Issue - Southern Medical Association

Article

‘Bacilli and Bullets’: William Osler and the Antivaccination Movement

ABSTRACT &NA; Public discourse concerning current vaccination recommendations has dramatically increased. The current battle is not new, having had a lengthy foreshadowing during the 19th and early 20th centuries. Over a 30‐year period, a concerted effort to limit the use of smallpox vaccine grew at the very time typhoid vaccines…

Case Report

Another Type of Medication Error Dilution Reconstitution

Case Report

Early Diagnostic Magnetic Resonance Imaging in Acute Disseminated Encephalomyelitis

ABSTRACT &NA; We report two cases and review the literature concerning the importance of early magnetic resonance imaging (MRI) of the brain as a guide for the early diagnosis and treatment of acute disseminated encephalomyelitis (ADEM). A nonspecific term, ADEM refers to an acute disease that is postinfectious, parainfectious, postvaccinal,…

Case Report

Squamous Cell Carcinoma of the Pancreas With Cystic Degeneration

ABSTRACT &NA; Most nonendocrine pancreatic neoplasms are adenocarcinomas of ductal cell or acinar origin. Primary carcinomas of the pancreas with squamous differentiation are rare enough to warrant a search for other primary tumors. In the past few decades, well‐documented individual reports and large series reviews support the view that these…

Case Report

Pulmonary Infarction After Liver Transplant and Previous Hepatopulmonary Syndrome

ABSTRACT &NA; We describe the case of a 36‐year‐old woman with previous hepatopulmonary syndrome in which a focal pulmonary lesion developed after liver transplantation. Thoracoscopic resection showed a pulmonary infarction of the superior segment of the right lower lobe. The patient recovered and had no further thrombotic events after 2…

Case Report

Lipofibromatous Hamartoma and Related Peripheral Nerve Lesions

ABSTRACT &NA; Three unusual cases of a rare, tumor‐like condition, lipofibromatous hamartoma, are reported. This lesion is composed of fibrous and fatty tissue that infiltrates peripheral nerves, typically on the volar aspect of the upper extremities of children and young adults. All three patients had a painless soft tissue mass…

Case Report

High-Dose Indium 111 In Pentetreotide Radiotherapy for Metastatic Atypical Carcinoid Tumor

ABSTRACT &NA; Indium In 111 pentetreotide imaging of neuroendocrine tumors that overexpress somatostatin receptors has become standard for localization of these tumors. This radioligand is internalized into the cell and can induce receptor‐specific cytotoxicity by emission of Auger electrons. We hypothesized that high‐dose 111In‐pentetreotide could be therapeutic in patients with…

Case Report

Obstructing Giant Colonic Diverticulum

ABSTRACT &NA; We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75‐year‐old patient had clinical symptoms for only…

Case Report

Idiopathic Splenic Vein Stenosis: A Cause of Gastric Variceal Hemorrhage

ABSTRACT &NA; We report the case of a patient with isolated gastric variceal bleeding. Obesity precluded the use of noninvasive means for assessing splenic vein patency. Splenic vein stenosis was diagnosed by transhepatic portal and splenic venography with pressure measurements. A cause for the stenosis could not be found. Splenectomy…

Case Report

Hemangiosarcoma of the Spleen Helical Computed Tomography Features

ABSTRACT &NA; Hemangiosarcoma of the spleen is a rare malignant tumor. Prognosis is poor and is usually related to splenic rupture. Clinical symptoms include abdominal pain and left upper quadrant mass. Many clinical conditions have similar presenting symptoms and make diagnosis difficult. However, in this case report, we describe characteristic…

Case Report

Apophyseal Fracture of the Greater Trochanter

ABSTRACT &NA; Apophyseal fractures about the pelvis and proximal femur are well‐described; however, these injuries rarely involve the greater trochanter. We report the case of a 15‐year‐old boy of large build who appeared to have all signs and symptoms of a left slipped capital femoral epiphysis. No specific inciting event…

Case Report

Allergic Reaction to Gemfibrozil Manifesting as Eosinophilic Gastroenteritis

ABSTRACT &NA; Eosinophilic gastroenteritis (EGE) is a rare condition of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. Previous associations with a drug or food allergy, allergic rhinitis, atopic dermatitis, and elevated IgE levels suggest an atopic predisposition in the pathogenesis of this disorder. Diagnostic criteria are…

Case Report

Extensive Leptomeningeal and Intraparenchymatous Spinal Cord Neurosarcoidosis

This case of neurosarcoidosis of the spinal cord involved several meningeal areas and spinal cord levels. It appears to be the tenth autopsy‐documented case of neurosarcoidosis of the spinal cord, though the patient had more extensive spinal cord disease than has been previously reported.

