Issue - Southern Medical Association

Case Report

Infection of a Pancreatic Pseudocyst Due to Candida albicans

ABSTRACT: A 40-year-old man with diabetes mellitus, congestive heart failure, alcoholic cirrhosis, and chronic pancreatitis had an exacerbation of pancreatitis due to alcohol abuse. His condition deteriorated rapidly with development of apparent sepsis; cultures were negative. He slowly improved with multiple antibiotic therapy and total parenteral nutrition. Serial imaging of…

Case Report

Regression of ST Segment Elevation After Thrombolysis in Acute Aortic Dissection

ABSTRACT: A 55-year-old man was admitted to the hospital with chest pain and electrocardiogram consistent with the diagnosis of evolving myocardial infarction. Treatment with streptokinase was administered, resulting in clinical and electrocardiographs signs of reperfusion. Hypotension and ST segment elevation occurred 2 hours later and cardiac catheterization was done. At…

Case Report

Transient Campylobacter Bacteremia in a Healthy Child

ABSTRACT: A 7-month-old immunocompetent child was brought to the emergency department with fever and diarrhea. Blood and stool cultures grew Campylobacter species. Campylobacter bacteremia resolved without treatment.

Case Report

Laparoscopic Cholecystectomy for Recurrent Gallstone Pancreatitis During Pregnancy

ABSTRACT: A pregnant patient with gallstone-induced pancreatitis initially responded to medical treatment, but the pancreatitis recurred. Endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy were done at 28 weeks' gestation. The remainder of the pregnancy was unremarkable. Although 20 cases of laparoscopic cholecystectomy have been reported for cholecystitis during pregnancy, this is…

Case Report

Giant Adrenal Myelolipoma

ABSTRACT: Adrenal myelolipomas are nonfunctioning benign tumors composed of hematopoietic elements and mature adipose tissue. These tumors usually remain small and asymptomatic; occasionally, however, they reach massive proportions and become symptomatic. To date, only two giant adrenal myelolipomas ( >4,000 g) have been described in the literature. We describe the…

Case Report

Cytomegalovirus Pneumonia Manifesting as a Focal Mass in Acquired Immunodeficiency Syndrome

ABSTRACT: Although cytomegalovirus (CMV) is commonly found in the lungs of patients with acquired immunodeficiency syndrome (AIDS), CMV is an infrequent cause of pneumonia in AIDS. We describe an unusual case of proven CMV pneumonia in an AIDS patient that manifested as a large mass on chest radiography and computed…

Case Report

Tetany in a Child With AIDS Receiving Intravenous Tobramycin

ABSTRACT: Aminoglycosides have been reported to cause tetany by inducing renal wasting of magnesium and secondary hypocalcemia. A 9-year-old girl with AIDS was brought to the emergency department because of tetany. She had just finished a 3-week course of intravenous tobramycin for bronchiectasis and had an elevated serum tobramycin trough…

Current Concepts

Bone Remodeling Around Cementless Hip Implants

ABSTRACT: Bone remodeling results from the adaptation of bone to the stresses that act upon it. The insertion of an endoprosthesis into a femur changes the stress distribution within the femur, causing the bone to remodel. In this paper, we show how radiographic bone remodeling changes can be used to…

Case Report

Calciphylaxis Mimicking Skin Lesions of Connective Tissue Diseases

ABSTRACT: Calciphylaxis is a rare condition found in patients with end-stage renal disease and secondary hyperparathyroidism. We describe two cases of prominent cutaneous manifestations of calciphylaxis in which skin lesions were refractory to topical treatments. We also include a brief description of calciphylaxis.

Case Report

Reconstruction of a Total Anterior Urethral Defect Using Buccal Mucosa

ABSTRACT: Extensive urethral defects in the presence of insufficient local skin can challenge the reconstructive urologist. We report a case of complete anterior urethral loss due to Fournier's gangrene that was successfully reconstructed using autologous buccal mucosa. A 17.5 x 2.5 cm tube graft was harvested, extending from the left…

Primary Article

Cumulative Trauma Disorders Among Apparel Manufacturing Employees in the Southeastern United States

ABSTRACT: Factors associated with cumulative trauma disorders (CTDs) of the upper extremities were studied retrospectively, using data from three apparel manufacturing plants in the southeastern United States. Reported CTDs among the employees at risk during fiscal years 1991 and 1992 were analyzed focusing on individual and plant variables. Results showed…

Case Report

Gas Gangrene of the Arm Due to Enterobacter cloacae in a Neutropenic Patient

ABSTRACT: Gas gangrene is a life-threatening emergency. Most cases are caused by clostridial infections, but nonclostridial causes are being increasingly recognized. Nonclostridial gas gangrene is most often due to polymicrobial organisms. Early diagnosis and therapy are required, since the disease may rapidly progress to fatal toxemia. We report a case…

Primary Article

Reconstructive Spinal Surgery: Assessment of Outcome

ABSTRACT: One of the foremost problems in evaluating patients who have had spinal surgery is the difficulty in reliably assessing changes in symptoms and function attributable to the operative procedure. In this study, a questionnaire was sent to patients who had had spinal surgery at least 6 months earlier. The…

