, and intestinal pseudoobstruction. We report a case of a renal transplant recipient developing a CMV-related giant gastric ulcer mimicking carcinoma.
To the Editor: The resistance to chemotherapy is a very important clinical issue in advanced stage nonsmall cell lung cancer (NSCLC), and because of this resistance, some patients unnecessarily receive chemotherapy despite adverse toxicities.
Dr. Luis M. Alvarado Franklinton, LA Dr. Michael Amsden Orange, TX Dr. William Anderson Charleston, SC Dr. Ignacio Andueza Coral Gables, FL Dr. Abdallah Askar Raleigh, NC Dr. Jeanne Attrep Avondale, AZ Dr. Janos Bacsanyi Chevy Chase, MD Dr. James Baker Williamsburg, VA Dr. Willie Banks Washington, DC Dr. &…
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