Case Report

Craniofacial Hyperhidrosis Successfully Treated With Topical Glycopyrrolate*

&NA; Treatment of craniofacial hyperhidrosis currently consists of thoracic sympathectomy, which is not widely available. Oral anticholinergic agents and &bgr;‐blockers may be effective but also carry significant side effects. We describe a healthy, active 27‐year‐old male resident physician who had excessive facial sweating with minimal exertion or stress. The sweating…

Case Report

Tuberculous Empyema Necessitatis in a Man Infected With the Human Immunodeficiency Virus

&NA; Empyema necessitatis is a collection of inflammatory tissue that ruptures spontaneously through a weakness in the chest wall into surrounding soft tissues. Although empyema necessitatis can be caused by a number of infectious agents, mycobacteria are the most frequently implicated. Empyema was a much more common complication of pulmonary…

Case Report

Nonsecretory Multiple Myeloma

&NA; Nonsecretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM) and accounts for 1% to 5% of all cases of MM. The clinical presentation and radiographic findings of NSMM and MM are the same. The diagnosis of MM requires the detection of a…

Case Report

Basosquamous Carcinoma of the Supraglottic Larynx With Sudden Death From Asphyxia

&NA; Excluding laryngeal papillomas, neoplasms of the hypopharynx rarely cause sudden asphyxial death in adults. We describe the first such death from a carcinoma and review the literature for similar cases since 1966. A high clinical index of suspicion and early laryngoscopy in individuals with symptoms suggestive of hypopharyngeal neoplasia…

Case Report

Spinal Epidural Abscess After Corticosteroid Injections

&NA; Although spinal epidural abscess is uncommon, its incidence is likely to rise with increasing use of epidural injections for the control of lower back pain. We report a case of spinal epidural abscess after epidural steroid injection. The abscess resolved with conservative medical management.

Case Report

Beals‐Hecht Syndrome

&NA; Beals‐Hecht syndrome, also known as congenital contractural arachnodactyly, is caused by a defect in fibrillin as in Marfan syndrome. This syndrome is characterized by a multitude of clinical findings including arachnodactyly, narrow body habitus, scoliosis, congenital contractures, and external ear deformities. Restrictive lung disease may be associated with the…

Case Report

Acetaminophen (Paracetamol)‐Induced Anaphylactic Shock

&NA; Acetaminophen (paracetamol) is a widely prescribed analgesic‐antipyretic drug. Adverse allergic reactions to this drug are rare. We report a case of anaphylactic shock due to acetaminophen. Results of skin prick tests and intradermal tests were negative. Oral rechallenge resulted in generalized urticaria associated with an increased plasma level of…

Case Report

Thin‐Glomerular‐Basement‐Membrane Nephropathy Is It a Benign Cause of Isolated Hematuria?

&NA; Thin‐glomerular‐basement‐membrane (TGBM) nephropathy is among the most common causes of isolated hematuria. This autosomal dominant disorder is characterized by diffuse thinning of the GBM and is diagnosed by electron microscopic examination of renal biopsy tissue. A study of an affected kindred has revealed a mutation in the &agr; chain…

Editorial

LETTER FROM THE PRESIDENT

Expired CME Topic

Southern Medical Journal Featured CME Topic: Attention Deficit/Hyperactivity Disorder

Original Article

Effect of a Second‐Year Primary Care Preceptorship on Medical Students' Career Plans

Background. Preceptorships with community physicians have been incorporated into medical curricula to foster interest in generalist careers. An evaluation of our preceptorship program was undertaken to determine this influence.

Original Article

Declines in Smokers' Understanding of Tobacco's Hazards Between 1986 and 1998 A Report From North Georgia

Background. The prevalence of smoking in the general US population has declined significantly over the past few decades. Despite this, few studies have examined changes in cigarette attributes perceived by less educated, rural, or southern populations.

