Issue - Southern Medical Association

Case Report

Benzocaine-Induced Methemoglobinemia

Methemoglobinemia is an uncommon but important complication associated with the use of topical anesthetics. We describe four cases of methemoglobinemia induced by topical benzocaine use. We review pathophysiology, early diagnosis, and therapy for this reversible yet potentially fatal condition. Physicians who use procedures involving the application of topical anesthetics need…

Case Report

Diffuse Alveolar Hemorrhage Syndrome Due to “Silent” Mitral Valve Regurgitation

A variety of clinical diseases are associated with diffuse alveolar hemorrhage. Although mitral valve disease can cause hemoptysis, it rarely is associated with diffuse alveolar hemorrhage at presentation. A 49‐year‐old woman was admitted to the hospital with the abrupt onset of fever, anemia, dyspnea, azotemia, and diffuse alveolar infiltrates. Two‐dimensional…

Case Report

Rapid Onset of Stupor

Catatonia is a syndrome with many causes that can be difficult to diagnose. In this report, we describe a case of rapid onset of stupor and loss of consciousness, subsequent evaluation, and treatment of catatonia in an HIV‐positive man.

Case Report

Lack of Mediastinal Shift as a Clue to Delayed Postpneumonectomy Empyema

Delayed postpneumonectomy empyema is uncommon. The condition is usually elusive and diagnosed late in the course of the disease, leading to increased morbidity. New air‐fluid level on chest x‐ray film or appearance of empyema necessitatis may enhance the index of suspicion and lead to early diagnosis, but in many cases…

Case Report

Appendiceal Diverticulitis

We report the case of a 56‐year‐old man with episodic right lower quadrant abdominal pain. Preoperative evaluation included computed tomography (CT) showing a right lower quadrant phlegmon consistent with cecal diverticulitis or appendicitis. The patient was treated with a short course of bowel rest and antibiotics. Four weeks later, he…

Case Report

Surreptitious Superwarfarin Ingestion With Brodifacoum

Physicians must have a high index of suspicion when patients have unexplained prolongation of the prothrombin time and bleeding in the absence of detectable warfarin. Several common rodenticides contain modified versions of warfarin that are not detectable in standard warfarin assays. We present a case of surreptitious brodifacoum ingestion in…

Case Report

Metastatic Small Cell Carcinoma to the Testis

Testicular neoplasms comprise 1% of all malignancies in men, with less than 3% of these malignancies due to metastatic disease. We report a case of a 51‐year‐old man with a history of left pneumonectomy done 2 years earlier for small cell carcinoma of the lung; the patient came to his…

Case Report

Spurious Elevation of Hemoglobin A1c by Hereditary Persistence of Fetal Hemoglobin*

We present the case of a 61‐year‐old black woman with a diagnosis of type 2 diabetes and a falsely elevated hemoglobin A1c (HbA1c) due to hereditary persistence of fetal hemoglobin. Physicians and allied health care professionals are alerted to this potentially significant problem in the diagnosis and management of diabetes…

Current Concepts

Remodeling of the Endocrine Pancreas The Central Role of Amylin and Insulin Resistance

Abstract Background. Remodeling of the endocrine pancreas, caused by the deleterious effects of amylin as it is co‐synthesized, co‐packaged, and co‐secreted with insulin, gives clinicians and researchers cause to ponder. Methods. A literature search was done, and relevant publications and texts on amylin and islet amyloid polypeptide (IAPP) were reviewed….

Editorial

HEADS UP FOR HEALTHY PEOPLE 2010

Expired CME Article

CME Article of the Month Southern Medical Association CME CREDIT

Primary Article

Folate and Vitamin B12‐Deficiency Anemias in Vietnamese Immigrants Living in Southern California

Abstract Background. Although the occurrence of iron deficiency anemia and hemoglobinopathies in Vietnamese immigrants has been reported, folate and vitamin B12 deficiencies have not. Proper diagnosis and effective treatment is necessary to achieve a complete correction of anemia. Methods. We retrospectively analyzed the records of Vietnamese immigrants seen in our…

Primary Article

Fulfillment of Diagnostic Criteria in Kawasaki Disease

Abstract Background. The diagnosis of Kawasaki disease (KD) is made by fulfillment of clinical criteria. The dramatic effectiveness of intravenous immune globulin in this disease might lead to treatment of cases that do not meet those criteria. Methods. A retrospective review was conducted of all cases of KD treated at…

Primary Article

Can Warfarin Randomized Trials Be Reproduced in ‘Real Life’? Adherence to Warfarin Guidelines for Intensity of Anticoagulation in a University‐Based Warfarin Clinic

