Issue - Southern Medical Association

Primary Article

Intravenous Amiodarone for Therapy of Atrial Fibrillation and Flutter in Critically Ill Patients With Severely Depressed Left Ventricular Function

ABSTRACT&colon; A retrospective review was done to determine the efficacy and hemodynamic effects of slow intravenous amiodarone administration on invasively monitored patients with acute onset of atrial fibrillation or atrial flutter and left ventricular ejection fractions <15&percnt;. Eight patients met predefined inclusion criteria. All received 300 mg amiodarone intravenously over…

Current Concepts

Migraine&colon; Definitions, Mechanisms, and Treatment

ABSTRACT&colon; Although ubiquitous, migraine remains incompletely understood and thus often ineffectively managed. Fortunately, new advances in our understanding of migraine's origins have led to identification and application of therapeutic intervention that is unparalleled in its specificity and clinical efficacy. We present a unified model of migraine genesis and explain how…

Case Report

Levels of Therapeutic Antivenin and Venom in a Human Snakebite Victim

ABSTRACT&colon; An enzyme–linked immunosorbent assay was used to measure the levels of therapeutic antivenin (Antivenin &lsqb;Crotalidae&rsqb; Polyvalent, Wyeth–Ayerst) in serum and the levels of venom in the urine of a patient bitten by a western diamondback rattlesnake (Crotalus atrox). Serum and urine samples were taken on admission, during hospitalization, and…

Case Report

Cisapride as a Successful Treatment for Acute Intestinal Pseudo–obstruction

ABSTRACT&colon; Cisapride has been used in the treatment of chronic intestinal pseudo–obstruction with some success; however, the use of cisapride in the treatment of acute pseudo–obstruction has not been adequately studied. We describe a case of acute intestinal pseudo–obstruction successfully treated with cisapride. To our knowledge, this is the second…

Primary Article

Efficacy of Ciprofloxacin in the Eradication of Helicobacter pylori

ABSTRACT&colon; In small preliminary trials, ciprofloxacin has failed to eradicate Helicobacter pylori. Since fluoroquinolones have a marked reduction in bactericidal activity at acidic pH, we altered the gastric pH using omeprazole and investigated the efficacy of ciprofloxacin in eradicating H pylori. Forty–four consecutive patients infected with H pylori were prospectively…

Case Report

Clinical and Postmortem Outcome of ‘No–Reflow’ Phenomenon in a Patient Treated With Rotational Atherectomy

ABSTRACT&colon; In the 77–year–old woman described, atherectomy of a circumflex artery with the Rotablator device was complicated by “no reflow.” Ten days later, a 75&percnt; right coronary artery stenosis was successfully managed by balloon angioplasty. On the following day, acute closure of this vessel resulted in death. Gross examination of…

Primary Article

Use of Texas Birth Certificate Data to Predict Measles Immunization Status

ABSTRACT&colon; Inadequate immunization has been a major cause of epidemic measles, but risk factors for inadequate immunization are poorly characterized. By using measles data bases and computerized birth certificate files, we identified a retrospective cohort of 1,070 Texas–born children who were aged 15 months to 10 years when they had…

Case Report

Fragmentation Hemolysis&colon; An Unusual Indication for Valve Replacement in Native Valve Infective Endocarditis

ABSTRACT&colon; Intravascular mechanical fragmentation of erythrocytes is an uncommon occurrence in native valve infective endocarditis. We report a case of fragmentation hemolysis in a patient with tricuspid valve endocarditis due to Staphylococcus aureus. She received transfusion of multiple units of packed red blood cells and ultimately required surgical removal of…

Case Report

Mesenteric Lymphangioma Causing Bowel Obstruction in a Child

ABSTRACT&colon; Mesenteric lymphangioma was manifested as a bowel obstruction in a child with cerebral palsy. Diagnosis was not confirmed until the time of laparotomy. Mesenteric lymphangioma is rare but should be considered in a child with bowel obstruction and no other known abdominal disease.

