Issue - Southern Medical Association

Case Report

Suspected Hypersensitivity Pneumonitis After Exposure to a Biologic Forage Inoculant

ABSTRACTA 44-year-old farmer had respiratory symptoms and bibasilar pulmonary infiltrates after three exposures to a new biologic forage inoculant. Open lung biopsy revealed chronic interstitial pneumonitis and bronchiolitis obliterans with organizing pneumonia. The patient responded to oral corticosteroids but acutely worsened after an inadvertent reexposure to the forage inoculant. He…

Case Report

Primary Varicella‐Zoster-Induced Rhabdomyolysis

ABSTRACTAcute rhabdomyolysis after uncomplicated, primary varicella-zoster infection is a rare condition that is sparsely reported in the literature. We report a case of acute rhabdomyolysis due to varicella-zoster infection and review the literature regarding the etiology, diagnosis, and management of this potentially life-threatening condition. Rapid recognition, along with appropriate treatment,…

Current Concepts

Allogeneic Bone Marrow Transplantation

ABSTRACTAllogeneic bone marrow transplantation (BMT) after high-dose, marrow-ablative chemoradiotherapy has been established as the treatment of choice for various hematologic, neoplastic, and congenital disorders. The most common type of marrow graft is an allogeneic one from a sibling donor who has compatible human leukocyte antigen (HLA). Only 30% of patients…

Case Report

Gastric Cancer and Pernicious Anemia Appearing as Pseudoachalasia

ABSTRACTAn elderly black man was admitted to our institution with macrocytic anemia, dysphagia, and significant weight loss. Results of an esophagogram were suggestive of achalasia. Gastric adenocarcinoma infiltrating the gastric cardia was seen on gastroscopy. The mode of presentation of gastric cancer in this case has not been previously reported…

Case Report

Massive Chylothorax Complicating Cirrhosis of the Liver

ABSTRACTChylothorax is an unusual complication of cirrhosis of the liver. This condition is probably underdiagnosed because appropriate tests are not usually done. We describe the case of a 54-year-old man with cirrhosis of the liver and massive chylothorax. Despite chest tube drainage and intensive supportive therapy, there was a fatal…

Current Concepts

Investigation of Deaths Related to Electrical Injury

ABSTRACTEven though the use of electricity is an integral part of our lives, the number of accidents and deaths related to electricity is on the decline. This is due to increased awareness of electrical hazards and, in large part, to increased inclusion of safety mechanisms by manufacturers. However rare, electrical…

Case Report

Fatal Duodenocaval Fistula Caused by Peptic Ulcer

ABSTRACTGastrointestinal bleeding caused by a duodenocaval fistula is rare, diagnostically challenging, and associated with a high mortality rate. We describe the case of a patient with polymicrobial fungemia and fatal gastrointestinal bleeding related to a duodenocaval fistula caused by peptic ulcer. Polymicrobial fungemia, which has not previously been associated with…

Case Report

Choroid Plexus Histoplasmoma Clinical, Pathologic, and Imaging Findings

ABSTRACTHistoplasmosis of the choroid plexus has not previously been described. We report its occurrence, as well as its clinical, pathologic, and imaging characteristics in one case. Clinically, our patient's choroid plexus lesion produced encephalopathy and third nerve palsy. On imaging it appeared as a hemorrhage or calcification. Cerebrospinal fluid studies…

Clinical Review

Diabetic Retinopathy A Review for the Primary Care Physician

ABSTRACTHyperglycemia can result in key biochemical reactions that may contribute to thickening of basement membranes, dysfunction of pericytes and endothelial cells, and closure of retinal vessels. The Diabetes Control and Complications Trial has proved the value of good glycemic control in preventing retinopathy and/or delaying its progression. The primary care…

Current Concepts

A Whiff of Death Fatal Volatile Solvent Inhalation Abuse

ABSTRACTInhalation abuse of volatile solvents, previously known genetically as “glue sniffing,” is typically pursued by adolescents. A wide range of legal, easily obtained products containing volatile substances are available for abuse. We report two illustrative cases of fatal volatile substance abuse: gasoline sniffing in a 20-year-old man and aerosol propellant…

Case Report

Prevention of Rh Isoimmunization After Spontaneous, Massive Fetomaternal Hemorrhage

ABSTRACTMassive fetomaternal hemorrhage has been associated with numerous risk factors and can occur spontaneously. The risk is probably greater when a woman who is Rh negative has an ABO-compatible fetus. We report the case of a gravid, A-negative unsensitized patient who came to the hospital at term complaining of decreased…

Current Concepts

Early Impact of New Health Care Legislation on the Pediatric Surgical Experience of Surgical Residents

ABSTRACTOn January 1, 1994, Tennessee implemented TennCare, an insurance program for the state's medically uninsured and those who were previously covered by Medicaid. To determine how this change has affected the pediatric surgical experience of residents in training, we reviewed our institution's operative case logs from the first quarter of…

Current Concepts

Drug Therapy for Parkinson’s Disease

ABSTRACTParkinson's disease (PD) is a common neurodegenerative disease characterized by tremor, rigidity, bradykinesia, and loss of postural reflexes. Although the agents available for symptomatic treatment now allow most parkinsonian patients to live a normal life-span, these patients become progressively unable to participate in social functions, perform activities of daily living,…

Case Report

Primary Small Cell Undifferentiated Carcinoma of the Rectum Associated With Ulcerative Colitis

ABSTRACTPrimary small cell undifferentiated carcinomas (SCUCs) are unusual tumors of the colon and rectum. Histologically, these lesions represent a spectrum of neuroendocrine differentiation, with oat cell carcinoma being the most primitive subtype and carcinoid tumors being the most differentiated. This observation is supported by immunohistochemical and ultrastructural findings. We report…

Current Concepts

Screening for Prostate Cancer A Comparison of Urologists and Primary Care Physicians

ABSTRACTProstate cancer screening has assumed increased importance with increasing mortality from this cancer. Newer diagnostic tests such as measurement of prostate-specific antigen (PSA) have improved detection of early prostate cancer. To determine practice patterns of prostate cancer screening, surveys were sent to 487 urologists (231 responses) and 542 family physicians…

Case Report

Uterine Pyomyoma as a Complication of Pregnancy in an Intravenous Drug User

ABSTRACTPyomyoma (suppurative leiomyoma) is a rare entity characterized by infarction and infection of a uterine leiomyoma. Pyomyomas may pose both diagnostic and therapeutic difficulties, leading to potential complications such as bacteremia, uterine rupture, and even death. In the case we describe, uterine pyomyoma occurred as a complication of pregnancy in…

Case Report

Polypoid Scrotal Calcinosis An Uncommon Variant of Scrotal Calcinosis

ABSTRACTScrotal calcinosis is a rare condition characterized by multiple calcified nodules within scrotal skin. To our knowledge, only 67 cases have been reported to date. The etiology has been widely disputed and is viewed by many to be idiopathic. We describe a case of “idiopathic” scrotal calcinosis that not only…

Current Concepts

Prevalence of Salmonella enteritidis in Poultry Shell Eggs in Arkansas

ABSTRACTThe objective of this study was to determine whether poultry shell eggs are a major reservoir of Salmonella enteritidis in Arkansas. One hundred dozen commercially purchased shell eggs were cultured for the presence of Salmonellasp. After each dozen eggs was examined, the contents of the 12 eggs were separated from…


Diagnosis of Thoracic Outlet Syndrome in the Emergency Department