Issue - Southern Medical Association

Case Report

Carcinosarcoma of the Uterus Associated With a Nongestational Choriocarcinoma

ABSTRACT: &NA; Choriocarcinoma has been reported in association with endometrial carcinoma and as a metaplastic change in multiple carcinomas, including liver, urinary bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in conjunction with a carcinosarcoma (also called malignant müllerian mixed tumor) in a 71‐year‐old woman whose hysterectomy specimen revealed…

Case Report

Pancreatic Pseudocyst Masquerading as an Incarcerated Inguinal Hernia

ABSTRACT: &NA; We present a case in which a pancreatic pseudocyst dissected into the right inguinal region, thus masquerading as an incarcerated right inguinal hernia. Computed tomography (CT) confirmed the diagnosis of a pseudocyst, and the patient was treated successfully with percutaneous drainage.

Case Report

Scoliosis Associated With Typical Mayer-Rokitansky-Küster-Hauser Syndrome

ABSTRACT: &NA; Disorders that cause congenital scoliosis include Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome. We present the case of a 46‐year‐old karyotypical (XX) woman with müllerian agenesis (MRKH type A, typical form), a rudimentary bicornate uterus, a blind vaginal pouch, and adenocarcinoma of both ovaries with subsequent bilateral salpingo‐oophorectomy. She also had scoliosis…

Case Report

Interstitial Cystitis and the Potential Role of Gabapentin

ABSTRACT: &NA; Gabapentin, an antiepileptic agent, is a safe and versatile medication also used in the adjunctive treatment of painful disorders. These include neuropathic pain, such as postherpetic neuralgia, diabetic neuropathy, and the pain of reflex sympathetic dystrophy. Interstitial cystitis, a painful disease entity, shares many common features of these…

Case Report

Typhlitis as a Presenting Manifestation of Acute Myelogenous Leukemia

ABSTRACT: &NA; We describe a case of typhlitis with onset before diagnosis of acute myelogenous leukemia or initiation of chemotherapy. Typhlitis is usually seen as a complication of chemotherapy for hematologic malignancies. It is being reported with increasing frequency in association with other disease states that produce profound neutropenia.

Case Report

Use of Technetium Tc 99m Sestamibi Scintigraphy for Recurrent Tertiary Hyperparathyroidism From a Parathyroid Forearm Graft

ABSTRACT: &NA; Technetium Tc 99m sestamibi scintigraphy is a sensitive technique for localizing recurrent parathyroid disease in the neck or mediastinum. We report the case of a 60‐year‐old woman with recurrent tertiary hyperparathyroidism after total parathyroidectomy. Technetium Tc 99m sestamibi images of the neck and mediastinum were negative; however, images…

Case Report

Acquired Segmental Megacolon in an Adult Patient With Cystic Fibrosis

Cystic fibrosis (CF) is characterized by symptoms related to pulmonary dysfunction and pancreatic insufficiency. Constipation, though a frequent complaint of patients with CF, receives less attention. We report a case of acquired segmental megacolon and constipation necessitating surgical colonic resection in an adult patient with CF. The differential diagnosis and…

Case Report

Concomitant Acute Sinusitis and Acute Lung Rejection

Two lung transplant recipients had concomitant acute sinusitis and acute lung rejection. Antibiotics and decongestants alleviated the sinusitis, but the symptoms of cough and dyspnea as well as spirometric defects necessitated treatment of acute lung rejection. In patients with clinical evidence of acute sinusitis after lung transplantation, concomitant acute lung…

Case Report

Polymicrobial Cholangitis and Liver Abscess in a Patient With the Acquired Immunodeficiency Syndrome

Cholangitis/cholangiopathy associated with the human immunodeficiency virus (HIV) infection is characterized by chronic abdominal pain, low‐grade fever, cholestasis, and sometimes areas of focal or diffuse dilatation of the bile ducts that may be apparent on noninvasive imaging studies. Although the etiology of this biliary disease may be multifactorial, it appears…

Case Report

Acute Compartment Syndrome After Rupture of the Medial Head of the Gastrocnemius Muscle

Rupture of the gastrocnemius muscle is an uncommon injury, with most cases occurring in athletically active individuals. The presentation of a gastrocnemius rupture is the acute onset of calf pain and subsequent ecchymosis. Most of these injuries can be treated symptomatically with good results. We present an unusual case of…

Case Report

Massive Upper Gastrointestinal Hemorrhage Due to Cytomegalovirus Infection in Two Patients With Acquired Immunodeficiency Syndrome

