Issue - Southern Medical Association

Current Concepts

Status of Treatment of Depression

Abstract Background.Depression is a common and highly treatable disorder, with most patients returning to predepression levels of functioning. Patients with depression must be carefully assessed for the presence of comorbid psychiatric or medical disorders, as well as psychosocial stresses. Methods.I present a clinical overview, supported by pertinent literature, of currently…

Current Concepts

Improving Medical Risk Factor Reporting on Birth Certificates in Alabama

Abstract Background.In 1995, a program was begun at the University of South Alabama (USA) to improve the reporting of medical risk factors on birth certificates. Methods.Data on medical risk factors for USA Hospital and the remainder of the state for 1994 and 1996 were examined to observe the effects of…

Current Concepts

Referral Patterns for the Evaluation of Non-Palpable Breast Abnormalities

Abstract Background.Non-palpable suspicious mammographic abnormalities require image-guided breast biopsies. In this study, we examined primary care physicians' knowledge of breast biopsy procedures for non-palpable lesions and referral patterns for breast biopsies; we also identified channels to disseminate information. Methods.We mailed a baseline survey to all primary care physicians, surgeons, and…

Current Concepts

Absolute Versus Relative Values: Effects on Medical Decisions and Personality of Patients and Physicians

Abstract Background.Speculation suggests that health care workers and patients who believe in ethical values that do not change—absolute values—will respond differently to ethical problems and personality tests than those who affirm changing—relative values. Methods.We did a cross-sectional survey to investigate the effects of absolute vs relative values on (1) decision…

Current Concepts

Long-Term Diuretic Therapy in Hypertensive Patients: Effects on Serum Homocysteine, Vitamin B6, Vitamin B12, and Red Blood Cell Folate Concentrations

Abstract Background.The effects of chronic diuretic use on serum homocysteine and its metabolic cofactors vitamin B6, vitamin B12, and red blood cell (RBC) folate have not been well studied. Methods.Blood samples from 17 hypertensive patients receiving long-term diuretic therapy and 17 hypertensive patients not taking diuretics were analyzed for serum…

Current Concepts

Evaluation of Primary Care Residents' Knowledge of Pharmacotherapy

Abstract Background.The study objective was to determine primary care residents' knowledge of pharmacotherapy. Methods.Eighty primary care residents at five Family Medicine residencies completed a pharmacotherapy survey used to assess their knowledge of drug interactions, adverse drug reactions, and new medications. Residents were asked whether they could benefit from more formal…

Current Concepts

Possible Role of Systemic Inflammatory Reaction in Vascular Access Thrombosis

Abstract Background.Vascular devices are an integral part of modern medicine. Catheter thrombosis is a frequent complication that interferes with their use. Method.We have observed a series of patients in whom vascular access thrombosis occurred in close temporal association with infectious or inflammatory processes. Results.Laboratory and clinical evidence suggests that activation…

Current Concepts

Prescription Medications: A Modifiable Contributor to Obesity

Abstract Background.While usually not the only factor in obese patients, prescription medications, which may increase appetite or body weight, can be important in some individuals. The cause of weight gain in such cases may go unrecognized or lead to cessation of medication with or without the practitioner's knowledge or approval….

Current Concepts

Homocyst(e)ine, Atherosclerosis, and Thrombosis

ABSTRACT: Ample clinical and epidemiologic evidence exists to implicate homocyst(e)ine as a risk factor for atherosclerotic vascular disease and thrombosis. The precise mechanisms by which this occurs are uncertain but probably involve injury to endothelium, impairment of endothelial function, lipid peroxidation, oxidation of low-density lipoprotein, and creation of a prothrombotic…

Case Report

Subdural Hematoma Mimicking a Transient Ischemic Attack Due to Antihypertensive Medication

ABSTRACT: An elderly man had two completely reversible episodes of aphasia, each occurring after taking his antihypertensive medications. He was subsequently found to have a subdural hematoma. The association between subdural hematomas (and other intracranial mass lesions) and reversible neurologic deficits is discussed, as is the pathophysiology of the phenomenon….

