Issue - Southern Medical Association

Case Report

Cervical Esophageal Web Caused by an Inlet Patch of Gastric Mucosa

ABSTRACT: A 55-year-old woman had chronic, progressive dysphagia. An esophageal web in the cervical esophagus was identified by barium swallow and endoscopy. At endoscopy, an inlet patch of gastric mucosa was identified in proximity to the cervical web. It is believed that gastric acid production from the inlet patch led…

Current Concepts

Pharmacologic and Dietary Therapies in Epilepsy: Conventional Treatments and Recent Advances

ABSTRACT: A number of treatment options are currently available for the medical management of epilepsy. Conventional antiepileptic drugs (AEDs) include phenytoin, carbamazepine, valproic acid, ethosuximide, barbiturates, and benzodiazepines. Although these drugs control seizures, they may also cause blood dyscrasias, sedation, and cognitive impairment. Felbamate, gabapentin, lamotrigine, and vigabatrin are new…

Case Report

Anaplastic Large Cell Lymphoma of T–Cell Phenotype in Acquired Immunodeficiency Syndrome

ABSTRACT: Anaplastic large cell lymphoma (ALCL) is an uncommon non-Hodgkin's lymphoma in the general population as well as in HIV-infected patients. Ordinarily, ALCL expresses T-cell phenotype, but lymphoproliferative disorders derived from T cells rarely occur in acquired immunodeficiency syndrome (AIDS). We describe a white male homosexual with AIDS who had…

Case Report

Angioedema Associated With Angiotensin II Receptor Antagonist Losartan

ABSTRACT: Angioedema has not been associated with losartan therapy in hemodialysis patients, as it has been with angiotensin converting enzyme (ACE) inhibitors. We report the case of a hemodialysis patient who previously had angioedema after therapy with ACE inhibitors and again had angioedema while taking losartan. We suggest caution in…

Primary Article

Illnesses and Injuries at Summer Camp

ABSTRACT: Children at summer camp are at risk of injury and illness. The American Academy of Pediatrics and the American Camping Association have specific guidelines for the medical care of children in summer residential camps. This report describes the types of illnesses and injuries seen in 730 children attending camp…

Case Report

When Exercise Goes Awry: Exertional Rhabdomyolysis

ABSTRACT: Exertional rhabdomyolysis occurs when exercise, often of the eccentric type, damages myofibrils and sarcolemma, with release of the enzyme creatine kinase and pigmented myoglobin into the serum. Severe muscle soreness and dark urine are the hallmark symptoms, and renal failure may develop. Formerly a disease of military recruits, it…

Primary Article

Proposed Algorithm to Aid the Diagnosis of Cerebellopontine Angle Tumors

ABSTRACT: Hearing and/or balance disorders are symptoms that may be associated with tumors of the cerebelloporitine angle (CPA). Between March 1988 and May 1995, 22 patients had diagnosis or evaluation of CPA tumors at Cleveland Clinic Florida. The most common presenting signs or symptoms included unilateral low-frequency tinnitus, unsteadiness, and/or…

Primary Article

Side Effects of Terazosin in the Treatment of Symptomatic Benign Prostatic Hyperplasia

ABSTRACT: In this report, we assess the safety of terazosin in the treatment of patients with symptomatic benign prostatic hyperplasia. We analyzed seven prospectively designed placebo-controlled trials involving 3,080 patients, 1,689 of whom received the study drug in doses ranging from 1 mg to 20 mg daily for a total…

Primary Article

Clinical, Radiographic, and Pathologic Features of Medial Calcific Sclerosis in the Breast

ABSTRACT: Medial calcific sclerosis (MCS), a nonocclusive calcification of the media of small to medium-sized muscular arteries, may occur in the breast. To ascertain whether MCS causes difficulty with mammographic interpretation of breast calcifications and to determine its clinical and pathologic associations, we reviewed the records and biopsy specimens from…

Primary Article

Prenatal Use of Medications by Women Giving Birth at a University Hospital

ABSTRACT: Medication use during pregnancy has changed over time because of various factors: new products have been marketed, concerns have arisen regarding safety and efficacy, public education has increased, and some prescription medications have been granted nonprescription status by the Food and Drug Administration. The purpose of this investigation was…

Case Report

Meperidine–Induced Generalized Seizures With Normal Renal Function

ABSTRACT: Meperidine is a widely prescribed opioid analgesic used in a variety of clinical situations. The parent compound has central nervous system depressant effects. However, the sole active metabolite, normeperidine, is a central nervous system excitatory agent and has the ability to cause seizures, especially in patients with renal failure….

