Issue - Southern Medical Association

Primary Article

Aspirin Administration for Cardiac‐related Acute Chest Pain/Angina Increased Use in Medicare Patients

Abstract Background. Coronary heart disease (CHD), the leading cause of death in the United States, accounted for approximately 490,000 deaths in 1993. Angina pectoris, a manifestation of CHD, accounted for 13,586 Medicare discharges in 1993 in Texas. A pilot project showed aspirin prophylaxis that reduces cardiovascular morbidity and mortality in…

Primary Article

Stroke in Hispanic Veterans A Descriptive Study*

Abstract Background. Differences in risk factor prevalence and distribution of atherosclerotic cerebrovascular disease have been reported among different racial‐ethnic groups. Identification of stroke syndromes and risk factors specific to the Puerto Rican male population should lead to more effective diagnosis, treatment, and prevention programs. Methods. We prospectively and consecutively evaluated…

Primary Article

Causes and Outcome of Upper and Lower Gastrointestinal Bleeding The Grady Hospital Experience

Abstract Background. Gastrointestinal (GI) bleeding remains a common medical condition, with a mortality rate believed to have remained unchanged over the past five decades. Methods. Over a 50‐month period, the gastroenterology consultative service at a large inner‐city hospital prospectively evaluated acute upper GI (UGI) bleeding or lower GI (LGI) bleeding…

Primary Article

Clinical Study of Mitral Valve Repair Short‐term and Long‐term Outcomes

Abstract Background. In recent years, mitral valve reconstructive techniques have become an increasingly preferential alternative to replacement. The purpose of this study was to evaluate short‐term and long‐term outcomes associated with mitral valve repair. Methods. This study involved 99 patients who had mitral valve repair for mitral regurgitation from January…

Primary Article

Prescribing Controlled Substances in Tennessee Progress, Not Perfection

Abstract Background. In the 1980s, Tennessee ranked among the top 10 states in per capita consumption of several controlled substances. We describe efforts designed to reduce non‐criminally motivated misprescribing in Tennessee, present Tennessee's recent Drug Enforcement Administration (DEA) rankings, and suggest how physicians may reduce misprescribing. Methods. Tennessee's Board of…

Current Concepts

Insulin Resistance Syndrome Options for Treatment

Abstract Background. Insulin resistance is characterized by impaired responsiveness to endogenous or exogenous insulin. Loss of responsiveness is associated with a “clustering” of cardiovascular risk factors that includes abdominal obesity, hypertension, dyslipidemia, glucose intolerance, and hyperinsulinemia; this association is referred to as the insulin resistance syndrome (IRS). Methods. We searched…

Primary Article

Prevalence of Previous Appendectomy Among Patients Needing Gastrointestinal Endoscopy

Abstract Background. The appendix may be an immune modulator of the gut, and its absence may lead to an increase in gastrointestinal illnesses. If this is true, we may expect patients needing endoscopy to have a higher prevalence of previous appendectomy. Methods. We did a case‐control study at the University…

Current Concepts

Automation of Clinical and Patient Records

Abstract Background. With advances in computer technology and mounting pressure to cut health care costs, there is a desire to automate clinical and patient records. Methods. We reviewed the barriers that hindered automation in the past, changes in the business environment, and the recent developments that could encourage automation, including…

Case Report

Exudative Eosinophilic Pleural Effusion Due to Strongyloides stercoralis in a Diabetic Man

ABSTRACT: &NA; A 61‐year‐old diabetic man had fever and a significant exudative type of eosinophilic pleural effusion. Microscopic examination of stained specimens of bronchial washings revealed filariform larvae of Strongyloides stercoralis. This intestinal nematode is endemic in some areas of the world. Pulmonary symptoms are usually mild, though severe pulmonary…

Case Report

Cryptogenic Mycotic Aneurysm of the Right Coronary Artery

ABSTRACT: &NA; A 61‐year‐old man with chest pain and fever was referred to our hospital. The physical examination and electrocardiogram were unrevealing. Laboratory tests showed leukocytosis, and echocardiography showed mild pericardial effusion. The patient died soon after hospital admission. Necropsy revealed ruptured mycotic aneurysm of the right coronary artery in…

Case Report

Acquired Lymphangiectasis

ABSTRACT: &NA; Acquired lymphangiectasis is a dilatation of lymphatic vessels that can result as a complication of surgical intervention and radiation therapy for malignancy. Acquired lymphangiectasis shares clinical and histologic features with the congenital lesion, lymphangioma circumscriptum. Diagnosis and treatment of these vesiculo‐bullous lesions is important because they may be…

Case Report

AIDS‐Related Kaposi's Sarcoma Involving Bone and Bone Marrow*

ABSTRACT: &NA; AIDS‐related Kaposi's sarcoma rarely involves bone or bone marrow. Computed tomography of the abdomen and pelvis of an AIDS patient with lower back pain and bilateral limb edema revealed multiple lesions involving liver, spleen, and axial skeleton. Bone marrow examination of the involved iliac crest revealed Kaposi's sarcoma….

Case Report

Successful Treatment of Widely Disseminated Acanthamoebiasis

ABSTRACT: &NA; Disseminated Acanthamoeba infections are almost invariably fatal, with no universally accepted standard for treatment. Reports of acanthamoebiasis in non‐human‐immunodeficiency‐virus infected hosts are rare. We successfully treated a lung transplant patient who had disseminated acanthamoebiasis using a combination of pentamidine, 5‐fluorocytosine, itraconazole, and topical chlorhexidine gluconate/ketoconazole cream.

Case Report

Marked Prolongation of the Succinylcholine Effect Two Hours After Neostigmine Reversal of Neuromuscular Blockade in a Patient With Chronic Renal Insufficiency

ABSTRACT: &NA; Prolonged neuromuscular blockade from succinylcholine after neostigmine administration has been reported in patients with frank renal failure. We present a case of prolonged neuromuscular blockade from succinylcholine administration, given 2 hours after neostigmine reversal of neuromuscular blockade in a patient with chronic renal insufficiency. This case shows that…

Case Report

Cat‐scratch Disease Causing Status Epilepticus in Children

ABSTRACT: &NA; Status epilepticus from cat‐scratch encephalopathy is often recalcitrant to usual therapies, causing treatment to focus on critical care management of the patient that may require aggressive interventions, such as continuous pentobarbital administration. We describe two children whose initial clinical presentation of cat‐scratch disease was status epilepticus with normal…

Case Report

Uterine Rhabdomyosarcoma Metastatic to Mediastinal Lymph Nodes Diagnosis By Transbronchial Needle Aspiration

ABSTRACT: &NA; Uterine rhabdomyosarcoma is rare, with only 60 reported cases. We describe an asymptomatic patient with metastatic uterine rhabdomyosarcoma manifested as extensive mediastinal lymphadenopathy. This 73‐year‐old woman had been previously treated for endometrial rhabdomyosarcoma and was referred to us when a right hilar density was seen on a chest…

Case Report

Mycobacterium avium Infection in a Patient With the Acquired Immunodeficiency Syndrome and Silicone Breast Implants

ABSTRACT: &NA; We describe a case of Mycobacterium avium‐intracellulare infection in a silicone augmented breast of a female patient with the acquired immunodeficiency syndrome and disseminated Mycobacterium avium complex. Explantation and treatment with appropriate antibiotics led to resolution of the breast infection.

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