Case Report

Contralateral Reexpansion Pulmonary Edema

ABSTRACT &NA; Reexpansion pulmonary edema (RPE) is an unusual complication of thoracentesis. Significant morbidity can result, and death is reported in 20% of cases. It is typically manifested as edema within a lung that has recently been reexpanded. Few reports document contralateral edema formation. We present a case of recurrent…

Case Report

Esophageal Ulcer Caused by Cytomegalovirus Resolution During Combination Antiretroviral Therapy for Acquired Immunodeficiency Syndrome

A 36‐year‐old man with a 5‐year history of untreated human immunodeficiency virus (HIV) infection had odynophagia for 14 days. Fifteen days earlier, he had begun taking trimethoprim‐sulphamethoxazole and combination antiretroviral therapy that included lamivudine, zidovudine, and nelfinavir. He had no history of opportunistic infection. The CD4 lymphocyte count was 67/μL…

Case Report

Disseminated Osteoarticular Sporotrichosis Treatment in a Patient With Acquired Immunodeficiency Syndrome

ABSTRACT &NA; We report a case of multiple skin lesions, lymphadenopathy, and osteoarticular sporotrichosis in a man infected with human immunodeficiency virus (HIV). He subsequently died of tuberculosis after successful treatment for osteoarticular sporotrichosis with amphotericin B. We describe the unusual histopathology in disseminated sporotrichosis with acquired immunodeficiency syndrome (AIDS)…

Current Concepts

Tumor Necrosis Factor Inactivation in the Management of Rheumatoid Arthritis

ABSTRACT &NA; Biologic agents that target molecules and cells involved in chronic inflammation are coming into clinical use for the treatment of rheumatoid arthritis (RA). New agents block the action of cytokines, which play a key role in the pathogenesis of RA. Among the many cytokines involved in RA, tumor…

Current Concepts

Evaluation and Treatment of Dystonia

Abstract Background. Dystonia is a neurologic disorder that interferes with normal motor control, causing development of bizarre postures and writhing, twisting movements. Methods. The patient database of the Duke Movement Disorders Clinic was searched to identify and characterize all cases of dystonia evaluated during the 3½ year period between July…

Primary Article

Leukocytosis is Proportional to HELLP Syndrome Severity Evidence for an Inflammatory Form of Preeclampsia

Abstract Background We investigated the possibility that HELLP syndrome is in part a systemic inflammatory response. Methods. We evaluated total white blood cell (WBC) counts of all patients with severe preeclampsia with and without HELLP syndrome admitted to our hospital between 1995 and 1997. Patients were grouped by diagnosis and…

Primary Article

Using DNA Fingerprinting to Detect Transmission of Mycobacterium tuberculosis Among AIDS Patients in Two Health‐Care Facilities in Puerto Rico

Abstract Background. Fourteen cases of tuberculosis (TB) in Puerto Rico, diagnosed from April 1993 to April 1995, had the same DNA fingerprint, documenting disease caused by the same strain of Mycobacterium tuberculosis. The 14 cases were retrospectively investigated for epidemiologic links. Methods. Records were reviewed and staffs of the TB…

Primary Article

Basic Skin Flaps for the General Surgeon A Teaching Method*

Abstract Background. Teaching residents the design and creation of skin flaps is challenging because the use of skin flaps is not common enough during the course of a typical residency to provide a broad experience base. Methods. A 12 × 12‐inch board with a ⅛‐inch foam rubber covering was designed…

Primary Article

Temperature‐Related Deaths in Alabama

Abstract Background. Mortality rates for hyperthermia and hypothermia are higher in Alabama than nationally, and Alabama has twice as many hypothermia deaths as hyperthermia deaths. These causes of death have not been studied in the southeastern United States. We describe the epidemiology of heat‐ and cold‐related deaths in Alabama. Methods….

Primary Article

Domestic Violence Awareness in a Medical School Class 2‐Year Follow‐up*

Abstract Background. Previous studies have examined short‐term effectiveness of domestic violence instruction. We studied the long‐term effectiveness (LTE) and long‐term retention (LTR) of formal instruction about domestic violence. Methods. A general knowledge survey on domestic violence was given before, 1 month after, and 2 years after 3 hours of instruction…

Trauma Rounds

Current Management of Pelvic Fractures

ABSTRACT &NA; Blunt pelvic injuries are becoming more common in this era of high‐speed, high‐energy collisions. At least 5% of blunt injuries result in pelvic fracture. With mortality rates approaching 55% for severe crush injuries of the pelvis, early stabilization and control of bleeding, as well as assessment for other…