Article

Dilemmas and Solutions for the Pathologist and Clinician Encountering Religious Views of the Autopsy

ABSTRACT: Religious objections to the autopsy are as old as autopsies themselves. The development of anatomic studies was hindered in ancient eras, as well as in more recent times, by spiritual views occasionally hostile to the opening of bodies. This review addresses historical and recent attitudes of the three major…

Case Report

Choledochal ‘Clipoliths’ After Cholecystectomy

ABSTRACT: Residual or recurrent stones in the common bile duct can pose a difficult diagnostic problem in the symptomatic postcholecystectomy patient. Although incrustation of unabsorbed suture material is the most important cause of stone recurrence in the common bile duct after surgery, hemostatic clips may also (though rarely) provide a…

Primary Article

Substance Abuse and Dependence in Physicians: The Missouri Physicians’ Health Program

ABSTRACT: Substance abuse and dependence (alcohol and drugs) are behavioral disorders and treatable medical diseases. There is growing concern in the medical community for physicians impaired by these diseases. The Missouri Physicians' Health Program has been established to help impaired physicians return to healthy personal and professional lives. This confidential…

Primary Article

Long-term Effectiveness and Safety of Topical Calcipotriene for Psoriasis

ABSTRACT: The long-term safety and effectiveness of calcipotriene 0.005% ointment has been evaluated in the treatment of 397 patients with stable plaque psoriasis. In this multicenter, open-label clinical investigation, the psoriasis characteristics of scaling, erythema, and plaque elevation and overall disease severity were evaluated periodically. Patients were carefully questioned and…

Clinical Review

Osteoarthritis in Elderly Knees

ABSTRACT: This review of osteoarthritis of the knees in the elderly touches on the clinical presentation and examination, epidemiology, etiology, radiologic characteristics, and origin of the pain. The discussion includes drug treatment, intra-articular drug use, nondrug therapy, and the role of arthroscopy and joint lavage.

Primary Article

Postoperative Nasogastric Decompression: A Prospective Randomized Trial

ABSTRACT: To determine which type of patient should receive routine postoperative nasogastric decompression (NGD), we observed 76 patients who were randomized into two groups: those who received routine NGD (n=39) and those who received selective NGD (n=37). Eighteen patients in the selective NGD group never required intubation, while 19 did…

Primary Article

Survey of Physicians’ Attitudes About Risks and Benefits of Chest Computed Tomography

ABSTRACT: To investigate physicians' use of computed tomography (CT) of the chest and their attitudes regarding the risks and benefits of chest CT, we conducted a nationwide survey of 1,000 board certified physicians from several specialties of medicine, using a self-administered mail questionnaire. Three hundred thirteen surveys were completed. Overall,…

Primary Article

Use of a National Data Base to Assess Perioperative Risk, Morbidity, Mortality, and Cost Savings in Coronary Artery Bypass Grafting

ABSTRACT: To show the usefulness of the Society of Thoracic Surgeons (STS) National Database in providing clinical and cost-related outcome data, we studied 297 consecutive patients who had isolated coronary artery bypass grafting (CABG) and who were assigned to either a “fast track” or traditional track. The observed overall mortality…

Primary Article

Neoplasms of the Pineal Region

ABSTRACT: Tumors of the pineal region are rare but pose interesting diagnostic and therapeutic challenges. A diverse group of neoplasms may occur in the pineal region, and correct histologic diagnosis is critical to proper management of the disease. To emphasize the need for tissue diagnosis, we present five cases of…

Case Report

Muscle Rigidity Due to Fentanyl Infusion in the Pediatric Patient

ABSTRACT: Two cases of fentanyl-induced muscle rigidity are presented. Significant features of these cases include the unusual pattern of rigidity and the use of fentanyl doses lower than those usually associated with muscle rigidity.

Case Report

Long-Term Subcutaneous Infusion of Midazolam for Refractory Delirium in Terminal Breast Cancer

ABSTRACT: We describe the case of a 56-year-old woman with terminal metastatic breast cancer who had delirium in the form of frightening hallucinations, paranoid delusions, and nightmares resulting in violent agitation. During this period, her bone pains from metastases were well controlled with narcotic analgesics, but her delirium proved refractory…

Case Report

Rhabdomyolysis and Hemolysis Associated With Sickle Cell Trait and Glucose-6- Phosphate Dehydrogenase Deficiency

ABSTRACT: We report a case of severe oxidative hemolysis and rhabdomyolysis in a patient with sickle cell trait and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The patient was a 34-year-old black man admitted 24 hours after vigorous exercise with myalgias, malaise, myoglobinuria, anemia, low haptoglobin, and a peripheral blood smear with bite…

Editorial

AUTOPSY CONSENT AND FAMILY RESISTANCE: THE ROLE OF THE CLINICIAN

Correspondence

Marked Hyperlipasemia After Radiotherapy in a Patient With Prostate Cancer