January 2003, Volume 96 - Issue 1

Precordial Catch Syndrome

Carl H. Gumbiner, MD

Abstract: 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...

(pp 38-41)

CME Credit—January 2003 Featured CME Topic: Precordial Catch Syndrome


Abstract: CME Credit—January 2003 Featured CME Topic: Precordial Catch...

(pp 42)

Reye’s Syndrome: Down but Not Out

Adnan T. Bhutta, MBBS, Van H. Savell, MD, Stephen M. Schexnayder, MD

Abstract: 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...

(pp 43-45)

Chronic Relapsing Thrombotic Thrombocytopenic Purpura in Adult Onset Still's Disease

Martin G.V. Perez, MD, Francis R. Rodwig Jr., MD

Abstract: 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...

(pp 46-49)

Spontaneous Pneumopericardium Due to Exertion

Gerald W. Westermann, MD, Barbara Suwelack, MD

Abstract: 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...

(pp 50-52)

Cystic Dysplasia of the Testis with Terminal Ureterectasis and Renal Absence: Evidence of Involution of a Dysplastic Kidney?

Joseph L. Cottone Jr., MD, John F. Redman, MD

Abstract: 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...

(pp 56-57)

Fatal Spontaneous Retroperitoneal Hematoma Secondary to Enoxaparin

Kirk M. Chan-Tack, MD

Abstract: 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...

(pp 58-60)

Association of Pancreatitis with Administration of Contrast Medium and Intravenous Lipid Emulsion in a Patient with the Acquired Immunodeficiency Syndrome

Vijaykumar S. Kasi MD, PhD, Carlos A. Estrada MD, MS, Wilhelmine Wiese MD

Abstract: 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...

(pp 66-69)

Favorable Outcome of Long-lasting Thoracic Spondylodiscitis with Spinal Epidural Abscess Induced by Staphylococcus aureus

Josef Finsterer, MD, Karl Mahr, MD, Volker Paral, MD

Abstract: 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...

(pp 70-73)

Cryptococcal Infection of the Larynx Simulating Laryngeal Carcinoma

David K. McGregor, MD, Deborah Citron, MD, Imran Shahab, MD

Abstract: 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...

(pp 74-77)

Intralobar and Extralobar Bronchopulmonary Sequestration Complicated by Nocardia asteroides Infection

Muhammad Shibli, MD, Cliff Connery, MD, Janet M. Shapiro, MD

Abstract: 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,...

(pp 78-80)

Emphysematous Gastritis in a Hemodialysis Patient

Madhuri Yalamanchili, MD, William Cady, MD

Abstract: 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...

(pp 84-88)

Extrahepatic Bile Duct Stricture and Elevated CA 19-9: Malignant or Benign?

Joshua Hyman, MD, Sharon P. Wilczynski, MD, Roderich E. Schwarz, MD

Abstract: 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...

(pp 89-92)

Bullet Migration within the Inferior Vena Cava

Krishnan Raghavendran, MD, James T. Evans, MD

Abstract: 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....

(pp 96-98)

Spontaneous Pneumothorax as the First Manifestation of Lymphoma: A Rare Presentation and the Importance of Diagnostic Biopsy

Maureen Okam, MD, Mohammad Alsolaiman MD, Alan Brau, MD, Mariette Austin, MD, Matthew Plymyer, MD

Abstract: 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...

(pp 99-100)

Severe Hypermagnesemia as a Result of Laxative Use in Renal Insufficiency

Fahim Zaman, MD, Kenneth Abreo, MD

Abstract: To the Editor:Hypermagnesemia is a rare laboratory finding. 1 We describe a patient with renal insufficiency who presented with magnesium...

(pp 102-103)

Abdominal Wall Rhabdomyolysis Mimicking Peritonitis: A Diagnostic Pitfall of Acute Abdomen

Ming-Shen Da,i MD, Shih-Hua Lin, MD, Rong-Yuan Shyu, MD, Phd, Chih Yung Yu, MD

Abstract: 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...

(pp 105-106)

Balanitis Xerotica Obliterans: A Form of Lichen Sclerosus

Alex E. Finkbeiner, MD

Abstract: 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...

(pp 7-8)

Recognition of Benign Transient Hyperphosphatasemia

Toshio Okazaki, PhD, Mitsuyuki Suzuki, BSc, Tatsuo Nagai, MD

Abstract: 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...

(pp 108-109)

Lumbosacral Plexopathy as the Harbinger of a Silent Retroperitoneal Hematoma

Levent Özçakar, MD, Ayşen Sivri, MD, Musa Aydınlı, MD, Yusuf Tavil MD

Abstract: 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...

