Issue - Southern Medical Association

Primary Article

Teenagers’ Perceptions of Barriers to Prenatal Care

ABSTRACT: A structured interview conducted during the postpartum hospitalization of 184 patients aged 17 years or younger was used to study teenagers' perceptions of barriers to prenatal care. The interview consisted of more than 100 questions on demographic characteristics, family and social support, desire for the pregnancy, perceptions of the…

Review Article

Chronic Pulmonary Aspiration in Children

ABSTRACT: According to established diagnostic and therapeutic guidelines for chronic pulmonary aspiration, clinical suspicion is raised by coughing and choking with feeding, coughing during sleep, recurrent pneumonia, failure to thrive, and radiologic signs of chronic lung injury. The upper gastrointestinal series accurately defines anatomy and function, can differentiate between direct…

Primary Article

Carisoprodol (Soma): A New and Cautious Perspective on an Old Agent

ABSTRACT: Carisoprodol (Soma, others) is a commonly prescribed, noncontrolled, skeletal muscle relaxant whose active metabolite is meprobamate. Patients for whom carisoprodol is prescribed are at risk for meprobamate dependence; several such cases have been reported. Toxicity and withdrawal associated with the use of meprobamate is high and has led to…

Primary Article

In Utero Exposure to Cocaine: A Review

ABSTRACT: Cocaine is now regarded as one of the most dangerous illicit drugs available today. A disturbing trend in the pattern of cocaine use is that groups long considered unlikely to be involved in drug use, including women of childbearing age, pregnant women, the pediatric age group, fetuses, and neonates,…

Article

Treating Diseases, Not Patients

ABSTRACT: Highly trained medical specialists now possess a vast array of sophisticated technical apparatus with which to fight diseases. These tools, coupled with a growing emphasis on cost accounting and a medical paradigm emphasizing facts and depicting the human body as a machine, depersonalize health care by militating against a…

Primary Article

Hyperpyrexia Among Patients in a Large Community Hospital: Causes, Features, and Outcomes

ABSTRACT: Hyperpyrexia, defined as temperature elevation of at least 106°F, is generally thought to be infrequently associated with infection. In a 3-year retrospective analysis of 39 episodes of hyperpyrexia in adults, 94%. of cases were associated with infection. In 35 patients (90%) the causes were potentially treatable, and the majority…

Primary Article

Changes Over Time in the Knowledge Acquisition Practices of Internists

ABSTRACT: Medical advances make continuing medical education (CME) necessary. Thirty practicing internists and 14 medical residents completed questionnaires and tests of critical appraisal knowledge designed to compare attitudes, behaviors, and skills for maintaining current knowledge. Eighteen internists were then given practical guidelines for “keeping up” with the literature, and this…

Primary Article

Stability of Midazolam Prepared for Oral Administration

ABSTRACT: Midazolam is used frequently as an oral premedication in children. To make it more palatable, it is often mixed in various syrups and solutions. No previous studies have documented the stability of midazolam when mixed in these solutions. Using high-pressure liquid chromatography, we assayed midazolam concentrations over time when…

Primary Article

Hyperammonemia: The Silent Killer

ABSTRACT: Nitrogen, derived from breakdown of dietary amino acids as ammonia, is normally converted to urea and excreted. Impairment in the conversion process (called the urea cycle) can occur, either as a consequence of primary genetic defects or through secondary suppression of enzyme activity. Either process results in hyperammonemia, producing…

Primary Article

Childhood Sexual Abuse, Depression, and Family Dysfunction in Adult Obese Patients: A Case Control Study

ABSTRACT: One hundred significantly overweight patients sequentially applying to a very low calorie diet (VLCD) program were interviewed to learn how the onset of obesity correlated with other life events. By comparison with a control group of 100 always-slender adults, the obese applicants were found to be different at a…

Our Medical Heritage

The First Reported Case of Radial Nerve Palsy

ABSTRACT: Radial nerve injury produced by anterior dislocation of the shoulder is uncommon. Here I present a probable case from 3,000 years ago, described in the Bible. My report is based on the “medical history” only. Differential diagnosis, laboratory findings, and treatment are discussed.

Primary Article

Evaluation of the Pelorus Stereotactic Surgical System for CT-Guided Stereotactic Brain Biopsy

ABSTRACT: The Pelorus Stereotactic Surgical System is a relatively new, commercially available device that can be used to perform computed tomography (CT)-guided stereotactic brain biopsy. It has been promoted as being a relatively simple and inexpensive system that is more rapid, less cumbersome, and generally easier to use than conventional…

Primary Article

Seastroke: A New Entity?

ABSTRACT: Three previously healthy young male patients had brain stem infarction (stroke) after swimming or wading in shallow water along the southeastern North Carolina coastline. Each patient remembered an unusual encounter with something in the water. None sustained any obvious local envenomation. Although these cases may be a highly unusual…

Primary Article

Cardiac Pacing Problems in Infants and Children: Results of a 4-Year Prospective Study

ABSTRACT: To evaluate cardiac pacing thresholds and the safety of a 2.5 V amplitude setting, we prospectively studied 29 pediatric patients during a mean follow-up of 16.4 months. Exit block (EB) at 2.5 V was confirmed during threshold analysis in 26% of 58 leads. No new cases were detected by…

Primary Article

Racial Differences in Perceptions Concerning Hypertension and Its Consequences

ABSTRACT: To investigate racial differences in hypertensive patients' understanding of their disorder, we administered a questionnaire to 83 black and 260 white outpatients with the diagnosis of hypertension designated in their medical chart. No racial differences in systolic or diastolic blood pressure, age, or male/female ratio were observed. However, blacks…

Primary Article

Nonpalpable Breast Lesion: Association of Mammographic Abnormalities With Diagnosis After Needle-Directed Biopsy

ABSTRACT: We reviewed the experience with needle-directed breast biopsies (NDBB) in a military medical center. In 195 patients, 207 NDBBs were done; 49 of these biopsies (24%) rendered a diagnosis of malignancy. The majority of patients (78%) had invasive cancer; 44% of them were found to have associated malignant axillary…

Primary Article

Diagnostic Dilemmas in Psychiatric Consultation/Liaison: The Problem of Depression

ABSTRACT: We use the case of a 62-year-old retired widow, referred for psychiatric evaluation by the internal medicine house staff, to illustrate the complexities of diagnosing depressive syndromes in medically ill patients. The patient's presenting symptoms included diarrhea, severe weight loss, and abdominal pain. She appeared cachectic, but diagnostic findings…

Case Report

Acute Epiglottitis During Pregnancy

Correspondence

Diagnosis of Systemic Histoplasmosis in AIDS Patients

Letter to the Editor

Diagnosis of Systemic Histoplasmosis in AIDS Patients Reply

Case Report

Disseminated Strongyloides stercoralis Infection

Case Report

Eastern Equine Encephalomyelitis With Hematuria and Bladder Dysfunction

Case Report

Hematocolpos in Elderly Women

Case Report

Hematometra Associated With Estrogen Replacement Therapy

Correspondence

Hypercalcemia Due to Hard Well Water in a Home Hemodialysis Patient

Case Report

Hyperprolactinemic Galactorrhea in a Patient With Hodgkin’s Disease and Intense Pruritus

Case Report

Midgut Volvulus Associated With Pregnancy

Case Report

Myeloperoxidase Deficiency and Severe Sepsis

Case Report

Pheochromocytoma Manifested as Noncardiogenic Pulmonary Edema

Current Concepts

Primary Care Management of Human Immunodeficiency Virus Infection

Case Report

Rifabutin in the Treatment of Cavitary Lung Disease Due to Mycobacterium gordonae