Issue - Southern Medical Association

Article

Dueling Doctors

ABSTRACT: &NA; Formal “duels of honor” ruled upper‐class conduct for centuries. That social pressure could compel a choice of “death before dishonor” seems nearly incomprehensible today. Physicians might have been expected to disdain dueling as contrary to professional ethics, but a few rather colorful physicians did enter the lists. Details…

Case Report

Pseudomyxoma Peritonei Manifesting as Intestinal Obstruction

Pseudomyxoma peritonei is an appendiceal tumor with distinct clinical and pathologic features. It frequently presents a problem in diagnosis and management. We report a case of pseudomyxoma peritonei, which initially appeared with intestinal obstruction. This is a rare initial manifestation in patients who have not had multiple surgical procedures. We…

Case Report

Cutaneous Nephrocolonic Fistula as a Consequence of a Kidney Stone

ABSTRACT: &NA; We report an unusual case of cutaneous nephrocolonic fistula caused by a renal calculus with perirenal infection. The diagnosis was made by fistulography and computed tomography, after which nephrectomy and resection of the descending colon were successful. We also review the literature on cutaneous nephrocolonic fistulas.

Case Report

Agenesis of the Gallbladder

ABSTRACT: &NA; Agenesis of the gallbladder is rare. Three groups have been identified: those with multiple fetal anomalies, asymptomatic cases, and symptomatic cases. Right upper quadrant pain is present in 90% of the cases, nausea and vomiting in 60%, and jaundice in 35%. Operative strategy is aimed at thorough exploration…

Case Report

Pyoderma Gangrenosum and Myelodysplastic Syndrome

ABSTRACT: &NA; Pyoderma gangrenosum (PG) is a painful, often rapidly progressive, ulcerating skin disorder frequently associated with systemic diseases. We report the case of a patient with PG and an anemia. A bone marrow biopsy showed changes consistent with one of the myelodysplastic syndromes, refractory anemia with ringed sideroblasts. Patients…

Case Report

Acute Tumor Lysis Syndrome With Choriocarcinoma

ABSTRACT: &NA; A 52‐year‐old man with retroperitoneal nodal, lung, and liver metastases from choriocarcinoma received chemotherapy with etoposide, cisplatin, and bleomycin. Within 48 hours of starting treatment, he had hypotension, hypoxemia, and anuria. Laboratory values showed hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis. He was placed on mechanical ventilation, and…

Case Report

Traumatic Asphyxia Complicated by Unwitnessed Cardiac Arrest

ABSTRACT: &NA; We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple‐blue neck and face discoloration. These facial…

Case Report

Hazardous Hedgehogs

ABSTRACT: &NA; The African pygmy hedgehog has recently become a fashionable exotic pet in the United States, particularly in the South. As illustrated by the three cases reported, this mammalian insectivore can be a carrier of fungi that cause human dermatomycoses. The African pygmy hedgehog has also been associated with…

Case Report

Secondary Abdominal Pregnancy in a Jehovah’s Witness

ABSTRACT: &NA; A 35‐year‐old woman, gravida 2, para 1, aborta 0, arrived at our emergency department with abdominal pain of more than 2 weeks' duration. Diagnostic pelvic ultrasonography confirmed a 16‐week intra‐abdominal pregnancy. Hemoglobin level was 6.9 mg/dL, and hematocrit value was 20.1%. The patient refused blood transfusion on religious…

Case Report

Subacute Thyroiditis Manifesting as Fever of Unknown Origin

ABSTRACT: &NA; Subacute thyroiditis (SAT) usually occurs in women in middle age with a viral prodrome, thyroid or neck tenderness, classic symptoms of thyrotoxicosis, and elevated erythrocyte sedimentation rate (ESR). We report a case in an 81‐year‐old man who initially had 2 days of fever to 101.2° F, confusion, and…

Case Report

Cocaine-Associated Ischemic Colitis

ABSTRACT: &NA; Cocaine use can result in various gastrointestinal complications, including gastric ulcerations, retroperitoneal fibrosis, visceral infarction, intestinal ischemia, and gastrointestinal tract perforation. We report cocaine‐associated colonic ischemia in three patients and review the literature. Including ours, 28 cases have been reported, with a mean patient age of 32.6 years…

Case Report

Hypercalcemia and T-Cell Lymphoma With Acquired Immunodeficiency Syndrome: Occurrence Without Human T-Cell Leukemia Virus