Article

‘Bacilli and Bullets’: William Osler and the Antivaccination Movement

ABSTRACT:Public discourse concerning current vaccination recommendations has dramatically increased. The current battle is not new, having had a lengthy foreshadowing during the 19th and early 20th centuries. Over a 30-year period, a concerted effort to limit the use of smallpox vaccine grew at the very time typhoid vaccines were being…

Case Report

Another Type of Medication Error Dilution/Reconstitution

Case Report

Idiopathic Splenic Vein Stenosis: A Cause of Gastric Variceal Hemorrhage

ABSTRACT:We report the case of a patient with isolated gastric variceal bleeding. Obesity precluded the use of noninvasive means for assessing splenic vein patency. Splenic vein stenosis was diagnosed by transhepatic portal and splenic venography with pressure measurements. A cause for the stenosis could not be found. Splenectomy was used…

Case Report

Apophyseal Fracture of the Greater Trochanter

ABSTRACT:Apophyseal fractures about the pelvis and proximal femur are well-described; however, these injuries rarely involve the greater trochanter. We report the case of a 15-year-old boy of large build who appeared to have all signs and symptoms of a left slipped capital femoral epiphysis. No specific inciting event had occurred…

Case Report

Allergic Reaction to Gemfibrozil Manifesting as Eosinophilic Gastroenteritis

ABSTRACT:Eosinophilic gastroenteritis (EGE) is a rare condition of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. Previous associations with a drug or food allergy, allergic rhinitis, atopic dermatitis, and elevated IgE levels suggest an atopic predisposition in the pathogenesis of this disorder. Diagnostic criteria are GI symptoms,…

Case Report

Lipofibromatous Hamartoma and Related Peripheral Nerve Lesions

ABSTRACT:Three unusual cases of a rare, tumor-like condition, lipofibromatous hamartoma, are reported. This lesion is composed of fibrous and fatty tissue that infiltrates peripheral nerves, typically on the volar aspect of the upper extremities of children and young adults. All three patients had a painless soft tissue mass of the…

Case Report

Early Diagnostic Magnetic Resonance Imaging in Acute Disseminated Encephalomyelitis

ABSTRACT:We report two cases and review the literature concerning the importance of early magnetic resonance imaging (MRI) of the brain as a guide for the early diagnosis and treatment of acute disseminated encephalomyelitis (ADEM). A nonspecific term, ADEM refers to an acute disease that is postinfectious, parainfectious, postvaccinal, or of…

Case Report

Obstructing Giant Colonic Diverticulum

ABSTRACT:We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75-year-old patient had clinical symptoms for only 6 months,…

Case Report

Extensive Leptomeningeal and Intraparenchymatous Spinal Cord Neurosarcoidosis

ABSTRACT:This case of neurosarcoidosis of the spinal cord involved several meningeal areas and spinal cord levels. It appears to be the tenth autopsy-documented case of neurosarcoidosis of the spinal cord, though the patient had more extensive spinal cord disease than has been previously reported.

Case Report

Esophageal Ulcer Caused by Cytomegalovirus Resolution During Combination Antiretroviral Therapy for Acquired Immunodeficiency Syndrome

ABSTRACT:A 36-year-old man with a 5-year history of untreated human immunodeficiency virus (HIV) infection had odynophagia for 14 days. Fifteen days earlier, he had begun taking trimethoprim-sulphamethoxazole and combination antiretroviral therapy that included lamivudine, zidovudine, and nelfinavir. He had no history of opportunistic infection. The CD4 lymphocyte count was 67/μL…

Case Report

Squamous Cell Carcinoma of the Pancreas With Cystic Degeneration

ABSTRACT:Most nonendocrine pancreatic neoplasms are adenocarcinomas of ductal cell or acinar origin. Primary carcinomas of the pancreas with squamous differentiation are rare enough to warrant a search for other primary tumors. In the past few decades, well-documented individual reports and large series reviews support the view that these squamous neoplasms…

Case Report

Hemangiosarcoma of the Spleen: Helical Computed Tomography Features

ABSTRACT:Hemangiosarcoma of the spleen is a rare malignant tumor. Prognosis is poor and is usually related to splenic rupture. Clinical symptoms include abdominal pain and left upper quadrant mass. Many clinical conditions have similar presenting symptoms and make diagnosis difficult. However, in this case report, we describe characteristic contrast enhancement…

Case Report

Disseminated Osteoarticular Sporotrichosis Treatment in a Patient With Acquired Immunodeficiency Syndrome

ABSTRACT:We report a case of multiple skin lesions, lymphadenopathy, and osteoarticular sporotrichosis in a man infected with human immunodeficiency virus (HIV). He subsequently died of tuberculosis after successful treatment for osteoarticular sporotrichosis with amphotericin B. We describe the unusual histopathology in disseminated sporotrichosis with acquired immunodeficiency syndrome (AIDS) and compare…

