Issue - Southern Medical Association

Article

Combination Agents as a Means of Improving Adherence and Other Aspects of the Sixth Joint National Committee Report

Article

Conference Summary

Article

Evaluation and Treatment of Renovascular Disease in the Elderly Clues for the Clinician

Article

Lessons From Recent Hypertension Trials: How Low to Lower Blood Pressure

Article

Systolic Blood Pressure, Diastolic Blood Pressure, or Pulse Pressure: Which Is More Important for the Practicing Clinician?

Article

Treating the African American With Hypertension Does Race Really Matter?

Case Report

Quinolones and Tendon Ruptures

We report two cases of tendon rupture associated with ciprofloxacin. One patient had a complete rupture of an Achilles tendon 6 months after taking the medication. The other case involved a partial rupture of the subscapularis tendon. Both ruptures occurred with minimal mechanical stress on the tendons, suggesting that the…

Case Report

Atypical Presentation of Hepatocellular Carcinoma

Hepatocellular carcinoma is relatively rare in the United States, and the patterns of extrahepatic manifestations are diverse. Disease dissemination occurs through hematogenous routes to frequently involve the lungs, bone, adrenal glands, and pancreas. Soft tissue metastasis is extremely rare and mandates systematic pathologic analysis, which may include the use of…

Case Report

Pulmonary Sarcoidosis Presentation as Bilateral Spontaneous Hydropneumothorax and Pulmonary Infiltrates

Pulmonary manifestations in sarcoidosis vary, ranging from asymptomatic chest radiographic abnormalities to progressive destruction of lung parenchyma with respiratory insufficiency. We describe a case of sarcoidosis in a patient with bilateral hydropneumothorax, parenchyma infiltrates, and respiratory insufficiency. Hydropneumothorax is extremely rare, and to our knowledge only two cases have been…

Case Report

Acute Abdomen With Colonic Necrosis Induced by Kayexalate-Sorbitol

Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increase awareness of this complication, we report a case of necrosis of the transverse colon in a patient given oral and rectal SPS‐sorbitol for hyperkalemia. Colonic necrosis was manifested as an…

Case Report

Delayed Death From Pulmonary Tuberculosis Unsuspected Subtherapeutic Drug Levels

A patient with fulminant pulmonary tuberculosis died after 41 days of intensive care despite pansensitive organisms and no known underlying immunosuppression. Two factors leading to death in this patient were a delay in seeking medical attention and a subtherapeutic serum level of rifampin, though no obvious evidence of malabsorption existed….

Case Report

Retrograde Jejunogastric Intussusception

Retrograde gastrointestinal intussusception is a rare entity, most commonly reported after gastric resection and gastrojejunostomy. Its occurrence in the absence of previous gastric resection is extremely unusual, with only four cases reported. All cases were associated with previously placed gastrostomy tubes and implicated these as the inciting factor. We present…

Case Report

Dual-Energy X-ray Absorptiometry in Osteopetrosis

We have used dual‐energy x‐ray absorptiometry (DXA) in evaluation and follow‐up of a patient with osteopetrosis, before and after cord blood transplantation. Other methods of follow‐up in such cases have been described, but the use of DXA has not previously been reported. We have shown that DXA offers a safe…

Case Report

Fatal Bladder Cancer and Dermatomyositis

Dermatomyositis is an uncommon inflammatory myopathy accompanied by characteristic cutaneous findings. Adult‐onset dermatomyositis is often associated with internal malignancy. We report a case of dermatomyositis associated with an aggressive and fatal case of transitional cell carcinoma of the bladder.

Case Report

Trovafloxacin-Induced Weakness Due to a Demyelinating Polyneuropathy

Fluoroquinolones have been associated with peripheral sensory disorders and weakness, especially in patients with underlying myasthenia gravis or myasthenia‐like Eaton‐Lambert syndrome. Trovafloxacin is a relatively new quinolone for which these side effects have not been described. We report a case of diffuse weakness due to a demyelinating polyneuropathy that began…

Case Report

Hashimoto’s Encephalopathy

Hashimoto’s encephalopathy is a subacute condition associated with autoimmune thyroiditis. Its presentation varies from focal neurologic deficits to global confusion. Unlike encephalopathy associated with hypothyroidism, Hashimoto’s encephalopathy responds to steroid therapy and not thyroxine replacement.

Case Report

Tracheal Lipoma: A Rare Intrathoracic Neoplasm

Primary tracheal lipomas are extremely rare neoplasms. The typical patient is a middle‐aged man with complaints of cough and shortness of breath. Often, the diagnosis is delayed, and patients are treated for asthma or bronchitis. The diagnosis of a tracheal lipoma is best approached by computed tomography (CT) and bronchofibroscopy….

