Issue - Southern Medical Association

Primary Article

Antineutrophil Cytoplasmic Antibodies: Clinical Characteristics of 10 Patients With the Perinuclear Pattern of Immunofluorescence on ANCA Testing

ABSTRACTAntineutrophil cytoplasmic antibodies (ANCA) have recently been described in association with necrotizing glomerulonephritis, systemic vasculitis, and other autoimmune-mediated connective tissue diseases, including systemic lupus erythematosus (SLE) and polychondritis. At least two distinct classes of ANCA have been described, differentiated by characteristic immunofluorescence patterns using neutrophils as substrate for indirect immunofluorescence…

Primary Article

Transplacentally Transmitted Autoimmune Disorders of the Fetus and Newborn: Pathogenic Considerations

ABSTRACTAutoimmune diseases affect a significant number of women in their childbearing years. This group of disorders constitutes a heterogeneous spectrum with a common basis involving the presence of autoantibodies often of the IgG type. Transplacental transfer of autoantibodies is not uncommon, and autoantibodies can be readily demonstrated in newborn serum….

Primary Article

Psychologic Sequelae of Chronic Toxic Waste Exposure

ABSTRACTExposure to toxic industrial substances has been a topic of increasing concern to environmentalists, government agencies, industrial engineers, and medical specialists. Our study focuses on the psychologic symptom responses of a community to perceived long-term exposure to toxic waste products. We compared their symptom clusters, as shown by their responses…

Primary Article

Automatic Implantable Cardioverter-Defibrillator: Early Experience at Wilford Hall USAF Medical Center

ABSTRACTFifteen patients with malignant ventricular arrhythmias were treated with the automatic implantable cardioverter-defibrillator (AICD) over a 22-month period. The cause of the arrhythmia was coronary artery disease in 13 of the patients (87%), sarcoid cardiomyopathy in one (7%), and a primary electrical abnormality in one (7%). The mean ejection fraction…

Primary Article

Cone Biopsy in Premenopausal Women: Why Was Outpatient Management Abandoned?

ABSTRACTIn a 2-year retrospective study, I reviewed the records of 180 premenopausal patients who had had cone biopsy. The purpose of this study was to determine the indications for the procedure in the view of the practicing clinician and to determine whether these young women might have received better treatment…

Review Article

Lesions of the Nasal Radix in Pediatric Patients: Diagnosis and Management

ABSTRACTLesions involving the nasal radix are not extremely uncommon in the pediatric population. Such lesions may represent inflammatory or infectious processes, neoplasia, traumatic sequelae, or developmental anomalies, but faulty embryogenesis is considered the most common cause. During my surgical experience, I have encountered nasal dermoids, nasal gliomas, and nasal encephaloceles…

Primary Article

Relationship Between Breast Cancer and Meningioma

ABSTRACTSeveral authors have suggested the existence of a relationship between breast cancer and meningioma occurring in the same patient. I describe four patients who had both of these neoplasms and present findings that dispute the implied relationship between the two.

Primary Article

Topical Pharmacotherapy for Allergic Rhinitis: New Agents

ABSTRACTThe advantages of topical (as opposed to systemic) therapy for allergic rhinitis include the avoidance of undesirable systemic effects and the concentration of therapeutic effect on the target organ. Successful topical therapy requires establishment of a proper diagnosis, followed by effective delivery of the medication to the nasal mucosa. In…

Primary Article

Drug Therapy in the Elderly

ABSTRACTThe segment of the population older than 65 accounts for about 25% of the total drug expenditures in developed countries. This figure is predicted to reach 40% by the year 2030. Drug therapy in the elderly can be complicated by many factors. The pharmacokinetic processes of absorption, distribution, metabolism, and…

Case Report

EDTA-Induced Pseudothrombocytopenia

SUMMARYA 45-year-old man was admitted to the hospital because of unstable angina pectoris. During the wait for coronary artery bypass surgery, the platelet count gradually decreased from 154 000 to 20 000/mm3, without hemorrhagic manifestations. Medications were discontinued and surgery was postponed. Direct blood smear revealed a normal number of…

Case Report

Adrenal Insufficiency and Stage D Carcinoma of the Prostate

SUMMARYA patient with stage D prostatic cancer but in reasonably good general health was discovered to have adrenal failure and tumor destruction of the adrenal glands. Because prostatic cancer is common and compatible with prolonged survival, we surveyed other patients with stage D prostatic cancer. On initial screening with the…

Case Report

Lyme Arthritis With Subarticular Cyst Formation in Metacarpal and Metatarsal Bones

SUMMARYA young woman was treated for seronegative rheumatoid arthritis for more than 9 years, without clinical improvement, before the diagnosis of chronic Lyme arthritis of the metacarpal and metatarsal phalangeal joints was made. Roentgenograms showed subarticular cyst formation in the metacarpal and metatarsal bones. The patient's response to treatment with…

Case Report

Antineutrophil Cytoplasmic Antibody Associated With Pulmonary Hemorrhage: Wegener’s Granulomatosis?

