February 2009, Volume 102 - Issue 2

Community-Associated Methicillin-Resistant Staphylococcal Infection in an Inner City Hospital Pediatric Inpatient Population

Elizabeth Tejeda-Ramirez MD, Majda Behani MD, Robert J. Leggiadro MD

Abstract: Background:Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a serious problem in the community setting, primarily as a cause of skin and soft tissue infections.Methods:A retrospective study based on the review of pediatric inpatients admitted to Lincoln...

(pp 135-138)

Pharmaceuticals Companies’ Medication Assistance Programs: Potentially Useful but Too Burdensome to Use?

Maria Pisu PhD, Joshua Richman MD, PhD, Jeroan J. Allison MD, O Dale Williams MPH, PhD, Catarina I. Kiefe MD, PhD

Abstract: Objectives:This study examined how physicians perceive pharmaceutical companies’ medication assistance programs (MAPs).Methods:The study was conducted using a survey of 373 primary care physicians from four southern states; they were surveyed within the formative...

(pp 139-144)

A Comparative Study of Unscheduled Hospital Readmissions in a Resident-Staffed Teaching Service and a Hospitalist-Based Service

Carlos Palacio MD, MPH, FACP, Irene Alexandraki MD, FACP, Jeffrey House DO, FACP, Arshag D. Mooradian MD

Abstract: Background:The rate of unscheduled readmissions is an important quality indicator with financial implications for hospitals.Objective:To determine if resident-staffed services have more favorable outcomes compared to hospitalist services, predictors of readmissions were...

(pp 145-149)

Use of Intrathecal Nicardipine for Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm

As’ad Ehtisham MD, MBBS, FAHA, Scott Taylor PharmD, Linda Bayless ARNP, Owen B. Samuels MD, Michael W. Klein BA, Jeff M. Janzen BA

Abstract: Background:Cerebral vasospasm leading to delayed ischemia is a common and serious complication of aneurysmal subarachnoid hemorrhage that often results in increased morbidity and mortality. Treatments for cerebral vasospasm, including triple-H therapy (therapeutic...

(pp 150-153)

Comparison of Bronchoscopic Washing and Gastric Lavage in the Diagnosis of Smear-Negative Pulmonary Tuberculosis

Bahadir T. Uskul MD, Hatice Turker MD, Aydin Kant MD, Mualla Partal MD

Abstract: Objective:To evaluate the diagnostic contribution and utility of bacteriologic surveys using bronchoscopic washing and gastric lavage in cases of radiologically suspected tuberculosis with no detectable acid-fast bacilli (AFB) in the sputum.Material and Methods:This...

(pp 154-158)

Chinese Metabolic Syndrome Risk Score

Fone-Ching Hsiao MD, Chung-Ze Wu MD, Chang-Hsun Hsieh MD, Chih-Tsueng He MD, Yi-Jen Hung MD, Dee Pei MD

Abstract: Background:The metabolic syndrome (MetS) was first proposed to predict the occurrence of cardiovascular disease and type 2 diabetes. However, it is difficult to identify subjects with MetS early. No previous studies designed to develop a predictive model for MetS in the...

(pp 159-164)

Tracheobronchial Foreign Body Aspiration in Adults

Michael Boyd MD, Arjun Chatterjee MD, Caroline Chiles MD, Robert Chin Jr MD

Abstract: Abstract:Tracheobronchial foreign body (TFB) aspiration is rare in adults, although incidence rates increase with advancing age. Risk factors for TFB aspiration in adults are a depressed mental status or impairment in the swallowing reflex. Symptoms associated with TFB...

(pp 171-174)

New Guidelines for the Prevention and Treatment of Osteoporosis

E Michael Lewiecki MD, Nelson B. Watts MD

Abstract: Abstract:The World Health Organization Fracture Risk Assessment Tool (FRAX™) and the National Osteoporosis Foundation’s (NOF) Clinician’s Guide to Prevention and Treatment of Osteoporosis are helpful clinical tools in the management of osteoporosis....

