Issue - Southern Medical Association

Article

The Epilepsy of First Lady Ida Saxton McKinley

Article

Pellagra in the United States: A Historical Perspective

ABSTRACT: &NA; Pellagra was in existence for nearly two centuries in Europe before being recognized in the United States, where it was first reported in 1902. Over the next two decades, pellagra occurred in epidemic proportions in the American South. Poverty and consumption of corn were the most frequently observed…

Article

Selected Abstracts*

Article

News Potpourri*

Case Report

Primary Extra-nodal Lymphoma of the Urinary Bladder

ABSTRACT: &NA; Primary non‐Hodgkin's lymphoma of the urinary bladder is rare. Only a few cases have been reported. We report the case of a woman with non‐Hodgkin's lymphoma of urinary bladder and review the literature.

Case Report

Recurrent Merkel Cell Carcinoma of the Upper Extremity

ABSTRACT: &NA; We report a case of recurrent Merkel cell carcinoma (MCC) of the upper extremity, treated aggressively with wide local excision, regional lymphadenectomy, and immediate reconstruction. Five years after surgery, there is no clinical or diagnostic evidence of locoregional recurrence or distant disease. The patient's upper extremity and hand…

Case Report

Pyomyositis in the Acquired Immunodeficiency Syndrome

ABSTRACT: &NA; Pyomyositis, a purulent infection of skeletal muscle, is usually caused by Staphylococcus aureus. Many cases of pyomyositis in human immunodeficiency virus (HIV) seronegative patients have been reported in North America and have been reviewed extensively. Moreover, pyomyositis has been reported in association with HIV infection in patients with…

Case Report

Atypical Presentation of Microscopically Advanced Ovarian Carcinoma

ABSTRACT: &NA; Epithelial ovarian cancer (EOC) continues to be an academically challenging and clinically problematic disease. Even with recent advances, the overall 5‐year survival is still 31% to 42% in various studies. Deaths from EOC outnumber those due to cervical, vulvar, and endometrial carcinomas combined. Screening for EOC has shown…

Case Report

Life-Threatening Subcutaneous Hematoma Caused by an Axillary Pad in an Anticoagulated Patient

ABSTRACT: &NA; A large subcutaneous hematoma extending from the left axillary region to the left flank developed in a 70‐year‐old man receiving anticoagulant therapy. The cause was repeated microtrauma caused by the axillary pad on a walker. Physicians and physiotherapists should be aware that rehabilitation devices causing pressure on the…

Case Report

Beware of Short-Course Therapy for Staphylococcus aureus Bacteremia Without a Removable Cause

Staphylococcus aureus bacteremia has long been known to cause significant morbidity and mortality. The optimal treatment of this disease has evolved over the years. Recently, criteria have been established for the use of shorter courses of antibiotic therapy in certain patients, most notably those with an easily removed source of…

Case Report

Benign Enterogenous Cyst of the Pancreas

A 26‐year‐old woman was evaluated for a mass found by computed tomography (CT). Radiographically, the mass resembled a pancreatic cystadenoma. The patient had had left upper quadrant abdominal pain for several years and low grade fevers and indigestion for 5 months. At surgery, a unilocular cystic mass was found anteriorly…

Case Report

Successful Thrombolytic Therapy for Massive Pulmonary Embolism

The use and scope of thrombolytic therapy in the management of pulmonary embolism (PE) continues to evolve. The results of small studies suggest that thrombolytic therapy might have an impact on survival in massive PE with cardiogenic shock; however, no large studies to further this notion exist. Furthermore, the expanded…

Case Report

Morphology of Right Ventricular Paced Beats in Posterior Myocardial Infarction

Premature ventricular beats or paced beats can unmask new or old myocardial infarction when sinus beats fail to exhibit the typical infarct pattern. Knowledge of their morphology is vital, since they may be the earliest or even the only evidence of a myocardial infarction in certain cases. Morphology of premature…

Case Report

Improved Sexual Function in Three Men Taking Lamotrigine for Epilepsy

Little information exists about the effects of newer antiepileptic drugs (AEDs) on sexual function in men with epilepsy. We report a series of three male veterans whose sexual disorders improved with lamotrigine. All three had partial seizures. One patient was taking phenobarbital and gabapentin and complained of decreased potency and…

Current Concepts

Differential Diagnosis of Gallstone‐Induced Complications

ABSTRACT: &NA; Early recognition and prompt intervention are the most crucial steps in the management of gallstone‐induced biliary disease. Many conditions can mimic the presentation of gallstone‐induced complications. Therefore, participation of a clinically astute physician is essential in evaluating symptoms and interpreting diagnostic data in patients with symptomatic gallstones.

