January 2011, Volume 104 - Issue 1

Tackling the Problem of Childhood Obesity

Saurabh Sethi, MD, MPH

Abstract: Obesity has become one of the most important public health problems in the United States (US).1 Body mass index (BMI) is the standard measure for classifications of overweight and obesity in children who are two years and older.2 An overweight condition for a child of...

(pp 3-4)

Vitamin D Deficiency in Primary Hyperparathyroidism


Abstract: Vitamin D deficiency is common in the general population, and even more prevalent in primary hyperparathyroidism. Boudou et al1 reported that 93% of patients who underwent parathyroidectomy had vitamin D deficiency compared to 38% of the general population. Another study...

(pp 5-6)

Overactive Bladder: An Urgent Problem

Brent A. Parnell, MD

Abstract: Urinary incontinence commonly affects women in the United States (US) with a prevalence of 15.7%. This prevalence increases with age, resulting in greater than 30% of women over 80 years of age experiencing significant incontinence.1 As the population in the US continues to...

(pp 7-8)

What Is It?

James V. Lewis, MD

Abstract: What is the object on the radiograph pictured at right? The answer to this question is provided in the letter to the editor on page 71 of this...

(pp 11)

Primary Care Practice Addressing Child Overweight and Obesity: A Survey of Primary Care Physicians at Four Clinics in Southern Appalachia

Nicole Holt, MPH, Karen E. Schetzina, MD, MPH, William T. Dalton III, PhD, Fred Tudiver, MD, Hazel Fulton-Robinson, BS, Tiejian Wu, MD, PhD

Abstract: Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these...

(pp 14-19)

Mortality from Chronic Obstructive Pulmonary Disease Among Adults Aged 25 Years or Older in North Carolina

David W. Brown, DSc, MScPH, MSc, Roy A. Pleasants, PharmD

Abstract: Objectives: Recent reports highlight variation in the burden of chronic obstructive pulmonary disease (COPD) mortality across the United States. This report describes COPD mortality in North Carolina (NC). Methods: Data on COPD deaths were obtained from the National Vital...

(pp 20-23)

Retrospective Analysis and Patient Satisfaction Assessment of Insulin Pump Therapy in Patients with Type 2 Diabetes

Chad K. Gentry, PharmD, L. Brian Cross, PharmD, CDE, Benjamin N. Gross, PharmD, BCPS, CDE, M. Shawn McFarland, PharmD, BCPS, BC-ADM, William H. Bestermann, MD

Abstract: Objectives: To evaluate and assess glycemic control, total daily insulin requirements, weight, and patient satisfaction after changing from multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) therapy in patients with type 2 diabetes. Methods:...

(pp 24-28)

Etiology and Treatment of Overactive Bladder in Women

Howard A. Shaw, MD, MBA, Lara J. Burrows, MD, MSc

Abstract: Overactive bladder (OAB) is a condition that affects millions of women in the United States (US). Although the etiology is largely unknown, risk factors include Caucasian race, insulin-dependent diabetes mellitus, and history of depression. Patients present with urgency...

(pp 34-39)

Emergence of Klebsiella pneumoniae Carbapenemase-Producing Bacteria

Ryan S. Arnold, MD, Kerri A. Thom, MD, MS, Saarika Sharma, MD, MA, Michael Phillips, MD, J. Kristie Johnson, PhD, Daniel J. Morgan, MD

Abstract: Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria are a group of emerging highly drug-resistant Gram-negative bacilli causing infections associated with significant morbidity and mortality. Once confined to outbreaks in the northeastern United States (US), they...

(pp 40-45)

Polyarteritis Nodosa in a Patient with Type 1 Autoimmune Hepatitis

Olga Giouleme, Alexander Mpoumponaris, Spiridon Aslanidis, Panagiotis Anagnostis, Panagiotis Giamalis, Nikolaos Nikolaidis, Themistoklis Vasiliadis, Nikolaos Evgenidis

Abstract: Polyarteritis nodosa is a systemic necrotizing vasculitis that affects small- and medium-sized arteries. Liver involvement in patients with polyarteritis nodosa has been described, and ranges from asymptomatic elevation of aminotransferases to hepatic aneurysm rupture. We...