Case Report

Captopril-Induced Toxic Epidermal Necrolysis and Agranulocytosis Successfully Treated With Granulocyte Colony-Stimulating Factor

ABSTRACT: Captopril-induced bone marrow suppression is rare, except in certain high-risk patient populations. Severe exfoliative rashes have also been associated with captopril, but a combined presentation of toxic epidermal necrolysis and agranulocytosis has not been previously described. We report an unusual case of captopril-induced toxic epidermal necrolysis with agranulocytosis in…

Case Report

Hypercalcemia as an Early Sign of Lymphoma in a Patient With Acquired Immunodeficiency Syndrome (AIDS)

ABSTRACT: Hypercalcemia is uncommon in patients infected with the human immunodeficiency virus (HIV). It has been described in association with cytomegalovirus infection, Pneumocystis carinii pneumonia, granulomatous diseases, and lymphoma. However, symptomatic hypercalcemia as an early sign of an underlying AIDS-related lymphoma is not well documented. We discuss the case of…

Case Report

Smitten by a Kitten

ABSTRACT&colon; Mammalian bite wounds are commonly encountered in the emergency department. When patients come early (<8 hours after injury), local infection is not usually evident. At this stage, the issue of providing prophylactic antibiotic therapy arises. We report a complication of a cat bite to the hand in a previously…

Case Report

Air Embolism After Intravenous Injection of Contrast Material

ABSTRACT&colon; Venous air embolism, though considered rare, occurs more frequently than it is recognized. We report the case of a 54-year-old man who was incidentally found to have air in the left brachiocephalic vein and right ventricle after contrast-enhanced computed tomography (CT). Air embolism has been noted to occur after…

Case Report

Use of the Amplatz Thrombectomy Device for Severe Deep Venous Thrombosis

ABSTRACT&colon; Venous thromboembolism is a significant cause of morbidity in the United States. Thrombectomy devices are not currently the standard of treatment in deep venous thromboses. The Amplatz thrombectomy device is used for arterial occlusions and pulmonary emboli, but its regular use in venous thromboses has not been documented in…

Case Report

Short Stature in a 46,XX Male Adolescent

ABSTRACT&colon; We describe a patient with a 46,XX karyotype who was assessed because of short stature and a subnormal rate of linear growth. The patient had normal male external genitalia. Endocrinologic analysis revealed elevated levels of luteinizing hormone and folliclestimulating hormone but an exaggerated gonadotropin response to luteinizing hormone-releasing hormone…

Case Report

Drug-Induced Hypertriglyceridemia With and Without Pancreatitis

ABSTRACT&colon; We describe two cases of drug-induced hypertriglyceridemia, one associated with interferon alfa-2b and the other with asparaginase, each of which is mediated through a different mechanism. Hypertriglyceridemia caused by these medications is not listed as an adverse reaction in the Physicians' Desk Reference, one of the most popular pharmacologic…

Case Report

Traumatic Abdominal Wall Hernia Caused by Persistent Cough

ABSTRACT&colon; We report a rare case of traumatic abdominal wall hernia caused by persistent and severe cough. We believe this is the first reported case of such an entity. We present computed tomography findings and a pertinent review of the literature.

Case Report

Rapid Respiratory Deterioration and Sudden Death Due to Disseminated Crypotcoccosis in a Patient With the Acquired Immunodeficiency Syndrome

ABSTRACT&colon; We report the case of a patient with the acquired immunodeficiency syndrome (AIDS) whose death occurred within 30 hours of hospitalization due to disseminated cryptococcosis, manifested by dizziness, cough, and shortness of breath. The clinical picture was consistent with pneumocystis pneumonia, and antibiotic therapy with corticosteroids was initiated. Despite…

Abstract

ASPIRIN AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGS DO NOT INCREASE THE RISK OF INTRACEREBRAL HEMORRHAGE

Abstract

BONE LOSS AND CELIAC DISEASE

Abstract

ESTROGEN USE AND COGNITIVE DECLINE IN OLDER WOMEN

Abstract

LIPOSUCTION MORTALITY

Abstract

MORTALITY AFTER OSTEOPOROTIC FRACTURES

Abstract

ORAL CONTRACEPTIVES AND FRACTURE RISK

Abstract

PASSIVE SMOKING AND CORONARY HEART DISEASE

Abstract

RIVASTIGMINE AND THE MANAGEMENT OF ALZHEIMER'S DISEASE

Abstract

SHOULD ANTICOAGULANT THERAPY BE EXTENDED FOR MORE THAN 3 MONTHS AFTER VENOUS THROMBOEMBOLISM?

Editorial

SHOULD PHYSICIANS UNIONIZE? YES, IT WOULD CURB HMO ABUSE

Abstract

THE ECONOMICS OF USING DONEPEZIL AND THE MANAGEMENT OF ALZHEIMER’S DISEASE