Current Concepts

Pitfalls in the Diagnosis and Management of Systolic Hypertension*

Abstract Background. Systolic blood pressure (SBP) is even more important than diastolic blood pressure (DBP) with regard to the risk of cardiovascular complications. Methods and Results. Pitfalls in the diagnosis of systolic hypertension include the auscultatory gap, use of the proper size cuff (obese adult size for mid‐arm circumference >33…

Primary Article

Initial Experience With Isradipine for the Treatment of Hypertension in Children

Abstract Background. Isradipine is a calcium channel blocker of the dihydropyridine class. It has limited effects on myocardial contractility; is available in a powder‐filled capsule and has a half‐life of 6 to 8 hours. Methods. Pharmacy records were reviewed to identify pediatric patients who had received isradipine. The following demographic…

Primary Article

Correlation Between Increased Colloid Osmotic Pressure and the Resolution of Refractory Ascites After Transjugular Intrahepatic Portosystemic Shunt

Abstract Background. This study compared the changes in serum albumin, globulin, and colloid osmotic pressure (COP) before and after transjugular intrahepatic portosystemic shunt (TIPS) or large volume paracentesis (LVP) in patients with ascites. Methods. Of 23 patients with refractory ascites, 17 had TIPS and 6 had LVP with infusion of…

Primary Article

Are Patients With Hyperlipidemia Being Treated? Investigation of Cholesterol Treatment Practices in an HMO Primary Care Setting

Abstract Background. The main study objective was to investigate cholesterol treatment practices of primary care physicians in a managed care setting. Methods. The study was a retrospective review of data with a quasiexperimental design. The National Cholesterol Education Program‐Adult Treatment Panel II (NCEP‐ATP II) guidelines were used as the reference…

Primary Article

Lipid Profiles of Obese Children and Adolescents Before and After Significant Weight Loss Differences According to Sex

Abstract Background. Childhood obesity has been associated with elevated serum levels of total cholesterol, triglycerides, and low‐density lipoproteins (LDLs). We observed the lipid profiles of obese female subjects versus obese male subjects before and after significant weight loss. Methods. We studied 29 girls and 21 boys enrolled in a multidisciplinary…

Primary Article

Comparing the Effectiveness of Video and Written Material for Improving Knowledge Among Sleep Disorders Clinic Patients With Limited Literacy Skills*

Abstract Background. Health care professionals often use written material or video recordings to teach their patients without knowing which is more effective for comprehension of the information. Methods. Patients watched either an instructional videotape about sleep apnea or read a newly designed brochure, then responded to a structured questionnaire containing…

Primary Article

Suicidal Behavior in Psychiatric Emergency Room Patients

Abstract Background. Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. Methods. Charts of 311 consecutive psychiatric ER patients were reviewed. Suicidal…

Primary Article

Caffeine in the Treatment of Apnea Associated With Respiratory Syncytial Virus Infection in Neonates and Infants

Abstract Background. The xanthines have been shown to be effective in the treatment of apnea of prematurity. Limited reports are available in the literature concerning the use of these agents with apnea related to respiratory syncytial virus (RSV) infections. Methods. A retrospective review was done to identify infants who received…

Trauma Rounds

Scalp Laceration An Obvious ‘Occult’ Cause of Shock

ABSTRACT: &NA; Scalp lacerations are often present in patients requiring emergency care for blunt trauma. These injuries are most commonly seen in unrestrained drivers or occupants involved in motor vehicle crashes in which the victim is partially or totally ejected. Patients with scalp lacerations often have associated injuries that redirect…

Article

The Epilepsy of First Lady Ida Saxton McKinley

Article

Pellagra in the United States: A Historical Perspective

ABSTRACT:Pellagra was in existence for nearly two centuries in Europe before being recognized in the United States, where it was first reported in 1902. Over the next two decades, pellagra occurred in epidemic proportions in the American South. Poverty and consumption of corn were the most frequently observed risk factors….

