Issue - Southern Medical Association

Case Report

An Unusual Complication of Diabetes Mellitus The Zebra That Became a Horse*

ABSTRACT: &NA; A 41‐year‐old black woman with a history of well‐controlled, insulin‐dependent diabetes mellitus was in her usual state of relatively good health when she had acute onset of right upper quadrant and epigastric abdominal pain, nausea, and vomiting. Physical examination and laboratory evaluation revealed gastrointestinal hemorrhage, decreased mental status,…

Primary Article

Efficacy of a Central Venous Access Service

ABSTRACT: &NA; A central venous access service (CVAS) was created in a 600‐bed teaching hospital to do elective percutaneous central venous catheterization (PCVC) in a safe and expeditious manner. A vascular surgeon, physician assistants, and registered nurses specializing in intravenous therapy comprise the service. From November 1990 through June 1995,…

Primary Article

Modern Analysis of Pathologic Uterine Rings

ABSTRACT: &NA; A computerized medical record search of 61,406 live births from January 1, 1990, through December 31, 1994, identified 14 cases of pathologic uterine rings. This yielded an incidence of pathologic uterine rings of 0.02% of all live births. In a retrospective, matched study design, three control subjects having…

Case Report

Idiopathic Midesophageal Stricture A New Cause of Dysphagia in a Patient With AIDS

ABSTRACT: &NA; A number of disorders may result in the complaint of dysphagia in HIV‐infected patients. These include fungal, viral, bacterial, parasitic, medication‐induced, and idiopathic lesions in the esophagus. In the current case, a 32‐year‐old man with advanced HIV infection had recurrent bouts of esophageal stricture. No ulcer was associated…

Case Report

Rapid Progression of Acquired Amegakaryocytic Thrombocytopenia to Aplastic Anemia

ABSTRACT: &NA; Acquired amegakaryocytic thrombocytopenia is a rare disorder characterized by severe thrombocytopenia and selective, marked decrease or absence of megakaryocytes. Although immunosuppressive therapy (prednisone and/or antithymocyte globulin) has been shown to induce remissions in a subset of patients, most patients do not respond, and progression to aplastic anemia occurs…

Primary Article

Appendiceal Spirochetosis

ABSTRACT: &NA; Appendiceal spirochetosis is rarely described in the literature. We assessed the incidence of spirochetosis in a series of 109 appendectomies (76 adult and 33 pediatric cases) done for either suspected acute appendicitis or as a concurrent procedure. Appendiceal spirochetosis was identified on hematoxylin‐eosin sections and confirmed by Steiner…

Case Report

Elevated Tumor‐Associated Antigen CA 19‐9 in a Patient With an Enlarged Pancreas Does It Always Imply Malignancy?

ABSTRACT: &NA; Carbohydrate antigen 19‐9 (CA 19‐9) has been used as a serum tumor marker for adenocarcinoma of the upper gastrointestinal tract, particularly primary adenocarcinoma of the pancreas. This tumor marker has also been used to differentiate benign from malignant diseases of the pancreas. However, significant elevations of CA 19‐9…

Current Concepts

Intracranial Hemorrhage Complicating Acute Myocardial Infarction in the Era of Thrombolytic Therapy

ABSTRACT: &NA; Cerebrovascular accidents are one of the most serious causes of morbidity in patients sustaining an acute myocardial infarction. In patients who do not receive thrombolytic therapy, the most common form of stroke is thromboembolic, occurring in up to 2.4% of patients, predominantly in those sustaining large anterior infarctions….

Case Report

Pseudo‐Gaucher’s Cells in Association With Common Acute Lymphoblastic Leukemia

ABSTRACT: &NA; Gaucher‐like cells were found in the bone marrow and liver of an Omani teenager who had common acute lymphoblastic leukemia (cALL) confirmed on peripheral blood analysis by the presence of CD10 antigen. Leukocytic or fibroblastic &bgr;‐glucocerebrosidase enzyme activity was not measured, but other biochemical data and features of…

Case Report

Pulmonary Nodules Due to Toxocara canis Infection in an Immunocompetent Adult

ABSTRACT: &NA; Infection with Toxocara canis is well described in the pediatric literature but is reported less commonly in adults. We report a case of T canis infection manifested as abdominal pain with diarrhea, eosinophilia, and diffuse noncavitating nodules in an immunocompetent adult.

