Issue - Southern Medical Association

Primary Article

Prevalence of Coronary Heart Disease Risk Factors Among Rural Blacks: A Community-Based Study

ABSTRACT Background.Coronary heart disease (CHD) remains the most common cause of death among blacks, and the difference in CHD mortality between blacks and whites is growing. This trend may be due in part to higher rates of CHD risk factors among blacks. This study was done to determine the prevalence…

Primary Article

Conscious Sedation With High-Dose Midazolam for Pediatric Gastrointestinal Endoscopy

ABSTRACT Background.Midazolam is used frequently to sedate children for gastrointestinal endoscopy. The sedative dosage of intravenous midazolam commonly reported in children is up to 0.3 mg/kg. We hypothesized that larger doses of midazolam could be used for pediatric endoscopy. Methods.We retrospectively reviewed the medical records of 116 pediatric patients (aged…

Current Concepts

Nondepolarizing Neuromuscular Blocking Drugs in the Intensive Care Unit: A Clinical Review

ABSTRACT Background.The use of nondepolarizing neuromuscular blocking drugs (NDNMBDs) via continuous infusion in the intensive care unit (ICU) is gaining in popularity. Several new NDNMBDs have been developed recently; these drugs vary in their elimination, metabolism, and half-lives. Methods.A review of the recent English language literature was done, with those…

Current Concepts

Bipolar Illness

ABSTRACT Background.Within the past 5 years, several factors have altered our view of the diagnosis, prognosis, treatment, and genetics of bipolar illness. Methods.Significant advances in these areas are reviewed. Results.Diagnostic changes include establishment of symptom duration requirements that limit confusion with affective instability. Prognostic insights include the realization that illness…

Case Report

Autoimmune Progesterone Dermatitis: Onset in a Woman Without Previous Exogenous Progesterone Exposure

ABSTRACT: Autoimmune progesterone dermatitis is a rare clinical entity that may be seen by the family practitioner, gynecologist, or dermatologist. Recognition of the entity is paramount in the therapy of this easily treated condition. We report a case of a 36-year-old woman with a recurrent facial dermatitis of many months'…

Primary Article

Back Pain in Children and Adolescents A Retrospective Review of 648 Patients

ABSTRACT: Back pain in children has long been considered a serious condition with an organic cause. The staff of the Shriner's Hospital had been informally noting that diagnoses among children with back pain had been changing. We conducted a retrospective study of 648 patients with spinal disorders treated at the…

Case Report

Posttraumatic Cervical Osteophytosis Causing Progressive Dysphagia

ABSTRACT: Dysphagia is a commonly encountered patient complaint. The differential diagnosis for dysphagia is extensive. One long-recognized etiology of dysphagia is cervical osteophytosis. Degenerative joint disease, ankylosing spondylosis, and diffuse idiopathic skeletal hyperostosis (DISH) can all cause cervical osteophyte formation. We describe a patient with dysphagia and a large cervical…

Case Report

Brodifacoum Rodenticide Ingestion in a Patient With Shigellosis

ABSTRACT: Factitious disorders are characterized by the intentional feigning or induction of signs and/or symptoms in order to assume the sick role. The spectrum of diseases and symptoms simulated is extensive. Although some patients may seek only the gratifications of the sick role, typically patients seek health care for their…

Case Report

Hodgkin's Disease Associated With Neurologic Paraneoplastic Syndrome

ABSTRACT: In this case of neurologic paraneoplastic syndrome in a patient with Hodgkin's disease, both the Hodgkin's disease and the associated neurologic syndrome were cured by surgical intervention and postoperative adjuvant chemotherapy. The patient's tumor was removed en bloc. Postoperative chemotherapy consisted of doxorubicin (Adriamycin), etoposide, and vinblastine. At 5-year…

Case Report

Spontaneous Resolution of Rhodococcal Pulmonary Infection in a Liver Transplant Recipient

ABSTRACT: Pulmonary infection by Rhodococcus equi is characterized by indolent infection in an immunocompromised host with a propensity to form cavitary lesions. Mortality can be greater than 50%; treatment involves prolonged therapy with multiple antibiotics and, occasionally, surgical resection. Recurrence is common. We report a case of a liver transplant…

Case Report

High Grade Dysplasia/Esophageal Adenocarcinoma in Short Segment Barrett's Esophagus

ABSTRACT: Short segment Barrett's esophagus (SSBE) is a frequent finding in patients having endoscopy, but its clinical significance is not fully understood. With the rising incidence of esophageal adenocarcinoma, a potential role of SSBE has been suggested. Biopsy of such lesions may have to be done when seen on endoscopy.