ABSTRACT: &NA; We describe the case of a patient with acquired immunodeficiency syndrome (AIDS) who had a CD4 cell count of 60/μL, bilateral hilar adenopathy, and hypercalcemia. Transbronchial biopsy showed T‐cell anaplastic large cell lymphoma. Serology was negative for human T‐cell leukemia virus‐I (HTLV‐I). This appears to be the first…

Case Report

Reemergence of Sucrose Nephropathy: Acute Renal Failure Caused by High-Dose Intravenous Immune Globulin Therapy

ABSTRACT: &NA; Sucrose nephropathy was first described more than 50 years ago. The disorder is characterized by acute renal failure caused by the uptake of sucrose by renal proximal tubule cells with subsequent cellular swelling and occlusion of the tubule lumen. Approximately 114 cases of renal failure have been associated…

Case Report

Primary Nodal Neuroendocrine (Merkel Cell) Tumor in a Patient With HIV Infection

ABSTRACT: &NA; Lymphadenopathy in the human immunodeficiency virus (HIV) can be of diverse etiology, ranging from infection to cancer. A neoplasm of epithelial origin manifested as inguinal lymphadenopathy without a primary lesion is rare. We report a case of Merkel cell tumor confined only to a lymph node in a…

Current Concepts

Gambling in the South Implications for Physicians

ABSTRACT: &NA; Three historical cycles of legalized gambling have occurred in the South. Currently, every southern state has legalized some form of gaming. Adult past‐year prevalence rates of problem gambling in southern states are within the national range. Higher prevalence rates occur in states with casinos and multiple forms of…

Current Concepts

The Intrauterine Device: Still Misunderstood After All These Years

ABSTRACT: &NA; The intrauterine device (IUD) is one of the most effective, safe, and economic methods of contraception today. It is used by more women worldwide than any other reversible method of birth control, yet less than 1% of women in the United States use the IUD. Still remembering the…

Expired CME Article

Confronting the Problem of Increasing Antibiotic Resistance

ABSTRACT: &NA; Significant increases in prevalence of resistance to antibiotics have been observed in common pathogens of humans in the United States and worldwide. The consequences of the appearance and spread of antibiotic resistance have included increasing morbidity, mortality, and cost of health care. The fundamental cause for the appearance…

Primary Article

Transcutaneous Lumbar Diskectomy for Internal Disk Derangement: A New Indication

Abstract Background. Percutaneous diskectomy has been used effectively to treat lumbar disk herniation. The purpose of this review was to determine whether transcutaneous diskectomy is an effective surgical option for treating lumbar internal disk derangement. Methods. Comprehensive retrospective review via personal interview included 103 consecutive patients available for long‐term follow‐up….

Primary Article

Tuberculosis Exposure in a Day‐Care Center: Recommended Management

Abstract Background. This article describes the contact investigation, clinical evaluation, and prophylactic treatment of the children and staff members in a day‐care center after exposure to a teaching assistant with tuberculosis (TB). Methods. The investigation included baseline and follow‐up tuberculin skin testing, history and physical examinations, and chest radiographs. Directly…

Primary Article

Striae Gravidarum as a Predictor of Vaginal Lacerations at Delivery

Abstract Background. Abdominal stretch marks found during pregnancy may be indicative of poor skin elasticity. One who does not have stretch marks may have better skin elasticity and may be less likely to tear perineal and vaginal tissue during vaginal delivery. This study was conducted to determine whether striae gravidarum…

Primary Article

Use of Misoprostol for Cervical Ripening

Abstract Background. Misoprostol, the prostaglandin E, analog, is increasingly used for cervical ripening and induction of labor. We evaluated our experience with misoprostol in an open‐ label setting. Methods. Patients were selected for cervical ripening based on clinical profile. At 3 cm cervical dilation, misoprostol was discontinued and other means…

Trauma Rounds

Combined Blunt Thoracic Aortic and Abdominal Trauma Diagnostic and Treatment Priorities

ABSTRACT: &NA; Combined blunt trauma to the thoracic aorta and abdomen challenges the surgeon from a diagnostic and therapeutic standpoint. Appropriately prioritizing diagnostic workup and treatment is critical to assuring patient survival. A management approach that considers the patient's injuries and clinical condition as well as the availability of aortography…

Article

Dueling Doctors

ABSTRACT:Formal “duels of honor” ruled upper-class conduct for centuries. That social pressure could compel a choice of “death before dishonor” seems nearly incomprehensible today. Physicians might have been expected to disdain dueling as contrary to professional ethics, but a few rather colorful physicians did enter the lists. Details of some…