Massive upper gastrointestinal (GI) hemorrhage is a rare manifestation of GI cytomegalovirus (CMV) infection. A review of the English language literature yielded 21 well‐documented cases of gastric ulcers due to CMV, and 7 of these 21 cases were complicated by significant GI bleeding. This report describes two cases of massive…

Current Concepts

The Major Histocompatibility Complex and Inflammation

ABSTRACT: &NA; The major histocompatibility complex (MHC) is of major medical interest because of its contribution to transplant rejection and to variation among individuals in susceptibility to a variety of autoimmune disorders. In addition to its role in influencing the propensity for known autoimmune diseases, the MHC contains genes contributing…

Current Concepts

How Common Are Various Causes of Dizziness? A Critical Review

Abstract Background. Although dizziness is a common symptom in both primary care and referral practices, the relative frequency of various causes has not been well delineated. Methods. A MEDLINE search identified 12 articles containing original data on the etiology of dizziness in consecutive patients. Study sites included primary care offices…

Primary Article

Drug Use and HIV Risk‐Related Sex Behaviors A Street Outreach Study of Black Adults

Abstract Background. Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk‐related sex behaviors of black adults. The study focused on three HIV‐related risks: multiple sex partners, unprotected sex, and drugs during sex. Methods. Data for this study were…

Primary Article

The Cost of Running American City Hospitals The Gorgas 1910 Survey

Abstract Background. COL William C. Gorgas was appointed Chief Sanitary Officer of the Isthmian Canal Commission during construction of the Panama Canal (1904‐1914). In 1910, Gorgas sought to determine the administrative and operating costs of major metropolitan hospitals in the United States and compare these with similar costs in the…

Primary Article

Comparing the Toxicity of Digoxin and Digitoxin in a Geriatric Population Should an Old Drug Be Rediscovered?

Abstract Background. Little information is available regarding toxicity rates of the two available forms of cardiac glycosides (digoxin, digitoxin) when used in elderly patients. Methods. We retrospectively analyzed the charts of all patients more than 60 years of age who were chronically managed with a cardiac glycoside and were hospitalized…

Primary Article

Domestic Violence in a University Emergency Department*

Abstract Background. We attempted to determine the prevalence and demographics of domestic violence (DV) among male and female patients in a university emergency department (ED). Methods. The validated Index of Spouse Abuse (ISA) was used. Patients aged 18 years or older seen during 28 randomly selected 4‐hour shifts were eligible….

Primary Article

Aortopulmonary Fistula

Abstract Background. Aortopulmonary fistula is an uncommon but usually fatal condition if not treated surgically. The most frequent cause is erosion of a false aneurysm of the descending thoracic aorta into the left lung. Methods. Review of charts of all patients who had had resection of a thoracic aortic aneurysm…

Primary Article

Accuracy of Clinical Evaluation in the Determination of Brain Death

Abstract Background. The accuracy of the clinical diagnosis of brain death has never been established. Methods. Seventy‐one consecutive clinically brain dead patients were studied retrospectively. Inclusion criteria were complete cessation of brain function with profound coma of known cause, complete absence of brain stem reflexes, and apnea, all persisting for…

Primary Article

Anserine Bursitis in Patients With Osteoarthritis of the Knee

Abstract Background. We sought to determine the frequency of anserine bursitis (AB) in Koreans with osteoarthritis (OA) of the knee and its relationship to age, sex, and radiographic severity of OA, and to evaluate its response to various forms of therapy. Methods. In a retrospective study, we reviewed the charts…

Primary Article

Acute Mesenteric Ischemia and Malpractice Claims

Abstract Background. Acute mesenteric ischemia can be a difficult diagnosis to make, but delay contributes directly to infarction, and this may provide a setting for malpractice claims. Methods. We reviewed 180 consecutive malpractice claims submitted by attorneys for medical expert (ME) review during the 12 years ending in late 1998….

Primary Article

Impact of a Formal Trauma Program on a Small Rural Hospital in Mississippi

Abstract Background. Since Mississippi is largely rural, most of the initial care given to trauma patients is at small community hospitals. This study examined the impact of the institution of a formal trauma program on trauma care at such a hospital. Methods. All trauma cases at a single institution during…

Trauma Rounds

Blunt Thoracic Aortic Injuries Initial Evaluation and Management

ABSTRACT: &NA; In at least one large study, the average time from arrival at the emergency department to arrival in the operating room was nearly 6 hours. That 30% of survivors will die in the same amount of time underscores the need for rapid diagnosis and treatment. In blunt thoracic…

