Issue - Southern Medical Association

Article

Neurocysticercosis

Case Report

Primary Meningioma of the Fallopian Canal

ABSTRACT: &NA; Meningiomas are slow‐growing lesions that represent approximately 20% of all intracranial tumors and are the second most common tumor of the cerebellopontine angle. In contrast, primary extracranial meningiomas are found relatively infrequently, and most cases have inadequate radiologic studies to determine if they were actually an extension from…

Case Report

Quinine‐Induced Hemolytic‐Uremic Syndrome

ABSTRACT: &NA; Quinine is still frequently used by practitioners for the treatment of nocturnal leg cramps, despite the lack of Food and Drug Administration (FDA) approval. We report the 15th case of quinine‐induced hemolytic‐uremic syndrome (HUS) in the medical literature. The likely mechanism by which quinine induces HUS is via…

Case Report

Hyperthyroidism After Hypothyroidism

ABSTRACT: &NA; The development of hyperthyroidism after primary hypothyroidism is unusual. We report such a case in a 37‐year old man and review the clinical and immunologic aspects of the previously published cases of 50 female and 19 male patients with a similar condition.

Case Report

Paraplegia Diagnosed by a New Physical Sign

ABSTRACT: &NA; Clinical diagnosis is a process of logical deduction from the data gathered by history and physical examination. When organic causes of an illness have been ruled out, a diagnosis of “functional disorder” or “conversion reaction” is considered. Cost of care of such patients can be enormous, especially when…

Case Report

Massive Left Diaphragmatic Separation and Rupture Due to Coughing During an Asthma Exacerbation

ABSTRACT: &NA; We report a case of herniation of abdominal contents into the left hemithorax in a patient hospitalized with an acute exacerbation of asthma accompanied by paroxysms of coughing. There was no history of trauma. We believe this is the first reported case of diaphragmatic rupture complicating an asthma…

Case Report

Amniotic Fluid Embolism

ABSTRACT: &NA; Amniotic fluid embolism is a rare occurrence, with no single pathognomonic clinical or laboratory finding. Diagnosis is based on clinical presentation and supportive laboratory values. We describe the case of a 17‐year‐old nulliparous woman at 27 weeks' gestation who had uterine bleeding, hematuria, hemoptysis, hypotension, dyspnea, and hypoxemia…

Case Report

Biliary Cystadenoma Rare Variant of Intrahepatic Cystic Disease

ABSTRACT: &NA; Intrahepatic nonparasitic cystic disease is rare and may be of congenital or neoplastic origin. The most frequent symptoms and signs are nonspecific and include pain, nausea, fullness, increased girth, and palpable mass. Interventional therapy is reserved for symptomatic patients, which usually corresponds to cysts >5 cm in diameter….

Case Report

Diagnosis of Polycythemia Vera in an Anemic Patient

ABSTRACT: &NA; Criteria proposed by the Polycythemia Vera Study Group (PVSG) as well as several derived algorithms are currently used for the diagnosis of polycythemia vera. Although these guidelines have significantly enhanced diagnostic accuracy, they uniformly consider erythrocytosis as the requisite premise for instigating the subsequent workup. We describe the…

Case Report

Bacteremia and Possible Endocarditis Caused by Moraxella phenylpyruvica

ABSTRACT: &NA; Moraxella phenylpyruvica, a gram‐negative coccobacillus, is usually considered a nonpathogenic bacterium. Only a few cases of invasive disease caused by this organism were reported in the 1970s. We report a well‐documented case of bacteremia and possible endocarditis due to M phenylpyruvica in a previously healthy man.

Case Report

Extramammary Paget's Disease

ABSTRACT: &NA; Extramammary Paget's disease (EMPD) is an uncommon but distinctive tumor. The lesion is defined as an intra‐epidermal neoplasm. The lesion may be accompanied by an invasive adenocarcinoma or in situ adenocarcinoma of apocrine glands. Visceral carcinoma may also coexist or develop. Definitive diagnosis requires biopsy of the lesion…

Case Report

Epidural Catheters The Long and Winding Road

ABSTRACT: &NA; Entrapment and knotting of epidural catheters has been described, as well as techniques for removal. Several cases of successful removal have been reported; however, significant resistance was encountered during removal. Following the techniques described previously, we successfully removed a knotted epidural catheter.

