September 2010, Volume 103 - Issue 9

Urinothorax: Presentation of a New Case as Pleural Exudate

Roberto Bernabeu Mora, MD, Carmen Marín Silvente, MD, Juan Miguel Sánchez Nieto, MD, Maria Ángeles Chans Cuervo, MD

Abstract: Urinothorax or urothorax (UT) is a rare condition which often goes undiagnosed. In published cases of UT, the pleural fluid is usually transudative and is very rarely exudative. We present a case of UT after right nephroureterectomy for urothelial carcinoma, in which the...

(pp 931-933)

Types of Hair Loss and Treatment Options, Including the Novel Low-Level Light Therapy and Its Proposed Mechanism

Mahyar Ghanaat, MD

Abstract: Androgenetic alopecia (AGA) is the most common form of hair loss in men, and female pattern hair loss (FPHL) is the most common form of hair loss in women. Traditional methods of treating hair loss have included minoxidil, finasteride, and surgical transplantation....

(pp 917-921)

Change in Bilirubin Level Following Acute Myocardial Infarction Is an Index for Heme Oxygenase Activation

Koichiro Okuhara, MD, Tomohiko Kisaka, MD, Ryoji Ozono, MD, PhD, Satoshi Kurisu, MD, PhD, Ichiro Inoue, MD, PhD, Junko Soga, MD, Yoko Yano, MD, Tetsuya Oshima, MD, PhD, Yasuki Kihara, MD, PhD, Masao Yoshizumi, MD, PhD

Abstract: Objectives: Heme oxygenase 1 (HO-1) is rapidly induced by stress, degrading pro-oxidant heme into carbon monoxide, bilirubin, and free iron (Fe). Induction of HO-1 is an important defense mechanism against tissue injury. Here, we tested the hypothesis that HO-1 is activated...

(pp 876-881)

A Case of an Unusual Foreign Body of the Tongue

Tariq Parray, MD, M. Saif Siddiqui, MD, Edwin Abraham, MD, Jesus Apuya, MD, Shailesh Shah, MD

Abstract: To the Editor: We describe the management of a very unusual case of a 13-year-old girl presenting to the emergency department (ED) for removal of a large metallic globe (approximately 3 inches in diameter) entrapping the tongue (Fig.). The access to the oropharynx was...

(pp 966-967)

Clinical Manifestations, Radiographic Findings, Treatment Options, and Outcome in Sarcoidosis Patients with Upper Respiratory Tract Involvement

Efstratios Panselinas, MD, Lucinda Halstead, MD, Rodney J. Schlosser, MD, Marc A. Judson, MD

Abstract: Background: Sarcoidosis of the upper respiratory tract (SURT) is an underappreciated manifestation of sarcoidosis. We described the clinicoradiological findings, methods of treatment, and outcomes of 68 patients with SURT seen in our clinic over a 7-year period. Methods:...

(pp 870-875)

Successful Endoscopic Clip Closure of Postoperative Esophageal Leak

Ankur Sheth, MD, MPH, FACP, Deepthi Bollineni, MD, Kenneth Manas, MD

Abstract: To the Editor: Esophageal leaks can occur secondary to instrumental or pathologic perforation, postsurgical anastomotic leak, or formation of benign or malignant esophageal fistulae. Repair of the leak and diversion of the luminal contents along with nutritional support and...

(pp 968-969)

Scedosporium apiospermum Infection Presenting as a Pneumothorax and Cavitary Lung Lesions in a Patient with Acquired Immune Deficiency Syndrome

Shirin A. Mazumder, MD, Kerry O. Cleveland, MD, John Norwood, MD

Abstract: The Scedosporium genus consists of filamentous fungi that inhabit soil, sewage, manure, and polluted waters, and contains two medically important species: Scedosporium apiospermum and Scedosporium prolificans. Scedosporiosis is caused by inhalation or traumatic subcutaneous...

