Issue - Southern Medical Association

Primary Article

Drooping of the Big Toe: Another Diagnostic Marker for L-5 Radiculopathy

ABSRACT:Drooping of the big toe is found in a host of neurologic diseases. If found in isolation in a patient who has low back pain, with or without clear sensory deficit, this finding can be a useful, objective aid in localizing the lesion to the L-5 nerve root.

Primary Article

Use of Greenfield Filters in Pregnant Women at Risk for Pulmonary Embolism

ABSTRACT: A 3-year retrospective study (1992 to 1995) was done to identify all cases of Greenfield filter use in pregnant patients cared for by the Maternal-Fetal Medicine Service of our institution. The patient selection criteria included placement of a Greenfield filter in the index pregnancy or placement of a Greenfield…

Case Report

Human Infestation With Rodent Botfly Larvae: A New Route of Entry?

ABSTRACT: A 3-year-old child was infested with two larvae of the rodent botfly (insect order Diptera, genus Cuterebra), one on the back and one on the neck. Both larvae produced tracklike lesions in the skin. Ater week 1, the back lesion did not develop further, but the neck lesion continued…

Case Report

Alveolar Hemorrhage in IgA Nephropathy Treated With Plasmapheresis

ABSTRACT: A 66-year-old man had diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis due to IgA nephropathy. The diffuse alveolar hemorrhage resolved after high-dose corticosteroid therapy, and renal function improved after plasmapheresis. This response suggests an adjunctive role for plasmapheresis in the treatment of patients presenting this rare clinical picture.

Case Report

Hyperphosphatemia Associated With Phosphorus-Containing Laxatives in a Patient With Chronic Renal Insufficiency

ABSTRACT: A patient with chronic renal insufficiency had hyperphosphatemia, hypocalcemia, hypomagnesemia, hypokalemia, metabolic acidosis, and QT prolongation on electrocardiogram after taking prescribed laxatives containing phosphorus. Clinical findings included tetany in the form of Chvostek's and Trousseau's signs. Symptoms resolved after careful rehydration and electrolyte replacement. The interactions between these electrolytes…

Article

History of the Cytomegalovirus

ABSTRACT: Because it is capable of producing both congenital and acquired infections, the cytomegalovirus (CMV) has become an extremely important pathogen, and review of its history is pertinent. Inclusion-bearing cells were first shown by Ribbert in 1881. Goodpasture and Talbert in 1921 were the first to suggest that the “cytomegalia”…

Case Report

Bronchiolitis Obliterans Organizing Pneumonia as the First Manifestation of Polymyositis

ABSTRACT: Bronchiolitis obliterans organizing pneumonia (BOOP) preceding polymyositis is rare. In this report, a 51-year-old patient with fever, nonproductive cough, and dyspnea had bilateral basal interstitial infiltrates on chest roentgenogram. Open lung biopsy was consistent with BOOP. Prednisone therapy led to improvement, but 8 weeks later, fever, cough, and weakness…

Case Report

Diaphragmatic Flutter Emulating Recalcitrant Asthma

ABSTRACT: Diaphragmatic flutter is a rare phenomenon characterized by high-frequency, pulsatile contractions of the thorax and abdominal wall associated with breathlessness. We describe the case of a patient previously treated for status asthmaticus who had physical signs of diaphragmatic flutter. Respiratory inductive plethysmography confirmed the diagnosis, simplifying medical management.

Primary Article

Hypertension-Related Mortality and Morbidity in the Southeast

ABSTRACT: Geographic variations in adverse health outcomes have long been recognized in the United States, with specific focus on the southeastern region of the country. Cerebrovascular disease mortality rates have identified the Southeast as the “stroke belt” for decades, though rates are also high for other hypertension-related diseases including ischemic…

Case Report

Iatrogenic Hypoglycemia and Malpractice Claims

ABSTRACT: Iatrogenic neuroglycopenia represents a medical emergency for which accepted and usually effective treatment exists. Treating physicians face a malpractice risk if there is permanent neurologic damage and there is a perception of failure to act prudently both before and after the damaging episode. We report two cases to illustrate…

Current Concepts

How to Treat Coexistent Mental Illness and Substance Abuse

ABSTRACT: Integration of mental illness and substance abuse treatments is important for patients with “dual diagnosis,” the coexistence of an emotional ailment and a chemical dependency. Such comorbidity is usually associated with a poor prognosis. Both disorders require appropriate therapy so that remission of psychiatric symptoms and maintenance of sobriety…

Article

Marijuana to Prevent Nausea and Vomiting in Cancer Patients: A Survey of Clinical Oncologists