Case Report

Interstitial Cystitis and the Potential Role of Gabapentin

ABSTRACT:Gabapentin, an antiepileptic agent, is a safe and versatile medication also used in the adjunctive treatment of painful disorders. These include neuropathic pain, such as postherpetic neuralgia, diabetic neuropathy, and the pain of reflex sympathetic dystrophy. Interstitial cystitis, a painful disease entity, shares many common features of these chronic pain…

Primary Article

Acute Compartment Syndrome After Rupture of the Medial Head of the Gastrocnemius Muscle

ABSTRACT:Rupture of the gastrocnemius muscle is an uncommon injury, with most cases occurring in athletically active individuals. The presentation of a gastrocnemius rupture is the acute onset of calf pain and subsequent ecchymosis. Most of these injuries can be treated symptomatically with good results. We present an unusual case of…

Case Report

Pancreatic Pseudocyst Masquerading as an Incarcerated Inguinal Hernia

ABSTRACT:We present a case in which a pancreatic pseudocyst dissected into the right inguinal region, thus masquerading as an incarcerated right inguinal hernia. Computed tomography (CT) confirmed the diagnosis of a pseudocyst, and the patient was treated successfully with percutaneous drainage.

Case Report

Use of Technetium Tc 99m Sestamibi Scintigraphy for Recurrent Tertiary Hyperparathyroidism From a Parathyroid Forearm Graft

ABSTRACT:Technetium Tc 99m sestamibi scintigraphy is a sensitive technique for localizing recurrent parathyroid disease in the neck or mediastinum. We report the case of a 60-year-old woman with recurrent tertiary hyperparathyroidism after total parathyroidectomy. Technetium Tc 99m sestamibi images of the neck and mediastinum were negative; however, images of the…

Case Report

Typhlitis as a Presenting Manifestation of Acute Myelogenous Leukemia

ABSTRACT:We describe a case of typhlitis with onset before diagnosis of acute myelogenous leukemia or initiation of chemotherapy. Typhlitis is usually seen as a complication of chemotherapy for hematologic malignancies. It is being reported with increasing frequency in association with other disease states that produce profound neutropenia.

Case Report

Massive Upper Gastrointestinal Hemorrhage Due to Cytomegalovirus Infection in Two Patients With Acquired Immunodeficiency Syndrome

ABSTRACT:Massive upper gastrointestinal (GI) hemorrhage is a rare manifestation of GI cytomegalovirus (CMV) infection. A review of the English language literature yielded 21 well-documented cases of gastric ulcers due to CMV, and 7 of these 21 cases were complicated by significant GI bleeding. This report describes two cases of massive…

Case Report

Concomitant Acute Sinusitis and Acute Lung Rejection

ABSTRACT:Two lung transplant recipients had concomitant acute sinusitis and acute lung rejection. Antibiotics and decongestants alleviated the sinusitis, but the symptoms of cough and dyspnea as well as spirometric defects necessitated treatment of acute lung rejection. In patients with clinical evidence of acute sinusitis after lung transplantation, concomitant acute lung…

Case Report

Acquired Segmental Megacolon in an Adult Patient With Cystic Fibrosis

ABSTRACT:Cystic fibrosis (CF) is characterized by symptoms related to pulmonary dysfunction and pancreatic insufficiency. Constipation, though a frequent complaint of patients with CF, receives less attention. We report a case of acquired segmental megacolon and constipation necessitating surgical colonic resection in an adult patient with CF. The differential diagnosis and…

Case Report

Carcinosarcoma of the Uterus Associated With a Nongestational Choriocarcinoma

ABSTRACT:Choriocarcinoma has been reported in association with endometrial carcinoma and as a metaplastic change in multiple carcinomas, including liver, urinary bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in conjunction with a carcinosarcoma (also called malignant müllerian mixed tumor) in a 71-year-old woman whose hysterectomy specimen revealed two polypoid…

Case Report

Polymicrobial Cholangitis and Liver Abscess in a Patient With the Acquired Immunodeficiency Syndrome

ABSTRACT:Cholangitis/cholangiopathy associated with the human immunodeficiency virus (HIV) infection is characterized by chronic abdominal pain, low-grade fever, cholestasis, and sometimes areas of focal or diffuse dilatation of the bile ducts that may be apparent on noninvasive imaging studies. Although the etiology of this biliary disease may be multifactorial, it appears…

Case Report

Scoliosis Associated With Typical Mayer-Rokitansky-Küster-Hauser Syndrome

ABSTRACT:Disorders that cause congenital scoliosis include Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. We present the case of a 46-year-old karyotypical (XX) woman with müllerian agenesis (MRKH type A, typical form), a rudimentary bicornate uterus, a blind vaginal pouch, and adenocarcinoma of both ovaries with subsequent bilateral salpingo-oophorectomy. She also had scoliosis of the…