Current Concepts

Smokeless Tobacco Use Among Adults in the Southeast

ABSTRACT: &NA; Tobacco use is associated with numerous illnesses and contributes to as many as 400,000 deaths in the United States each year. Most tobacco use in the United States is in the form of cigarette smoking, but smokeless tobacco use is particularly high in certain areas and within certain…

Current Concepts

Perpetrators of Abusive Head Trauma A Comparison of Two Geographic Populations

Abstract Background. Abusive head trauma accounts for significant morbidity and mortality in infants. We compared a Southern population of victims with those in a previous study of a Western population, which found that men, particularly fathers and mothers' boyfriends, are the most common perpetrators. Methods. All cases of child abuse…

Current Concepts

Response to Warfarin and Other Oral Anticoagulants Effects of Disease States

Abstract Background. Warfarin is associated with numerous drug and food interactions, and much attention has been appropriately focused on this subject. Because several disease states may also affect response to oral anticoagulants, we present a summary of the literature. Methods. We searched MEDLINE for original articles on the effect of…

Editorial

FLUOROQUINOLONES

Primary Article

Use of HFE Mutation Analysis for Hereditary Hemochromatosis The Need for Physician Education in the Translation of Basic Science to Clinical Practice

Abstract Background. Hereditary hemochromatosis (HH) is a common hereditary disorder of iron metabolism causing iron overload, organ failure, and malignancy. Preclinical diagnosis using HFE gene analysis followed by prophylactic phlebotomy can completely prevent the disease. Methods. We conducted a mail survey of all registered primary care physicians, gastroenterologists, and hematologists…

Primary Article

Physicians' Attitudes Toward Pain and the Use of Opioid Analgesics Results of a Survey from the Texas Cancer Pain Initiative

Abstract Background. Despite extensive progress in the scientific understanding of pain in humans, serious mismanagement and undermedication in treating acute and chronic pain is a continuing problem. This study was designed to examine the barriers to adequate pain management, especially as they might be associated with community size and medical…

Primary Article

Medical Students' Attitudes Toward Pain and the Use of Opioid Analgesics Implications for Changing Medical School Curriculum

Abstract Background. Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics. Methods. We tested a medical school class during their freshman and senior years. Stepwise regression analysis was used to…

Trauma Rounds

Vascular Injuries of the Upper Extremity

ABSTRACT: &NA; Vascular injuries of the upper extremity represent approximately 30% to 50% of all peripheral vascular injuries. The majority of injuries are to the brachial artery, and 90% of injuries are due to penetrating trauma. Return of function is often related to concomitant injury to peripheral nerves. However, timely…

Article

Treating the African American With Hypertension: Does Race Really Matter?

Article

Evaluation and Treatment of Renovascular Disease in the Elderly: Clues for the Clinician

Article

Systolic Blood Pressure, Diastolic Blood Pressure, or Pulse Pressure: Which Is More Important for the Practicing Clinician?

Article

Lessons From Recent Hypertension Trials: How Low to Lower Blood Pressure

Article

Combination Agents as a Means of Improving Adherence and Other Aspects of the Sixth Joint National Committee Report

Article

Conference Summary:

Article

Hypertension Conference

Case Report

Tracheal Lipoma: A Rare Intrathoracic Neoplasm

ABSTRACT:Primary tracheal lipomas are extremely rare neoplasms. The typical patient is a middle-aged man with complaints of cough and shortness of breath. Often, the diagnosis is delayed, and patients are treated for asthma or bronchitis. The diagnosis of a tracheal lipoma is best approached by computed tomography (CT) and bronchofibroscopy….

Case Report

Pulmonary Sarcoidosis: Presentation as Bilateral Spontaneous Hydropneumothorax and Pulmonary Infiltrates

ABSTRACT:Pulmonary manifestations in sarcoidosis vary, ranging from asymptomatic chest radiographic abnormalities to progressive destruction of lung parenchyma with respiratory insufficiency. We describe a case of sarcoidosis in a patient with bilateral hydropneumothorax, parenchyma infiltrates, and respiratory insufficiency. Hydropneumothorax is extremely rare, and to our knowledge only two cases have been…

Case Report

Atypical Presentation of Hepatocellular Carcinoma

ABSTRACT:Hepatocellular carcinoma is relatively rare in the United States, and the patterns of extrahepatic manifestations are diverse. Disease dissemination occurs through hematogenous routes to frequently involve the lungs, bone, adrenal glands, and pancreas. Soft tissue metastasis is extremely rare and mandates systematic pathologic analysis, which may include the use of…

Case Report

Delayed Death From Pulmonary Tuberculosis: Unsuspected Subtherapeutic Drug Levels

ABSTRACT:A patient with fulminant pulmonary tuberculosis died after 41 days of intensive care despite pansensitive organisms and no known underlying immunosuppression. Two factors leading to death in this patient were a delay in seeking medical attention and a subtherapeutic serum level of rifampin, though no obvious evidence of malabsorption existed….

Case Report

Hashimoto’s Encephalopathy

ABSTRACT:Hashimoto's encephalopathy is a subacute condition associated with autoimmune thyroiditis. Its presentation varies from focal neurologic deficits to global confusion. Unlike encephalopathy associated with hypothyroidism, Hashimoto's encephalopathy responds to steroid therapy and not thyroxine replacement.

