Issue - Southern Medical Association

Case Report

Thoracoscopic Management of Pleural Effusions in Kaposi's Sarcoma A Rapid and Effective Alternative for Diagnosis and Treatment

&NA; Kaposi's sarcoma (KS) is one of the most common causes of pleural effusion in patients with acquired immunodeficiency syndrome (AIDS). Pleural effusions due to KS carry a high morbidity and mortality. Their treatment is difficult, and they respond poorly to chemical pleurodesis. Even systemic chemotherapy against KS has little…

Case Report

Herniated Nucleus Pulposus With Radiculopathy in an Adolescent Successful Nonoperative Treatment

&NA; The following report describes a 17‐year old girl with a central herniated nucleus pulposus (HNP) at L4‐5. The diagnosis of lumbar disk herniation was based on findings from magnetic resonance imaging (MRI). A decision to use conservative treatment was unanimously agreed upon by a team of orthopedists, a neurosurgeon,…

Case Report

Primary Splenic Lymphoma Complicated by Hematemesis and Gastric Erosion

&NA; Gastrosplenic fistula resulting from erosion of a primary splenic lymphoma is a rare cause of massive upper gastrointestinal hemorrhage associated with benign peptic ulcer disease, gastric Crohn's disease, gastric adenocarcinoma, and primary gastric and splenic lymphomas. Upper intestinal hemorrhage can be successfully treated with splenic artery embolization, followed by…

Case Report

Metastatic Breast Cancer Manifested as Refractory Anemia and Gastric Polyps

&NA; Gastric metastasis from breast cancer is uncommon and typically occurs in patients with disseminated disease. The vast majority of patients with gastric lesions have a known preexisting diagnosis of breast cancer. In contrast, we describe a case in which a minimal breast cancer was found to be the primary…

Case Report

HELLP Syndrome Leading to a Diagnosis of Pregnancy

&NA; HELLP syndrome (an acronym for hemolysis, elevated liver enzymes, and low platelets) is a life‐threatening complication of pregnancy seen in association with either preeclampsia or eclampsia. HELLP syndrome is rarely diagnosed before 24 weeks of gestation. This atypical form of severe preeclampsia is associated with significant fetal and maternal…

Case Report

Klüver‐Bucy Syndrome as a Result of Minor Head Trauma

&NA; Klüver‐Bucy syndrome (KBS) has been described as a disconnection of the temporal lobes from the remainder of the brain. Its presence in minor head trauma has not been previously reported. We therefore report what we believe to be the first case of KBS due to mild head trauma and…

Case Report

Long‐Term Survival of a Patient With Human Immunodeficiency Virus Infection and Hodgkin's Lymphoma

&NA; When patients infected with human immunodeficiency virus (HIV) are found to have Hodgkin's lymphoma (HL), it is generally advanced, with involvement of extranodal sites including bone marrow, spleen, and liver, and prognosis tends to be unfavorable. We present the case of a 38‐year‐old white man who had HIV and…

Case Report

Coexisting Gilbert's Syndrome and Sickle Cell Disease

&NA; We report the coexistence of Gilbert's syndrome and homozygous sickle cell disease in a child with persistent unconjugated hyperbilirubinemia.

Case Report

Hemothorax and Retroperitoneal Hematoma After Anticoagulation With Enoxaparin

&NA; A 58‐year‐old woman with chronic obstructive pulmonary disease had spontaneous bilateral hemothorax and a retroperitoneal hematoma after 4 days of anticoagulation therapy with enoxaparin (1 mg/kg subcutaneously every 12 hours) for suspected pulmonary thromboembolism. The patient was successfully managed with red blood cell and plasma transfusions, multiple thoracenteses for…

Case Report

Self‐Medication With &ggr;‐Hydroxybutyrate to Reduce Alcohol Intake

&NA; We describe a 52‐year‐old man who self‐medicated with &ggr;‐hydroxybutyrate (GHB), a widely available illicit substance, to obtain a decrease in ethanol consumption. He successfully reduced his ethanol intake over a 3‐month period, but he was unable to sustain abstinence. Although case reports on the use of GHB to induce…

Editorial

KLÜVER‐BUCY SYNDROME AFTER MINOR BRAIN INJURY

Editorial

NHLBI STOPS TRIAL OF ESTROGEN PLUS PROGESTIN DUE TO INCREASED BREAST CANCER RISK AND LACK OF OVERALL BENEFIT

Editorial

HEAT STROKE

Editorial

&ggr;‐HYDROXYBUTYRIC ACID A MEDICINE OR A DRUG OF ABUSE?

