The renin-angiotensin-aldosterone system (RAAS) plays a major role in blood pressure regulation and is thus an important therapeutic target in the management of hypertension. Angiotensin receptor blockers (ARBs), which interrupt RAAS overactivity by blocking a specific receptor that mediates the pathogenic activity of angiotensin II, represent a major addition to…
Objective: To determine if B-natriuretic peptide (BNP), handheld ultrasound, and echo interpretation was an accurate and reliable screening for stage B heart failure. Methods: One hundred and forty-five indigent diabetic patients were prospectively enrolled, and their BNP levels were measured. Each patient underwent a handheld echo. Results: BNP was correlated…
Hypertension affects about one-third of the adult United States population.1 Although multiple classes of antihypertensive agents are currently available, hypertension remains untreated or undertreated in a large proportion of persons in the US and worldwide.2 Reasons cited for this observation include physician inertia—failure in initiation of treatment or failure to…
Infected cardiac myxoma is a rare entity. It poses a diagnostic challenge as clinical presentation may reflect an underlying infectious, immune, or a neoplastic disease process. To the best of our knowledge, the first case of a cardiac myxoma infected with Staphylococcus lugdunensis is reported in a 54-year-old man with…
Objectives: Emergency physicians (EPs) and Juris Doctors (JDs) often disagree on the correct use of restraints for emergency department (ED) patients. The objective of the study was to compare EPs and JDs propensity to restrain patients given various scenarios. The study hypothesis was that EPs and JDs would agree on…
In their accompanying article, Vrettos et al1 report a case of severe thrombocytopenia in a 65-year-old woman that was associated with the use of rosuvastatin for treatment of dyslipidemia. The reported adverse event did not result in a serious adverse clinical outcome and resolved with the discontinuation of the culprit…
To the Editor: Over the last decades, few reports have linked cholangiocarcinoma with humoral hypercalcemia of malignancy (HHM). We present herein a female patient with cholangiocarcinoma involving multifocally the right hepatic lobe. In our patient, the HHM was the presenting clinical sign, leading to increasing confusion and somnolence. Most of…
To the Editor: Cocaine in its varied forms has become increasingly popular as a recreational drug in the past few years. Along the increase of cocaine abuse, there has been an increasing incidence of medical complications including: myocardial infarction, spontaneous abortion, and intracerebral hemorrhage. In addition to the expanding list…
Objective: The aim of this study was to identify the degree of burnout among resident physicians enrolled in seven postgraduate training programs at Texas Tech University Health Sciences Center (TTUHSC), Paul L. Foster School of Medicine, El Paso, Texas, as it related to residents’ age, gender, marital status, number of…
We report an unusual case of tibial osteomyelitis resulting from Bacille Calmette-Guerin vaccination and causing subsequent cortical destruction and a subcutaneous abscess. A 10-month-old infant initially presented with a tender palpable mass below the left knee. Radiographs showed an osteolytic lesion in the proximal metaphysis of the tibia. Magnetic resonance…
With the passage of the healthcare bill, even as Americans continue to debate health care reform, several components of this giant monster are under scrutiny. However, one important element of the industry is all but forgotten. It is common knowledge that in 2008, the nation spent $2.3 trillion1 on healthcare…
Correction of hyperlipidemia with statins is often limited by the side-effect of statin-induced myalgias. Vitamin D deficiency is also associated with myalgias that resolve with correction of the vitamin D deficiency. Myalgias associated with statin therapy may also resolve with correction of vitamin D deficiency. This case report presents a…
To the Editor: I read the recent original report by Lin et al1 on Chlamydia pneumoniae and metabolic syndrome (MeS) with a great interest. Lin et al1 concluded that “there is a positive association between C pneumoniae seropositivity and MeS, which supports the role of infection in the pathogenesis of…
We are reporting the case of a 37-year-old immunocompetent patient who presented with anterior chest wall swelling, jaw swelling and pain, back pain, night sweats, and unintentional weight loss. He underwent mediastinoscopy with lymph node biopsy, which revealed caseating and noncaseating granuloma and special stains positive for acid-fast bacteria. Cultures…
To the Editor: Dyspnea leading to respiratory failure is not uncommon in patients with known malignancy. The underlying differential for this presentation is broad and needs careful clinical assessment and imaging studies to make a correct diagnosis. Microscopic pulmonary tumor embolus is a rare but potentially fatal complication of cancer,…
Objective: To determine whether faulty pool maintenance and substandard lifeguard performance critically delayed retrieval and resuscitation of a significant number of pool drowning victims. Methods: One hundred and eighty drowning incidents that resulted in litigation from 1998 to 2008 were studied to determine whether faulty pool maintenance and/or substandard lifeguard…
Objective: Liver disease associated with hepatitis C virus (HCV) is a serious cause of mortality among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (PLWHA). Little is known about the HCV knowledge of PLWHA. Methods: One hundred seventy-nine patients at an infectious disease clinic were interviewed on HCV knowledge…
To the Editor: Acute colonic pseudo-obstruction (ACPO) is the clinical syndrome of acute large bowel dilatation without mechanical obstruction. Typically, it develops in hospitalized or instutionalized patients with serious underlying medical and surgical conditions.1 We report an unusual case of ACPO that happened after polypectomy was performed in an otherwise…
Acquired hemophilia is a severe hemorrhagic diathesis characterized by the emergence of anti-factor VIII inhibiting antibodies. It is rarely seen in certain types of cancers as a paraneoplastic syndrome. The case of a 73-year-old patient who developed acquired hemophilia during the course of treatment for a gastrointestinal stromal tumor is…
Delusions of parasitosis are a rare psychiatric disorder in which the patient has a fixed, false belief of being infested with parasites. The disorder is classified as primary if no cause is identified or secondary if associated with general organic conditions, psychiatric illnesses, and drugs (substance induced). Several medications have…
Objective: Lymphoma can arise at any anatomic site, but it is rare to find kidney involvement. The aim of this study was to assess the role of 18F-flourodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in detecting lymphoma with renal involvement. Reports of such use of 18F-FDG PET/CT are limited….