Abstract Background. Subjects in clinical trials may benefit from the increased attention and specific focus of the trial, thereby limiting the external validity of clinical trial results to clinical practice. Our study evaluated adherence to guidelines for intensity of anticoagulation in a large, university‐based warfarin clinic to assess the generalizability…

Primary Article

Immunization Status of Children Born to Human Immunodeficiency Virus (HIV)‐Infected Mothers in Two Texas Cities

Abstract Background. Because HIV‐infected and HIV‐exposed children are at risk of acquiring infectious diseases, they should be immunized. Methods. We abstracted charts at pediatric HIV clinics in Dallas and San Antonio, matched the children to birth certificates and assessed up‐to‐date immunization status. Results. Of the 178 children, 108 (61%) were…

Author Index

AUTHOR INDEX

Case Report

Lack of Mediastinal Shift as a Clue to Delayed Postpneumonectomy Empyema

ABSTRACT:Delayed postpneumonectomy empyema is uncommon. The condition is usually elusive and diagnosed late in the course of the disease, leading to increased morbidity. New air-fluid level on chest x-ray film or appearance of empyema necessitatis may enhance the index of suspicion and lead to early diagnosis, but in many cases…

Case Report

Surreptitious Superwarfarin Ingestion With Brodifacoum

ABSTRACT:Physicians must have a high index of suspicion when patients have unexplained prolongation of the prothrombin time and bleeding in the absence of detectable warfarin. Several common rodenticides contain modified versions of warfarin that are not detectable in standard warfarin assays. We present a case of surreptitious brodifacoum ingestion in…

Case Report

Metastatic Small Cell Carcinoma to the Testis

ABSTRACT:Testicular neoplasms comprise 1% of all malignancies in men, with less than 3% of these malignancies due to metastatic disease. We report a case of a 51-year-old man with a history of left pneumonectomy done 2 years earlier for small cell carcinoma of the lung; the patient came to his…

Case Report

Spurious Elevation of Hemoglobin A1c by Hereditary Persistence of Fetal Hemoglobin

ABSTRACT:We present the case of a 61- year-old black woman with a diagnosis of type 2 diabetes and a falsely elevated hemoglobin A1c (HbA1c) due to hereditary persistence of fetal hemoglobin. Physicians and allied health care professionals are alerted to this potentially significant problem in the diagnosis and management of…

Case Report

Benzocaine-Induced Methemoglobinemia

ABSTRACT:Methemoglobinemia is an uncommon but important complication associated with the use of topical anesthetics. We describe four cases of methemoglobinemia induced by topical benzocaine use. We review pathophysiology, early diagnosis, and therapy for this reversible yet potentially fatal condition. Physicians who use procedures involving the application of topical anesthetics need…

Trauma Rounds

Perforation of the Colon After Blunt Trauma

ABSTRACT: &NA; Blunt rupture of the colon follows a direct blow to the abdomen. Physical findings suggesting peritoneal irritation are usually present early in the postinjury period and lead to further evaluation and operation. In unresponsive patients, physical findings may be masked, diagnosis delayed, and outcome compromised. Perioperative antibiotics and…

Case Report

Diffuse Alveolar Hemorrhage Syndrome Due to ‘Silent’ Mitral Valve Regurgitation

ABSTRACT:A variety of clinical diseases are associated with diffuse alveolar hemorrhage. Although mitral valve disease can cause hemoptysis, it rarely is associated with diffuse alveolar hemorrhage at presentation. A 49-year-old woman was admitted to the hospital with the abrupt onset of fever, anemia, dyspnea, azotemia, and diffuse alveolar infiltrates. Two-dimensional…

Case Report

Rapid Onset of Stupor

ABSTRACT:Catatonia is a syndrome with many causes that can be difficult to diagnose. In this report, we describe a case of rapid onset of stupor and loss of consciousness, subsequent evaluation, and treatment of catatonia in an HIV-positive man.