Expired CME Topic

Featured CME Topic Drug‐Associated Heat Stroke

Expired CME Topic

Drug‐Associated Heat Stroke

&NA; During the June 1998 heat wave in New Orleans, 8 patients came to the emergency department of a large public hospital over a 14‐day period. They were subsequently admitted to the intensive care unit with a diagnosis of heat stroke. On each of these days, the ambient temperature exceeded…

Original Article

Limb Amputation and Limb Deficiency Epidemiology and Recent Trends in the United States

Background. The purpose of this study was to provide a comprehensive perspective on the epidemiology and time trends in the incidence of limb amputations and limb deficiency in the United States.

Original Article

Simultaneous Bilateral Rupture of Quadriceps Tendons Analysis of Risk Factors and Associations

Background. Simultaneous bilateral quadriceps tendon rupture is an uncommon injury that is frequently misdiagnosed. It has been associated with multiple medical conditions including renal disease, rheumatologic disorders, and endocrine disorders.

Original Article

Deaths Associated With Pregnancy Outcome A Record Linkage Study of Low Income Women*

Background. A national study in Finland showed significantly higher death rates associated with abortion than with childbirth. Our objective was to examine this association using an American population over a longer period.

Original Article

Displaced Plaque in Retroperitoneal Adenopathy

Background. This study was designed to determine when to consider incidental retroperitoneal masses on the basis of a displaced calcified atheromatous abdominal aorta on lateral radiographs.

Original Article

Injuries to Tobacco Farmers in Kentucky

&NA; Like all types of farming, raising tobacco has many hazards that may lead to injury, disability, or death. Burley tobacco farming is a multistep process that is not highly mechanized. An 8‐year emergency department surveillance system in Kentucky identified 674 injury cases related to the production of burley tobacco….

Original Article

Noninvasive Carbon Dioxide Monitoring During Neurosurgical Procedures in Adults End‐Tidal Versus Transcutaneous Techniques

Background. We prospectively compared transcutaneous (TC) versus end‐tidal (ET) carbon dioxide monitoring during neurosurgical procedures in adults.

Original Article

Comparison of Rectal and Tympanic Thermometry During Exercise

Background. Heat‐related deaths are among the most preventable injuries in athletics. We sought to examine two methods of monitoring body temperature during exercise as a means of preventing heat‐related illnesses.

Original Article

Urinary Tract Infection as a Possible Marker for Teenage Sex

Background. Pediatric urinary tract infections (UTIs) are markers for genitourinary reflux or obstruction. Adult UTIs are treated by telephone triage without microbiologic study. The contrast between pediatric and adult UTIs prompted our retrospective review of adolescent UTIs.

Original Article

Emergency Department Overcrowding in Florida, New York, and Texas

Background. This study was done to determine the incidence, causes, and effects of overcrowding in emergency departments (EDs) in Florida, New York, and Texas.

Original Article

Breastfeeding Rates at an Urban Medical University After Initiation of an Educational Program

Background. Our objective was to improve breastfeeding initiation rates at an urban medical center.

Original Article

Incidental Granulomatous Inflammation of the Uterus

Background. Granulomas of the uterine corpus have been reported in a variety of pathologic conditions but are relatively rare findings in routine histopathologic material.

Original Article

Effect of Helicobacter pylori Eradication in the Glycemia of Children With Type 1 Diabetes A Preliminary Study

Background. We previously reported that children with diabetes and Helicobacter pylori infection had higher levels of glycated hemoglobin (HbA1c) than uninfected peers. We sought to determine whether eradication of the infection could decrease their HbA1c level.

Original Article

Hepatitis A Epidemic in the Elderly

Background. The purpose of this study was to characterize acute hepatitis A in patients more than 40 years old.

