Issue - Southern Medical Association

Case Report

Complex Enterocutaneous Fistula Closure With Rectus Abdominis Muscle Flap

Most enterocutaneous fistulas are caused by complications of abdominal surgery that may result from anastomotic failure, poor blood supply, or iatrogenic bowel injuries. Mortality rates are high when associated sepsis and malnutrition are uncontrolled. Fistulas that occur late and those that recur spontaneously present more difficulty and may close spontaneously…

Case Report

Camphor Hepatotoxicity

We report a case of hepatotoxicity in a 2‐month‐old baby after a camphor‐containing cold remedy was applied dermally. Liver function tests returned to normal after the application of the cold remedy was discontinued. Ingestion of camphor can cause severe liver and central nervous system injury, and neurotoxicity has been observed…

Case Report

Noncaseating Granulomatous Disease in Common Variable Immunodeficiency

Patients with common variable immunodeficiency (CVID) are occasionally recognized to have a concurrent noncaseating granulomatous disease. The granulomatous disease (GD) associated with CVID shares many clinical properties typical of sarcoidosis. Some investigators speculate that the GD‐CVID is actually sarcoidosis that is expressed atypically because of the patient’s immunodeficiency. Clinical differences,…

Case Report

Recurrent Cholangiocarcinoma Negative Autopsy Results After Aggressive Management

ABSTRACT &NA; Cholangiocarcinoma is one of the most common malignancies of the biliary tree. Most cases are perihilar. Cholangiocarcinoma usually has an indolent, slowly progressive course and is associated with a high mortality rate. In this article, we discuss the management of perihilar cholangiocarcinoma by radiation therapy and chemotherapy in…

Case Report

FGFR3 Gene Mutation (Gly380Arg) With Achondroplasia and (21) Down Syndrome Phenotype-Genotype Correlation

ABSTRACT &NA; We report the case of a boy with achondroplasia and i(21q) Down syndrome. Besides craniofacial features typical in Down syndrome, the skeletal findings of achondroplasia dominate the clinical picture. The diagnosis of Down syndrome was based on clinical features and the cytogenetic finding of i(21q) trisomy 21. The…

Case Report

Intracanalicular Meningioma

ABSTRACT &NA; Intracanalicular meningiomas are extremely rare and difficult to differentiate from intracanalicular vestibular schwannomas. We report an unusual case of a posterior fossa meningioma in the proximal internal auditory canal that was originally diagnosed as a vestibular schwannoma due to its appearance on magnetic resonance imaging. However, closer inspection…

Case Report

Spontaneous Rupture of Spleen Due to Q Fever

ABSTRACT &NA; Spontaneous rupture of the spleen is a rare complication of acute Q fever infection. Only two cases have been reported, both in Europe. This is the first reported case of spontaneous rupture of the spleen caused by acute Q fever in the United States.

Case Report

Coronary Arteriovenous Fistula With Papillary Muscle Rupture

ABSTRACT &NA; We describe a patient who had a coronary arteriovenous fistula (CAVF) and whose mitral valve papillary muscle ruptured from chronic ischemia due to a coronary steal phenomenon. He was treated surgically with ligation of the CAVF (left circumflex to coronary sinus), coronary artery bypass grafting, and mitral valve…

Case Report

Toxoplasma gondii Pneumonia in a Pancreas Transplant Patient

ABSTRACT &NA; A 41‐year‐old woman had fever of 3 days' duration. She had had pancreas transplantation 2 years previously and had recently completed a course of antirejection medication. Temperature spikes occurred during treatment with broad spectrum antibiotics. No obvious cause for the fever was found. The patient's condition worsened, with…

Case Report

Prochlorperazine-Induced Extrapyramidal Effects Mimicking Meningitis in a Child

ABSTRACT &NA; Certain medications, such as the phenothiazines, may cause side effects that result in neck stiffness and may actually mimic the presentation of meningitis, especially in children. Despite the controversial use of antiemetics, they continue to be used in children with viral gastroenteritis. I describe the case of a…

Case Report

Superior Mesenteric Artery Syndrome: An Uncommon Cause of Intestinal Obstruction

ABSTRACT &NA; Superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction, most frequently occurring in patients who have had rapid weight loss. Identification of this syndrome can be a diagnostic dilemma and is frequently made by exclusion. The most characteristic symptoms are postprandial epigastric pain, eructation,…

Case Report

Pleural Fluid and Serum Eosinophilia Association With Fluoxetine Hydrochloride

We report the case of a patient who was treated with fluoxetine hydrochloride (Prozac) for depression. Approximately 8 weeks into the treatment, an eosinophilic pleural effusion and serum eosinophilia developed. An extensive workup for the etiology of eosinophilic pleural effusion was unrevealing. Pleural biopsy showed a nonspecific inflammatory reaction and…

Case Report

Peliosis Hepatis After Treatment With 2-Chloro-3-deoxyadenosine

ABSTRACT &NA; Peliosis hepatis is an unusual disorder associated with a variety of diseases and treatments. This is the first report of peliosis hepatis associated with administration of 2‐chloro‐3′‐deoxyadenosine. The literature is reviewed.