Case Report

Benign Enterogenous Cyst of the Pancreas

ABSTRACT:A 26-year-old woman was evaluated for a mass found by computed tomography (CT). Radiographically, the mass resembled a pancreatic cystadenoma. The patient had had left upper quadrant abdominal pain for several years and low grade fevers and indigestion for 5 months. At surgery, a unilocular cystic mass was found anteriorly…

Case Report

Atypical Presentation of Microscopically Advanced Ovarian Carcinoma

ABSTRACT:Epithelial ovarian cancer (EOC) continues to be an academically challenging and clinically problematic disease. Even with recent advances, the overall 5-year survival is still 31% to 42% in various studies. Deaths from EOC outnumber those due to cervical, vulvar, and endometrial carcinomas combined. Screening for EOC has shown limited success…

Case Report

Beware of Short-Course Therapy for Staphylococcus aureus Bacteremia Without a Removable Cause

ABSTRACT:Staphylococcus aureus bacteremia has long been known to cause significant morbidity and mortality. The optimal treatment of this disease has evolved over the years. Recently, criteria have been established for the use of shorter courses of antibiotic therapy in certain patients, most notably those with an easily removed source of…

Case Report

Life-Threatening Subcutaneous Hematoma Caused by an Axillary Pad in an Anticoagulated Patient

ABSTRACT:A large subcutaneous hematoma extending from the left axillary region to the left flank developed in a 70-year-old man receiving anticoagulant therapy. The cause was repeated microtrauma caused by the axillary pad on a walker. Physicians and physiotherapists should be aware that rehabilitation devices causing pressure on the skin increase…

Case Report

Primary Extra-nodal Lymphoma of the Urinary Bladder

ABSTRACT:Primary non-Hodgkin's lymphoma of the urinary bladder is rare. Only a few cases have been reported. We report the case of a woman with non-Hodgkin's lymphoma of urinary bladder and review the literature.

Case Report

Improved Sexual Function in Three Men Taking Lamotrigine for Epilepsy

ABSTRACT:Little information exists about the effects of newer antiepileptic drugs (AEDs) on sexual function in men with epilepsy. We report a series of three male veterans whose sexual disorders improved with lamotrigine. All three had partial seizures. One patient was taking phenobarbital and gabapentin and complained of decreased potency and…

Case Report

Successful Thrombolytic Therapy for Massive Pulmonary Embolism

ABSTRACT:The use and scope of thrombolytic therapy in the management of pulmonary embolism (PE) continues to evolve. The results of small studies suggest that thrombolytic therapy might have an impact on survival in massive PE with cardiogenic shock; however, no large studies to further this notion exist. Furthermore, the expanded…

Case Report

Pyomyositis in the Acquired Immunodeficiency Syndrome

ABSTRACT:Pyomyositis, a purulent infection of skeletal muscle, is usually caused by Staphylococcus aureus. Many cases of pyomyositis in human immunodeficiency virus (HIV) seronegative patients have been reported in North America and have been reviewed extensively. Moreover, pyomyositis has been reported in association with HIV infection in patients with or without…

Case Report

Recurrent Merkel Cell Carcinoma of the Upper Extremity

ABSTRACT:We report a case of recurrent Merkel cell carcinoma (MCC) of the upper extremity, treated aggressively with wide local excision, regional lymphadenectomy, and immediate reconstruction. Five years after surgery, there is no clinical or diagnostic evidence of locoregional recurrence or distant disease. The patient's upper extremity and hand remain fully…

Case Report

Morphology of Right Ventricular Paced Beats in Posterior Myocardial Infarction

ABSTRACT:Premature ventricular beats or paced beats can unmask new or old myocardial infarction when sinus beats fail to exhibit the typical infarct pattern. Knowledge of their morphology is vital, since they may be the earliest or even the only evidence of a myocardial infarction in certain cases. Morphology of premature…