Case Report

Pyoderma Gangrenosum and Myelodysplastic Syndrome

ABSTRACT:Pyoderma gangrenosum (PG) is a painful, often rapidly progressive, ulcerating skin disorder frequently associated with systemic diseases. We report the case of a patient with PG and an anemia. A bone marrow biopsy showed changes consistent with one of the myelodysplastic syndromes, refractory anemia with ringed sideroblasts. Patients with PG…

Case Report

Cyclooxygenase-2 Inhibitor Celecoxib: A Possible Cause of Gastropathy and Hypoprothrombinemia

ABSTRACT:Gastrointestinal side effects from nonsteroidal anti-inflammatory drugs (NSAIDs) result mainly from inhibition of the enzyme cyclooxygenase (COX)-1; it is responsible for the synthesis of prostaglandin E2, which leads to increased mucosal blood flow, increased bicarbonate secretion, and mucus production, thus protecting the gastrointestinal mucosa. In inflammation, COX-2 is induced, causing…

Case Report

Acute Tumor Lysis Syndrome With Choriocarcinoma

ABSTRACT:A 52-year-old man with retroperitoneal nodal, lung, and liver metastases from choriocarcinoma received chemotherapy with etoposide, cisplatin, and bleomycin. Within 48 hours of starting treatment, he had hypotension, hypoxemia, and anuria. Laboratory values showed hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and metabolic acidosis. He was placed on mechanical ventilation, and hemodialysis was…

Case Report

Pseudomyxoma Peritonei Manifesting as Intestinal Obstruction

ABSTRACT:Pseudomyxoma peritonei is an appendiceal tumor with distinct clinical and pathologic features. It frequently presents a problem in diagnosis and management. We report a case of pseudomyxoma peritonei, which initially appeared with intestinal obstruction. This is a rare initial manifestation in patients who have not had multiple surgical procedures. We…

Case Report

Hazardous Hedgehogs

ABSTRACT:The African pygmy hedgehog has recently become a fashionable exotic pet in the United States, particularly in the South. As illustrated by the three cases reported, this mammalian insectivore can be a carrier of fungi that cause human dermatomycoses. The African pygmy hedgehog has also been associated with contact urticaria…

Case Report

Cutaneous Nephrocolonic Fistula as a Consequence of a Kidney Stone

ABSTRACT:We report an unusual case of cutaneous nephrocolonic fistula caused by a renal calculus with perirenal infection. The diagnosis was made by fistulography and computed tomography, after which nephrectomy and resection of the descending colon were successful. We also review the literature on cutaneous nephrocolonic fistulas.

Case Report

Cocaine-Associated Ischemic Colitis

ABSTRACT:Cocaine use can result in various gastrointestinal complications, including gastric ulcerations, retroperitoneal fibrosis, visceral infarction, intestinal ischemia, and gastrointestinal tract perforation. We report cocaine-associated colonic ischemia in three patients and review the literature. Including ours, 28 cases have been reported, with a mean patient age of 32.6 years (range, 23…

Case Report

Hypercalcemia and T-Cell Lymphoma With Acquired Immunodeficiency Syndrome: Occurrence Without Human T-Cell Leukemia Virus-I

ABSTRACT:We describe the case of a patient with acquired immunodeficiency syndrome (AIDS) who had a CD4 cell count of 60/&mgr;L, bilateral hilar adenopathy, and hypercalcemia. Transbronchial biopsy showed T-cell anaplastic large cell lymphoma. Serology was negative for human T-cell leukemia virus-I (HTLV-I). This appears to be the first case of…

Case Report

Secondary Abdominal Pregnancy in a Jehovah’s Witness*

ABSTRACT:A 35-year-old woman, gravida 2, para 1, aborta 0, arrived at our emergency department with abdominal pain of more than 2 weeks' duration. Diagnostic pelvic ultrasonography confirmed a 16-week intra-abdominal pregnancy. Hemoglobin level was 6.9 mg/dL, and hematocrit value was 20.1%. The patient refused blood transfusion on religious grounds. Laparotomy…

Case Report

Reemergence of Sucrose Nephropathy Acute Renal Failure Caused by High-Dose Intravenous Immune Globulin Therapy

ABSTRACT:Sucrose nephropathy was first described more than 50 years ago. The disorder is characterized by acute renal failure caused by the uptake of sucrose by renal proximal tubule cells with subsequent cellular swelling and occlusion of the tubule lumen. Approximately 114 cases of renal failure have been associated with high-dose…