(pp 960-962)

Coexistence of Cerebral Tubers with Neurocysticercosis

Ramachandiran Nandhagopal MBBS, DM

Abstract: A case of tuberous sclerosis with seizure disorder and coexisting neurocysticercosis is reported. The diagnostic and therapeutic implications of establishing the proximate cause of clinical seizure type are described and...

(pp 953-955)

Southern Medical Association Announcement 3

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Abstract: SMA Insurance...

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Panniculitis Ossificans in a Patient with Excessive Push-ups: Imaging Findings with Histological Correlation

Wei-Chou Chang, MD, Herng-Sheng Lee, MD, Yi-Chih Hsu, MD, Chian-Her Lee, MD, Guo-Shu Huang, MD

Abstract: Panniculitis ossificans arising symmetrically in the subcutaneous layer of both shoulders is rare. A case of a 27-year-old man with recent history of doing excessive push-ups is reported. According to the patient's statement, there is no notable history of alcoholism, major...

(pp 947-949)

Clostridium difficile: An Update for the Primary Care Clinician

Alan R. Salkind, MD

Abstract: Clostridium difficile infection (CDI) is an important cause of intestinal disease, primarily affecting hospitalized patients exposed to antibiotics. Infection has been associated with prolonged hospital stays and excess healthcare expenditures. Recent changes in the...

(pp 896-902)

Subcutaneous Hydatid Cyst of the Thigh

Rikki Singal, MS, FICS, Usha Dalal, MS, Ashwani Kumar Dalal, MS, Prem Singh, MD, Raman Gupta, MS

Abstract: To the Editor: A 26-year-old woman presented with a swelling in the anteromedial part of her left thigh for the previous 14 months. The swelling had been gradually increasing. There was no history of trauma or fever. On examination, a well-defined, nontender swelling in the...

(pp 965-966)

Southern Medical Association Announcement 2

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Abstract: MedEd On-Demand...

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Bordetella bronchiseptica Bacteremia in a Patient with AIDS

Shirin A. Mazumder, MD, Kerry O. Cleveland, MD

Abstract: Bordetella bronchiseptica bacteremia is often associated with various infection in animals. The majority of B bronchiseptica infections reported in humans are cases of pneumonia. Very few cases have been reported in patients with a history of acquired immune deficiency...

(pp 934-935)

Type 2 Diabetes Mellitus: Managing Hemoglobin A1c and Beyond

Grant C. Fowler, MD, Deepa A. Vasudevan, MD

Abstract: Comprehensive glycemic control, as demonstrated by desirable glycated hemoglobin A1c (HbA1c), postprandial glucose (PPG), and fasting plasma glucose (FPG) levels, is imperative for managing patients with type 2 diabetes mellitus (T2DM). It is important to minimize...

(pp 911-916)

Acute Pylephlebitis Following Gastrointestinal Infection: An Unrecognized Cause of Septic Shock

José Altamirano, MD, Laura Zapata, MD, Manuel Poblano, MD, Agustín Rodríguez, MD, Leonardo Camargo, MD, Belinda Martínez, MD, Ramón Bataller, MD, PhD

Abstract: Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially...

(pp 956-959)

Alanine Aminotransferase Concentrations in Elite Athletes

Giuseppe Banfi, PhD

Abstract: To the Editor: I read the interesting paper published by Selden et al1,2 and the related correspondence. High values of alanine aminotransferase (ALT) in football players are linked with hypertension and metabolic syndrome, denying the expected healthy status of elite...

(pp 966)

Consideration of Subcutaneous Immunoglobulin Replacement Therapy in Humoral Immunodeficiency Patients

Jason K. Lee, MD, FRCPC, Stephen D. Betschel, MD, FRCPC

Abstract: Antibody-related defects or humoral primary immunodeficiencies account for 65–70% of all primary immunodeficiencies.1–3 Common variable immunodeficiency (CVID) is the clinically relevant primary immunodeficiency most commonly encountered. CVID is a heterogeneous group...

