Issue - Southern Medical Association

Case Report

Insulin‐Resistant Diabetes Mellitus in a Black Woman With Ataxia‐Telangiectasia

A 24-year-old woman with ataxia-telangiectasia had traumatic arthritis, elevated serum transaminase values, polyuria, polydipsia, and a serum glucose level of 575 mg/dL. A relatively high daily dose of insulin (2.8 U/kg) was required to achieve near normoglycemia. The fasting insulin concentration was elevated. During an insulin-modified frequently sampled intravenous glucose…

Current Concepts

Decreasing Length of Hospital Stay by Early Excision and Grafting of Burns

All acutely burned patients admitted to one surgeon's practice during a 1-year period were considered for burn excision and grafting. A total of 222 patients were enrolled; 57 did not have surgery. In all, 130 patients having surgery within 24 hours after admission were compared with 48 patients having excision…

Case Report

Persistent Cutaneous Larva Migrans Due to Ancylostoma Species

Cutaneous larva migrans is considered to be a self-limited parasitic infection of about 2 to 8 weeks' duration, though it has been reported to persist for as long as 55 weeks. In this case, a healthy 47-year-old white man had multiple serpiginous lesions typical of cutaneous larva migrans for 18…

Case Report

Intravenous Pamidronate for Hypercalcemia of Primary Hyperparathyroidism

Intravenous pamidronate disodium has been used successfully in the treatment of malignancy-associated hypercalcemia and Paget's disease of bone. Although the definitive treatment of primary hyperparathyroidism (PHPT) is surgical, intravenous pamidronate has been used to treat hypercalcemia of PHPT when surgery was contraindicated. We report two cases of PHPT in which…

Case Report

Escherichia Lobar Pneumonia Fatal Infection in a Patient With Mental Retardation

Lobar pneumonia due to Escherichia coli is rare. Most lobar pneumonias are caused by either Streptococcus pncumoniae or Klebsiella pneumoniae, and most E coli pneumonias are bronchopneumonias. We report an acute fulminant course of E coli lobar pneumonia in a 37-year-old patient who was profoundly retarded, institutionalized, and nonimmunosuppressed and…

Case Report

Mosquito‐Transmitted Malaria Acquired in Texas

Malaria was endemic in the United States before World War II. However, locally acquired malaria was thought to have been eradicated. Since the mid-1980s, cases of locally acquired malaria have been described. We report the case of a 62-year-old man who came to the Houston Veterans Affairs Medical Center with…

Case Report

Persistent Paralysis After Prolonged Use of Atracurium in the Absence of Corticosteroids

Neuromuscular blocking agents (NMBAs) are often used for patients requiring prolonged mechanical ventilation. Reports of persistent paralysis after the discontinuance of these drugs have most often involved aminosteroid-based NMBAs such as vecuronium bromide, especially when used in conjunction with corticosteroids. Atracurium besylate, a short-acting benzylisoquinolinium NMBA that is eliminated independently…

Current Concepts

Variation in Recommendations for Breast and Cervical Cancer Screening Among Primary Care Physicians in North Carolina, 1991

Physicians play an important role in recommending and doing cancer screening for their patients. In 1991, the North Carolina Department of Environment, Health and Natural Resources and the Centers for Disease Control and Prevention conducted a survey to determine the counseling and referral practices of primary care physicians practicing in…

Current Concepts

Frankel A Paraplegia A Comparison of Two Spinal Instrumentation Systems

Seventeen patients with unstable thoracolumbar fracture dislocations and Frankel A (complete) paraplegia had posterior spinal fusion and instrumentation—nine with Cotrel-Dubousset instrumentation and eight with Luque rod instrumentation (LRI). Both systems maintained fracture reduction, and fusion occurred in all cases within a mean of 42 months (range, 30 to 66 months)….