Current Concepts

The Major Histocompatibility Complex and Inflammation

ABSTRACT:The major histocompatibility complex (MHC) is of major medical interest because of its contribution to transplant rejection and to variation among individuals in susceptibility to a variety of autoimmune disorders. In addition to its role in influencing the propensity for known autoimmune diseases, the MHC contains genes contributing to several…

Current Concepts

How Common Are Various Causes of Dizziness? A Critical Review

AbstractBackground.Although dizziness is a common symptom in both primary care and referral practices, the relative frequency of various causes has not been well delineated. Methods.A MEDLINE search identified 12 articles containing original data on the etiology of dizziness in consecutive patients. Study sites included primary care offices (n = 2),…

Primary Article

Impact of a Formal Trauma Program on a Small Rural Hospital in Mississippi

AbstractBackground.Since Mississippi is largely rural, most of the initial care given to trauma patients is at small community hospitals. This study examined the impact of the institution of a formal trauma program on trauma care at such a hospital. Methods.All trauma cases at a single institution during 1998 were retrospectively…

Primary Article

Drug Use and HIV Risk-Related Sex Behaviors: A Street Outreach Study of Black Adults

AbstractBackground.Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk-related sex behaviors of black adults. The study focused on three HIV-related risks: multiple sex partners, unprotected sex, and drugs during sex. Methods.Data for this study were collected in a…

Primary Article

Accuracy of Clinical Evaluation in the Determination of Brain Death

AbstractBackground.The accuracy of the clinical diagnosis of brain death has never been established. Methods.Seventy-one consecutive clinically brain dead patients were studied retrospectively. Inclusion criteria were complete cessation of brain function with profound coma of known cause, complete absence of brain stem reflexes, and apnea, all persisting for at least 6…

Primary Article

Comparing the Toxicity of Digoxin and Digitoxin in a Geriatric Population: Should an Old Drug Be Rediscovered?

AbstractBackground.Little information is available regarding toxicity rates of the two available forms of cardiac glycosides (digoxin, digitoxin) when used in elderly patients. Methods.We retrospectively analyzed the charts of all patients more than 60 years of age who were chronically managed with a cardiac glycoside and were hospitalized during the period…

Primary Article

The Cost of Running American City Hospitals: The Gorgas 1910 Survey

AbstractBackground.COL William C. Gorgas was appointed Chief Sanitary Officer of the Isthmian Canal Commission during construction of the Panama Canal (1904-1914). In 1910, Gorgas sought to determine the administrative and operating costs of major metropolitan hospitals in the United States and compare these with similar costs in the Canal Zone…

Primary Article

Aortopulmonary Fistula

AbstractBackground.Aortopulmonary fistula is an uncommon but usually fatal condition if not treated surgically. The most frequent cause is erosion of a false aneurysm of the descending thoracic aorta into the left lung. Methods.Review of charts of all patients who had had resection of a thoracic aortic aneurysm at the MidAmerica…

Primary Article

Acute Mesenteric Ischemia and Malpractice Claims

AbstractBackground.Acute mesenteric ischemia can be a difficult diagnosis to make, but delay contributes directly to infarction, and this may provide a setting for malpractice claims. Methods.We reviewed 180 consecutive malpractice claims submitted by attorneys for medical expert (ME) review during the 12 years ending in late 1998. Seven cases involved…

Primary Article

Anserine Bursitis in Patients With Osteoarthritis of the Knee

AbstractBackground.We sought to determine the frequency of anserine bursitis (AB) in Koreans with osteoarthritis (OA) of the knee and its relationship to age, sex, and radiographic severity of OA, and to evaluate its response to various forms of therapy. Methods.In a retrospective study, we reviewed the charts of patients with…

Primary Article

Domestic Violence in a University Emergency Department

AbstractBackground.We attempted to determine the prevalence and demographics of domestic violence (DV) among male and female patients in a university emergency department (ED). Methods.The validated Index of Spouse Abuse (ISA) was used. Patients aged 18 years or older seen during 28 randomly selected 4-hour shifts were eligible. Results.Of the 97…

Trauma Rounds

Blunt Thoracic Aortic Injuries: Initial Evaluation and Management

ABSTRACT:In at least one large study, the average time from arrival at the emergency department to arrival in the operating room was nearly 6 hours. That 30% of survivors will die in the same amount of time underscores the need for rapid diagnosis and treatment. In blunt thoracic aortic injury,…