Issue - Southern Medical Association

Case Report

Sporotrichoid Cutaneous Leishmaniasis in a Traveler

ABSTRACT: A 19-year-old construction worker from Virginia who had traveled in Bolivia had sporotrichoid lesions on the left arm. Only after unsuccessful therapy for sporotrichosis was a diagnosis of cutaneous leishmaniasis considered. Biopsies revealed necrotizing granulomatous changes, and culture of the biopsy specimens grew Leishmania (Viannia) braziliensis. The sporotrichoid pattern…

Case Report

Sequential Herniation of Stomach, Then Colon Through the Aortic Hiatus

ABSTRACT: A patient with a large paraesophageal hernia had a Nissen fundoplication via laparoscopy. He returned a year later with the transverse colon herniated into the chest. At operation, the hernia ostium was found to be the aortic hiatus. We believe that the original ostium was missed because of the…

Case Report

Unilateral Pulmonary Agenesis Without Mediastinal Displacement

ABSTRACT: A radiographic hallmark in pulmonary agenesis is opacification of the ipsilateral hemithorax with displacement of the mediastinum in the direction of the agenetic lung. We believe this case report is the first in which the mediastinum was not displaced; instead, the liver and intact hemidiaphragm were displaced cephalad, preventing…

Case Report

Dermatomyositis in Association With Tubulovillous Adenoma: Resolution After Resection of Adenoma

ABSTRACT: Dermatomyositis (DM) has been associated with gastrointestinal malignancy but not with polyps or adenoma. We report a case of villous adenoma associated with DM. An 80-year-old white woman was referred for a rash of 2 months' duration that was suggestive of DM. On examination, Gottron's papules and heliotrope rash…

Primary Article

Polymerase Chain Reaction Testing for Early Detection of HIV Infection in Children

ABSTRACT: Diagnosis of vertically acquired human immunodeficiency virus (HIV) infection is often difficult because of transplacentally acquired maternal antibodies. The polymerase chain reaction (PCR) test is commercially available and has high sensitivity and specificity. To evaluate the usefulness of PCR testing in the early diagnosis of perinatally acquired HIV infection,…

Primary Article

Management of Multiple-Antibody–Mediated Hyperthyroidism in Children With Down’s Syndrome

ABSTRACT: During a period of 7 years at our institution, four girls and one boy with Down's syndrome, ages 9 to 16 years, were examined and treated for hyperthyroidism. Two patients had Graves' disease and they responded to propylthiouracil (PTU) with a predictable clinical course resulting in remission within 4…

Case Report

Eagle’s Syndrome (Elongated Styloid Process)

ABSTRACT: Eagle's syndrome occurs when an elongated styloid process or calcified stylohyoid ligament causes recurrent throat pain or foreign body sensation, dysphagia, or facial pain. Additional symptoms may include neck or throat pain with radiation to the ipsilateral ear. In adults, the styloid process is approximately 2.5 cm long, and…

Primary Article

Community-Acquired Pneumonia in the Elderly: Association of Mortality With Lack of Fever and Leukocytosis

ABSTRACT: Elderly patients with community-acquired pneumonia may not have a systemic inflammatory response characterized by fever and leukocytosis. We compared lack of fever and leukocytosis with mortality in elderly patients with community-acquired pneumonia. Patients with fever and leukocytosis (group A, 47 patients) were compared with those without fever and leukocytosis…

Case Report

Successful Resection of Multifocal Hepatic Adenoma During Pregnancy

ABSTRACT: Hepatic adenoma is an unusual complication of pregnancy. Most of these lesions are solitary and associated with hormonal contraceptives. We believe ours is the first case of successful resection of multifocal hepatic adenoma during pregnancy in a patient with no history of oral contraceptive use.