(pp 175-179)

Concurrent Smoking-Related Interstitial Lung Diseases in a Single Patient

Abdullah Altayeh MD, Fadi Alkhankan MD, William Triest MD, Shadi Badin MD

Abstract: Abstract:The three smoking-related interstitial lung diseases (ILD) include desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and pulmonary Langerhans cell histiocytosis (PLCH). They are considered discrete...

(pp 180-183)

Adult Segmental Hirschsprung Disease

İlhami Yüksel MD, Hilmi Ataseven MD, İbrahim Ertuğrul MD, Ömer Başar MD, Nurgül Şaşmaz MD

Abstract: Abstract:Hirschsprung disease (HD) is characterized by aganglionosis, which mainly occurs in the rectum and distal sigmoid colon. Typical HD is seldom diagnosed in adulthood, and segmental involvement is very rare. A 37-year-old man suffered from refractory constipation for...

(pp 184-185)

A Strange Case of Acute Abdomen

Laurence A. Galea MD, MRCSEd, Predrag Andrejevic MD, FRCSI, Mario Vassallo MD, FRCP

Abstract: Abstract:A 30-year-old male suffered from acute abdomen following duodenal biopsy taken at esophagogastroduodenoscopy (EGD). Exploratory laparotomy showed a large retroperitoneal hematoma arising from the second part of the duodenum that was then treated conservatively. To...

(pp 186-187)

Acute Acalculous Cholecystitis Simulating Mirizzi Syndrome: A Very Rare Condition

Sushil K. Ahlawat MD

Abstract: Abstract:Mirizzi syndrome, a rare complication of chronic cholelithiasis, is caused by an impacted stone in the cystic duct or the neck of the gallbladder. Patients present with abdominal pain, fever, and obstructive jaundice. The cholangiographic finding is a smooth...

(pp 188-189)

Disseminated Intravascular Coagulation Precipitated by Thyroid Storm

Donald Martin MD

Abstract: Abstract:Thyroid storm is a rare disorder. Early recognition and treatment are essential in reducing morbidity and mortality from this disease. Described here is a case of atypical thyroid storm (normothermic, normotensive), accompanied by multiple organ dysfunction...

(pp 193-195)

Xanthogranulomatous Inflammation of the Colon: A Rare Cause of Cecal Mass With Bleeding

A Ziya Anadol MD, FACS, Ipek Isik Gonul MD, Ekmel Tezel MD, PhD

Abstract: Abstract:Xanthogranulomatous inflammation is a well-defined disease most frequently reported in the kidney and gallbladder. The occurrence of this disease in the colon is extremely rare, with only five cases of appendix vermiformis involvement in the literature. Its...

(pp 196-199)

The Rising Tide: Skin and Soft Tissue Infections Due to Community-Associated Methicillin-Resistant Staphylococcus aureus

Michael P. Stevens MD, Michael B. Edmond MD, MPH, MPA

Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of skin and soft tissue infections (SSTIs) in persons without typical healthcare-associated MRSA (HA-MRSA) risk factors, such as hospitalization or residence in a long-term care facility,...

(pp 121-122)

Community-Acquired Methicillin-Resistant Staphylococcus aureus: An Emerging Cause of Acute Bacterial Parotitis

Nelson P. Nicolasora MD, Mark A. Zacharek MD, Anurag N. Malani MD

Abstract: Abstract:Staphylococcus aureus has long been recognized as a cause of acute bacterial parotitis. A case of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) parotitis is presented, highlighting the emergence of this increasingly important pathogen to...