(pp 851-852)

Invasive Cancer in a Diminutive Rectal Polyp Amidst Internal Hemorrhoids Detected by Rectal Retroflexion

Mitchell S. Cappell, MD, PhD, Mihaela Batke, MD

Abstract: A diminutive rectal polyp amidst internal hemorrhoids, detected by rectal retroflexion during colonoscopy, was shown to harbor invasive rectal adenocarcinoma by colonoscopic biopsy. Initially this lesion had appeared to be a relatively innocuous prominent anorectal mucosal...

(pp 943-946)

Hemoptysis Requiring Bronchial Artery Embolization in Pulmonary Arterial Hypertension

Jose A. Cantu, MD, Zeenat Safdar, MD

Abstract: Objectives: Hemoptysis is an uncommon complication in patients with pulmonary arterial hypertension (PAH). Although the mechanism of hemoptysis is unknown, treatment with bronchial artery embolization (BAE) is proposed to be a safe and reliable method of treatment. We...

(pp 887-891)

Adenosquamous Carcinoma of the Pancreas: A Distinct Clinicopathologic Entity

Guru Trikudanathan, MD, Constantin A. Dasanu, MD, PhD

Abstract: Among exocrine pancreatic tumors, adenosquamous carcinoma (ASC) is a rare, aggressive subtype with a worse prognosis and a higher potential for metastases compared to its more conventional glandular counterpart, adenocarcinoma. The disease distribution shows an...

(pp 903-910)

Mucosa-Associated Lymphoma Tissue of the Dura Presenting as Meningioma

John Shaia, MD, P. Benjamin Kerr, MD, Ashima Saini, MD, Fabio Roberti, MD, Jyoti Kapil, MD, Robert Jones, MD, Jeanny B. Aragon-Ching, MD

Abstract: Mucosa-associated lymphoma tissue (MALT) of the dura is extremely rare, with only a few reported cases worldwide. We present a unique case of a 61-year-old female who presented with neurologic symptoms of unsteady gait, dizziness, and sharp pain on her scalp for 3 weeks. A...

(pp 950-952)

Southern Medical Association Announcement 1

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Abstract: 2010 Calendar of Educational...

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Amiodarone and Thyroid Dysfunction

Hema Padmanabhan, MD, FACP

Abstract: Amiodarone is a potent antiarrhythmic drug associated with thyroid dysfunction. Its high iodine content causes inhibition of 5′-deiodinase activity. Most patients remain euthyroid. Amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH) may...

(pp 922-930)

Myocarditis Masquerading as a ST Elevation Myocardial Infarction (STEMI)

Atman Shah, MD

Abstract: Myocarditis is an inflammatory disease of the myocardium with a wide range of clinical presentations, from vague flu-like symptoms to rapidly progressive heart failure. The diagnosis is made histopathologically, with the help of immunohistochemical stains. Myocarditis is...

(pp 936-939)

Cervical Myelopathy from Spinal Sarcoidosis as the Unexpected Initial Presentation for Systemic Sarcoidosis

Hien Nguyen, MD, Connie Le, MD

Abstract: This is a case which highlights unique diagnostic challenges in the evaluation of a previously healthy patient presenting with a myelopathy initially most concerning for malignancy. However, timely recognition and nonoperative therapy of unexpected spinal sarcoidosis with...

(pp 940-942)

Carotid Artery Puncture, Myocardial Injury, and Ventricular Arrhythmia

Vijay Arun Doraiswamy, MD, Vinayak Hegde, MD, Rajan Bhatt, MD, Jarrod Mosier, MD, Peter Ott, MD

Abstract: To the Editor: A 51-year-old woman with a history of obesity (body mass index of 40), alcohol abuse, and cirrhosis of the liver, came to our emergency room; she had lower left-sided chest pain, back pain, and hematuria resulting from an assault more than one week before....

(pp 967-968)

Proximal Intercessory Prayer

John R. Peteet, MD

Abstract: Studies of coping and of integrative therapies underline the importance of prayer to many patients and family. But what is the evidence that prayer influences medical...