Case Report

Gestational Herpes Simplex Virus Hepatitis

ABSTRACT: Hepatitis due to herpes simplex virus (HSV) is unusual in healthy individuals. To date, only 56 cases of HSV hepatitis in adult patients have been reported, including 21 pregnant patients. We describe a 25-year-old white woman in her 30th week of gestation who had progressive acute hepatitis. Histologic examination…

Primary Article

Ipsilateral Femoral Neck and Shaft Fractures

ABSTRACT: Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern encountered by orthopaedic surgeons. We review 11 cases of this fracture pattern. Treatment was by reduction and stabilization of the femoral neck fracture with one or more cannulated screws, followed by fixation of the femoral shaft using…

Case Report

Nonfatal Gastric Mucormycosis in a Renal Transplant Recipient

ABSTRACT: Mucormycosis historically has caused substantial morbidity with high mortality in renal transplant patients with disseminated and/or rhinocerebral infection and in patients with gastrointestinal illness regardless of predisposing conditions. We report the first successful treatment of gastric mucormycosis in a renal transplant recipient and review presumed pathogenic mechanisms of mucormycosis…

Expired CME Article

Implications of the Diabetes Control and Complications Trial for Persons With Non-Insulin-Dependent Diabetes Mellitus

ABSTRACT: The Diabetes Control and Complications Trial has conclusively established that intensive control of insulin-dependent diabetes mellitus in persons aged 19 to 26 years (almost exclusively white, normotensive, nondyslipidemic, of normal weight, and insulin sensitive) reduces by ± 50% the likelihood of retinopathy, nephropathy, and neuropathy. In contrast, persons with…

Primary Article

Mental Disorders in Children and Adolescents With Sickle Cell Disease

ABSTRACT: This study compares the rate of mental disorders in children and adolescents with sickle cell disease with the rate in a corresponding control population. Using the clinical interview, a diagnosis based on DSM-III-R criteria for the presence of 13 mental disorders common to childhood was considered in a sequential…

Primary Article

Chlordane as a Neurotoxin in Humans

ABSTRACT: To assay and profile chronic neurobehavioral impairment associated with chlordane exposure in symptomatic patients, consecutive evaluations of nine patients were done with sensitive neurophysiologic and neuropsychologic tests for neurobehavioral function. Their visual fields, balance, reaction time, blink, color discrimination, grip strength, cognitive function, recall, memory, and perceptual motor speed…

Primary Article

Twenty-four-Hour Ambulatory Esophageal pH Monitoring in the Diagnosis of Acid Reflux-Related Chronic Cough

ABSTRACT: To define the role of ambulatory pH monitoring in evaluating chronic cough, we studied esophageal pH values of patients referred to a gastroenterology laboratory. Chronic cough was evaluated in 31 patients, who were grouped based on response to treatments; 11 patients (35.5%) had gastroesophageal reflux (GER)-related cough, 11 (35.5%)…

Case Report

Radiodermatitis After Transjugular Intrahepatic Portosystemic Shunt

ABSTRACT: Transjugular intrahepatic portosystemic shunt (TIPS) is a recently introduced angiographic technique for achieving portal decompression. New invasive radiographic procedures such as TIPS can result in radiation exposure equal to that received by patients during radiation therapy. With these high doses of radiation, patients are at increased risk for radiodermatitis…

Case Report

Bilateral Non-Hodgkin’s Lymphoma of the Breast Mimicking Mastitis

ABSTRACT: We recently encountered a case of recurrent non-Hodgkin's lymphoma manifested after a long period of quiescence as bilateral involvement of the breasts. This 37-year-old woman had stage IVA nodular poorly differentiated lymphocytic lymphoma diagnosed 9 years previously and was followed up without treatment. She was lost to follow-up after…

Case Report

Symptomatic Pleural Collection of Cerebrospinal Fluid Caused by a Ventriculopleural Shunt

ABSTRACT: We report a case of symptomatic pleural collection of cerebrospinal fluid caused by a ventriculopleural shunt in a 4-year-old child. Since ventriculopleural shunts are not commonly used in the management of hydrocephalus, primary physicians must be aware of this potential complication.

Primary Article

Cervical and Breast Cancer Screening Rates in Sioux Indian Women

ABSTRACT: With increasing evidence of the effectiveness of mass screening in reducing mortality from both cervical and breast cancer, we began to study the rates of cervical cytology and mammography in 1994 for its impact on increased efforts to gain participation among its target population, the Sioux Indian women. Data…

Correspondence

Cancer Pain Management and Rectal Opioids

Correspondence

Parkinsonian Syndrome in a Dialysis-Supported Patient Receiving High-Dose Chemotherapy for Multiple Myeloma

Case Report

Two Lives