(pp 208-210)

An Interesting Case of Positional Hypoxia: The Effect of Multiple Synergistic Pathological Conditions

Michael W. Tempelhof MD, Alice L. Gray MD, Thomas W. Wallace MD

Abstract: Abstract:This report describes an elderly patient evaluated for generalized fatigue, dyspnea, presyncopal episodes, and positional hypoxemia. Workup revealed posturally related oxygen desaturation, a patent foramen ovale (PFO), an atrial septal aneurysm, and primary adrenal...

(pp 211-213)

Bilateral Leser-Trélat Sign Mirroring Lung Adenocarcinoma with Early Metastases to the Contralateral Lung

Constantin A. Dasanu MD, PhD, Doru T. Alexandrescu MD

Abstract: Abstract:We present a case featuring a unique overlap between the body areas involved by lung adenocarcinoma and the cutaneous paraneoplastic sign of Leser-Trélat. In our patient, the Leser-Trélat sign consisted of explosive multiple seborrheic keratoses in...

(pp 216-218)

Physician Customer Satisfaction and Medication Assistance Programs from Pharmaceutical Companies

Joshua Fogel PhD

Abstract: According to the US Census Bureau, in 2006 approximately 15.8% (47 million) of Americans did not have health insurance1—many because of financial constraints. Consequently, these people also cannot afford the cost of the medications necessary to treat their...

(pp 123-124)

Unusual Metastasis of Carcinoma Gallbladder

Pankaj Kumar Garg MS, Niladhar S. Hadke MS

Abstract: To the Editor:A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall, anterior chest wall, back, and in both breasts for the previous two months. These nodules presented simultaneously, were painless and increased progressively in size. She...

(pp 220-221)

Synchronous Occurrence of Colorectal Adenocarcinoma and Colonic Gastrointestinal Stromal Tumor

Dimitrios A. Dimitroulopoulos MD, PhD, Niki A. Arnogiannaki MD, PhD, Dimitrios P. Korkolis MD, PhD, Dimitrios N. Xinopoulos MD, PhD, Emmanouil T. Paraskevas MD, PhD, Aikaterini P. Fotopoulou MD

Abstract: To the Editor:Gastrointestinal stromal tumors (GISTs) have only recently become recognized as a distinct pathologic entity.1 The vast majority of these tumors are positive for CD117 and vimentin in immunohistochemical staining.2GISTs typically present in older individuals...

(pp 221-222)

Big Bleed After Endoscopic Mucosal Biopsy

David M. Friedel MD

Abstract: The case report by Galea et al1 concerns a life-threatening retroperitoneal bleed after duodenal biopsies during a routine esophagogastroduodenoscopy (EGD) to screen for celiac disease. It is likely that the artery inadvertently was clasped or punctured by the forceps....

(pp 129)

Thyroid Dysfunction and the Coagulation System: The Often Ignored Link

Hima Boppidi MBBS, Sumanth R. Daram MD, FACP

Abstract: The relationship between thyroid dysfunction and coagulation abnormalities has been known for a very long time.1 These coagulation abnormalities have been in the form of thrombotic disorders as well as bleeding diatheses. Most of the abnormalities of the coagulation system...

(pp 132)

Tick Paralysis as a Cause of Autonomic Dysfunction in a 57-Year-Old Female

Paul Crawford MD, Deana Mitchell DO

Abstract: Abstract:Both Guillain-Barré and tick paralysis can present with ataxia and acute, ascending, flaccid motor paralysis. While autonomic dysfunction has been identified in Guillain-Barré, it has never been reported in association with tick...

(pp 190-192)

Childhood Hepatitis A Virus Infection Complicated by Pseudotumor Cerebri

Rajoo Thapa MD, Apurba Ghosh MD, MRCP (Ire), MRCP (UK), FRCPCH, Swapan Mukherjee MD, DM

Abstract: Abstract:A 4-year-old male child with hepatitis A virus (HAV) infection is presented. His disease course was complicated by the development of pseudotumor cerebri (PC), as evidenced by symptoms and signs of increased intracranial pressure in the presence of normal...

