Issue - Southern Medical Association

Clinical Review

Alzheimer’s Disease Patients and Their Caregivers: Medical Care Issues for the Primary Care Physician

ABSTRACT: Alzheimer's disease (AD) is a common problem with complex challenges in assessment and management for the primary care physician. We present a practical, six-step strategy for physicians to use in AD care, summarized by the acronym ACROSS: assessment of AD, communication of the diagnosis, referral to appropriate community resources,…

Case Report

Recurrent Amiodarone Pulmonary Toxicity

ABSTRACT: Amiodarone, a widely used antiarrhythmic drug, is associated with pulmonary toxicity, with an estimated mortality of 1% to 33%. Standard treatment for amiodarone pulmonary toxicity (APT) has been discontinuance of the drug and steroid therapy. We report a case of APT that recurred after withdrawal of steroids and failed…

Primary Article

Detection of Clonal Immunoglobulin Heavy-Chain Gene Rearrangements in Cases of Suspected Lymphoproliferative Disorders: Comparison of Polymerase Chain Reaction and Southern Blot Analysis

ABSTRACT: Demonstration of clonality is supportive of a diagnosis of malignancy in cases of lymphoproliferative disorders. Determination of clonality at the molecular level is currently accomplished by Southern analysis; however, the polymerase chain reaction offers a potential alternative that is rapid, simple, and less expensive. To test its feasibility as…

Current Concepts

Integrated Management of Venous Thromboembolism

ABSTRACT: Diagnostic methods for pulmonary embolism and deep vein thrombosis of the lower extremity are intertwined, since the latter nearly always precedes the former. Recent prospective studies show that an independent clinical estimate of disease probability helps to refine probability estimates of ventilation-perfusion lung scans and of ultrasonography with compression,…

Case Report

Peritonitis Due to Penicillium sp in a Patient Receiving Continuous Ambulatory Peritoneal Dialysis

ABSTRACT: Infectious peritonitis is a common complication of continuous ambulatory peritoneal dialysis (CAPD). Only one case of CAPD-related peritonitis due to Penicillium sp has previously been reported. We present a second case in which fungal colonies were observed on the inner surface of the CAPD catheter. The infection was successfully…

Primary Article

Organism Isolation and Serum Bactericidal Titers in Oral Antibiotic Therapy for Pediatric Osteomyelitis

ABSTRACT: Isolation of the etiologic organism and monitoring of serum bactericidal titers are considered necessary in oral antibiotic therapy for osteomyelitis. Over a 5-year period, 26 pediatric patients with hematogenous osteomyelitis were treated with sequential parenteraloral therapy. No organism was isolated in 9 cases, and bactericidal titers were determined in…

Primary Article

Bayesian Analysis of Noninvasive Versus Oral Temperature Measurements to Determine Hypothermia in Postoperative Patients

ABSTRACT: Measurement of body temperature in the postanesthesia care unit (PACU) is an important parameter in patient management. Failure to reach minimal acceptable body temperature standards has been associated with physiologic derangements, the application of additional therapy, and prolonged PACU stays. Newer methods to monitor temperature introduced into the PACU…

Case Report

Moyamoya Disease in an Adult With Down Syndrome: Comparison of Magnetic Resonance Angiography and Conventional Angiography

ABSTRACT: Moyamoya disease, or idiopathic progressive arteriopathy, is a vascular occlusive disease that results in stenosis of the internal carotid arteries, stimulating the development of 1 collaterals and telangiectatic vasculature from basilar and leptomeningeal arteries. Within the past several years, several reports have suggested that children with Down syndrome can…

Primary Article

Drug Therapy in Attention-Deficit Hyperactivity Disorder

ABSTRACT: Of 292 patients (210 males and 82 females) receiving medication for attentiondeficit hyperactivity disorder (ADHD), 272 (93%) responded well to sustained-release dextroamphetamine (D-Amp) and 21 patients (7%) to sustained-release methylphenidate (MPD). The dose of D-Amp ranged from 0.2 to 3.6 mg/kg/day and the dose of MPD from 1.4 to…

Case Report

Using the KTP/532 Laser to Control Epistaxis in Patients With Hereditary Hemorrhagic Telangiectasia

ABSTRACT: Osler-Weber-Rendu disease remains a challenging clinical management problem. We have found the potassium-titanyl-phosphate laser (KTP/532) for photocoagulation of intranasal telangiectases to be useful in controlling epistaxis refractory to traditional surgical therapy. We present the case of a patient who had Osler-Weber-Rendu disease previously treated with partial septectomy, turbinectomy, and…

Current Concepts

Palliative Procedures for Pancreatic Cancer: When and Which One?

