Issue - Southern Medical Association

Primary Article

Acute Myocardial Infarction in Patients Who Have Had Coronary Artery Bypass Surgery

ABSTRACT Background.Although acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG) are frequently discussed, the issue of AMI in patients who have previously had CABG has not been addressed yet. Methods.We critically reviewed data obtained from the medical literature on this subject since 1974. Results.The overall incidence of AMI…

Primary Article

Women's Experiences With Domestic Violence and Their Attitudes and Expectations Regarding Medical Care of Abuse Victims

ABSTRACT Background.Although domestic violence (DV) is recognized as a serious crime, only recently has it been acknowledged as a critical public health problem. Methods.To develop appropriate medical intervention methods to stop abuse, we interviewed 406 female patients in the ambulatory clinics at the Miami Veterans Affairs Medical Center, using a…

Medical Education

Bedside Teaching

ABSTRACT Background.Clinical teachers have been exhorted to “return to the bedside” so that the three critical parties—teacher, trainee, and patient—can participate together in the educational encounter. The presence of the patient is deemed essential for the optimal demonstration and observation of physical examination, medical interviewing, and interpersonal skills, as well…

Primary Article

Factors Influencing the Accuracy of Home Blood Pressure Measurement

ABSTRACT Background.Hypertension is a common disorder, affecting approximately 50 million Americans. Because many people have this disorder and its sequela, it is important not only to detect hypertension but also to monitor adequacy of control. Over the past few years, blood pressure monitoring devices (BPMDs) have become available for individuals…

Primary Article

Stage I Ovarian Carcinoma: Specialty-Related Differences In Survival and Management

ABSTRACT Background.In patients with FIGO (International Federation of Gynecology and Obstetrics) stage I ovarian carcinoma given care with or without subspecialists, we compared completeness of initial staging and disease-free survival. Methods.Two groups of patients with stage I ovarian carcinoma were compared. Patients were managed by either gynecologic oncologists or community-based…

Primary Article

Pleural Thickening in Mild Kaolinosis

ABSTRACT Background.Kaolin is found along the “fall line” in Georgia, and parenchymal changes, both simple and complicated pneumoconiosis, have been previously described. This study was done to determine whether pleural thickening occurs in workers with mild kaolin pneumoconiosis. Methods.We evaluated 350 workers at a kaolin plant in Georgia. Thirty-two workers…

Primary Article

Laryngeal Manifestations of Gastroesophageal Reflux Before and After Treatment With Omeprazole

ABSTRACT Background.Laryngeal manifestations of gastroesophageal reflux disease are thought to be prevalent in our society. In general, diagnosis has been primarily based on symptoms. Historically, additional testing has included laryngoscopy, barium swallow, manometry, and single and double probe pH monitoring. Methods.We assessed 96 patients who had symptoms suggestive of reflux…

Primary Article

Medical Care for Mass Gatherings at Collegiate Football Games

ABSTRACT Background.Many articles have reviewed medical care at mass gatherings, but few have specifically looked at care provided during football games. Some of the largest gatherings occur at various stadiums during football season. Methods.We analyzed the medical care provided for the spectators at Williams-Brice Stadium for the University of South…

Current Concepts

Necrotizing Fasciitis: Improved Survival With Early Recognition by Tissue Biopsy and Aggressive Surgical Treatment

ABSTRACT Background.Necrotizing fasciitis is a soft tissue gangrenous infection that is optimally treated by early diagnosis,radical surgical debridement of all involved necrotic tissue, broad spectrum antibiotics, and aggressive nutritional support. The early clinical diagnosis of an area of necrotizing fasciitis is difficult and frequently unreliable. We are reporting a series…

Primary Article

Radionuclide Angiography as a Confirmatory Test for Brain Death: A Review of 229 Studies in 219 Patients

ABSTRACT Background.Radionuclide angiography (RA) has been used for many years to confirm the clinical diagnosis of brain death, but quantitative data regarding the technique are unavailable. Methods.We conducted a retrospective review of 229 RA procedures done in 219 patients. Results.Of 206 patients who had interpretable studies and met clinical criteria…

Primary Article

Cancer Screening in Women by Internal Medicine Resident Physicians

ABSTRACT Background.Research suggests that women may not have consistent cancer surveillance. Methods.We conducted a retrospective review of internal medicine resident physicians' screening methods for breast, cervical, and colorectal cancer of women aged 50 or older. Results.Resident physicians did breast examinations in 39.1%, mammography in 37.3%, Pap smears in 32.7%, rectal…

Primary Article

Depressive Symptoms as Correlates of Polydrug Use for Blacks in a High-Risk Community