Current Concepts

Pitfalls in the Diagnosis and Management of Systolic Hypertension*

AbstractBackground.Systolic blood pressure (SBP) is even more important than diastolic blood pressure (DBP) with regard to the risk of cardiovascular complications. Methods and Results.Pitfalls in the diagnosis of systolic hypertension include the auscultatory gap, use of the proper size cuff (obese adult size for mid-arm circumference >33 cm and child's…

Current Concepts

Differential Diagnosis of Gallstone-Induced Complications

ABSTRACT:Early recognition and prompt intervention are the most crucial steps in the management of gallstone-induced biliary disease. Many conditions can mimic the presentation of gallstone-induced complications. Therefore, participation of a clinically astute physician is essential in evaluating symptoms and interpreting diagnostic data in patients with symptomatic gallstones.

Primary Article

Initial Experience With Isradipine for the Treatment of Hypertension in Children

AbstractBackground.Isradipine is a calcium channel blocker of the dihydropyridine class. It has limited effects on myocardial contractility; is available in a powder-filled capsule and has a half-life of 6 to 8 hours. Methods.Pharmacy records were reviewed to identify pediatric patients who had received isradipine. The following demographic data were obtained:…

Primary Article

Correlation Between Increased Colloid Osmotic Pressure and the Resolution of Refractory Ascites After Transjugular Intrahepatic Portosystemic Shunt

AbstractBackground.This study compared the changes in serum albumin, globulin, and colloid osmotic pressure (COP) before and after transjugular intrahepatic portosystemic shunt (TIPS) or large volume paracentesis (LVP) in patients with ascites. Methods.Of 23 patients with refractory ascites, 17 had TIPS and 6 had LVP with infusion of albumin. Colloid osmotic…

Primary Article

Lipid Profiles of Obese Children and Adolescents Before and After Significant Weight Loss: Differences According to Sex

AbstractBackground.Childhood obesity has been associated with elevated serum levels of total cholesterol, triglycerides, and low-density lipoproteins (LDLs). We observed the lipid profiles of obese female subjects versus obese male subjects before and after significant weight loss. Methods.We studied 29 girls and 21 boys enrolled in a multidisciplinary weight reduction program….

Primary Article

Comparing the Effectiveness of Video and Written Material for Improving Knowledge Among Sleep Disorders Clinic Patients With Limited Literacy Skills*

AbstractBackground.Health care professionals often use written material or video recordings to teach their patients without knowing which is more effective for comprehension of the information. Methods.Patients watched either an instructional videotape about sleep apnea or read a newly designed brochure, then responded to a structured questionnaire containing 11 knowledge-based questions…

Primary Article

Are Patients With Hyperlipidemia Being Treated? Investigation of Cholesterol Treatment Practices in an HMO Primary Care Setting

AbstractBackground.The main study objective was to investigate cholesterol treatment practices of primary care physicians in a managed care setting. Methods.The study was a retrospective review of data with a quasiexperimental design. The National Cholesterol Education Program–Adult Treatment Panel II (NCEP-ATP II) guidelines were used as the reference for conducting a…

Primary Article

Suicidal Behavior in Psychiatric Emergency Room Patients

AbstractBackground.Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. Methods.Charts of 311 consecutive psychiatric ER patients were reviewed. Suicidal behavior was considered…

Primary Article

Caffeine in the Treatment of Apnea Associated With Respiratory Syncytial Virus Infection in Neonates and Infants

AbstractBackground.The xanthines have been shown to be effective in the treatment of apnea of prematurity. Limited reports are available in the literature concerning the use of these agents with apnea related to respiratory syncytial virus (RSV) infections. Methods.A retrospective review was done to identify infants who received caffeine therapy for…

Trauma Rounds

Scalp Laceration: An Obvious ‘Occult’ Cause of Shock

ABSTRACT:Scalp lacerations are often present in patients requiring emergency care for blunt trauma. These injuries are most commonly seen in unrestrained drivers or occupants involved in motor vehicle crashes in which the victim is partially or totally ejected. Patients with scalp lacerations often have associated injuries that redirect the clinician's…