Original Article

Clostridium difficile—Associated Diarrhea and Chronic Renal Insufficiency

Background. Clostridium difficile—associated diarrhea (CDAD) is a common cause of mortality and morbidity in hospitalized patients. Some case reports have implicated renal failure as a risk factor for CDAD. The aim of this study was to assess whether chronic renal insufficiency is a risk factor for CDAD and whether it…

Original Article

Improving Glycemic Control in Adults With Diabetes Mellitus Shared Responsibility in Primary Care Practices

Background. Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications

Original Article

Age‐Related Underutilization of Left Ventricular Function Evaluation in Older Heart Failure Patients

Background. Underutilization of left ventricular function (LVF) evaluation in older patients with heart failure has been well documented, but age‐related variation in the use of LVF evaluation has not been.

Original Article

Age‐Related Underutilization of Angiotensin‐Converting Enzyme Inhibitors in Older Hospitalized Heart Failure Patients

Background. The extent to which age plays a role in the underutilization of angiotensin‐converting enzyme (ACE) inhibitors in heart failure patients has not been well studied.

Original Article

HLA‐DRB Alleles and Systemic Lupus Erythematosus in Jamaicans

Background. The human leukocyte antigens (HLA) are associated with susceptibility to systemic lupus erythematosus (SLE) and manifestations of SLE in different ethnic groups.

Original Article

Facial Cellulitis in Childhood A Changing Spectrum

Background. Before conjugated Haemophilus influenzae type b (Hib) vaccination, a syndrome known as buccal cellulitis, usually caused by Hib and often accompanied by bacteremia, was seen. We investigated the incidence and cause of facial cellulitis at our hospital during the 10 years before and the 10 years after introduction of…

Original Article

Hyperinfective Strongyloidiasis in the Medical Ward Review of 27 Cases in 5 Years

Background. Hyperinfective strongyloidiasis is rare, but the mortality rate is very high. It occurs most commonly in immunocompromised patients. We reviewed the clinical presentation and mortality rate of cases managed in our facility.

Original Article

Obesity and Health Status in Rural, Urban, and Suburban Southern Women

Background. Obesity has reached epidemic proportions over the past 20 years.

Review Article

Attention‐Deficit/Hyperactivity Disorder An Update

&NA; Attention‐deficit/hyperactivity disorder, a syndrome involving inattention, impulsivity, and hyperactivity, was originally thought to occur only in children. It is now a recognized condition throughout life in some individuals. For a valid diagnosis, the onset of symptoms should occur before age 7. Dysfunction of catecholamine neurotransmission is implied by the…

Review Article

Pfiesteria Complex Organisms and Human Illness

Background. Pfiesteria piscicida and look‐alike dinoflagellates are collectively known as Pfiesteria complex organisms (PCOs). The purposes of this paper are to evaluate the threat that PCOs pose to human health and to clarify some common misconceptions concerning these organisms.

Review Article

Attention Deficit Hyperactivity Disorder in Adults A Guide for the Primary Care Physician

&NA; Attention deficit hyperactivity disorder (ADHD) persists into adulthood in up to 60% of cases with childhood onset. A childhood history of ADHD is a prerequisite for making the ADHD diagnosis in an adult. The Utah, Copeland, and Brown self‐rating scales are useful in helping the primary care physician confirm…

Review Article

Maladies in Musicians

&NA; Certain medical ailments occur with increased frequency among musicians and can affect musicians of all ages and ability. These maladies range in severity from incidental, asymptomatic findings among casual and occasional players to serious injuries that significantly disable professional musicians from practicing or performing. The most prevalent problems involve…

Article

Highlights From the Annual Scientific Assembly: Patient‐Centered Approaches to Asthma Management Strategies for Treatment and Management of Asthma*

Case Report

Nonsecretory Multiple Myeloma

Nonsecretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma (MM) and accounts for 1% to 5% of all cases of MM. The clinical presentation and radiographic findings of NSMM and MM are the same. The diagnosis of MM requires the detection of a monoclonal…