In this issue of the Southern Medical Journal, inadvertent intravenous injection of contrast material during a cervical transforaminal injection is described.1 Two conclusions are drawn: Whitacre-type spinal needles do not prevent intravascular injections and a negative aspiration for blood is not a reliable sign of intravascular entry by the needle….
A 78-year-old euthyroid patient presented for evaluation of a symptomatic, slowly growing neck mass. Ultrasound scan revealed a multinodular goiter and a hypoechoic nodule of the right thyroid lobe. Total thyroidectomy was performed and the lesion was completely excised. Definite diagnosis was obtained after histological examination of the surgical specimen….
A 19-year-old female presented with acute onset of bizarre behavior, confusion, auditory hallucinations, and delusions after two weeks on a 100 kcal/day diet. She had a normal neurological examination. Urinalysis showed ketones 4+. She had elevated antinuclear antibody (ANA) (320) and positive heterozygous factor V Leiden mutation. Magnetic resonance imaging…
Isolated ventricular noncompaction (IVNC) is a congenital cardiomyopathy characterized by a distinctive (“spongy“) morphological appearance of the left ventricular (LV) myocardium. It is rare but, with improved imaging modalities and awareness, it is being reported more frequently. Clinical manifestations may range from being asymptomatic to heart failure, arrhythmias, sudden cardiac…
To the Editor: We read with interest the publication by Gupta et al1 on inappropriate use of acid suppression therapy (AST) in the hospital setting. Apart from being overused, they also showed that there were no predictive factors of inappropriate prescription of AST, including concomitant use of ulcerogenic drugs. Our…
To the Editor: We present the case of a 55-year-old woman with end-stage kidney disease requiring hemodialysis. She was found to have autosomal dominant polycystic kidney disease (ADPCKD) in 1999. Her mother was diagnosed with ADPCKD in the same year and had a deceased donor kidney transplant. The patient underwent…
Acute kidney injury (AKI) secondary to hepatorenal syndrome (HRS) is an ominous complication of end-stage liver disease (ESLD). In HRS, splanchnic and peripheral vasodilatation with reduction in effective arterial volume causes activation of mechanisms leading to intense renal vasoconstriction and functional AKI. HRS is a diagnosis of exclusion and all…
Minoxidil-Associated Exudative Pleural Effusion Atif Siddiqui, MD, Mohammed Ansari, MD, Jawairia Shakil, MD, and Rama Chemitiganti, MD In the case report that appeared on page 458 of the May 2010 issue, Dr Siddiqui’s affilation should have read Texas Tech University Health Science Center at the Permian Basin, Odessa, Texas.
To the Editor: I read with disbelief the letter entitled “Fantasy-Land, Reality-Land, and Guns” by Hemphill.1 I agree that guns are dangerous, as are automobiles, cigarettes, and childhood obesity. The fantasy is that objects are blamed for bad decisions, and the reality is that personal responsibility is the underlying issue.
A case of steroid-refractory organizing pneumonia (OP) as the initial presentation of plasma cell leukemia (PCL) in a patient who had no prior exposure to chemotherapy or radiation is described. Since OP is traditionally a steroid-responsive disease, this case raises the possibility of a previously unknown patient subgroup with variable…
We present a case of intravascular injection in a 41-year-old female during cervical selective nerve root injection using a 22-gauge 3.5-inch Whitacre-type pencil-point subarachnoid needle with a curve placed at the distal tip positioned using continual live fluoroscopic guidance. After negative aspiration for blood and cerebrospinal fluid and no elicited…
Rosuvastatin, a statin indicated for patients with primary hypercholesterolemia, mixed dyslipidemia and familial hypercholesterolemia, is well tolerated by most patients. Its most common adverse effects are gastrointestinal derangement, muscle aches and hepatitis. One rare complication of statin treatment is severe thrombocytopenia. The case of a 65-year-old patient who developed severe…
Objective: Pulmonary hypertension (PH) is a serious and often progressive disorder that results in right ventricular dysfunction. The general reported rate of patients who are responders is 10%–26%. More recently, using the current criteria, the rate of acute vasodilator response was as low as 6%. This study used the most…
A 65-year-old male with a history of diabetes, hypertension, hyperlipidemia, gout, Barrett esophagitis, and chronic gastritis developed acute pancreatitis after taking one week of the herbal medicine, saw palmetto, for symptoms related to benign prostatic hyperplasia (BPH). Ultrasound and computed tomography ruled out cholelithiasis and obstruction, triglycerides were normal, and…
Much of what is known today about the thyroid gland, its function in health and disease, is attributed to the pioneering work by Emil Theodor Kocher.1 Although at the dawn of a new millennium, videoscopic-assisted thyroidectomy is now possible, and the fundamental technical details remain the same as was described…
Macrodactylia Fibrolipomatosis Presenting as a Small Bowel Obstruction Sonya Kenkare, BS, and Bujji Ainapurapu, MD In the case report that appeared on page 248 of the March 2010 issue, the abstract identifies the patient as “she” and the text identifies the patient as “he.” The patient is, in fact, male.
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