The precordial catch syndrome is frequently mentioned as part of a long differential diagnosis of chest pain in children. It is an extremely common complaint but remains underrecognized. This review describes the distinctive features of the syndrome and points out that this is not a diagnosis of exclusion. Emphasis is…
CME Credit—January 2003 Featured CME Topic: Precordial Catch Syndrome
Reye’s syndrome presents as acute central nervous system and liver dysfunction in children. Its incidence has seen a sharp decline in parallel with the decline in the use of aspirin in the pediatric age group. This report describes a patient with Reye’s syndrome and serves as a reminder for health…
We report the first known case of chronic relapsing thrombotic thrombocytopenic purpura associated with adult-onset Still’s disease. The patient presented with diffuse arthralgias, sore throat, and a maculopapular rash involving the trunk and extremities; she was hospitalized with fever and confusion. Thrombocytopenia, renal failure, and microangiopathic hemolytic anemia developed within…
We report the unique case of a patient with an idiopathic pneumopericardium due to heavy lifting and discuss Valsalva’s maneuver as a rare cause in the pathogenesis of pneumopericardium. Our patient recovered without treatment and had no recurrence of pneumopericardium during follow-up. All physicians should be aware of pneumopericardium as…
Cystic dysplasia of the testis is a rare congenital anomaly, only 29 cases having been previously reported. We report a case of cystic dysplasia of the testis and absent ipsilateral kidney, but an ipsilateral ectatic terminal ureter, suggesting involution of a dysplastic kidney as a reason for the apparent renal…
An 83-year-old woman was transferred to our cardiac intensive care unit with an acute non-Q-wave myocardial infarction and pulmonary edema. Enoxaparin was one component of the treatment regimen used. Her hospital course was complicated by episodes of hypotension, as well as by recurrent left hip and left thigh pain. The…
Computed tomography is widely used to diagnose acute pancreatitis. Iodinated contrast medium lengthens the duration of pancreatitis and may increase the incidence of local or systemic complications. Total parenteral nutrition including IV lipid emulsion plays an important role in the management of patients with pancreatitis. Induction of pancreatitis by IV…
A favorable outcome in chronic spondylodiscitis with epidural abscess is rare. A 65-year-old woman developed recurrent, localized, thoracic back pain over 2.5 years. Nine months after the onset of the pain, sensory disturbances of the left lower leg occurred. Fourteen months before admission, she developed recurrent fever, bladder dysfunction, and…
Cryptococcus neoformans is an encapsulated yeast that can cause primary pulmonary infections or disseminate and cause infections of the central nervous system, meninges, skin, and bone in the immunocompromised host. We present here an unusual case of an immunocompetent patient who had laryngitis due to C. neoformans that mimicked a…
Pulmonary sequestration is a rare congenital or acquired pulmonary anomaly. Pulmonary sequestration may be classified as intralobar, located within normal lung, or extralobar, in which it is separated by pleura. The coexistence of both forms is extremely rare. Infection, mainly bacterial, is a major complication of sequestration. We report the…
Emphysematous gastritis is a condition characterized by gas within the wall of the stomach and associated systemic toxicity. We report a case of emphysematous gastritis in a 43-year-old diabetic patient receiving hemodialysis and review 41 cases published since 1889. The most common predisposing factors included ingestion of corrosive substances, alcohol…
Biliary obstruction due to a proximal bile duct stricture is commonly a result of cholangiocarcinoma. We describe a patient who began having intermittent episodes of jaundice 3 years after cholecystectomy. Despite endoscopic placement of a biliary stent and adequate biliary decompression, the serum CA 19-9 level remained elevated at 58…
We report the case of a patient who sustained gunshot wounds to the chest. The bullet lodged and moved freely within the inferior vena cava and its branches, but the patient had no symptoms. The bullet was retrieved from the right common femoral vein with a basket. Selective approach to…
To the Editor: Spontaneous pneumothorax as the first presentation of non-Hodgkin’s lymphoma (NHL) is extremely rare and may be attributed to a direct effect of disease or a complication of therapy. 1,2 We found only two other reported instances of spontaneous pneumothorax occurring in untreated lung lymphoma. 2,3 We describe…
To the Editor:Hypermagnesemia is a rare laboratory finding. 1 We describe a patient with renal insufficiency who presented with magnesium toxicity.
