Issue - Southern Medical Association

Case Report

Spontaneous Pneumomediastinum in a Patient With Diabetic Ketoacidosis A Potentially Hidden Complication

ABSTRACTA pediatric patient with diabetic ketoacidosis (DKA) was found to have a pneumomediastinum and a small pneumothorax. Because some of the signs and symptoms of pneumomediastinum may be confused with those of the patient's primary disease process, this complication may be present more frequently than has been previously described.

Primary Article

Profile of HIV Disease in an American Border City

ABSTRACTA previous study on patterns of migration of HIV-infected persons suggested that most patients in a rural setting in eastern Tennessee acquired their disease in an urban area, typically during a period of prolonged residence. Disease and disability were the most common reasons for returning to their hometown. We studied…

Case Report

Cerebral Vasculitis Complicating Rheumatoid Arthritis

ABSTRACTCentral nervous system vasculitis is a rarely described complication of rheumatoid arthritis. We report a case of cerebral vasculitis in a 55-year-old woman with a 7-year history of seropositive, nodular rheumatoid arthritis. Striking multifocal abnormalities of the white matter on magnetic resonance imaging led to a suspicion of vasculitis despite…

Case Report

Compound Adrenal Medullary Tumor

ABSTRACTCompound tumors of the adrenal medulla, characterized by a mixture of pheochromocytoma and ganglioneuroma, are rare, only 12 cases having been reported in the literature. We present the case of a 66-year-old woman with a left-sided incidentally discovered adrenal mass that was subsequently shown to contain elements of pheochromocytoma and…

Primary Article

Supplemental Oxygen and Gastric pH in Unfed Preterm Infants

ABSTRACTHypoxia has been associated with decreased gastric acidity in infants and children. In neonates, an inverse relationship between gestational age and gastric acidity may confound this association. To assess the relationship between oxygen supplementation and gastric acidity in premature neonates, mean 24-hour continuous measurements of gastric pH, obtained by an…

Primary Article

Fluoroscopically Guided Nasoenteric Feeding Tube Placement Versus Bedside Placement

ABSTRACTIn debilitated patients, establishment of adequate nutritional status is important to decrease morbidity and mortality. The objective of this study is to compare the relative benefits and costs of bedside placement of enteric feeding tubes to fluoroscopic placement. We did a 4-year retrospective study of 328 nasoenteric feeding tube placements….

Primary Article

Forced Expiratory Flow Is Reduced by 100% Oxygen in Patients With Chronic Obstructive Pulmonary Disease

ABSTRACTIn order to determine the effect of breathing high fractional concentrations of oxygen on forced expiratory flow in individuals with chronic obstructive pulmonary disease (COPD), we studied 18 patients with moderately severe disease. The patients were studied breathing air, 100% oxygen, or a four-gas mixture in a randomized double-blind study…

Case Report

Vitiligo and Alopecia Areata in Patients With Human Immunodeficiency Virus Infection

ABSTRACTIn patients infected with human immunodeficiency virus (HIV) the development of autoimmune diseases, while not life threatening, is an interesting phenomenon that may result from immune dysfunction or from B cell infection by HIV, Epstein-Barr virus, or other unknown viruses. Vitiligo and alopecia areata are among the autoimmune diseases that…

Primary Article

Inguinal Wound Fluid Collections After Vascular Surgery Management by Early Reoperation

ABSTRACTInguinal wounds complicated by significant fluid collections after vascular grafting procedures were managed by exploration soon after recognition in 14 patients. Within 24 hours, incisions were reexplored, fluid collections were evacuated and cultured, and closed suction drains were placed. The wound was reapproximated, and broad spectrum antibiotics were given intravenously…

Case Report

Marked Deterioration in Glycemic Control With Change in Brand of Lactulose Syrup

ABSTRACTLactulose is a poorly absorbed synthetic disaccharide frequently used in the treatment of portasystemic encephalopathy. Because lactulose syrup contains small amounts of absorbable sugars, it may cause hyperglycemia in diabetic individuals, but is usually well tolerated. We report the case of a patient with diet-controlled diabetes and cirrhosis who experienced…

Primary Article

Meropenem Versus Imipenem/Cilastatin in the Treatment of Hospitalized Patients With Skin and Soft Tissue Infections

ABSTRACTMeropenem is a new carbapenem antibiotic shown to resist degradation by renal dehydropeptidase I. In a multicenter, open-label, prospective trial, we compared the efficacy and safety of meropenem with imipenem/cilastatin in patients with skin and soft tissue infections. Patients received either 500 mg of meropenem every 8 hours (n =…

Primary Article

Pseudoepitheliomatous Hyperplasia Mistaken for Cancer After Delayed Reconstruction*

ABSTRACTPseudoepitheliomatous hyperplasia (PEH) arises in areas of chronic inflammation and can be mistaken for squamous cell carcinoma, leading to unnecessary removal of more tissue. We present a study of 21 patients having delayed reconstruction of defects left by Mohs micrographic surgery (MMS) to remove facial skin cancers. Reconstruction was done…

Case Report

Circulating Xanthine Oxidase in Human Ischemia Reperfusion

ABSTRACTReactive oxygen species (ROS) generated from xanthine oxidase (XO) play an important role in ischemia-induced injury. We hypothesize that XO and xanthine dehydrogenase (XDH) are released into the circulation with ischemia reperfusion to the human liver and intestine. Blood was drawn from a patient, before and at intervals after an…