SUMMARYAntineutrophil cytoplasmic antibodies have been described mainly in patients with Wegener's granulomatosis. It has proven useful for both diagnosis and follow-up in these patients. We have described a patient with diffuse pulmonary hemorrhage in whom the suspicion of Wegener's granulomatosis was raised by the identification of antineutrophil cytoplasmic antibodies.

Case Report

Infantile Gastrointestinal Hemangioma as a Cause of Chronic Anemia

SUMMARYGastrointestinal hemangiomas, though rare, can be an important source of GI bleeding in infants. In the past, diagnosis has been hampered by a lack of reliable methods. With the recent advent of selective mesenteric angiography, the suspected diagnosis can be readily confirmed. Surgical resection remains the definitive therapy; steroid therapy…

Case Report

Transvaginal Intra-abdominal Impalement Injury

SUMMARYImpalement injuries due to sexual activity are highly unusual and variable. We have described a case of transvaginal impalement injury of the rectum, bladder, omentum, and mesentery manifested by vaginal bleeding. The patient could not recount how she had been injured. Management of such an injury requires extensive initial evaluation…

Case Report

Malignant Fibrous Histiocytoma Arising From the Superficial Femoral Artery

SUMMARYPrimary sarcomatous arterial tumors are rare. We have reported a case of malignant fibrous histiocytoma in an elderly woman successfully treated by resection of the involved femoral vessel and reconstruction with a PTFE graft. The long-term result in this patient is presently uncertain.

Case Report

Cushing’s Syndrome With Cranial and Pulmonary Lesions: Necessity for Tissue Diagnosis

SUMMARYThis report describes two cases of Cushing's syndrome associated with radiologic abnormalities in the lung and brain. In both cases, the pathologic diagnosis of the intracranial lesion was unsuspected and prompted changes in management. These cases illustrate that the etiology of pulmonary and central nervous system mass lesions in patients…

Case Report

Pancytopenia Caused by Unsuspected Pernicious Anemia Complicating Sickle Cell β-Thalassemia

SUMMARYWe have described a a 23-year-old black woman with sickle cell β-thalassemia who had a urinary tract infection and who was incidentally found to be pancytopenic. Although her anemia was categorized as “normocytic, normochromic” by an electronic particle counter, evaluation of the pancytopenia confirmed unsuspected pernicious anemia. Greater vigilance and…

Case Report

Miliary Tuberculosis: Unusual Cause of Abdominal Pain in Pregnancy

SUMMARYWe have described a case of miliary tuberculosis, with symptoms primarily due to hepatic involvement during pregnancy. Liver biopsy showed granulomatous hepatitis, and subsequent cultures of sputum, urine, and gastric aspirate were positive for Mycobacterium tuberculosis. Although this patient was seronegative for HIV, an increased incidence of extrapulmonary and disseminated…

Case Report

Primary Squamous Cell Carcinoma of the Breast

SUMMARYWe have described three patients with primary squamous cell carcinoma of the breast. All three have remained well after modified radical mastectomy. One patient received postoperative radiotherapy. Estrogen receptor status was determined by monoclonal antibody technology in two cases, and the results were negative.

Case Report

Undifferentiated Small Cell Carcinoma of the Urinary Bladder

SUMMARYWe have reported a case of small cell carcinoma of the urinary bladder in a 65-year-old white man with a smoking history. He had radical cystectomy, but died 6 months after initial diagnosis. The patient terminally had liver metastasis, confirmed by fine needle aspiration and radiographic evidence of intra-abdominal and…

Announcement

86th Annual Scientific Assembly of the Southern Medical Association

Case Report

Azathioprine: Effective Steroid-Sparing Therapy for Generalized Lichen Planus

Case Report

Cholesterol Microembolization and Stable Renal Function With Continued Anticoagulation

Letter to the Editor

Drug Interactions With Oral Contraceptives

Editorial

FIRST-ORDER PREVENTION AND SECOND-ORDER TREATMENT: HEALTH CARE IN THE DEVELOPED WORLD IS TOO LONG ON THE LATTER

Evagations

GOOD MORNING, LUCIFER

Case Report

Listeria monocytogenes Causing Endovascular Infection

Letter to the Editor

Missing Members

Letter to the Editor

Prolonged Recrudescence of Plasmodium falciparum

Announcement

Scientific Exhibits and Posters Rules and Regulations

Letter to the Editor

The Future of CME

Article

Theoretic Orientations and Folk Medicine Research in the Appalachian South

Editorial

WHY CLINICAL TRIALS FAIL: THE HIDDEN ASSUMPTIONS OF CLINICAL TRIALS