ABSTRACT Background.This study examined the relationship between depressive symptoms and polydrug use (alcohol, marijuana, and cocaine) among blacks in a high-risk community. Methods.A street sample (N = 570) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug use behavior during the…

Primary Article

Urologic Experience in 48 Heart Transplant Recipients

ABSTRACT Background.Urologic experience in heart transplant recipients as a population group has not been reported. Methods.We reviewed the charts of 48 consecutive heart transplant recipients who were evaluated and treated in our outpatient urologic clinic. Patients were treated for various urologic conditions by both medical and surgical means. Results.No major…

Primary Article

Cholecystectomy Alleviates Acalculous Biliary Pain in Patients With a Reduced Gallbladder Ejection Fraction

ABSTRACT Background.We sought to determine whether a reduced gallbladder ejection fraction, (GBEF) ascertained by cholecystokinin-cholescintigraphy (CCK-CS), predicts symptomatic improvement after cholecystectomy. Methods.Medical records of patients who had had CCK-CS as well as negative results of gallbladder ultrasonography were reviewed, and patients were contacted by telephone to determine whether they had…

Case Report

Duodenal Obstruction in Thyroid Storm

ABSTRACT: A 35-year-old, previously healthy woman, known to be thyrotoxic, was transferred from a community hospital for “acute abdomen.” Abdominal pain, distention, and hyperemesis resolved with placement of nasogastric tube (NGT) and return of 2,600 mL of bilious fluid. Continued high NGT output made oral or NGT administration of antithyroid…

Case Report

Thoracic Actinomycosis and Human Immunodeficiency Virus Infection

ABSTRACT: Despite the impairments of cellular and humoral immunity that accompany the acquired immunodeficiency syndrome, there has not been increased evidence of thoracic actinomycosis. We report on a patient with the human immunodeficiency virus (HIV) infection who had pulmonary actinomycosis. We review the current ideas regarding this unusual pulmonary pathogen…

Case Report

Erysipelothrix rhusiopathiae Endocarditis Clinical Features of an Occupational Disease

ABSTRACT: Erysipelothrix rhusiopathiae is becoming more commonly recognized in humans and has the potential for significant morbidity and mortality. In this article, we describe one patient's clinical symptoms after occupational exposure to E rhusiopathiae and its sequela. We discuss the natural history of the organism, three major categories of human…

Case Report

Coexistence of Granular Cell Tumor and Ipsilateral Infiltrating Ductal Carcinoma of the Breast

ABSTRACT: Granular cell tumor is a benign neoplasm that is rarely seen in the breast and can mimic carcinoma, both clinically and by gross pathologic examination. The coexistence of a granular cell tumor with a primary mammary carcinoma can potentially pose diagnostic and therapeutic problems. In this report, we document…

Case Report

Fatal Rhino-orbital-cerebral Zygomycosis

ABSTRACT: Rhinocerebral zygomycosis is usually an aggressive, fulminant and, at times, fatal disease most often affecting poorly controlled diabetics of all ages. We report the case of a 13-month-old white boy, a previously undiagnosed diabetic. He came to our hospital with recurrent epistaxis, decreasing consciousness, and a small visible infection…

Case Report

Renal Angiosarcoma: A Rare Primary Genitourinary Malignancy

ABSTRACT: Sarcomatous lesions of the kidney comprise less than 2% of all primary renal malignancies. Angiosarcomas are an exquisitely infrequent histologic type in this setting and are associated with a universally poor prognosis. We report the eighth known case of primary renal angiosarcoma and review the available literature on this…

Case Report

Splenogonadal Fusion With Limb Deficiency and Micrognathia

ABSTRACT: Splenogonadal fusion (SGF) is a rare abnormality with two known types. In the continuous type, the spleen is connected to the gonad, and there are often limb defects, micrognathia, or other congenital malformations such as ventricular septal defect, anal atresia, microgastria, spina bifida, craniosynostosis, thoracopagus, diaphragmatic hernia, hypoplastic lung…

Case Report

Tension Hydrothorax

ABSTRACT: Tension hydrothorax is a rare complication associated with a variety of diseases. In this case report, we describe the acute hemodynamic and respiratory effects of tube thoracostomy drainage in a patient with tension hydrothorax.

Case Report

Combined Saphenous Vein With Free Flap Reconstruction in the Treatment of Carotid Stenosis

ABSTRACT:Revascularization for arterial stenosis in varied anatomic sites exposed to therapeutic radiation has been well described. In most circumstances, symptomatic end organ ischemia has been the indication for surgical intervention. We report the case of a patient who had symptomatic carotid stenosis 40 years after having ipsilateral neck dissection with…