Case Report

Remission of Facial and Scalp Hyperhidrosis With Clonidine Hydrochloride and Topical Aluminum Chloride

ABSTRACT:Axillary and palmar hyperhidrosis are featured prominently in the literature, but no previous studies have detailed a treatment regimen for specific excessive localized sweating of the face and scalp. In this report, a patient was treated for this condition with a combination of clonidine hydrochloride (0.3 to 0.4 mg/day) and…

Case Report

Appendiceal Diverticulitis

ABSTRACT:We report the case of a 56-year-old man with episodic right lower quadrant abdominal pain. Preoperative evaluation included computed tomography (CT) showing a right lower quadrant phlegmon consistent with cecal diverticulitis or appendicitis. The patient was treated with a short course of bowel rest and antibiotics. Four weeks later, he…

Current Concepts

Osteoporosis: Epidemiology, Diagnosis, and Treatment

ABSTRACT:Osteoporosis is an important health problem in the United States affecting approximately 24 million Americans, 15 to 20 million of whom are women over 45 years of age. Bone fractures are the major cause of morbidity and mortality associated with osteoporosis. The most common fractures are those of the forearm,…

Current Concepts

Supernumerary Breast Tissue Historical Perspectives and Clinical Features

ABSTRACT:The presence of extra nipples and breasts, polythelia and polymastia respectively, is not uncommon. Such supernumerary breast tissue usually is found within the milk line extending from the axilla to pubic region. It was once thought that this condition was a symbol of increased fertility and femininity. Anne Boleyn was…

Current Concepts

Deactivating the Implantable Cardioverter-Defibrillator A Biofixture Analysis

ABSTRACT:Automatic implantable cardioverter-defibrillators (ICDs) are becoming increasingly common, as is refusal of resuscitative efforts at the end of life, both by patients and surrogate decision-makers. While it is clear that a terminally ill patient who lacks decisional capacity may, through a surrogate, refuse cardiopulmonary resuscitation (CPR), is it appropriate for…

Current Concepts

Remodeling of the Endocrine Pancreas The Central Role of Amylin and Insulin Resistance

AbstractBackground.Remodeling of the endocrine pancreas, caused by the deleterious effects of amylin as it is co-synthesized, co-packaged, and co-secreted with insulin, gives clinicians and researchers cause to ponder. Methods.A literature search was done, and relevant publications and texts on amylin and islet amyloid polypeptide (IAPP) were reviewed. Results.The mechanisms and…

Editorial

HEADS UP FOR HEALTHY PEOPLE 2010

Primary Article

Fulfillment of Diagnostic Criteria in Kawasaki Disease

AbstractBackground.The diagnosis of Kawasaki disease (KD) is made by fulfillment of clinical criteria. The dramatic effectiveness of intravenous immune globulin in this disease might lead to treatment of cases that do not meet those criteria. Methods.A retrospective review was conducted of all cases of KD treated at Kosair Children's Hospital…

Primary Article

Can Warfarin Randomized Trials Be Reproduced in ‘Real Life’? Adherence to Warfarin Guidelines for Intensity of Anticoagulation in a University-Based Warfarin Clinic

AbstractBackground.Subjects in clinical trials may benefit from the increased attention and specific focus of the trial, thereby limiting the external validity of clinical trial results to clinical practice. Our study evaluated adherence to guidelines for intensity of anticoagulation in a large, university-based warfarin clinic to assess the generalizability of randomized…

Primary Article

Immunization Status of Children Born to Human Immunodeficiency Virus (HIV)-Infected Mothers in Two Texas Cities

AbstractBackground.Because HIV-infected and HIV-exposed children are at risk of acquiring infectious diseases, they should be immunized. Methods.We abstracted charts at pediatric HIV clinics in Dallas and San Antonio, matched the children to birth certificates and assessed up-to-date immunization status. Results.Of the 178 children, 108 (61%) were up to date for…

Primary Article

Folate and Vitamin B 12-Deficiency Anemias in Vietnamese Immigrants Living in Southern California

AbstractBackground.Although the occurrence of iron deficiency anemia and hemoglobinopathies in Vietnamese immigrants has been reported, folate and vitamin B12 deficiencies have not. Proper diagnosis and effective treatment is necessary to achieve a complete correction of anemia. Methods.We retrospectively analyzed the records of Vietnamese immigrants seen in our medical clinic from…

Primary Article

Rural Acquired Immunodeficiency Syndrome in Low and High Prevalence Areas

AbstractBackground.Too little is understood about the spread of the acquired immunodeficiency syndrome (AIDS) in rural America. This study focuses on changes over 5 years in two low prevalence and two high prevalence human immunodeficiency virus (HIV) rural service areas. Methods.An initial study conducted in 1993 provided a base line for…

Subject Index

Subject Index

Trauma Rounds

Perforation of the Colon After Blunt Trauma

ABSTRACT:Blunt rupture of the colon follows a direct blow to the abdomen. Physical findings suggesting peritoneal irritation are usually present early in the postinjury period and lead to further evaluation and operation. In unresponsive patients, physical findings may be masked, diagnosis delayed, and outcome compromised. Perioperative antibiotics and early celiotomy…