(pp 204-205)

Peritoneal Dialysis Masking Symptoms of an Insulinoma Uncovered During the Perioperative Period: A Case Report

Robert A. Jarrett MD, MS, Clay A. Block MD

Abstract: Abstract:A 61-year-old male with a chronic history of renal insufficiency treated with peritoneal dialysis (PD) was discovered to be asymptomatic for an occult insulinoma after peripheral revascularization. The patient's near continuous provision of glucose in the PD...

(pp 214-215)

Paralysis in an Adolescent

Krishan Kumar MD, Faiz Khan MD, Haidee Custodio MD

Abstract: Abstract:An 18-year-old male with a history of diabetes presented with hemiparesis. His serum glucose was low, but did not fit the numerical criteria for hypoglycemia. His symptoms rapidly reversed after glucose infusion. This case illustrates crucial features of...

(pp 200-201)

Inguinal Endometriosis: Three Cases and Literature Review

Stelios Apostolidis MD, PhD, Antonis Michalopoulos MD, PhD, Theodossis S. Papavramidis MD, Vassilis N. Papadopoulos MD, PhD, Daniel Paramythiotis MD, PhD, Nick Harlaftis FACS

Abstract: Abstract:Three cases of endometriosis infiltrating the round ligament are presented. The initial diagnosis was irreducible hernia, since this rare nosologic entity often causes unusual preoperative symptoms and diagnostic problems. Diagnosis is frequently made by histologic...

(pp 206-207)

Artifactual Laboratory Abnormalities in Patients with Paraproteinemia

Vivek Roy MD

Abstract: Abstract:Paraproteinemia, most often as a result of monoclonal gammopathy of unknown significance (MGUS), is very common and its prevalence is expected to increase with the aging of the population. Paraproteins can be associated with a variety of laboratory abnormalities....

(pp 167-170)

Boerhaave Syndrome Presenting as Massive Hemothorax

Herb A. Phelan MD, FACS, Scott C. Brakenridge MD, Travis J. Rutland MD, Carl Maltese MD

Abstract: Abstract:Boerhaave syndrome is a rare entity which classically presents with perforation and mediastinal sepsis. The patients' outcome is directly related to the length of time required to diagnose and surgically address the syndrome. Atypical presentations can...

(pp 202-203)

Hirschsprung Disease in Adults

Kunal Grover MD, Sushil K. Ahlawat MD

Abstract: Congenital aganglionic megacolon was first described in 1886 by Harald Hirschsprung, who described the autopsies of infants who died with swollen abdomens and hypertrophied colonic walls. The pathophysiology has been hypothesized to be a failure of the neural crest cells to...

(pp 127-128)

Cholecystectomy in Patients with Mirizzi Syndrome: A Formidable Challenge

Jaques Waisberg MD, FACS

Abstract: In this issue of the Journal, Ahlawat1 describes a case of acute acalculous cholecystitis which simulated Mirizzi syndrome (MS). MS, a rare complication of prolonged cholelithiasis, has a spectrum that varies from extrinsic compression of the common hepatic duct to the...

(pp 130)

Guidelines to Improve Maternity Practices and Support Breast-Feeding Are Readily Available

Virginia Thorley OAM, PhD, IBCLC, FILCA

Abstract: To the Editor:Breast-feeding, as the species-specific food for infants, offers optimal nutrition and provides economic benefits to the family, health system, and society.1–5 There is convincing evidence for the adequacy of human milk as the only nutritional intake for...

(pp 222-223)

Bilateral Vocal Cord Paralysis in Systemic Lupus Erythematosus

Ankur Lodha MD, Mehandi Haran MD, Michael Byrne MD

Abstract: To the Editor:Laryngeal involvement in systemic lupus erythematosus (SLE) is rare. It can range from mild ulcerations to vocal cord paralysis. Most are responsive to steroid therapy. We present a rare case of SLE with rapidly progressing pulmonary hypertension and bilateral...