Case Report

High-Dose Indium 111In Pentetreotide Radiotherapy for Metastatic Atypical Carcinoid Tumor

ABSTRACT:Indium In 111 pentetreotide imaging of neuroendocrine tumors that overexpress somatostatin receptors has become standard for localization of these tumors. This radioligand is internalized into the cell and can induce receptor-specific cytotoxicity by emission of Auger electrons. We hypothesized that high-dose 111In-pentetreotide could be therapeutic in patients with somatostatin receptor–expressing…

Case Report

Pulmonary Infarction After Liver Transplant and Previous Hepatopulmonary Syndrome

ABSTRACT:We describe the case of a 36-year-old woman with previous hepatopulmonary syndrome in which a focal pulmonary lesion developed after liver transplantation. Thoracoscopic resection showed a pulmonary infarction of the superior segment of the right lower lobe. The patient recovered and had no further thrombotic events after 2 years of…

Case Report

Contralateral Reexpansion Pulmonary Edema

ABSTRACT:Reexpansion pulmonary edema (RPE) is an unusual complication of thoracentesis. Significant morbidity can result, and death is reported in 20% of cases. It is typically manifested as edema within a lung that has recently been reexpanded. Few reports document contralateral edema formation. We present a case of recurrent left-sided pulmonary…

Current Concepts

Evaluation and Treatment of Dystonia

AbstractBackground.Dystonia is a neurologic disorder that interferes with normal motor control, causing development of bizarre postures and writhing, twisting movements. Methods.The patient database of the Duke Movement Disorders Clinic was searched to identify and characterize all cases of dystonia evaluated during the 3½ year period between July 1995 and December…

Current Concepts

Tumor Necrosis Factor Inactivation in the Management of Rheumatoid Arthritis

ABSTRACT:Biologic agents that target molecules and cells involved in chronic inflammation are coming into clinical use for the treatment of rheumatoid arthritis (RA). New agents block the action of cytokines, which play a key role in the pathogenesis of RA. Among the many cytokines involved in RA, tumor necrosis factor…

Primary Article

Leukocytosis is Proportional to HELLP Syndrome Severity Evidence for an Inflammatory Form of Preeclampsia

AbstractBackground.We investigated the possibility that HELLP syndrome is in part a systemic inflammatory response. Methods.We evaluated total white blood cell (WBC) counts of all patients with severe preeclampsia with and without HELLP syndrome admitted to our hospital between 1995 and 1997. Patients were grouped by diagnosis and timing of platelet…

Primary Article

Domestic Violence Awareness in a Medical School Class: 2-Year Follow-up

AbstractBackground.Previous studies have examined short-term effectiveness of domestic violence instruction. We studied the long-term effectiveness (LTE) and long-term retention (LTR) of formal instruction about domestic violence. Methods.A general knowledge survey on domestic violence was given before, 1 month after, and 2 years after 3 hours of instruction to medical students….

Primary Article

Using DNA Fingerprinting to Detect Transmission of Mycobacterium tuberculosis Among AIDS Patients in Two Health-Care Facilities in Puerto Rico

AbstractBackground.Fourteen cases of tuberculosis (TB) in Puerto Rico, diagnosed from April 1993 to April 1995, had the same DNA fingerprint, documenting disease caused by the same strain of Mycobacterium tuberculosis. The 14 cases were retrospectively investigated for epidemiologic links. Methods.Records were reviewed and staffs of the TB program, hospital/clinic, and…

Primary Article

Basic Skin Flaps for the General Surgeon: A Teaching Method

Background. Teaching residents the design and creation of skin flaps is challenging because the use of skin flaps is not common enough during the course of a typical residency to provide a broad experience base. Methods. A 12 x 12-inch board with a 1/8-inch foam rubber covering was designed to…

Primary Article

Temperature-Related Deaths in Alabama

AbstractBackground.Mortality rates for hyperthermia and hypothermia are higher in Alabama than nationally, and Alabama has twice as many hypothermia deaths as hyperthermia deaths. These causes of death have not been studied in the southeastern United States. We describe the epidemiology of heat- and cold-related deaths in Alabama. Methods.We examined state…

Trauma Rounds

Current Management of Pelvic Fractures

ABSTRACT:Blunt pelvic injuries are becoming more common in this era of high-speed, high-energy collisions. At least 5% of blunt injuries result in pelvic fracture. With mortality rates approaching 55% for severe crush injuries of the pelvis, early stabilization and control of bleeding, as well as assessment for other injuries, requires…