Case Report

Tuberculous Empyema Necessitatis in a Man Infected With the Human Immunodeficiency Virus

Empyema necessitatis is a collection of inflammatory tissue that ruptures spontaneously through a weakness in the chest wall into surrounding soft tissues. Although empyema necessitatis can be caused by a number of infectious agents, mycobacteria are the most frequently implicated. Empyema was a much more common complication of pulmonary tuberculosis…

Case Report

Spinal Epidural Abscess After Corticosteroid Injections

Although spinal epidural abscess is uncommon, its incidence is likely to rise with increasing use of epidural injections for the control of lower back pain. We report a case of spinal epidural abscess after epidural steroid injection. The abscess resolved with conservative medical management.

Case Report

Beals-Hecht Syndrome

Beals-Hecht syndrome, also known as congenital contractural arachnodactyly, is caused by a defect in fibrillin as in Marfan syndrome. This syndrome is characterized by a multitude of clinical findings including arachnodactyly, narrow body habitus, scoliosis, congenital contractures, and external ear deformities. Restrictive lung disease may be associated with the severe…

Case Report

Basosquamous Carcinoma of the Supraglottic Larynx With Sudden Death From Asphyxia

Excluding laryngeal papillomas, neoplasms of the hypopharynx rarely cause sudden asphyxial death in adults. We describe the first such death from a carcinoma and review the literature for similar cases since 1966. A high clinical index of suspicion and early laryngoscopy in individuals with symptoms suggestive of hypopharyngeal neoplasia are…

Case Report

Craniofacial Hyperhidrosis Successfully Treated With Topical Glycopyrrolate

Treatment of craniofacial hyperhidrosis currently consists of thoracic sympathectomy, which is not widely available. Oral anticholinergic agents and [H9252]-blockers may be effective but also carry significant side effects. We describe a healthy, active 27-year-old male resident physician who had excessive facial sweating with minimal exertion or stress. The sweating was…

Case Report

Acetaminophen (Paracetamol)-Induced Anaphylactic Shock

Acetaminophen (paracetamol) is a widely prescribed analgesic-antipyretic drug. Adverse allergic reactions to this drug are rare. We report a case of anaphylactic shock due to acetaminophen. Results of skin prick tests and intradermal tests were negative. Oral rechallenge resulted in generalized urticaria associated with an increased plasma level of histamine….

Case Report

Thin-Glomerular-Basement-Membrane Nephropathy: Is It a Benign Cause of Isolated Hematuria?

Thin-glomerular-basement-membrane (TGBM) nephropathy is among the most common causes of isolated hematuria. This autosomal dominant disorder is characterized by diffuse thinning of the GBM and is diagnosed by electron microscopic examination of renal biopsy tissue. A study of an affected kindred has revealed a mutation in the &agr; chain of…

Editorial

LETTER FROM THE EDITOR

Editorial

LETTER FROM THE PRESIDENT

Original Article

HLA-DRB Alleles and Systemic Lupus Erythematosus in Jamaicans

Background.The human leukocyte antigens (HLA) are associated with susceptibility to systemic lupus erythematosus (SLE) and manifestations of SLE in different ethnic groups.

Original Article

Clostridium difficile–Associated Diarrhea and Chronic Renal Insufficiency

Background.Clostridium difficile–associated diarrhea (CDAD) is a common cause of mortality and morbidity in hospitalized patients. Some case reports have implicated renal failure as a risk factor for CDAD. The aim of this study was to assess whether chronic renal insufficiency is a risk factor for CDAD and whether it increases…

Original Article

Declines in Smokers’ Understanding of Tobacco’s Hazards Between 1986 and 1998: A Report From North Georgia

Background.The prevalence of smoking in the general US population has declined significantly over the past few decades. Despite this, few studies have examined changes in cigarette attributes perceived by less educated, rural, or southern populations.