Current Concepts

The Dutch Health Care System Lessons for Reform in the United States

The Dutch health care system achieves universal access with high-quality outcomes at a cost below that in the United States. As US policy makers struggle with issues regarding access, quality, and cost, scrutiny of successful systems in other nations may be useful. Review of health care in the Netherlands and…

Clinical Review

Laryngeal Mask Airway Uses in Anesthesiology

The laryngeal mask airway (LMA), developed in 1983, is a new device to assist in the management of the pediatric and adult airway. In 1991, the Food and Drug Administration gave its approval for use of the LMA in the United States. The LMA is reusable and appears to provide…

Case Report

Diagnosis and Management of Laryngeal Trauma in Sports

The management of sports-related laryngeal trauma presents a diagnostic and therapeutic challenge. The application of basic treatment principles such as airway monitoring, thorough physical examination, and fiberoptic laryngeal examination will direct the management. Further radiologic examination or surgical intervention may be required to adequately assess and manage the injury. We…

Case Report

Agranulocytosis and Near Fatal Sepsis Due to ‘Mexican Aspirin’ (Dipyrone)

The use of “unconventional” or alternative medicine has been reported in up to one third of American households, yet only 28% report the use of such agents to their physician. We present here a case of near fatal sepsis and agranulocytosis. The agranulocytosis is attributed to the use of dipyrone…

Current Concepts

Interpretive and Procedural Skills of the Internal Medicine Clerkship Performance and Supervision

This descriptive study prospectively examined the performance and supervision of interpretive and procedural skills during an internal medicine clerkship. Students (N = 150) documented having done 7 required and 12 elective skills. Preceptors of required skills were interns (44%), residents (29%), attending physicians (12%), and others (16%). The elective procedures…

Current Concepts

Current Medical Therapy for Inflammatory Bowel Disease

Traditional medical therapy for inflammatory bowel disease (IBD) includes corticosteroids and sulfasalazine. In recent years, several mesalamine derivatives of sulfasalazine have become available. These allow delivery of increased dosages of active medication with minimal side effects. Newer steroid preparations, all investigational at this point, likely will offer efficacy similar to…

Case Report

Tripe Palms A Cutaneous Paraneoplastic Syndrome

Tripe palms is a cutaneous paraneoplastic syndrome. We report a case of tripe palms in a 71-year-old man with non-small cell lung cancer. Approximately 90% of patients with tripe palms have an associated cancer, most commonly involving the lung or the stomach. Any patient with tripe palms must have a…

Current Concepts

Radical Hysterectomy for Stage IB Cervical Cancer Recurrence Interval as a Predictor of Survival

Two hundred patients with stage IB carcinoma of the cervix were treated with radical hysterectomy. We evaluated the impact of recurrence interval on survival and determined its relationship to other prognostic factors. Thirty-one patients (15.5%) had recurrence, with a median follow-up of 2.8 years (range, 1 to 5 years). Multivariate…

Case Report

Cranial Migration of a Lumboperitoneal Shunt Catheter

We describe a patient with pseudotumor cerebri for which a lumboperitoneal (LP) shunt was placed. After a pseudomeningocele was noted at the lumbar incision site, an LP shunt revision was done, at which time migration of the catheter into the thecal sac was noted. Three months later, radiologic studies revealed…

Case Report

Extranodal Sinus Histiocytosis With Massive Lymphadenopathy Isolated Central Nervous System Involvement Mimicking Meningioma

We present the fifth reported case of extranodal sinus histiocytosis with massive lymphadenopathy (SHML) isolated in the central nervous system. This case emphasizes the importance of recognizing the clinical and radiographic presentation of SHML and shows that immunohistochemical evaluation is required for definitive diagnosis.

Current Concepts

Felodipine as an Alternative to More Expensive Calcium Antagonists in Mild to Moderate Hypertension

We studied the therapeutic substitution of a less expensive but equally effective antihypertensive agent and assessed patient outcome. The medication of 39 patients with hypertension was changed from once-daily diltiazem hydrochloride (Cardizem CD) or nifedipine (Procardia XL) to felodipine (Plendil). Titration to a final dose was based on home and…

Editorial

HERI, HODIE, CRAS...YESTERDAY, TODAY, AND TOMORROW

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Interferon Alfa and Autoimmunity

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Malpractice Claims

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