(pp 223-224)

Simple Disease, Complex Work-up

Ali Seifi MD, Zia Salam MD, FACE, M Yaser Mourad MD, FACP, Sahar Avestimehr MD, Dara Lankaranian MD, Gurpreet Sidhu MD

Abstract: To the Editor:Hypercalcemia is a fairly common metabolic emergency. Rapid diagnosis of hypercalcemia may be complicated because symptoms associated with hypercalcemia are characteristically nonspecific.A 50-year-old white male with no significant past medical history was...

(pp 224)

Klebsiella pneumoniae Deep Neck Infection with Acute Necrotizing Esophagitis

Yi-Heng Liu MD, Yu-Sheng Lin MD, Hung-Jen Chen MD, Chih-Yen Tu MD, Wei Chen MD

Abstract: To the Editor:Deep neck space infections are potentially life-threatening conditions which may cause significant complications, such as mediastinitis, pleural empyema, pericarditis, and disseminated intravascular coagulopathy. However, to our knowledge, acute necrotizing...

(pp 219)

Smoking-Associated Interstitial Lung Diseases

Chirag Choudhary MD, Rendell W. Ashton MD

Abstract: Smoking is the number one preventable cause of untimely death and mortality in the Unites States and worldwide.1,2 Cigarette smoking is the main cause of lung cancer and the leading cause of death due to cancer in both sexes.1,2 Every year, research reveals more harmful...

(pp 125-126)

Unilateral Clubbing Without Shunts

Weekitt Kittisupamongkol MD

Abstract: To the Editor:I read with interest the article by Cerny et al.1 The authors conclude that arteriovenous shunts are a “condition sine qua non” to develop hypertrophic pulmonary osteoarthropathy. I disagree. Arterial graft sepsis and hemiplegic stroke, which are...

(pp 219-220)

Lecturing for Industry—Death by Powerpoint®

John F. Fisher MD, FACP, FIDSA

Abstract: In a cramped antechamber with noisy, sliding glass doors just off the main dining room of a trendy Italian restaurant, a few physicians, a few more hospital pharmacists, two nurse clinicians, and a medical technologist mill about in several uncomfortable groups waiting for...

(pp 133-134)

Tick Paralysis: An Uncommon Dimension of Tick-Borne Diseases

Shashank Purwar MD, PhD

Abstract: Ticks are arachnids, related to spiders and scorpions. During the late Paleozoic or early Mesozoic era they became parasites,1 and are second only to mosquitoes in transmitting vector-borne diseases to humans. Ticks of medical importance are divided into two families:...

(pp 131)

Medical Webwatch

Jim Young

Abstract: From Indiana University comes Human Embryology Animations http://www.indiana.edu/∼anat550/embryo_main/index.html produced by “Dr. Valerie O'Loughlin, Assistant Professor of Anatomy and Director of Undergraduate Human Anatomy.” Their animations were...

(pp 225)

Patient’s Page

Melissa Bright BA

Abstract: Preventing Heart Failure: Protecting Your Heart, Saving Your LifeThe heart is the body’s most important organ. The fetal heart develops as early as three weeks, and, from there, works nonstop for an entire lifetime. The human heart beats around 100,000 times...

(pp 119-120)

February 2009 CME Questions


Abstract: Artifactual Laboratory Abnormalities in Patients with Paraproteinemia1. The following is true about monoclonal gammopathy:A. The most common cause in unselected individuals is monoclonal gammopathy of undetermined significance (MGUS)B. The prevalence of monoclonal...

(pp 165)

CME Submission Form


Abstract: ...

(pp 166)



Abstract: In the article “Gastric Carcinoid Tumor in Association with Hepatocellular Carcinoma: A Case Report,” which appeared in volume 101 of the Southern Medical Journal on pages 1170–1172, the last names of several of the authors were inadvertently listed as the...

(pp 218)