Primary Article

Survival Benefits of Pulmonary Cellular Activation in AIDS Patients With Pneumocystis Infection

ABSTRACT: Pneumocystis carinii pneumonia (PCP) is the most common life-threatening, opportunistic infection in patients with acquired immunodeficiency syndrome. Between 1984 and 1987, patients infected with human immunodeficiency virus (HIV) received bronchoalveolar lavages to confirm PCP diagnosis. Unstained slides containing bronchoalveolar cells from 20 of these patients were stored. Eight years…

Current Concepts

Management of Gallbladder Polyps

ABSTRACT: Polyps of the gallbladder are often incidentally identified during radiographic evaluation of abdominal pain. Once identified, they pose a dilemma with respect to their proper long-term management. Herein, polyps of the gallbladder are reviewed with specific attention to their management in light of their malignant potential. The available data…

Case Report

Rhabdomyolysis Associated With Simvastatin–Gemfibrozil Therapy

ABSTRACT: Simvastatin is a potent inhibitor of hydroxymethylglutaryl coenzyme A (HMGCoA) reductase intended for use as a hypocholesterolemic agent. The long-term clinical experience with simvastatin indicates that it is a safe, effective, and well-tolerated hypolipidemic agent. Laboratory adverse events involving elevations of serum transaminase levels and serum creatine kinase (CK)…

Primary Article

Systemic Radionuclide Therapy With Strontium Chloride Sr 89 for Painful Skeletal Metastases in Prostate and Breast Cancer

ABSTRACT: Systemic radionuclide therapy with strontium chloride Sr 89 is a rediscovered alternative to relieve pain from bony metastases. Although numerous advances have been made in the diagnosis and treatment of cancer, pain remains a serious and debilitating disease complication. An increasing number of clinical trials are reporting satisfactory results…

Primary Article

Left Vagus Nerve Stimulation in Children With Refractory Epilepsy: An Update

ABSTRACT: This report updates previous reports regarding the tolerance and efficacy of periodic vagus nerve stimulation in a group of 19 children with medically and surgically intractable epilepsy. After vagal stimulator implantation, follow-up continued from 2 months to 30 months, with the study period ending in October 1995. Of the…

Primary Article

Outpatient Bowel Preparation For Elective Colon Resection

ABSTRACT: To determine the safety and cost-effectiveness of outpatient preoperative bowel preparation with polyethylene glycol-electrolyte lavage solution, we retrospectively analyzed 726 cases of colectomy done by colon and rectal surgeons between July 1987 and July 1991. Included were 319 patients who had elective segmental or total abdominal colectomy with primary…

Case Report

Wilson's Disease

ABSTRACT: We describe a patient who had severe neurologic symptoms, psychiatric abnormalities, and secondary amenorrhea superimposed on a history of hemolytic anemia and micronodular cirrhosis attributed to hemochromatosis. The correct diagnosis of Wilson's disease was delayed until the appearance of Kayser-Fleischer rings and a low serum ceruloplasmin level. Appropriate treatment…

Primary Article

Enuresis in Children With Attention–Deficit Hyperactivity Disorder

ABSTRACT: We did a retrospective study of the prevalence of nocturnal and diurnal enuresis in patients with attention-deficit hyperactivity disorder (ADHD). Patients with ADHD were identified at a referral center for developmental pediatrics. Control patients were identified at a general pediatric and pediatric allergy clinic. Adjusting for differences in sex…

Case Report

Primary Cardiac Lymphoma: Initial Symptoms Suggestive of Gastrointestinal Disease

ABSTRACT: We report a case of primary cardiac lymphoma in a patient who was not infected with human immunodeficiency virus and had symptoms suggestive of upper gastrointestinal (GI) disease. Examination revealed no GI abnormalities. Echocardiography, prompted by sudden development of congestive heart failure, revealed a large right atrial mass. Cardiac…

Case Report

Vibrio fluvialis: An Underrecognized Enteric Pathogen in Infants?

ABSTRACT: We report a case of Vibrio fluvialis gastroenteritis in an infant 3 ½ weeks old. The case was unusual because no likely epidemiologic risk factors were involved. Since several other such cases in young infants have been reported, V fluvialis should be considered in the differential diagnosis of infantile…

Primary Article

Tongue Protrusion Dystonia: Treatment With Botulinum Toxin

ABSTRACT: We report the treatment experience in a series of patients with involuntary tongue protrusion resulting from oromandibular dystonia (OMD) or Meige's syndrome. A retrospective analysis of clinical findings and results of treatment was conducted on patients treated at Vanderbilt University Medical Center between 1989 and 1995. After unsuccessful treatment…

Primary Article

Can Market–Based Solutions Work for All of Medicare? Barriers to Reform in the Medicare Population Residing in Health Professional Shortage Areas

ABSTRACT:The proportion of the Medicare-eligible population living in health professional shortage areas (HPSAs), their demographics, and three health status indicators were examined in relationship to market-based reform proposals. Medicare-eligible residents of Georgia and Kentucky were classified as living in an HPSA (n = 154,812) or non-HPSA (n = 556,602). Chi-squares…

Correspondence

Delayed Posttraumatic Tamponade

Correspondence

Effects of Age, Sex, and Initial Presentation on the Clinical Course of Behcet's Syndrome

Correspondence

Medical Therapy for Inflammatory Bowel Disease