To the Editor: Rhabdomyolysis in young adults with a history of vigorous exertion, such as marathon running, weightlifting, or military recruit training, usually involves the skeletal muscle of the extremities. Although diverse clinical features may be observed in rhabdomyolysis, involvement of only the abdominal wall muscle, as in our patient’s…
Lichen sclerosus is a chronic dermatosis characterized by atrophic white papules or plaques of skin and mucosa. This dermatosis can affect any part of the body; it occurs most commonly on the anogenital skin of postmenopausal women, though it is seen in all age groups and both sexes. It is…
To the Editor:We read with interest the article by Tolaymat and de Melo 1 describing benign transient hyperphosphatasemia (BTH) of infancy and childhood. They recommended that the condition be identified at the earliest possible stage without extensive, superfluous evaluation. What they did not describe, however, was how to recognize patients…
To the Editor: Retroperitoneal hematomas are very rarely seen in otherwise healthy people, and the condition is usually not accompanied by a neurologic deficit. We present a case of lumbosacral plexopathy that was later proved to be due to a silent retroperitoneal hematoma that developed contralateral to a femoral catheterization…
Background: We analyzed the incidence of balanitis xerotica obliterans (BXO) by both age and ethnicity at an equal-access health care facility. Methods: We retrospectively reviewed discharge records from 1997 to 1999 at Brooke Army Medical Center to determine ethnicity and age of patients with BXO. Results: Of 153,432 male patients,…
To the Editor: Spontaneous retroperitoneal hematoma is rare. Isolated case reports or small series published in the literature are associated with tumors of the adrenal gland and kidney, hypoprothrombinemia associated with cumarin overdose and alcoholic cirrhosis, polycythemia vera, anticoagulant therapy, hemodialysis, retroperitoneal aneurysmal rupture of any blood vessel, and unknown…
To the Editor:Only 10 cases of extraneural hematogenous metastases of intracranial germinoma have been reported to date. We report one more case, that of a 23-year-old man with a pineal-body germinoma presenting as Parinaud syndrome. Hematogenous spread and vertebral column metastasis developed 7 months later.
Objective: This study evaluates the efficacy of recombinant factor VII (rVIIa) in the treatment of coagulation dysfunction in pediatric patients. Methods: We retrospectively reviewed the records of pediatric patients who received rVIIa in the intensive care unit or operating room for treatment of coagulopathy. Case series in the literature were…
Objective: Deep venous thrombosis (DVT) is a major cause of morbidity and mortality after surgery for primary and metastatic brain tumors. Methods: We conducted a confidential survey of American neurosurgeons interested in tumor surgery to assess DVT risk awareness and thromboprophylaxis patterns. Results: Of the 172 respondents, 108 (63%) underestimated…
Objective: Guidelines for emergency treatment of stroke are not always known or followed. Florida Medical Quality Assurance, Inc. collaborated with hospitals to determine how closely the current American Heart Association (AHA) and the Florida Agency for Health Care Administration (AHCA) guidelines were being followed and to improve compliance with these…
Calciphylaxis is a condition with a high mortality rate that is often found in patients with renal failure. It is characterized by soft tissue calcification and painful skin ulceration. A serum calcium-phosphorus product of more than 60 mg2/dl2 indicates great risk for calciphylaxis. The diagnosis is made on the basis…
We report three cases of pica for foam rubber among sickle cell disease patients. All three were African-American males, and at the times of initial presentation for the pica, two of them were 11 years of age and one was 15 years of age. In all cases, the pica reportedly…
A young Arab woman with sickle cell-β0-thalassemia disease developed acute colonic pseudo-obstruction that became chronic but showed some response to hydroxyurea. There was no evidence of microvascular or macrovascular occlusion. We also report the case of an Arab man with sickle cell anemia who presented with acute colonic pseudo-obstruction from…
This case report describes a rare dermatologic reaction in a patient after administration of pneumococcal vaccine. A 65-year-old man developed an extensive dermatitis with pruritus, urticaria, and petechiae 1 week after receiving an intramuscular injection of the vaccine. The reaction resolved with application of topical steroids and oral diphenhydramine hydrochloride….