(pp 49-52)

Disseminated Intravascular Large B Cell Lymphoma with Slowly Decreasing High-Density Lipoprotein Cholesterol

Amit Garg, MD, Elizabeth M. Hosfield, MD, Leslea Brickner, MD, FACP

Abstract: Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal large B cell lymphoma in the lumina of small vessels. Low high-density lipoprotein cholesterol (HDL-C) is associated with sepsis, malignancy, and death. Recent evidence suggests an inverse...

(pp 53-56)

Lead Poisoning from a Gunshot Wound

Bhavya Rehani, MD, Robert Wissman, MD

Abstract: Lead poisoning from gunshot wounds is unusual. Awareness of this rare but serious complication can guide the physician in making a prompt diagnosis. We present a case of a 30-year-old male who had a remote history of a gunshot wound in the right knee and presented with...

(pp 57-58)

An Unusual Cause of Chronic Lower Back Pain in an Elderly Woman: Lost Intrauterine Device

Nuray Kadioğlu Voyvoda, MD, Gülay Koçak, MD, Erdem Koçak, MD, Bekir Voyvoda, MD

Abstract: To the Editor: Intrauterine contraceptive devices (IUCD) are an effective means of contraception for many women worldwide. Migration of an IUCD into the urinary bladder, rectum, colon, peritoneum, omentum, appendix, wall of the iliac vein, or ovary has been reported.1 The...

(pp 71)

Prompt Diagnosis and Treatment of Strongyloidiasis in a Renal Transplant Patient

Alexandros Briasoulis, MD, George Psevdos, MD

Abstract: To the Editor: A 44-year-old woman on hemodialysis for the last nine years received a cadaveric renal transplant one month prior to presentation. She had immigrated to the United States from Guyana at age 29 years and subsequently had never traveled to an area where...

(pp 72-73)

Erythema Multiforme Secondary to H1N1 Vaccine

Irenawati Samad, MBBS, Vui Heng Chong, MRCP, FAMS, FRCP, Sabrina Su Hong Binti Abdul, Azim Lim, MBBS, MRCP

Abstract: To the Editor: Since the development of the H1N1 pandemic vaccines, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have recommended vaccination to reduce the impact of the current H1N1 influenza pandemic.1,2 These vaccines have been...

(pp 73-74)

Operational Tolerance After Immunosuppressive Withdrawal in a Case with Renal Transplantation

Salih İnal, MD, Yasemin Erten, MD, Kürsad Öneç, MD, Fatma Ayerden Ebinç, MD, Turgay Arinsoy, MD

Abstract: To the Editor: Renal transplantation is the first choice of replacement therapy in patients with end-stage renal disease. New immunosuppressive regimens have greatly reduced the risk of acute rejection and led to overall improvements in graft and patient survival. However,...

(pp 74)

Effect of Sequential Treatment as a First-Line Therapy for Helicobacter pylori Eradication in Patients with Diabetes Mellitus: Erratum


Abstract: In the article that appeared on page 988 of the October 2010 issue, incorrect dosing information regarding tetracycline was provided. The dose frequency should be tetracycline 500 mg four times per day (q.i.d.) for the remaining seven days, rather than tetracycline 500 mg...

(pp 75)

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


Abstract: In the article that appeared on page 940 of the September 2010 issue, an author was inadvertently omitted from the article's byline. The byline should appear as follows: Hien Nguyen, MD, Connie Le, MD, and Hanh Nguyen, MD. Dr. Hanh Nguyen's affiliation is the Department of...

(pp 75)

Addressing Childhood Obesity in Primary Care Practice: A Challenge and an Opportunity

Michael A. Tolle, MD, MPH

Abstract: With appropriate fanfare, First Lady Michelle Obama formally announced in February the far-reaching Let's Move campaign, directed at eliminating in a generation America's epidemic of childhood obesity.1 Encouraging involvement from a broad range of sectors–public,...

(pp 1-2)

Carbon Monoxide or Nitric Oxide: Which Came First?