Original Article

Age-Related Underutilization of Left Ventricular Function Evaluation in Older Heart Failure Patients

Background.Underutilization of left ventricular function (LVF) evaluation in older patients with heart failure has been well documented, but age-related variation in the use of LVF evaluation has not been.

Original Article

Obesity and Health Status in Rural, Urban, and Suburban Southern Women

Background.Obesity has reached epidemic proportions over the past 20 years.

Original Article

Facial Cellulitis in Childhood: A Changing Spectrum

Background.Before conjugated Haemophilus influenzae type b (Hib) vaccination, a syndrome known as buccal cellulitis, usually caused by Hib and often accompanied by bacteremia, was seen. We investigated the incidence and cause of facial cellulitis at our hospital during the 10 years before and the 10 years after introduction of the…

Original Article

Age-Related Underutilization of Angiotensin-Converting Enzyme Inhibitors in Older Hospitalized Heart Failure Patients

Background.The extent to which age plays a role in the underutilization of angiotensin-converting enzyme (ACE) inhibitors in heart failure patients has not been well studied.

Original Article

Improving Glycemic Control in Adults With Diabetes Mellitus: Shared Responsibility in Primary Care Practices

Background.Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications

Original Article

Hyperinfective Strongyloidiasis in the Medical Ward: Review of 27 Cases in 5 Years

Background.Hyperinfective strongyloidiasis is rare, but the mortality rate is very high. It occurs most commonly in immunocompromised patients. We reviewed the clinical presentation and mortality rate of cases managed in our facility.

Original Article

Effect of a Second-Year Primary Care Preceptorship on Medical Students’ Career Plans

Background.Preceptorships with community physicians have been incorporated into medical curricula to foster interest in generalist careers. An evaluation of our preceptorship program was undertaken to determine this influence.

Review Article

Attention-Deficit/Hyperactivity Disorder: An Update

Attention-deficit/hyperactivity disorder, a syndrome involving inattention, impulsivity, and hyperactivity, was originally thought to occur only in children. It is now a recognized condition throughout life in some individuals. For a valid diagnosis, the onset of symptoms should occur before age 7. Dysfunction of catecholamine neurotransmission is implied by the clinical…

Review Article

Attention Deficit Hyperactivity Disorder in Adults: A Guide for the Primary Care Physician

Attention deficit hyperactivity disorder (ADHD) persists into adulthood in up to 60% of cases with childhood onset. A childhood history of ADHD is a prerequisite for making the ADHD diagnosis in an adult. The Utah, Copeland, and Brown self-rating scales are useful in helping the primary care physician confirm the…

Review Article

Maladies in Musicians

Certain medical ailments occur with increased frequency among musicians and can affect musicians of all ages and ability. These maladies range in severity from incidental, asymptomatic findings among casual and occasional players to serious injuries that significantly disable professional musicians from practicing or performing. The most prevalent problems involve overuse…

Review Article

Pfiesteria Complex Organisms and Human Illness

Background.Pfiesteria piscicida and look-alike dinoflagellates are collectively known as Pfiesteria complex organisms (PCOs). The purposes of this paper are to evaluate the threat that PCOs pose to human health and to clarify some common misconceptions concerning these organisms.

Article

Incidental Finding of Bilateral Adrenal Calcification in a Patient With Congenital Heart Disease

Article

Lidocaine Patch 5% and the Management of Chronic Pain

Article

Recurrence of Bacterial Meningitis in a Patient With Crouzon Syndrome and Pseudomeningocele

Article

Paraganglioma of the Organ of Zuckerkandl With Electrocardiographic Changes Mimicking Acute Myocardial Infarction During the Early Postoperative Period

Article

Staphylococcus aureus Bacteremia in Patients With Neutropenia

Article

Highlights From the Annual Scientific Assembly: Patient-Centered Approaches to Asthma Management: Strategies for Treatment and Management of Asthma

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