ABSTRACT: Marijuana, if rescheduled by the Drug Enforcement Agency, would be the only Food and Drug Administration (FDA)-approved drug to be administered by smoking. American physicians need timely, factual information about probable usage patterns and potential adverse effects of medical marijuana, and a factual complete review of the literature on…

Primary Article

Mesothelioma: A Study of 22 Case

ABSTRACT: Mesothelioma is a rare, asbestos-associated tumor that infrequently metastasizes. We reviewed 22 autopsies (from February 1989 through July 1994) showing mesothelioma. We determined distribution of metastases and staining characteristics of primary mesotheliomas compared to tissue involved by metastases and/or direct extension. Mean patient age was 68 years (range, 38…

Case Report

Functional Mitral Stenosis Resulting From a Large Mitral Valve Prosthesis Vegetation

ABSTRACT: Obstruction of a prosthetic valve by an infective vegetation is a rare and life-threatening complication of endocarditis that demands emergent surgical intervention. In our patient's case, transthoracic echocardiography showed the large vegetation, transthoracic Doppler imaging showed severe obstruction of diastolic flow through the bioprosthetic valve, and transesophageal echocardiography showed…

Case Report

Pregnancy Complicated by Primary Aldosteronism

ABSTRACT: Pregnancy is rarely complicated by aldosteronism. We report the case of a 32- year-old woman who became pregnant soon after primary aldosteronism was diagnosed. Only antihypertensive medication and oral potassium supplementation were required in addition to routine prenatal care. A healthy female infant was delivered at term. In this…

Primary Article

Ineffectiveness of Latex Condoms in Preventing Contamination of the Transvaginal Ultrasound Transducer Head

ABSTRACT: The efficacy of condoms in preventing contamination of the transvaginal ultrasound transducer head and possible transmission of blood-borne pathogens is unknown. Our objective was to determine the rate of contamination of the transvaginal ultrasound probe after use in the emergency department. After indicated transvaginal ultrasound scans, the latex condom…

Primary Article

Social Influence on Southern Adolescents’ Smoking Transition: A Retrospective Study

ABSTRACT: The purpose of this study was to examine social factors that predicted adolescent smoking transition to more advanced stages of smoking behavior during a 3-year span. A national cohort sample of adolescents (N = 2,099) who participated in the 1989 and 1993 Teenage Attitudes and Practices Survey (TAPS I…

Primary Article

Esophageal ‘Stars’: A Sinister Foreign Body Ingestion

ABSTRACT: This paper describes an “epidemic” of foreign body ingestion in six consecutive prisoners from the same jail. The resulting esophageal perforations won all patients “temporary vacations” from prison. The nature of the ingested foreign body (hypodermic needles fashioned into a “star”) guaranteed perforation of the esophagus. All six patients…

Primary Article

Ultrasound-Guided Compression for the Treatment of Iatrogenic Femoral Pseudoaneurysms

ABSTRACT: To assess the emerging use of ultrasound-guided compression (USGC) to treat iatrogenic femoral artery pseudoaneurysm (PA), we reviewed the experience in the accredited vascular laboratory of a large community teaching hospital from June 1993 to August 1994. Femoral duplex ultrasonography was done on 94 consecutive patients suspected of having…

Case Report

Neonatal Torulopsis glabratas Fungemia

ABSTRACT: Torulopsis glabrata is a yeastlike fungus that has recently become recognized as an important opportunistic pathogen. Only four cases of T glabrata infection in neonates-have been reported. We report two cases of fungemia caused by this organism in premature infants. Both patients were treated with amphotericin B and survived…

Case Report

Airway Obstruction in Ulcerative Colitis

ABSTRACT: We present a case of fulminant ulcerative colitis with associated extraintestinal manifestations, including upper airway obstruction from acute laryngotracheitis. Review of the literature shows few other cases of airway obstruction in chronic inflammatory bowel disease. Aggressive medical management of the underlying inflammatory bowel disease may facilitate a conservative approach…

Current Concepts

Potential for Tolerance, Morbidity, and Mortality Resulting From Regular Use of β2-Adrenergic Agonists in Asthma

ABSTRACT:The inhaled β2-adrenergic agonists form the mainstay of therapy for mild to moderate asthma. They are also highly effective for the management of exercise-induced asthma and nocturnal symptoms of the disease. Mounting evidence suggests that these agents may have the potential for the development of tolerance, particularly to their bronchodilating…

Correspondence

Appendectomy

Editorial

SETTING LIMITS AND LONG-TERM CARE OF THE FRAIL ELDERLY

Correspondence

The Avalanche of Forms

Correspondence

The Dutch Health Care System