Case Report

Pseudoaneurysm of the Superficial Temporal Artery

ABSTRACT&colon; Ours is the first report of pseudoaneurysm of the superficial temporal artery in a 90–year–old woman. Although falls with associated head and scalp injuries in the geriatric population are common, pseudoaneurysm of the superficial temporal artery is rarely reported, probably due to the generally protected course of the superficial…

Current Concepts

Management of Cancer Pain

ABSTRACT&colon; Pain is often the first symptom of cancer. Pain and fear of pain are concerns of most cancer patients and their families. The therapeutic options available to control pain are numerous, allowing practitioners to better individualize treatment. We present an overview of the pathophysiology of cancer pain, the current…

Primary Article

Patient Understanding of Emergency Department Discharge Instructions

ABSTRACT&colon; Patients were interviewed immediately after discharge outside the emergency department to determine whether they could read their discharge instructions and recall their diagnosis and treatment plan. The association between frequency of correct responses and various characteristics of the patients was assessed. Of the patients completing the interview, 72&percnt; could…

Case Report

Pulmonary Alveolar Proteinosis&colon; An Unusual Association With Mycobacterium avium–intracellulare Infection and Lymphocytic Interstitial Pneumonia

ABSTRACT&colon; Pulmonary alveolar proteinosis is a nonspecific alveolar response to various forms of injuries. Many cases have been associated with hematologic malignancies. The most commonly reported complication of pulmonary alveolar proteinosis is superinfection with fungal, bacterial, and viral infections. We report a case of a 33–year–old man with alveolar proteinosis…

Primary Article

The Effect of High–Dose Right Upper Quadrant Lithotripsy on Normal Swine Tissue

ABSTRACT&colon; To assess the effects of high doses of shock waves to organs in the right upper quadrant of the abdomen, 36 adolescent swine were given one treatment of either 2,000 (2k), 6,000 (6k), or 10,000 (10k) shock waves at 24 kV peak pressure using a spark–gap lithotriptor. Shock waves…

Case Report

Left Hilar Mass in a 62–Year–Old Man&colon; Severe Pulmonary Valvular Stenosis With a Poststenotic Aneurysm

ABSTRACT&colon; We describe a patient who had a left hilar mass initially diagnosed as probable bronchogenic carcinoma. When a paradoxic arterial embolus led to further investigation, the hilar mass was found to be a poststenotic dilatation due to a severe pulmonary valve stenosis. Percutaneous balloon valvuloplasty of the pulmonary valve…

Case Report

Systemic Lupus Erythematosus Diagnosed During Interferon Alfa Therapy

ABSTRACT&colon; We describe a patient who had clinical manifestations of several autoimmune disorders&colon; Sjögren's syndrome, benign hypergammaglobulinemic purpura of Waldenström, and systemic lupus erythematosus (SLE). The SLE was diagnosed during therapy with interferon alfa. Testing for anti–Ro and anti–La antibodies was negative until the serum was diluted to eliminate a…

Case Report

Fracture and Migration of a Pacemaker Atrial Lead Retention Wire Found by Fluoroscopic Screening in an Asymptomatic Patient

ABSTRACT&colon; We present the case of a woman who had an Accufix atrial “J” pacemaker lead implanted in 1990. Subsequently, Telectronics Pacing Systems recalled two models of the atrial leads after problems with fracture and malfunction were reported. One of these models was used in our case. Fifty–two months after…

Case Report

Sting of the Puss Caterpillar&colon; An Unusual Cause of Acute Abdominal Pain

ABSTRACT&colon; We report the case of a 41–year–old man with abdominal pain after envenomization by a puss caterpillar. The patient's medical history and physical examination revealed classic symptoms, leading to the correct diagnosis and appropriate therapy with intravenous calcium gluconate. Although severe, local reactions to puss caterpillar envenomization have been…

Correspondence

Gouty Arthritis in a Patient With Ivemark Syndrome

Editorial

PATHOPHYSIOLOGIC INFORMATION AND THERAPY FOR NON–INSULIN–DEPENDENT DIABETES MELLITUS