Primary Article

Blastomycosis Pulmonary and Pleural Manifestations

ABSTRACTSeven diverse cases of pulmonary blastomycosis were recently diagnosed at this institution. It is our purpose to review the unique features in the spectrum of this systemic illness as illustrated by these cases. The wide range of radiographic findings included parenchymal disease, mass-like lesions, and pleural effusions. One patient had…

Current Concepts

Hyperlipidemia Perspectives in Diagnosis and Treatment

ABSTRACTSeveral forms of dyslipidemia are associated with premature coronary artery disease (CAD) and other vascular disease. These include elevated low-density lipoprotein cholesterol, low levels of high-density lipoprotein cholesterol, and elevated triglyceride. Because of the high incidence of CAD in many Western countries, including the United States, guidelines for managing dyslipidemia…

Article

The American Social Health Association Celebrates 80 Years of Fighting Sexually Transmitted Diseases

ABSTRACTThe American Social Health Association (ASHA) can look back on 80 years of service as the only national nongovernmental organization devoted exclusively to prevention of sexually transmitted diseases (STDs). The valuable contributions made by physicians since the agency's founding in 1914 are noted and gratefully acknowledged. To commemorate its 80th…

Case Report

Pseudoleukemia After Granulocyte Colony‐Stimulating Factor Therapy

ABSTRACTTherapy with myeloid colony-stimulating factors has been safely and effectively used in a wide variety of situations associated with neutropenia. We present a case of pseudoleukemia occurring in a patient with lymphoma and pancytopenia after 2 days of treatment with granulocyte colony-stimulating factor (G-CSF). Bone marrow aspirate and flow cytometry…

Case Report

Rapid Reocclusion of Left Primary Bronchus by Fibrinomucinous Cast in a Case of Large Cell Lung Cancer

ABSTRACTThis report describes a case of large cell carcinoma of the lung in a patient whose left primary bronchus became completely occluded by a fibrinomucinous cast that recurred within 24 hours despite extensive lavage and removal of the cast via flexible bronchoscopy. The primary tumor involved the aortopulmonary window and…

Primary Article

D‐Dimer Test for Early Detection of HELLP Syndrome

ABSTRACTWe attempted to predict patients at risk for HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) by using the D-dimer test to screen 81 preeclamptic gravidas and 12 control subjects. Among preeclamptic patients, 43 had positive and 38 had negative results of D-dimer tests. All controls had negative…

Case Report

Subdural Injection of a Local Anesthetic With Steroids Complication of Epidural Anesthesia

ABSTRACTWe describe the unintentional injection of a small amount of local anesthetic with steroids into the subdural space during an attempted lumbar epidural injection for low back pain. When small volumes of local anesthetic are injected into the subdural space, a patchy and unilateral block of greater magnitude than expected…

Case Report

Solitary Plasmacytoma of the Sacrum Presenting as a Pelvic Mass Report of Two Cases

ABSTRACTWe describe two unusual cases of solitary plasmacytoma of the sacrum seen as a pelvic mass. Excessive bleeding, a distinct possibility, should be anticipated whenever a biopsy or resection of the tumor is considered. Because of the tumor's apparent radioresponsiveness and known evolution to multiple myeloma in some cases, radiotherapy…

Primary Article

Epidemiology of Cleft Lip and Cleft Palate in Mississippi

ABSTRACTWe present an epidemiologic study of the cases of cleft lip and cleft palate in Mississippi from 1980 through 1989. Cases were stratified by race (white and nonwhite) but not by association with a major malformation. During this period, a total of 457 new patients with cleft lip or cleft…

Case Report

Iatrogenic Transplantation of Osteosarcoma

ABSTRACTWe report a case in which a patient having curettage and resection of a presumed benign lesion of the tibia (later recognized as osteosarcoma) had probable iatrogenic transplantation of tumor to the contralateral iliac crest, which had served as a donor site for bone chips used to pack the tibial…

Case Report

Candidemia After Endoscopic Retrograde Cholangiopancreatography

ABSTRACTWe report a case of candidemia associated with manipulation of the common bile duct during endoscopic retrograde cholangiopancreatography. The patient had received parenteral nutrition and prolonged antibiotic therapy before the procedure and before Candida tropicalis was grown from blood cultures. Antifungal therapy resulted in clinical response.

Primary Article

Ventral Hernia and Other Complications of 1,000 Midline Incisions

ABSTRACTWe report the outcome in 1,079 consecutive clean or clean-contaminated midline abdominal incisions closed with running 0-loop nylon suture after both elective and emergency operations done between 1984 and 1991. Postoperatively, 79 patients were lost to follow-up, resulting in 1,000 having long-term follow-up. Mean follow-up among these patients was 22…

Primary Article

Incidence of Neonatal Circumcision in Atlanta, 1985–1986

ABSTRACTWe reviewed Atlanta area hospital records to determine the following regarding neonatal circumcision: incidence in July 1985; incidence after publicized serious complications of circumcision in August 1985; medical record documentation; and the complication rate. After stratified sampling from hospital birth logs, we abstracted information from medical charts and calculated weighted…

Primary Article

Biliary Sludging in Critically Ill Trauma Patients

ABSTRACTWe used serial weekly ultrasonography to prospectively screen 19 critically ill trauma victims for the development of biliary sludge. Fourteen patients had sludge formation during their hospitalization. Sludge development was positively associated with increased transfusion requirements, but not with any other laboratory or clinical findings, including injury severity scores. The…

Editorial

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Editorial

MALIGNANT MELANOMA A MAJOR CANCER HAZARD FOR THE 21ST CENTURY

Correspondence

Report of a New Technique for Replacement of Umbilical Arterial Catheters in Very Low Birth Weight (VLBW) Neonates

Correspondence

Screening Program for Prostate Cancer