Current Concepts

Actinic Keratosis Is Squamous Cell Carcinoma

Abstract Background. The prevalence of nonmelanoma skin cancer in the United States is alarming. It can be most appropriately treated if the earliest manifestation of cutaneous squamous cell carcinoma is recognized. Methods. Clinical, histologic, and molecular biology considerations were reviewed to determine whether actinic keratosis is the earliest clinical manifestation…

Current Concepts

Male Pattern Baldness

Abstract Background. Male pattern baldness, or androgenetic alopecia (AGA) in men, occurs with varying severity and age of onset. Two new treatments widely available as alternatives to 2% minoxidil are 1 mg finasteride and topical 5% minoxidil. Finasteride is a 5 alpha‐reductase inhibitor available by prescription only; 5% minoxidil is…

Editorial

ACTINIC KERATOSIS TIME TO CALL A SPADE A SPADE

Editorial

Manuscript Submission Agreement

Editorial

Information for Authors

Expired CME Article

CME Article of the Month Southern Medical Association CME CREDIT

Primary Article

Munchausen by Internet Detecting Factitious Illness and Crisis on the Internet

ABSTRACT: &NA; Within the past few years, the Internet has exploded into a medium of choice for those interested in health and medicine. Along with the promise of immediate access to authoritative resources via websites, the Internet offers “virtual support groups” through formats such as chat rooms and newsgroups. These…

Primary Article

Right Ventricular Alterations in Scuba Divers Findings on Electrocardiography and Echocardiography

Abstract Background. Scuba diving imposes uncommon environmental stresses. This study assesses the effects of recreational scuba diving on the electrocardiogram (ECG) and echocardiogram and compares them with those of normal controls. Methods. We studied 50 recreational scuba divers and 50 age‐matched and sex‐matched normal control subjects. Each subject had a…

Primary Article

Increasing Maternal Weight A Risk Factor for Preeclampsia/Eclampsia But Apparently Not for HELLP Syndrome

Abstract Background. Maternal obesity is a risk factor for severe preeclampsia. We sought to ascertain whether a similar relationship exists between maternal weight and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) as an atypical form of severe preeclampsia. Methods. In this retrospective investigation, 434 patients with HELLP syndrome…

Primary Article

Positive Urine Nitrite Test An Accurate Predictor of Absence of Pure Enterococcal Bacteriuria

Abstract Background. The aim of this study was to determine the potential ability of the urine nitrite test (NT) to predict the class of organism causing urinary tract infection. Methods. We retrospectively reviewed the records of all adult patients with a positive urine culture over a 6‐month period. The infecting…

Primary Article

Utility of Bone Marrow Biopsy for Rapid Diagnosis of Febrile Illnesses in Patients With Human Immunodeficiency Virus Infection

Abstract Background. Histochemical staining of bone marrow biopsy samples for microorganisms may provide a presumptive diagnosis weeks before culture. Methods. To identify predictors of histochemical positivity, we reviewed 161 bone marrow biopsies from febrile patients with human immunodeficiency virus &lpar;HIV&rpar; infection. Results. By multivariate analysis, both hematocrit value <30&percnt; and…

Primary Article

Acute Care of Patients Aged 95 to 99 Years Experience in a Community Teaching Hospital

Abstract Background. People older than 90 years represent an increasing segment of the US population, but little information exists on their hospitalization for acute illness. Methods. We retrospectively analyzed the clinical characteristics of patients aged 95 through 99 years admitted during 1 year to a large teaching hospital. Results. Of…

Primary Article

Is the Leak Test Reproducible&quest;

Abstract Background. The leak test is an accepted practice for evaluating airway edema and patient readiness for extubation. Reproducibility and interobserver reliability for this test have not been established. We studied the reproducibility and reliability of the leak test in and among health care professionals. Methods. Thirteen consecutive intubated patients…

Trauma Rounds

Transcatheter Arterial Embolization in Blunt Hepatic Trauma

ABSTRACT&colon; &NA; Patients with blunt hepatic injury can safely be managed nonoperatively if they show hemodynamic stability. Transcatheter arterial embolization &lpar;TAE&rpar; is a useful adjunct in the treatment of patients who show evidence of continued hemorrhage or who have pooling of contrast material on computed tomography &lpar;CT&rpar;. In these patients,…