ABSTRACT: Pancreatic cancer usually requires palliative rather than curative therapy. Palliative procedures should have low morbidity and mortality, provide a good quality of life, and necessitate minimal hospitalization. The surgeon, endoscopist, and radiologist all play a role in delivering effective palliation to properly selected patients

Primary Article

Does Hemodilution Exist? Effects of Saline Infusion on Hematologic Parameters in Euvolemic Subjects

ABSTRACT: The effects of intravenous fluids on hematocrit are debated. We sought to determine whether maintenance or bolus fluid therapy causes a significant change in the hematocrit and other hematologic parameters included in the complete blood count. Nine subjects completed a randomized three-period crossover designed trial in which they were…

Primary Article

Rhinosporidiosis: Three Domestic Cases

ABSTRACT: Three cases of rhinosporidiosis in Americans who had not traveled abroad are reported. We believe this is the largest cluster of indigenous cases reported in the United States. The three patients had lived in rural northeast Georgia all of their lives. One had a polypoid conjunctival lesion, and the…

Primary Article

Laparoscopic Fundoplication in the Treatment of Severe Gastroesophageal Reflux Disease: Preliminary Results of a Prospective Trial

ABSTRACT: To determine the technical feasibility and success of laparoscopic fundoplication in the treatment of severe gastroesophageal reflux disease (GERD), 18 consecutive adult patients were enrolled in a prospective study. All patients had received unsuccessful conservative treatment, were refractory to medical management, or had recurrence of symptoms of esophagitis after…

Primary Article

Laparoscopic Tubal Sterilization in Obese Women: Experience From a Teaching Institution

ABSTRACT: To determine whether laparoscopy presents any significant risks for tubal sterilization in obese women, we retrospectively reviewed the records of 248 consecutive patients who had laparoscopic tubal sterilization between January and December 1991 at our institution. The 147 obese women were compared with the 101 nonobese women as controls…

Case Report

Painless Thyroiditis Occurring During Long-term Treatment With Interferon Alfa in a Patient With Chronic Active Hepatitis C

ABSTRACT: We describe here painless thyroiditis during interferon (IFN) therapy in a 65-year-old man with chronic active hepatitis C. The patient had hypothyroidism in the late stage of a 24-week course of treatment with IFN-α. After cessation of the treatment a small, firm goiter was noticed, and chronic focal thyroiditis…

Clinical Review

Clinical and Imaging Features of Pulmonary Strongyloidiasis

ABSTRACT: We evaluated 20 patients with pulmonary strongyloidiasis for risk factors, clinical and imaging manifestations, complications, treatment, and outcome. Eighteen (90%) had risk factors for strongyloidiasis including steroid use, age greater than 65, chronic lung disease, use of histamine blockers, or chronic debilitating illness. Pulmonary signs and symptoms, including cough,…

Primary Article

Short-Term Volunteer Staffing of a Hospital

ABSTRACT: We surveyed 136 physicians, nurses, dentists, physician assistants, and other medical professionals who were residents of the United States and had volunteered their professional services for 6 months or less from October 1992 through January 1994 at St. Jude Hospital, a rural hospital on the island of St. Lucia…

Author Index

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Editorial

BLUE ROADS AND HOMEWORK

Editorial

Chest Pain and Breast Implants

Editorial

CORRESPONDENCE

Correspondence

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Editorial

MEDICATION FOR ATTENTION-DEFICIT HYPERACTIVITY DISORDER: BALANCING ART AND SCIENCE

Announcement

Officers of SMA—1995-1996