Case Report

Dual-Energy X-ray Absorptiometry in Osteopetrosis

ABSTRACT:We have used dual-energy x-ray absorptiometry (DXA) in evaluation and follow- up of a patient with osteopetrosis, before and after cord blood transplantation. Other methods of follow-up in such cases have been described, but the use of DXA has not previously been reported. We have shown that DXA offers a…

Case Report

Retrograde Jejunogastric Intussusception

ABSTRACT:Retrograde gastrointestinal intussusception is a rare entity, most commonly reported after gastric resection and gastrojejunostomy. Its occurrence in the absence of previous gastric resection is extremely unusual, with only four cases reported. All cases were associated with previously placed gastrostomy tubes and implicated these as the inciting factor. We present…

Case Report

Quinolones and Tendon Ruptures

ABSTRACT:We report two cases of tendon rupture associated with ciprofloxacin. One patient had a complete rupture of an Achilles tendon 6 months after taking the medication. The other case involved a partial rupture of the subscapularis tendon. Both ruptures occurred with minimal mechanical stress on the tendons, suggesting that the…

Case Report

Fatal Bladder Cancer and Dermatomyositis

ABSTRACT:Dermatomyositis is an uncommon inflammatory myopathy accompanied by characteristic cutaneous findings. Adult-onset dermatomyositis is often associated with internal malignancy. We report a case of dermatomyositis associated with an aggressive and fatal case of transitional cell carcinoma of the bladder.

Case Report

Trovafloxacin-Induced Weakness Due to a Demyelinating Polyneuropathy

ABSTRACT:Fluoroquinolones have been associated with peripheral sensory disorders and weakness, especially in patients with underlying myasthenia gravis or myasthenia-like Eaton-Lambert syndrome. Trovafloxacin is a relatively new quinolone for which these side effects have not been described. We report a case of diffuse weakness due to a demyelinating polyneuropathy that began…

Case Report

Acute Abdomen With Colonic Necrosis Induced by Kayexalate-Sorbitol

ABSTRACT:Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increase awareness of this complication, we report a case of necrosis of the transverse colon in a patient given oral and rectal SPS-sorbitol for hyperkalemia. Colonic necrosis was manifested as an…

Current Concepts

Perpetrators of Abusive Head Trauma: A Comparison of Two Geographic Populations

AbstractBackground.Abusive head trauma accounts for significant morbidity and mortality in infants. We compared a Southern population of victims with those in a previous study of a Western population, which found that men, particularly fathers and mothers' boyfriends, are the most common perpetrators. Methods.All cases of child abuse identified in a…

Current Concepts

Response to Warfarin and Other Oral Anticoagulants: Effects of Disease States

AbstractBackground.Warfarin is associated with numerous drug and food interactions, and much attention has been appropriately focused on this subject. Because several disease states may also affect response to oral anticoagulants, we present a summary of the literature. Methods.We searched MEDLINE for original articles on the effect of disease states on…

Current Concepts

Smokeless Tobacco Use Among Adults in the Southeast

ABSTRACT:Tobacco use is associated with numerous illnesses and contributes to as many as 400,000 deaths in the United States each year. Most tobacco use in the United States is in the form of cigarette smoking, but smokeless tobacco use is particularly high in certain areas and within certain subpopulations. Among…

Editorial

FLUOROQUINOLONES

Primary Article

Use of HFE Mutation Analysis for Hereditary Hemochromatosis: The Need for Physician Education in the Translation of Basic Science to Clinical Practice

AbstractBackground.Hereditary hemochromatosis (HH) is a common hereditary disorder of iron metabolism causing iron overload, organ failure, and malignancy. Preclinical diagnosis using HFE gene analysis followed by prophylactic phlebotomy can completely prevent the disease. Methods.We conducted a mail survey of all registered primary care physicians, gastroenterologists, and hematologists in Arkansas (n…

Primary Article

Medical Students’ Attitudes Toward Pain and the Use of Opioid Analgesics: Implications for Changing Medical School Curriculum

AbstractBackground.Barriers to pain management include physicians' lack of knowledge and attitudes. Our aim was to investigate future physicians' knowledge and attitudes toward pain and the use of opioid analgesics. Methods.We tested a medical school class during their freshman and senior years. Stepwise regression analysis was used to identify the personal…

Primary Article

Physicians’ Attitudes Toward Pain and the Use of Opioid Analgesics: Results of a Survey from the Texas Cancer Pain Initiative

AbstractBackground.Despite extensive progress in the scientific understanding of pain in humans, serious mismanagement and undermedication in treating acute and chronic pain is a continuing problem. This study was designed to examine the barriers to adequate pain management, especially as they might be associated with community size and medical discipline. Methods.A…

Trauma Rounds

Vascular Injuries of the Upper Extremity

ABSTRACT:Vascular injuries of the upper extremity represent approximately 30% to 50% of all peripheral vascular injuries. The majority of injuries are to the brachial artery, and 90% of injuries are due to penetrating trauma. Return of function is often related to concomitant injury to peripheral nerves. However, timely restoration of…