Case Report

Primary Nodal Neuroendocrine (Merkel Cell) Tumor in a Patient With HIV Infection

ABSTRACT:Lymphadenopathy in the human immunodeficiency virus (HIV) can be of diverse etiology, ranging from infection to cancer. A neoplasm of epithelial origin manifested as inguinal lymphadenopathy without a primary lesion is rare. We report a case of Merkel cell tumor confined only to a lymph node in a patient with…

Case Report

Subacute Thyroiditis Manifesting as Fever of Unknown Origin

ABSTRACT:Subacute thyroiditis (SAT) usually occurs in women in middle age with a viral prodrome, thyroid or neck tenderness, classic symptoms of thyrotoxicosis, and elevated erythrocyte sedimentation rate (ESR). We report a case in an 81-year-old man who initially had 2 days of fever to 101.2° F, confusion, and bilateral lower…

Case Report

Traumatic Asphyxia Complicated by Unwitnessed Cardiac Arrest

ABSTRACT:We report a case of traumatic asphyxia complicated by unwitnessed cardiac arrest in which the patient has made a good, functional recovery. Traumatic asphyxia is an uncommon clinical syndrome usually occurring after chest compression. Associated physical findings include subconjunctival hemorrhage and purple-blue neck and face discoloration. These facial changes can…

Case Report

Agenesis of the Gallbladder

ABSTRACT:Agenesis of the gallbladder is rare. Three groups have been identified: those with multiple fetal anomalies, asymptomatic cases, and symptomatic cases. Right upper quadrant pain is present in 90% of the cases, nausea and vomiting in 60%, and jaundice in 35%. Operative strategy is aimed at thorough exploration to locate…

Current Concepts

Gambling in the South: Implications for Physicians

ABSTRACT:Three historical cycles of legalized gambling have occurred in the South. Currently, every southern state has legalized some form of gaming. Adult past-year prevalence rates of problem gambling in southern states are within the national range. Higher prevalence rates occur in states with casinos and multiple forms of legalized gambling….

Current Concepts

The Intrauterine Device: Still Misunderstood After All These Years

ABSTRACT:The intrauterine device (IUD) is one of the most effective, safe, and economic methods of contraception today. It is used by more women worldwide than any other reversible method of birth control, yet less than 1% of women in the United States use the IUD. Still remembering the tragedy of…

Current Concepts

Confronting the Problem of Increasing Antibiotic Resistance

ABSTRACT:Significant increases in prevalence of resistance to antibiotics have been observed in common pathogens of humans in the United States and worldwide. The consequences of the appearance and spread of antibiotic resistance have included increasing morbidity, mortality, and cost of health care. The fundamental cause for the appearance and spread…

Primary Article

Striae Gravidarum as a Predictor of Vaginal Lacerations at Delivery

AbstractBackground.Abdominal stretch marks found during pregnancy may be indicative of poor skin elasticity. One who does not have stretch marks may have better skin elasticity and may be less likely to tear perineal and vaginal tissue during vaginal delivery. This study was conducted to determine whether striae gravidarum could predict…

Primary Article

Transcutaneous Lumbar Diskectomy for Internal Disk Derangement A New Indication

AbstractBackground.Percutaneous diskectomy has been used effectively to treat lumbar disk herniation. The purpose of this review was to determine whether transcutaneous diskectomy is an effective surgical option for treating lumbar internal disk derangement. Methods.Comprehensive retrospective review via personal interview included 103 consecutive patients available for long-term follow-up. For determining results…

Primary Article

Tuberculosis Exposure in a Day-Care Center Recommended Management

AbstractBackground.This article describes the contact investigation, clinical evaluation, and prophylactic treatment of the children and staff members in a day-care center after exposure to a teaching assistant with tuberculosis (TB). Methods.The investigation included baseline and follow-up tuberculin skin testing, history and physical examinations, and chest radiographs. Directly observed prophylactic therapy…

Primary Article

Use of Misoprostol for Cervical Ripening

AbstractBackground.Misoprostol, the prostaglandin E1 analog, is increasingly used for cervical ripening and induction of labor. We evaluated our experience with misoprostol in an open- label setting. Methods.Patients were selected for cervical ripening based on clinical profile. At 3 cm cervical dilation, misoprostol was discontinued and other means of labor augmentation…

Trauma Rounds

Combined Blunt Thoracic Aortic and Abdominal Trauma Diagnostic and Treatment Priorities

ABSTRACT:Combined blunt trauma to the thoracic aorta and abdomen challenges the surgeon from a diagnostic and therapeutic standpoint. Appropriately prioritizing diagnostic workup and treatment is critical to assuring patient survival. A management approach that considers the patient's injuries and clinical condition as well as the availability of aortography and cardiac…