Issue - Southern Medical Association

Case Report

Systemic Ehrlichiosis Presenting as Progressive Hepatosplenomegaly

ABSTRACTA 42-year-old white man had headache, fever, chills, abdominal pain, nausea and vomiting, night sweats, and dark urine for 3 days before admission; he had history of a tick bite 6 weeks earlier. Progressive systemic deterioration, heralded by progressive hepatosplenomegaly and pancytopenia, occurred despite doxycycline therapy. Subsequent recovery was preceded…

Current Concepts

Characteristics of Patients With Rapidly Growing Cervical Cancer

ABSTRACTBetween April 1983 and December 1990, 387 newly diagnosed cervical cancer cases were managed at our institution. We retrospectively reviewed 59 of those cases, which were identified as having developed within 3 years of the patients' last normal Pap smear. Squamous cell carcinoma was found in 45 patients, and 33…

Current Concepts

Tobacco Smoking A Survey in a Community With Excess Lung Cancer

ABSTRACTDuval County, Florida (Jacksonville) has had one of the highest lung cancer mortality rates among large US cities in recent decades. This survey was conducted to determine whether this might be due in part to higher prevalence or amount of smoking. Telephone interviews using a random digit dialing technique were…

Current Concepts

Roles of Mental Health Professionals in Multidisciplinary Medically Supervised Treatment Programs for Obesity

ABSTRACTExcess weight is a major medical problem for more than one third of Americans and, after cigarette smoking, is the second largest cause of death. However, obesity treatments remain controversial, and only surgical therapies have patient volume and appropriate follow-up adequate to prove effectiveness. National Institutes of Health conferences on…

Case Report

Lemierre's Syndrome

ABSTRACTLemierre's syndrome is an acute medical condition characterized by anaerobic oropharyngeal infection leading to septic thrombophlebitis of the internal jugular vein. The illness is often complicated by septic pulmonary emboli and distant metastatic infections. Treatment consists of surgical drainage of purulent collections and long-term intravenous antibiotic therapy. Although Lemierre's syndrome…

Case Report

Isolated Splenic Metastases From Colon Cancer

ABSTRACTMetastatic tumors of the spleen are rare and usually occur in the presence of disseminated visceral metastases. The liver is the most common site of metastatic spread from colon cancer. We report a case of isolated intrasplenic metastasis from sigmoid colon cancer and review the possible reasons for the rarity…

Current Concepts

Sarin Poisoning on Tokyo Subway

ABSTRACTOn the day of the disaster, 641 victims were seen at St. Luke's International Hospital. Among those, five victims arrived with cardiopulmonary or respiratory arrest with marked miosis and extremely low serum cholinesterase values; two died and three recovered completely. In addition to these five critical patients, 106 patients, including…

Case Report

Late Recurrence of Seminoma

ABSTRACTPatients with testicular cancer usually are cured if they survive disease-free for 2 years after therapy. We report a case of documented seminoma that recurred at both 21 years and 32 years after the patient's orchiectomy. We discuss late recurrences in germ cell cancer, possible mechanisms of recurrence, and the…

Case Report

Primary Breast Cancer in Aberrant Breast Tissue in the Axilla

ABSTRACTPrimary breast cancer in aberrant axillary breast tissue is rare. Breast cancer in the axilla is most often due to lymph node metastases from an ipsilateral breast tumor or from an occult primary lesion. We describe two patients with primary breast cancer in aberrant breast tissue in the axilla, and…

Case Report

Ferrous Sulfate‐Induced Increase in Requirement for Thyroxine in a Patient With Primary Hypothyroidism

ABSTRACTRecent studies have shown that under experimental conditions ferrous sulfate may reduce the gastrointestinal absorption of orally administered levothyroxine sodium in patients with primary hypothyroidism. We describe a patient who became hypothyroid while taking ferrous sulfate. The hypothyroid status was corrected by increasing die dose of levothyroxine. Subsequently, when ferrous…

Case Report

Delayed Onset of Pseudomembranous Colitis After Rifampin Therapy

ABSTRACTRifampin therapy is an infrequently reported cause of pseudomembranous colitis. A low index of suspicion may account for this lack of recognition. Awareness of this potentially hazardous complication of rifampin therapy is encouraged, especially since increasing numbers of patients infected with the human immunodeficiency virus, who may have diarrhea from…

Current Concepts

Use of Emergency Departments by the Elderly in Rural Areas

ABSTRACTSparse information is available concerning use of emergency departments (EDs) by the elderly in rural areas. We reviewed records of all patients seeking care at EDs of three rural hospitals during 7 days in October 1991. We found that elderly people did not use EDs in proportion to their numbers…

Current Concepts

Ventilator Management of Infants Before Extracorporeal Membrane Oxygenation

ABSTRACTThe aim of this project was to review the course of infants referred for consideration of extracorporeal membrane oxygenation (ECMO) to identify maximal ventilator settings that, when exceeded, did not provide clinical benefit to the patient. These settings might then be used in defining failure of conventional mechanical ventilation. We…

Current Concepts

Neurologic and Neuropsychiatric Complications of Crohn's Disease

ABSTRACTThe literature contains sporadic accounts of neurologic complications occurring in patients with Crohn's Disease (CD). The pathogenesis of these is unknown and little has been reported about their incidence. Our review of the medical records of 253 patients with confirmed CD showed that neurologic and neuropsychiatric complications were evident in…

Case Report

Campho‐Phenique Ingestion An intentional Overdose

ABSTRACTWe report a suicide attempt with the camphorated phenol preparation Campho-Phenique. The total dose ingested was 68 mg/kg of camphor and 28.9 mg/kg of phenol. The patient had grand mal seizures minutes after ingestion. Supportive medical care and intubation resulted in full recovery within 12 hours. Although Campho-Phenique has been…

Case Report

Pneumococcal Sacroiliitis

ABSTRACTWe report an unusual case of Streptococcus pneumoniae sacroiliitis in a previously healthy 31-year-old woman. Six cases of pneumococcal sacroiliitis have been reported; the only two cases in adults occurred in young women in the preantibiotic era. Our patient had fever and a depressed level of consciousness, with subsequent right…

Current Concepts

The Culture of Morning Report Ethnography of a Clinical Teaching Conference

ABSTRACTWe studied the structure, process, and subjective meaning of “morning report,” a time-honored, medical teaching conference attended by faculty, house officers, and students at a pediatric teaching hospital. Methods included participant observation, focused interviews, and content analyses. Results showed substantial variation by rank in behavior, perception, and participation based on…

Current Concepts

In Vitro Activities of Oral Antimicrobial Agents Against Penicillin‐resistant Streptococcus pneumoniae Implications for Outpatient Treatment

ABSTRACTWe tested 83 penicillin-intermediate (Peni) and 50 penicillin-resistant (Penr) isolates of Streptococcus pneumoniae against eight oral antimicrobials. Clarithromycin's MICs (minimal inhibitory concentration) were generally the same or one to two dilutions less than those of azithromycin. Seventy-two percent of Peni isolates were susceptible to clarithromycin and azithromycin, in contrast to…

Correspondence

Tick‐Borne Diseases in the United States