Original Article

Access to Care and Stage at Diagnosis for Patients With Lung Cancer and Esophageal Cancer Analysis of the Savannah River Region Information System Cancer Registry Data

Background. Disparities have been observed in both the incidences of lung and esophageal cancers and the survival of those patients. Our goals were to determine if race was associated with stage of cancer at diagnosis, and to identify predictors of advanced‐stage lung and esophageal cancers.

Original Article

Aspergillosis in Liver Transplant Recipients Successful Treatment and Improved Survival Using a Multistep Approach

Background. Invasive aspergillosis is a life‐threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population.

Original Article

Squamous Cell Carcinoma of the Penis A Retrospective Review of Forty‐Five Patients in Northwest Louisiana

Background. Squamous cell carcinoma of the penis is a rare malignancy in the United States, accounting for only 0.4% of all cancers in men.

Original Article

Impact of Medicaid Managed Care on Utilization of Obstetric Care Evidence From TennCare's Early Years

Background. TennCare expanded Medicaid coverage, substituting managed care for fee‐for‐service reimbursement in Tennessee.

Original Article

Anemia of Cancer in Intermediate‐Grade Non‐Hodgkin's Lymphoma

Background. Current literature suggests that anemia at baseline is an important adverse prognostic factor for lymphoma‐related outcomes. We evaluated the prevalence, risk factors, and prognostic value of anemia in patients with intermediate‐grade non‐Hodgkin's lymphoma (IGNHL) treated in a community‐based practice.

Review Article

Emerging Technology in Diabetes Mellitus Glucose Monitoring and New Insulins

&NA; Modern diabetes management requires intensive self‐monitoring of blood glucose levels, often coupled with a multicomponent insulin program. Recent advances include alternate site blood glucose testing devices, which facilitate more frequent sampling by individuals with diabetes. Continuous glucose monitoring through interstitial fluid analysis is now available and appears to give…

Case Report

Metastatic Breast Cancer Manifested as Refractory Anemia and Gastric Polyps

Gastric metastasis from breast cancer is uncommon and typically occurs in patients with disseminated disease. The vast majority of patients with gastric lesions have a known preexisting diagnosis of breast cancer. In contrast, we describe a case in which a minimal breast cancer was found to be the primary tumor…

Case Report

Klüver-Bucy Syndrome as a Result of Minor Head Trauma

Klüver-Bucy syndrome (KBS) has been described as a disconnection of the temporal lobes from the remainder of the brain. Its presence in minor head trauma has not been previously reported. We therefore report what we believe to be the first case of KBS due to mild head trauma and unilateral…

Case Report

Herniated Nucleus Pulposus With Radiculopathy in an Adolescent: Successful Nonoperative Treatment

The following report describes a 17-year old girl with a central herniated nucleus pulposus (HNP) at L4-5. The diagnosis of lumbar disk herniation was based on findings from magnetic resonance imaging (MRI). A decision to use conservative treatment was unanimously agreed upon by a team of orthopedists, a neurosurgeon, and…

Case Report

Long-Term Survival of a Patient With Human Immunodeficiency Virus Infection and Hodgkin’s Lymphoma

When patients infected with human immunodeficiency virus (HIV) are found to have Hodgkin's lymphoma (HL), it is generally advanced, with involvement of extranodal sites including bone marrow, spleen, and liver, and prognosis tends to be unfavorable. We present the case of a 38-year-old white man who had HIV and HL…

Case Report

Coexisting Gilbert’s Syndrome and Sickle Cell Disease

We report the coexistence of Gilbert's syndrome and homozygous sickle cell disease in a child with persistent unconjugated hyperbilirubinemia.