Current Concepts

Drug‐Facilitated Sexual Assault (‘Date Rape’)

ABSTRACT &NA; In the past few years, drug‐facilitated sexual assaults have received widespread media coverage. In addition to alcohol, the most frequently used date‐rape drug, flunitrazepam (Rohypnol), a fast‐acting benzodiazepine, and &ggr;‐hydroxybutyrate (GHB) and its congeners are among the most popular drugs used for this purpose. The latter drug is…

Current Concepts

When Antihypertensive Monotherapy Fails Fixed‐Dose Combination Therapy

Abstract Background. Antihypertensive monotherapy fails to control blood pressure in many patients. Methods. Data on the efficacy and tolerance of fixed dose angiotensin‐converting enzyme (ACE) inhibitor/calcium antagonist combinations were reviewed, since they are the most widely prescribed medications for hypertension. Results. A fixed‐dose combination of two drug classes is an…

Current Concepts

Recurrent Coagulopathy After Antivenom Treatment of Crotalid Snakebite

Abstract Background. We studied whether recurrence of coagulopathy, defined as the return of a coagulation abnormality after initial normalization, occurred after the use of antivenin (Crotalidae) polyvalent. Methods. A retrospective, blinded, descriptive analysis of 354 consecutive cases of North American crotalid snake envenomation was done. Inclusion criteria were documented clinical…

Editorial

THE LAST OF THE REAL MEN

Primary Article

Adherence to Prescription Medications Among Medical Professionals

Abstract Background. We evaluated adherence to medication usage by health care professionals to estimate the expected upper limit of adherence among the general population. Methods. In a self‐administered survey, physicians and nurses were asked about their use of prescribed medications for acute and chronic illnesses. The settings were a teaching…

Primary Article

Blood Pressure in Acute Vaso‐occlusive Crises of Sickle Cell Disease

Abstract Objective. We compared blood pressure (BP) in patients with sickle cell disease (SCD)‐related crises and black patients without SCD. Methods. We retrospectively reviewed charts of emergency department (ED) patients with SCD crises in a 2‐year period, recording BPs and demographic and SCD data. A cohort of consecutive black patients…

Primary Article

Complications of Lower Extremity Arteriovenous Grafts in Patients With End‐Stage Renal Disease

Abstract Background. More data are needed to assess lower extremity angioaccess sites for hemodialysis. Methods. We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996. Results. Lower extremity grafts accounted for 16% (134/843) of patients in this series….

Primary Article

Inpatients With Menometrorrhagia Etiologies, Treatments, and Outcomes

Abstract Background. Abnormal uterine bleeding is commonly seen in emergency departments and gynecologic clinics. In a southern, inner‐city hospital, a seemingly large number of women are admitted with life‐threatening anemia of benign gynecologic origin. We examine its causes, review treatments and outcomes, and discuss optimization of therapy. Methods. A chart…

Primary Article

Medical Exclusion of Sick Children From Child Care Centers A Plea for Reconciliation

Abstract Background. Policies for excluding ill children from child care can affect parental absenteeism from the workplace and the utilization of pediatric health care resources. Methods. We surveyed a representative sample of 310 child care centers throughout Virginia to assess policies for excluding children with fever, common upper respiratory tract…

Primary Article

Daily Smoking by Louisiana Students Sixth Through Twelfth Grades, 1996‐1997

Abstract Objectives. We sought to determine the prevalence of daily smoking in Louisiana in grades 6 through 12 and to compare Louisiana students' daily smoking to that of national student and Louisiana adult rates. Methods. A statewide, randomized, stratified classroom‐based survey of 11,736 subjects was done for the school year…

Trauma Rounds

Penetrating Neck Injuries

ABSTRACT &NA; Penetrating neck trauma may be managed operatively or nonoperatively, depending on precise anatomic location. Conservative management of zone II injuries is currently an issue under debate. We present a brief case report followed by a description of the current strategies for operative exploration and diagnostic maneuvers in penetrating…