As the use of computers, the Internet, and Internet technology becomes more pervasive in society, psychopathological thought content characterized by the incorporation of the Internet into delusions and hallucinations will become increasingly common. In the following report, three cases of psychotic inpatients are briefly presented to exemplify this trend in…
The “For Debate” editorial by Jones and Thomasson 1 suggests that the practice of medicine can now be reduced to a mere online interview. A series of articles on this subject also was published in the March 9, 2002, issue of BMJ. 2–10 The position of Jones and Thomasson puts…
The American Medical Association called for the establishment of guidelines to allow electronic prescription of medications “for established patients.” Based on experience writing more than 10,000 Internet-based prescriptions, we agree that guidelines are long overdue. Restricting such prescribing to patients with whom a face-to-face relationship has previously been established violates…
Southern Medical Journal Featured CME Topic: Precordial Catch Syndrome
Background: Current medical education policy seeks to address the health care needs of underserved populations, among whom are individuals associated with agriculture. Methods: This paper describes a focus group approach to planning farm field trips whereby medical students accompany agricultural extension agents to study the personal, occupational, and environmental health…
Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and…
To the Editor: It is known that the toxic effects of chemotherapeutic agents used in cancer therapy affect mainly the bone marrow and the digestive tract, and to a lesser extent they can cause cardiotoxicity. We report the case of a patient with squamous cell carcinoma of neck who presented…
To the Editor: Isoniazid is a bactericidal antituberculosis agent. 1 Overdose of isoniazid is characterized by seizures, metabolic acidosis, and coma. 2 Because it can result in death if untreated, early consideration of the possibility of isoniazid poisoning is important. We describe a patient treated with pyridoxine after an isoniazid…
To the Editor: I am writing with regard to an article published in the Southern Medical Journal concerning the finding of an Ascaris lumbricoidesadult worm that had supposedly exited from a man’s urethra while he was urinating. 1 The article included a figure showing the 15-cm worm. As a reasonable…
To the Editor: A 37-year-old African American bisexual man with acquired immunodeficiency syndrome (AIDS) presented with recurrent chest pain. His CD4 cell count was 4/mm3 and viral load was 19,000 copies/mm3. An esophageal biopsy performed 2 months previously had revealed extensive candidal infection with ulceration. He had a temporary response…
To the Editor:We read with interest the review article by Fox et al 1 concerning the clinical significance of magnesium as an essential intracellular cation. The authors present an excellent dialogue on the basic metabolism and physiologic effects of magnesium. The remainder of the article discusses magnesium deficiency, its links…
To the Editor: Ornithine transcarbamylase (ornithine carbamoyltransferase) deficiency is an X-linked disorder of the urea cycle in which deficiency of the enzyme leads to impaired generation of citrulline and urea from ornithine and carbamoyl phosphate. 1 It is the most common inherited disorder of the urea cycle. The disease has…
To the Editor:The association of autoimmune hemolytic anemia and idiopathic thrombocytopenic purpura (ITP) is known as Evans syndrome. We describe a patient with a relapse of Evans syndrome complicated by acute inflammatory demyelinating polyneuropathy (AIDP), suggesting a relationship between the two disorders.
To the Editor:Having had hypertension since the age of 29 years (I am now 59), I was interested to read your editorial on hypertension treatment in the Southern Medical Journal1 but disappointed at the implication that modern drugs (which are definitely great pharmacologic advances) have far fewer sided effects than,…
To the Editor:It is well known that persistent itching without a rash may be a symptom of serious systemic illness. About 25% of patients with Hodgkin’s disease have pruritus at some time during their illness, and in approximately 10% of Hodgkin’s disease patients, itching without a rash is the presenting…
To the Editor: The relationships of religious values to health continue to receive much attention. 1 Data indicate that such values affect diverse areas, including frequency of psychiatric disorders, incidence of cardiovascular disease, recovery from surgery, and treatment compliance. One classification of religious values is a relative versus absolute dichotomy….
To the Editor:A 66-year-old woman presented with the chief complaints of weight loss, generalized weakness, and a history of milky-appearing urine. The patient had a medical history significant for filariasis, which had been treated 25 years before this admission. She was born in Haiti but had lived in Africa 30…
In Reply: I appreciate the review and comments of Drs. Perkowski and Thompson regarding the article by my colleagues and me. 1 True, the patient in our case report remained hemodynamically stable and virtually asymptomatic with a bullet lodged in the myocardium of the right ventricle for approximately 24 hours….
To the Editor: Septic thrombophlebitis is an uncommon complication of catheter-related infections. We report a case of catheter-related staphylococcal thrombosis at a previous catheter insertion site in a patient with cancer and persistent fevers.
To the Editor:The report by the Institute for Health Policy 1 concerning the appalling decline of clinical research conducted at academic health centers deserves the attention of primary care physicians and researchers. The potential consequences in terms of the threat to public health are enormous. Many of these consequences remain…
To the Editor:Congestive heart failure (CHF) is an important public health concern. It afflicts an estimated 4 million Americans and is a leading cause of morbidity and mortality. Deficiency of thiamine intake can lead to impaired cardiac performance in the form of beriberi heart disease. Loop diuretics, such as furosemide…
To the Editor: A 34-year-old African-American woman presented to the emergency department complaining of 6 hours of bilateral pleuritic chest pain and shortness of breath. She had experienced four similar though less severe attacks during the previous 6 weeks. She had also noted a weight loss of 15 pounds during…
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