Article

Neurocysticercosis

Case Report

Diagnosis of Polycythemia Vera in an Anemic Patient

ABSTRACT:Criteria proposed by the Polycythemia Vera Study Group (PVSG) as well as several derived algorithms are currently used for the diagnosis of polycythemia vera. Although these guidelines have significantly enhanced diagnostic accuracy, they uniformly consider erythrocytosis as the requisite premise for instigating the subsequent workup. We describe the unusual presentation…

Case Report

Epidural Catheters The Long and Winding Road

ABSTRACT:Entrapment and knotting of epidural catheters has been described, as well as techniques for removal. Several cases of successful removal have been reported; however, significant resistance was encountered during removal. Following the techniques described previously, we successfully removed a knotted epidural catheter.

Case Report

Amniotic Fluid Embolism

ABSTRACT:Amniotic fluid embolism is a rare occurrence, with no single pathognomonic clinical or laboratory finding. Diagnosis is based on clinical presentation and supportive laboratory values. We describe the case of a 17-year-old nulliparous woman at 27 weeks' gestation who had uterine bleeding, hematuria, hemoptysis, hypotension, dyspnea, and hypoxemia within 30…

Case Report

Quinine-Induced Hemolytic-Uremic Syndrome

ABSTRACT:Quinine is still frequently used by practitioners for the treatment of nocturnal leg cramps, despite the lack of Food and Drug Administration (FDA) approval. We report the 15th case of quinine-induced hemolytic-uremic syndrome (HUS) in the medical literature. The likely mechanism by which quinine induces HUS is via quinine-dependent antibodies…

Case Report

Hyperthyroidism After Hypothyroidism

ABSTRACT:The development of hyperthyroidism after primary hypothyroidism is unusual. We report such a case in a 37-year old man and review the clinical and immunologic aspects of the previously published cases of 50 female and 19 male patients with a similar condition.

Case Report

Primary Meningioma of the Fallopian Canal

ABSTRACT:Meningiomas are slow-growing lesions that represent approximately 20% of all intracranial tumors and are the second most common tumor of the cerebellopontine angle. In contrast, primary extracranial meningiomas are found relatively infrequently, and most cases have inadequate radiologic studies to determine if they were actually an extension from a primary…

Case Report

Paraplegia Diagnosed by a New Physical Sign

ABSTRACT:Clinical diagnosis is a process of logical deduction from the data gathered by history and physical examination. When organic causes of an illness have been ruled out, a diagnosis of “functional disorder” or “conversion reaction” is considered. Cost of care of such patients can be enormous, especially when a large…

Case Report

Extramammary Paget’s Disease

ABSTRACT:Extramammary Paget's disease (EMPD) is an uncommon but distinctive tumor. The lesion is defined as an intra-epidermal neoplasm. The lesion may be accompanied by an invasive adenocarcinoma or in situ adenocarcinoma of apocrine glands. Visceral carcinoma may also coexist or develop. Definitive diagnosis requires biopsy of the lesion and immunohistochemical…

Case Report

Biliary Cystadenoma: Rare Variant of Intrahepatic Cystic Disease

ABSTRACT:Intrahepatic nonparasitic cystic disease is rare and may be of congenital or neoplastic origin. The most frequent symptoms and signs are nonspecific and include pain, nausea, fullness, increased girth, and palpable mass. Interventional therapy is reserved for symptomatic patients, which usually corresponds to cysts >5 cm in diameter. Retrospective analysis…

Case Report

Bacteremia and Possible Endocarditis Caused by Moraxella phenylpyruvica

ABSTRACT:Moraxella phenylpyruvica, a gram-negative coccobacillus, is usually considered a nonpathogenic bacterium. Only a few cases of invasive disease caused by this organism were reported in the 1970s. We report a well-documented case of bacteremia and possible endocarditis due to M phenylpyruvica in a previously healthy man.