Case Report

Camphor Hepatotoxicity

ABSTRACT:We report a case of hepatotoxicity in a 2-month-old baby after a camphor-containing cold remedy was applied dermally. Liver function tests returned to normal after the application of the cold remedy was discontinued. Ingestion of camphor can cause severe liver and central nervous system injury, and neurotoxicity has been observed…

Case Report

Intracanalicular Meningioma

ABSTRACT:Intracanalicular meningiomas are extremely rare and difficult to differentiate from intracanalicular vestibular schwannomas. We report an unusual case of a posterior fossa meningioma in the proximal internal auditory canal that was originally diagnosed as a vestibular schwannoma due to its appearance on magnetic resonance imaging. However, closer inspection of the…

Case Report

Recurrent Cholangiocarcinoma: Negative Autopsy Results After Aggressive Management

ABSTRACT:Cholangiocarcinoma is one of the most common malignancies of the biliary tree. Most cases are perihilar. Cholangiocarcinoma usually has an indolent, slowly progressive course and is associated with a high mortality rate. In this article, we discuss the management of perihilar cholangiocarcinoma by radiation therapy and chemotherapy in a case…

Case Report

Superior Mesenteric Artery Syndrome: An Uncommon Cause of Intestinal Obstruction

ABSTRACT:Superior mesenteric artery (SMA) syndrome is an atypical cause of high intestinal obstruction, most frequently occurring in patients who have had rapid weight loss. Identification of this syndrome can be a diagnostic dilemma and is frequently made by exclusion. The most characteristic symptoms are postprandial epigastric pain, eructation, fullness, and…

Case Report

Complex Enterocutaneous Fistula: Closure With Rectus Abdominis Muscle Flap

ABSTRACT:Most enterocutaneous fistulas are caused by complications of abdominal surgery that may result from anastomotic failure, poor blood supply, or iatrogenic bowel injuries. Mortality rates are high when associated sepsis and malnutrition are uncontrolled. Fistulas that occur late and those that recur spontaneously present more difficulty and may close spontaneously…

Case Report

Coronary Arteriovenous Fistula With Papillary Muscle Rupture

ABSTRACT:We describe a patient who had a coronary arteriovenous fistula (CAVF) and whose mitral valve papillary muscle ruptured from chronic ischemia due to a coronary steal phenomenon. He was treated surgically with ligation of the CAVF (left circumflex to coronary sinus), coronary artery bypass grafting, and mitral valve replacement. This…

Case Report

Toxoplasma gondii Pneumonia in a Pancreas Transplant Patient

ABSTRACT:A 41-year-old woman had fever of 3 days' duration. She had had pancreas transplantation 2 years previously and had recently completed a course of antirejection medication. Temperature spikes occurred during treatment with broad spectrum antibiotics. No obvious cause for the fever was found. The patient's condition worsened, with development of…

Case Report

Peliosis Hepatis After Treatment With 2-Chloro-3′-deoxyadenosine

ABSTRACT:Peliosis hepatis is an unusual disorder associated with a variety of diseases and treatments. This is the first report of peliosis hepatis associated with administration of 2-chloro-3′-deoxyadenosine. The literature is reviewed.

Case Report

FGFR3 Gene Mutation (Gly380Arg) With Achondroplasia and i(21q) Down Syndrome Phenotype-Genotype Correlation

ABSTRACT:We report the case of a boy with achondroplasia and i(21q) Down syndrome. Besides craniofacial features typical in Down syndrome, the skeletal findings of achondroplasia dominate the clinical picture. The diagnosis of Down syndrome was based on clinical features and the cytogenetic finding of i(21q) trisomy 21. The diagnosis of…

Case Report

Noncaseating Granulomatous Disease in Common Variable Immunodeficiency

ABSTRACT:Patients with common variable immunodeficiency (CVID) are occasionally recognized to have a concurrent noncaseating granulomatous disease. The granulomatous disease (GD) associated with CVID shares many clinical properties typical of sarcoidosis. Some investigators speculate that the GD-CVID is actually sarcoidosis that is expressed atypically because of the patient's immunodeficiency. Clinical differences,…

Case Report

Spontaneous Rupture of Spleen Due to Q Fever

ABSTRACT:Spontaneous rupture of the spleen is a rare complication of acute Q fever infection. Only two cases have been reported, both in Europe. This is the first reported case of spontaneous rupture of the spleen caused by acute Q fever in the United States.