Case Report

Thoracoscopic Management of Pleural Effusions in Kaposi’s Sarcoma: A Rapid and Effective Alternative for Diagnosis and Treatment

Kaposi's sarcoma (KS) is one of the most common causes of pleural effusion in patients with acquired immunodeficiency syndrome (AIDS). Pleural effusions due to KS carry a high morbidity and mortality. Their treatment is difficult, and they respond poorly to chemical pleurodesis. Even systemic chemotherapy against KS has little effect…

Case Report

HELLP Syndrome Leading to a Diagnosis of Pregnancy

HELLP syndrome (an acronym for hemolysis, elevated liver enzymes, and low platelets) is a life-threatening complication of pregnancy seen in association with either preeclampsia or eclampsia. HELLP syndrome is rarely diagnosed before 24 weeks of gestation. This atypical form of severe preeclampsia is associated with significant fetal and maternal mortality….

Case Report

Hemothorax and Retroperitoneal Hematoma After Anticoagulation With Enoxaparin

A 58-year-old woman with chronic obstructive pulmonary disease had spontaneous bilateral hemothorax and a retroperitoneal hematoma after 4 days of anticoagulation therapy with enoxaparin (1 mg/kg subcutaneously every 12 hours) for suspected pulmonary thromboembolism. The patient was successfully managed with red blood cell and plasma transfusions, multiple thoracenteses for evacuation…

Case Report

Primary Splenic Lymphoma Complicated by Hematemesis and Gastric Erosion

Gastrosplenic fistula resulting from erosion of a primary splenic lymphoma is a rare cause of massive upper gastrointestinal hemorrhage associated with benign peptic ulcer disease, gastric Crohn's disease, gastric adenocarcinoma, and primary gastric and splenic lymphomas. Upper intestinal hemorrhage can be successfully treated with splenic artery embolization, followed by splenectory…

Case Report

Self-Medication With γ-Hydroxybutyrate to Reduce Alcohol Intake

We describe a 52-year-old man who self-medicated with &ggr;-hydroxybutyrate (GHB), a widely available illicit substance, to obtain a decrease in ethanol consumption. He successfully reduced his ethanol intake over a 3-month period, but he was unable to sustain abstinence. Although case reports on the use of GHB to induce euphoria…

Correspondence

Treatment of Retroperitoneal Fibrosis With Tamoxifen

Correspondence

Relapsing Group B Streptococcal Bacteremia

Correspondence

Informed Consent for Circumcision

Correspondence

Successful Treatment of Cryptococcal Osteomyelitis and Paraspinous Abscess

Correspondence

Fatal Granulomatous Bronchopneumonia Complicated by Acute Renal Failure

Correspondence

Medicine and the Sin Tax

Editorial

HEAT STROKE

Editorial

NHLBI STOPS TRIAL OF ESTROGEN PLUS PROGESTIN DUE TO INCREASED BREAST CANCER RISK AND LACK OF OVERALL BENEFIT

Editorial

γ-HYDROXYBUTYRIC ACID: A MEDICINE OR A DRUG OF ABUSE?

Editorial

KLÜVER-BUCY SYNDROME AFTER MINOR BRAIN INJURY

Expired CME Article

Drug-Associated Heat Stroke

During the June 1998 heat wave in New Orleans, 8 patients came to the emergency department of a large public hospital over a 14-day period. They were subsequently admitted to the intensive care unit with a diagnosis of heat stroke. On each of these days, the ambient temperature exceeded 33.3°C…

Original Article

Simultaneous Bilateral Rupture of Quadriceps Tendons: Analysis of Risk Factors and Associations

Background.Simultaneous bilateral quadriceps tendon rupture is an uncommon injury that is frequently misdiagnosed. It has been associated with multiple medical conditions including renal disease, rheumatologic disorders, and endocrine disorders.

Original Article

Deaths Associated With Pregnancy Outcome: A Record Linkage Study of Low Income Women

Background.A national study in Finland showed significantly higher death rates associated with abortion than with childbirth. Our objective was to examine this association using an American population over a longer period.

Original Article

Hepatitis A Epidemic in the Elderly

Background.The purpose of this study was to characterize acute hepatitis A in patients more than 40 years old.

Original Article

Comparison of Rectal and Tympanic Thermometry During Exercise

Background.Heat-related deaths are among the most preventable injuries in athletics. We sought to examine two methods of monitoring body temperature during exercise as a means of preventing heat-related illnesses.