Primary Article

Solitary Fibrous Tumors: A Series of Lesions, Some in Unusual Sites

ABSTRACT: Solitary fibrous tumor (SFT) is a rare neoplasm that, in addition to its classic presentation as a pleural-based mass, can also be encountered in unusual sites. The main difficulty in making the diagnosis of SFTs results from the unfamiliarity with its diverse clinical and pathologic features. This series of…

Primary Article

Increased Incidence of Non-Transitional Cell Carcinoma of the Bladder in Women of the Texas Gulf Coast Region

ABSTRACT: The objective of our study was to verify a suspected increased incidence of non-transitional cell carcinoma (TCC) of the bladder in female patients treated at our institution. The study included 169 patients, 83% of whom resided in the Texas Gulf Coast region. Tumors were considered TCC or non-TCC on…

Primary Article

Prevalence of Obesity With Increased Blood Pressure in Elementary School-Aged Children

ABSTRACT: The objectives of this study were to estimate the prevalence of obesity in school-aged children in Jefferson County, Alabama; to learn when school-aged children become obese; to determine the susceptible groups; and to study the association between obesity and blood pressure. During the school year, 5,953 children, ranging in…

Case Report

Pill-Induced Esophageal Obstruction: Discovery of a Peptic Stricture

ABSTRACT: The patient described in this report had complete esophageal obstruction shortly after a new medication had been prescribed. When the obstructing pill was removed endoscopically, a peptic stricture was discovered. Curiously, the patient had had only rare transient dysphagia before this episode.

Primary Article

Correlation of Menstrual Cycle at Time of Breast Cancer Surgery to Disease-Free and Overall Survival

ABSTRACT: The timing of surgery during the menstrual cycle of premenopausal breast cancer patients was correlated with their disease-free survival (DFS) and overall survival (OS). The study included 150 premenopausal patients treated for breast cancer between 1977 and 1992. The data were analyzed using three different menstrual cycle phase categorization…

Case Report

Monoamine Oxidase Inhibitors and Cardiac Anesthesia Revisited

ABSTRACT: There are well-recognized adverse interactions between the monoamine oxidase inhibitors and anesthetic drugs, particularly narcotics. Patients having cardiopulmonary bypass procedures are commonly anesthetized using high-dose narcotic techniques. We describe an uneventful perioperative course in a parkinsonian patient who required urgent coronary artery bypass graft surgery while he was taking…

Case Report

Seizure After Overdose of Tramadol

ABSTRACT: Tramadol (Ultram) is a new analgesic agent with a dual mechanism of action that includes weak agonistic effects at the µ-opioid receptor as well as inhibition of neurotransmitter (serotonin, norepinephrine) re-uptake. Although it has proven to be a safe and effective agent for the control of pain, adverse effects…

Case Report

Pulmonary Blastomycosis With Acute Respiratory Failure as Predominant Clinical Feature

ABSTRACT: Two previously healthy young adults came to our community hospital with rapidly progressive respiratory failure. Investigation confirmed Blastomyces as the responsible etiologic agent. Despite adequate antifungal chemotherapy and intensive supportive care, both patients died, one within 24 hours and the other after 14 days. Overwhelming infection with Blastomyces dermatitidis…

Case Report

Cutaneous Protothecosis in Association With the Acquired Immunodeficiency Syndrome

ABSTRACT: We report a case of protothecosis that occurred in the skin over the left tibial region of a 25-year-old man with the acquired immunodeficiency syndrome (AIDS). The lesion was noticed a few months after he swam in a lake in south Alabama. Biopsy and culture revealed Prototheca wickerhamii. We…

Case Report

Large Transitional Cell Carcinoma of the Proximal Third of the Ureter in a Young Man

ABSTRACT: We report an unusual case of a 37-year-old black man found to have a large transitional cell carcinoma of the proximal third of the ureter. This case is of interest because of the relatively young age of the patient, the upper third ureteral origin of the tumor, and the…

Correspondence

Community-Acquired Pneumonia in the Elderly

Correspondence

Community-Acquired Pneumonia in the Elderly Reply

Correspondence

Passive Smoking Exposure on Submarines