Case Report

Esophageal Atresia in an In Vitro Fertilization Pregnancy

ABSTRACT: &NA; Major congenital anomalies occur in approximately 4% of the newborn population. Although this risk is apparently the same for in vitro fertilization (IVF) pregnancies, couples having assisted reproduction therapy should receive appropriate genetic counseling, because coincidental maloccurrences are often erroneously linked to the technology. We report a case…

Case Report

Myelomatous Pleural Effusion

ABSTRACT: &NA; Malignant pleural effusions due to multiple myeloma are rare. Effusion in such patients is usually due to congestive heart failure or another process. Malignant myeloma cells identified in cytologic examination of the pleural fluid or by pleural biopsy establish the diagnosis of a myelomatous effusion. This finding portends…

Case Report

Noninvasive Positive Pressure Ventilation

ABSTRACT: &NA; Noninvasive positive pressure ventilation (NPPV) has been used in treatment of a variety of clinical conditions, including acute respiratory failure (ARF) due to status asthmaticus. We present the case of a patient admitted with acute exacerbation of asthma who had ARF and required mechanical ventilation. After extubation, he…

Case Report

Perineal Hernia Repair Using Gracilis Myocutaneous Flap

ABSTRACT: &NA; Perineal hernia formation is an infrequent but well‐recognized complication of major pelvic surgery. Various methods of perineal reconstruction have been reported. This report describes one technique of perineal hernia repair using a unilateral gracilis myocutaneous flap. The gracilis myocutaneous flap provides well‐vascularized tissue that is useful in many…

Primary Article

Effects of Cardiac Rehabilitation and Exercise Programs on Exercise Capacity, Coronary Risk Factors, Behavior, and Quality of Life in Patients With Coronary Artery Disease*

ABSTRACT: &NA; Previous studies have indicated the benefits of cardiac rehabilitation programs after major coronary artery disease (CAD) events. We studied 591 consecutive patients from two academic institutions before and after completion of a cardiac rehabilitation and exercise training program to determine the effects of this therapy on exercise capacity,…

Clinical Review

Respiratory Manifestations of Tick‐Borne Diseases in the Southeastern United States

ABSTRACT: &NA; Pulmonary signs and symptoms may provide important differential clues to the diagnosis of tick‐borne illness incurred in the southern United States.

Primary Article

Ceftriaxone Versus Cefazolin in Peripheral Arterial Operations A Randomized, Prospective Trial

ABSTRACT: &NA; Serious morbidity and mortality are associated with postoperative wound infections in peripheral vascular surgery. The use of prophylactic antibiotics is considered the standard of care, with attention focused on the most efficacious agent. A prospective, randomized study was conducted to evaluate the efficacy of ceftriaxone versus cefazolin in…

Primary Article

Beachfront Screening for Skin Cancer in Texas Gulf Coast Surfers

ABSTRACT: &NA; Skin cancer screening programs may attract the “worried well,” while those at greatest risk for skin cancer are less likely to attend. Our purpose was to compare the results of skin cancer screening examinations between persons participating in the 1992 American Academy of Dermatology‐sponsored free skin cancer screening…

Primary Article

Elective Versus Emergency Cesarean Hysterectomy on a Teaching Service—1981 to 1991

ABSTRACT: &NA; We compared the differences in morbidity of elective and emergency cesarean hysterectomy (CH) in a training program. Records of patients who had elective or emergency CH were reviewed for information reflecting perioperative morbidity and fetal outcome. Eighty‐eight CHs were elective and 18 were emergencies. Compared to emergency CHs,…

Case Report

Extrarenal Retroperitoneal Angiomyolipoma

ABSTRACT: &NA; We describe a case of angiomyolipoma arising in the retroperitoneum and review other reported cases of extrarenal angiomyolipoma. We review the histologic characteristics of angiomyolipoma and describe our diagnostic evaluation. This case is the fifth reported occurrence of extrarenal retroperitoneal angiomyolipoma. In our case, as in the others,…

Current Concepts

Assessing Testamentary Capacity in Elderly People

ABSTRACT: &NA; We discuss the assessment of testamentary capacity (ability to execute a valid will) in elderly people. Such assessment should include evaluation of the person's knowledge regarding the purpose of the will, the extent of the property involved, the legal heirs, and how the property is distributed according to…

Primary Article

Inflammatory Pseudotumor of the Liver Associated With Extrahepatic Infection*

ABSTRACT: &NA; We present two cases that support an infectious cause of inflammatory pseudotumor of the liver. Each patient had sepsis due to chronic abdominal abscesses, along with a liver mass. Both patients had exploratory celiotomy, and histologic examination of the liver mass revealed inflammatory pseudotumor of the liver. Evidence…

Case Report

Guillain‐Barré Syndrome and Cytomegalovirus Infection During Pregnancy

ABSTRACT: &NA; We report a case of Guillain‐Barré syndrome and associated cytomegalovirus infection during pregnancy. A 15‐year‐old black adolescent had progressive ascending paralysis and vague sensory symptoms during week 10 of her first pregnancy. Diagnosis of Guillain‐Barré syndrome was confirmed by electrophysiologic findings consistent with acute demyelinating polyradiculoneuropathy. A mild…


Aminoglycoside Levels in Critically Ill Surgical Patients The Implications of Physiologic Criteria of Sepsis

ABSTRACT: &NA; We retrospectively reviewed medical records and computerized critical care data for 40 consecutive critically ill surgical patients receiving “standard” doses (1.5 to 2.0 mg/kg loading dose and 3 to 5 mg/kg/day) of gentamicin or tobramycin for gram‐negative infections. End points measured were serum drug levels and clearance of…