Original Article

Impact of Medicaid Managed Care on Utilization of Obstetric Care: Evidence From TennCare’s Early Years

Background.TennCare expanded Medicaid coverage, substituting managed care for fee-for- service reimbursement in Tennessee.

Original Article

Breastfeeding Rates at an Urban Medical University After Initiation of an Educational Program

Background.Our objective was to improve breastfeeding initiation rates at an urban medical center.

Original Article

Displaced Plaque in Retroperitoneal Adenopathy

Background.This study was designed to determine when to consider incidental retroperitoneal masses on the basis of a displaced calcified atheromatous abdominal aorta on lateral radiographs.

Original Article

Noninvasive Carbon Dioxide Monitoring During Neurosurgical Procedures in Adults: End-Tidal Versus Transcutaneous Techniques

Background.We prospectively compared transcutaneous (TC) versus end-tidal (ET) carbon dioxide monitoring during neurosurgical procedures in adults.

Original Article

Emergency Department Overcrowding in Florida, New York, and Texas

Background.This study was done to determine the incidence, causes, and effects of overcrowding in emergency departments (EDs) in Florida, New York, and Texas.

Original Article

Effect of Helicobacter pylori Eradication in the Glycemia of Children With Type 1 Diabetes: A Preliminary Study

Background.We previously reported that children with diabetes and Helicobacter pylori infection had higher levels of glycated hemoglobin (HbA1c) than uninfected peers. We sought to determine whether eradication of the infection could decrease their HbA1c level.

Original Article

Aspergillosis in Liver Transplant Recipients: Successful Treatment and Improved Survival Using a Multistep Approach

Background.Invasive aspergillosis is a life-threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population.

Original Article

Injuries to Tobacco Farmers in Kentucky

Like all types of farming, raising tobacco has many hazards that may lead to injury, disability, or death. Burley tobacco farming is a multistep process that is not highly mechanized. An 8-year emergency department surveillance system in Kentucky identified 674 injury cases related to the production of burley tobacco. Most…

Original Article

Access to Care and Stage at Diagnosis for Patients With Lung Cancer and Esophageal Cancer: Analysis of the Savannah River Region Information System Cancer Registry Data

Background.Disparities have been observed in both the incidences of lung and esophageal cancers and the survival of those patients. Our goals were to determine if race was associated with stage of cancer at diagnosis, and to identify predictors of advanced-stage lung and esophageal cancers.

Original Article

Urinary Tract Infection as a Possible Marker for Teenage Sex

Background.Pediatric urinary tract infections (UTIs) are markers for genitourinary reflux or obstruction. Adult UTIs are treated by telephone triage without microbiologic study. The contrast between pediatric and adult UTIs prompted our retrospective review of adolescent UTIs.

Original Article

Squamous Cell Carcinoma of the Penis: A Retrospective Review of Forty-Five Patients in Northwest Louisiana

Background.Squamous cell carcinoma of the penis is a rare malignancy in the United States, accounting for only 0.4% of all cancers in men.

Original Article

Limb Amputation and Limb Deficiency: Epidemiology and Recent Trends in the United States

Background.The purpose of this study was to provide a comprehensive perspective on the epidemiology and time trends in the incidence of limb amputations and limb deficiency in the United States.

Original Article

Incidental Granulomatous Inflammation of the Uterus

Background.Granulomas of the uterine corpus have been reported in a variety of pathologic conditions but are relatively rare findings in routine histopathologic material.

Original Article

Anemia of Cancer in Intermediate-Grade Non-Hodgkin’s Lymphoma

Background.Current literature suggests that anemia at baseline is an important adverse prognostic factor for lymphoma-related outcomes. We evaluated the prevalence, risk factors, and prognostic value of anemia in patients with intermediate-grade non-Hodgkin's lymphoma (IGNHL) treated in a community-based practice.

Review Article

Emerging Technology in Diabetes Mellitus: Glucose Monitoring and New Insulins

Modern diabetes management requires intensive self-monitoring of blood glucose levels, often coupled with a multicomponent insulin program. Recent advances include alternate site blood glucose testing devices, which facilitate more frequent sampling by individuals with diabetes. Continuous glucose monitoring through interstitial fluid analysis is now available and appears to give a…