Case Report

Massive Left Diaphragmatic Separation and Rupture Due to Coughing During an Asthma Exacerbation

ABSTRACT:We report a case of herniation of abdominal contents into the left hemithorax in a patient hospitalized with an acute exacerbation of asthma accompanied by paroxysms of coughing. There was no history of trauma. We believe this is the first reported case of diaphragmatic rupture complicating an asthma exacerbation. We…

Current Concepts

Male Pattern Baldness

AbstractBackground.Male pattern baldness, or androgenetic alopecia (AGA) in men, occurs with varying severity and age of onset. Two new treatments widely available as alternatives to 2% minoxidil are 1 mg finasteride and topical 5% minoxidil. Finasteride is a 5 alpha-reductase inhibitor available by prescription only; 5% minoxidil is available over…

Current Concepts

Actinic Keratosis Is Squamous Cell Carcinoma

AbstractBackground.The prevalence of nonmelanoma skin cancer in the United States is alarming. It can be most appropriately treated if the earliest manifestation of cutaneous squamous cell carcinoma is recognized. Methods.Clinical, histologic, and molecular biology considerations were reviewed to determine whether actinic keratosis is the earliest clinical manifestation of cutaneous squamous…

Editorial

ACTINIC KERATOSIS: TIME TO CALL A SPADE A SPADE

Primary Article

Is the Leak Test Reproducible?

AbstractBackground.The leak test is an accepted practice for evaluating airway edema and patient readiness for extubation. Reproducibility and interobserver reliability for this test have not been established. We studied the reproducibility and reliability of the leak test in and among health care professionals. Methods.Thirteen consecutive intubated patients were tested in…

Primary Article

Munchausen by Internet Detecting Factitious Illness and Crisis on the Internet

ABSTRACT:Within the past few years, the Internet has exploded into a medium of choice for those interested in health and medicine. Along with the promise of immediate access to authoritative resources via websites, the Internet offers “virtual support groups” through formats such as chat rooms and newsgroups. These person-to-person exchanges,…

Primary Article

Acute Care of Patients Aged 95 to 99 Years Experience in a Community Teaching Hospital

AbstractBackground.People older than 90 years represent an increasing segment of the US population, but little information exists on their hospitalization for acute illness. Methods.We retrospectively analyzed the clinical characteristics of patients aged 95 through 99 years admitted during 1 year to a large teaching hospital. Results.Of 43 patients admitted at…

Primary Article

Utility of Bone Marrow Biopsy for Rapid Diagnosis of Febrile Illnesses in Patients With Human Immunodeficiency Virus Infection

AbstractBackground.Histochemical staining of bone marrow biopsy samples for microorganisms may provide a presumptive diagnosis weeks before culture. Methods.To identify predictors of histochemical positivity, we reviewed 161 bone marrow biopsies from febrile patients with human immunodeficiency virus (HIV) infection. Results.By multivariate analysis, both hematocrit value <30% and white blood cell count…

Primary Article

Right Ventricular Alterations in Scuba Divers: Findings on Electrocardiography and Echocardiography

AbstractBackground.Scuba diving imposes uncommon environmental stresses. This study assesses the effects of recreational scuba diving on the electrocardiogram (ECG) and echocardiogram and compares them with those of normal controls. Methods.We studied 50 recreational scuba divers and 50 age-matched and sex-matched normal control subjects. Each subject had a medical history, physical…

Primary Article

Increasing Maternal Weight: A Risk Factor for Preeclampsia/Eclampsia But Apparently Not for HELLP Syndrome

AbstractBackground.Maternal obesity is a risk factor for severe preeclampsia. We sought to ascertain whether a similar relationship exists between maternal weight and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) as an atypical form of severe preeclampsia. Methods.In this retrospective investigation, 434 patients with HELLP syndrome were assigned to…

Primary Article

Positive Urine Nitrite Test: An Accurate Predictor of Absence of Pure Enterococcal Bacteriuria

AbstractBackground.The aim of this study was to determine the potential ability of the urine nitrite test (NT) to predict the class of organism causing urinary tract infection. Methods.We retrospectively reviewed the records of all adult patients with a positive urine culture over a 6-month period. The infecting microorganisms and the…

Trauma Rounds

Transcatheter Arterial Embolization in Blunt Hepatic Trauma

ABSTRACT:Patients with blunt hepatic injury can safely be managed nonoperatively if they show hemodynamic stability. Transcatheter arterial embolization (TAE) is a useful adjunct in the treatment of patients who show evidence of continued hemorrhage or who have pooling of contrast material on computed tomography (CT). In these patients, TAE may…