Case Report

Prochlorperazine-Induced Extrapyramidal Effects Mimicking Meningitis in a Child

ABSTRACT:Certain medications, such as the phenothiazines, may cause side effects that result in neck stiffness and may actually mimic the presentation of meningitis, especially in children. Despite the controversial use of antiemetics, they continue to be used in children with viral gastroenteritis. I describe the case of a child who…

Case Report

Pleural Fluid and Serum Eosinophilia: Association With Fluoxetine Hydrochloride

ABSTRACT:We report the case of a patient who was treated with fluoxetine hydrochloride (Prozac) for depression. Approximately 8 weeks into the treatment, an eosinophilic pleural effusion and serum eosinophilia developed. An extensive workup for the etiology of eosinophilic pleural effusion was unrevealing. Pleural biopsy showed a nonspecific inflammatory reaction and…

Current Concepts

When Antihypertensive Monotherapy Fails: Fixed-Dose Combination Therapy

AbstractBackground.Antihypertensive monotherapy fails to control blood pressure in many patients. Methods.Data on the efficacy and tolerance of fixed dose angiotensin-converting enzyme (ACE) inhibitor/calcium antagonist combinations were reviewed, since they are the most widely prescribed medications for hypertension. Results.A fixed-dose combination of two drug classes is an option for hypertension treatment….

Current Concepts

Drug-Facilitated Sexual Assault (‘Date Rape’)

ABSTRACT:In the past few years, drug-facilitated sexual assaults have received widespread media coverage. In addition to alcohol, the most frequently used date-rape drug, flunitrazepam (Rohypnol), a fast-acting benzodiazepine, and &ggr;-hydroxybutyrate (GHB) and its congeners are among the most popular drugs used for this purpose. The latter drug is easily procured…

Current Concepts

Recurrent Coagulopathy After Antivenom Treatment of Crotalid Snakebite

AbstractBackground.We studied whether recurrence of coagulopathy, defined as the return of a coagulation abnormality after initial normalization, occurred after the use of antivenin (Crotalidae) polyvalent. Methods.A retrospective, blinded, descriptive analysis of 354 consecutive cases of North American crotalid snake envenomation was done. Inclusion criteria were documented clinical evidence of crotalid…

Editorial

THE LAST OF THE REAL MEN

Primary Article

Daily Smoking by Louisiana Students: Sixth Through Twelfth Grades, 1996-1997

AbstractObjectives.We sought to determine the prevalence of daily smoking in Louisiana in grades 6 through 12 and to compare Louisiana students' daily smoking to that of national student and Louisiana adult rates. Methods.A statewide, randomized, stratified classroom-based survey of 11,736 subjects was done for the school year 1996-1997. Results.We found…

Primary Article

Adherence to Prescription Medications Among Medical Professionals

AbstractBackground.We evaluated adherence to medication usage by health care professionals to estimate the expected upper limit of adherence among the general population. Methods.In a self-administered survey, physicians and nurses were asked about their use of prescribed medications for acute and chronic illnesses. The settings were a teaching hospital, employee health…

Primary Article

Complications of Lower Extremity Arteriovenous Grafts in Patients With End-Stage Renal Disease

AbstractBackground.More data are needed to assess lower extremity angioaccess sites for hemodialysis. Methods.We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996. Results.Lower extremity grafts accounted for 16% (134/843) of patients in this series. Complications occurred in 58…

Primary Article

Inpatients With Menometrorrhagia: Etiologies, Treatments, and Outcomes

AbstractBackground.Abnormal uterine bleeding is commonly seen in emergency departments and gynecologic clinics. In a southern, inner-city hospital, a seemingly large number of women are admitted with life-threatening anemia of benign gynecologic origin. We examine its causes, review treatments and outcomes, and discuss optimization of therapy. Methods.A chart review of patients…

Primary Article

Blood Pressure in Acute Vaso-occlusive Crises of Sickle Cell Disease

AbstractObjective.We compared blood pressure (BP) in patients with sickle cell disease (SCD)–related crises and black patients without SCD. Methods.We retrospectively reviewed charts of emergency department (ED) patients with SCD crises in a 2-year period, recording BPs and demographic and SCD data. A cohort of consecutive black patients without SCD was…

Primary Article

Medical Exclusion of Sick Children From Child Care Centers: A Plea for Reconciliation

AbstractBackground.Policies for excluding ill children from child care can affect parental absenteeism from the workplace and the utilization of pediatric health care resources. Methods.We surveyed a representative sample of 310 child care centers throughout Virginia to assess policies for excluding children with fever, common upper respiratory tract illnesses, or head…

Trauma Rounds

Penetrating Neck Injuries

ABSTRACT:Penetrating neck trauma may be managed operatively or nonoperatively, depending on precise anatomic location. Conservative management of zone II injuries is currently an issue under debate. We present a brief case report followed by a description of the current strategies for operative exploration and diagnostic maneuvers in penetrating neck injuries….