(pp 853)

Cerebrospinal Fluid Viscosity: A Novel Diagnostic Measure for Acute Meningitis

Funda Yetkin, MD, Uner Kayabas, MD, Yasemin Ersoy, MD, Yasar Bayindir, MD, Sibel Altunisik Toplu, MD, Ibrahim Tek, MD

Abstract: Introduction: Early diagnosis of acute meningitis has paramount importance in clinical practice because of mortality and morbidity of the disease. Examination of cerebrospinal fluid (CSF) has critical value for the diagnosis of acute meningitis and discrimination of...

(pp 892-895)

Study of the Therapeutic Effects of Proximal Intercessory Prayer (STEPP) on Auditory and Visual Impairments in Rural Mozambique

Candy Gunther Brown, PhD, Stephen C. Mory, MD, Rebecca Williams, MB BChir, DTM&H, Michael J. McClymond, PhD

Abstract: Background: Proximal intercessory prayer (PIP) is a common complementary and alternative medicine (CAM) therapy, but clinical effects are poorly understood, partly because studies have focused on distant intercessory prayer (DIP). Methods: This prospective study used an...

(pp 864-869)

Case of Reverse Takotsubo Cardiomyopathy in Status Asthmaticus

Dusan A. Stanojevic, MD, Venkata M. Alla, MBBS, MD, Joseph D. Lynch, MD, Claire B. Hunter, MD

Abstract: To the Editor: We read with interest the paper on stress cardiomyopathy (SC) following use of ketamine and epinephrine by Osuorji et al1 in the March 2009 issue of the Southern Medical Journal. In this context, we would like to bring to the readers' attention a somewhat...

(pp 964)

Goals for HbA1c Need To Be Individualized Based on Clinical Judgment, Instead of Third Party Recommendations

David S.H. Bell, MD

Abstract: Fowler et al1 in this issue of the SMJ recommend a comprehensive approach to achieving a desirable HbA1c by controlling both postprandial and fasting glucose levels and are careful to emphasize that, in achieving a desirable HbA1c, hypoglycemia should be avoided. Very...

(pp 854-855)

Public Health Response to a Multidrug-Resistant Tuberculosis Outbreak Among Guatemalans in Tennessee, 2007

Roque Miramontes, PA-C, MPH, Lauren Lambert, MPH, Maryam B. Haddad, MSN, MPH, Valerie Boaz, MD, Stephen Hawkins, MD, Margaret Zylstra, RN, Rachel Allen, BS, Sheliah Rivers, RN, Brenda Ali, RN, Sarah Stuart Chewning, MPH, Erin Holt, MPH, Jon Warkentin, MD, MPH

Abstract: Background: In June 2007, the Tennessee Department of Health notified the Centers for Disease Control and Prevention of four multidrug-resistant tuberculosis (MDR TB) cases in individuals of Guatemalan descent, and requested onsite epidemiologic assistance to investigate...

(pp 882-886)

Improved Quality of Life, Immunoglobulin G Levels, and Infection Rates in Patients with Primary Immunodeficiency Diseases during Self-Treatment with Subcutaneous Immunoglobulin G

Melvin Berger, MD, PhD, Elyse Murphy, RN, BSN, Patty Riley, RN, BAN, CRN, Garrett E. Bergman, MD The VIRTUE Trial Investigators

Abstract: Objectives: Primary immunodeficiency diseases (PIDDs) include a large class of genetically heterogeneous disorders which predispose patients to significant risk of serious and chronic/recurrent infections, as well as reduced quality of life (QoL). Intravenous immunoglobulin...

(pp 856-863)

A Rare Cause of Wheezing

Martin Lopez, MD, Brighita Weinberg, MD, Muhammad Waseem, MD

Abstract: To the Editor: Wheezing is a common presentation in the emergency department (ED). Although common causes of wheezing are routine, certain etiologies may not be considered and can be overlooked. Scimitar syndrome is a rare cause of wheezing in infants. The usual...

(pp 963-964)