Jana G. Spillers, BSN, RNC

Abstract: Pulmonary hypertension has a poor prognosis with mortality, ranging as high as 50%. Echocardiograms, measures of pulmonary artery pressures, and ventilation-perfusion scans (V/Q scan) offer the most definitive diagnosis and assessment of disease progression and treatment...

(pp 9-10)

In Memory – Former SMA President G. Thomas Jansen, MD

Kane Webb

Abstract: Dr. G. Thomas Jansen, aged 84, of Little Rock, Arkansas passed away peacefully on September 14, 2010, surrounded by his family in...

(pp 12-13)

Clinical Significance of Vitamin D Deficiency in Primary Hyperparathyroidism, and Safety of Vitamin D Therapy

Nasser Mikhail, MD, MSc

Abstract: Vitamin D deficiency occurs more frequently in patients with primary hyperparathyroidism (PHPT) compared with the general population, and is usually associated with an aggravated form of the disease. Current guidelines recommend measurement of serum levels of 25-hydroxy...

(pp 29-33)

Carboxyhemoglobin Formation Secondary to Nitric Oxide Therapy in the Setting of Interstitial Lung Disease and Pulmonary Hypertension

Phillip Ruisi, DO, Michael Ruisi, MD

Abstract: Carbon monoxide (CO) has been widely recognized as an exogenous poison, although endogenous mechanisms for its formation involve heme-oxygenase (HO) isoforms, more specifically HO-1, in the setting of oxidative stress such as acute respiratory distress syndrome, sepsis,...

(pp 46-48)

Intramural Gallstones Mimicking Typical Lithiasic Cholecystitis

Stylianos Apostolidis, MD, PhD, Apostolos Zatagias, MD, Alexandros Zevgaridis, MD

Abstract: Gallstone disease is common in the western population. Intramural gallstones are rare, with only a few cases reported in the literature. We present a 30-year-old female patient with typical symptoms of cholecystitis. The patient underwent laparoscopic cholecystectomy one...

(pp 59-60)

False-Positive Amplified Mycobacterium tuberculosis Direct Tests in Skin Specimens of Leprosy

Thomas S. Breza Jr, MD, James M. Magill Jr, MD, Na’im K. Fanaian, MD, Francisco A. Ramos-Caro, MD

Abstract: The amplified Mycobacterium tuberculosis (M tuberculosis) direct test (MTD) is reported to be a highly sensitive (92.6%) and specific (100%) test for the detection of M tuberculosis. We report two cases of human leprosy in which false-positive amplified MTD testing on skin...

(pp 61-63)

Acute Epidural Abscess Complicating Pneumococcal Meningitis in Adult

Khalid Abidi, MD, Fatima Zohra Ahouzi, MD, Rachid Gana, MD, Tarek Dendane, MD, Naoufel Madani, MD, Amine Ali Zeggwagh, MD, Redouane Abouqal, MD

Abstract: Acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. We report an uncommon case of advanced pneumococcal meningitis complicated by acute lumbar epidural abscess in an adult. A 35-year-old man was admitted to the medical intensive care unit with...

(pp 64-67)

Adenoid Cystic Carcinoma of Trachea Treated with Tumor Curettage and Adjuvant Intensity Modulated Radiation Therapy

Cheng-Yu Chang, MD, Shin-Lung Cheng, MD, Shih-Chieh Chang, MD

Abstract: Primary tracheal tumors are rare, accounting for only 0.2% of all thoracic cancers. Adenoid cystic carcinoma (ACC) is the second most common tracheal malignancy. Most ACC patients present with dyspnea, and the symptoms often mimic those of asthma or chronic bronchitis. We...

(pp 68-70)

Radiation-Associated Prolactinoma

Floyd W. Robinson, BS, James M. Gray, MD

Abstract: To the Editor: Prolactinoma is a secretory pituitary tumor. Clinical symptoms and manifestations are secondary to either prolactinoma-associated growth (resulting in cranial nerve palsies and visual field defects), adenoma-related hyperprolactinemia (resulting in sexual and...

(pp 71-72)