(pp 109-110)

Balanitis Xerotica Obliterans: Epidemiologic Distribution in an Equal Access Health Care System

CPT William S. Kizer MD, MC, USA CPT Troy Prarie MD, MC, USA LTC Allen F. Morey MD

Abstract: 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...

(pp 9-11)

Lethal Spontaneous Retroperitoneal Hematoma and Multisystem Organ Failure Associated with Chronic Abuse of Ibuprofen and Alcohol

James Majeski, MD, PhD, Dennis Fried, MD

Abstract: 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,...

(pp 116-117)

Pineal Germinoma Followed by Hematogenous Metastases

Muhammad Wasif Saif, MD, Chris H. Takimoto, MD, PhD

Abstract: 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...

(pp 117-119)

Preliminary Experience with the Use of Recombinant Factor VIIa to Treat Coagulation Disturbances in Pediatric Patients

Joseph D. Tobias, MD, Kelly Groeper, MD, John W. Berkenbosch, MD

Abstract: 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...

(pp 12-16)

Prevention of Thromboembolism after Neurosurgery for Brain and Spinal Tumors

Teresa L. Carman MD, Andrew A. Kanner MD, Gene H. Barnett MD, Steven R. Deitcher MD

Abstract: 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...

(pp 17-22)

Cooperative Efforts Improve Compliance with Acute Stroke Guidelines

Erfan A. Albakri MD, Ferdinand Richards III MD, Marie Hall RN, Charles Dion MA, Luis S. Miranda MD, Robert Turkel MD, Charles Sand MD, Paulette Vasey MS, ARNP, Kathie McDonald RN, MPH, Mark Michelman MD, MBA, Zaid Smith PHD, Karen Davison RN, Lisa Pfannerstill RN

Abstract: 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...

(pp 23-26)

Early Recognition and Treatment of Calciphylaxis

Robert W. Parker MD, Charles P. Mouton MD, Derick W. Young MD, David V. Espino MD

Abstract: 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...

(pp 53-55)

Pica for Foam Rubber in Patients with Sickle Cell Disease

Samuel R. Hackworth PhD, Laura L. Williams MD

Abstract: 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...

(pp 81-83)

Colonic Pseudo-obstruction in Sickle Cell Disease

Huxley Knox-Macaulay, MD, FACP, FRCP, Mohiyaddin Ayyaril, MD, Nadeem Nusrat, MD, Abdallah Daar, DPhil, FRCP, FRCS

Abstract: 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...

(pp 93-95)

Rare Systemic Dermatologic Reaction after Pneumococcal Vaccine Administration

Mack R. Holdiness, MD, PHD

Abstract: 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....

(pp 64-65)

Internet Delusions

Michael T. Compton, MD

Abstract: 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...

(pp 61-63)

The Future of Medicine

Allen D. Seftel, MD

Abstract: 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...

(pp 6)

For Debate: Establishing Guidelines for Internet-based Prescribing

Miles J. Jones, MD, William Alvis Thomasson, PHD

Abstract: 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....

(pp 5-Jan)

Southern Medical Journal Featured CME Topic: Precordial Catch Syndrome

Carl H. Gumbiner, MD

Abstract: Southern Medical Journal Featured CME Topic: Precordial Catch...

(pp 37)

Agromedicine Focus Group: Cooperative Extension Agents and Medical School Instructors Plan Farm Field Trips for Medical Students

John R. Wheat, MD, MPH, Tamela J. Turner, PHD, Lloyd Weatherly, MS, Oscar S. Wiggins, MA

Abstract: 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...

(pp 27-31)

Current Controversies in Pouch Surgery

Jules E. Garbus, MD, Fabio Potenti, MD, Steven D. Wexner, MD

Abstract: 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...

(pp 32-36)

Non-Q-Wave Acute Anterior Myocardial Infarction Associated with 5-Fluorouracil and Cisplatin Chemotherapy

Mustafa Kemal, Erol MD, Mahmut Acikel, MD, Huseyin Senocak, MD

Abstract: 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...

(pp 99)

Treatment of Acute Isoniazid Toxicity of Unknown Dose

Hüsnü Kürşad, MD, Mehmet Kizilkaya, MD, Murat Şahin, MD, Nazım Dogan, MD, Asım İlgaz, MD

Abstract: 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....

(pp 101)

Ascaris Lumbricoides?

Lawrence R. Ash, PhD

Abstract: 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...

(pp 101-102)

Esophageal Actinomycosis

Ashoni K. Arora, MD, Jill Nord, MD, O. Olofinlade, MD, Bruce Javors, MD

Abstract: 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...

(pp 103-104)

Magnesium: Its Proven and Potential Clinical Significance

Ryland P. Byrd, Jr. MD, Thomas M. Roy, MD

Abstract: 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...

(pp 104)

Hyperammonemic Encephalopathy Precipitated by a Bleeding Peptic Ulcer

Sumit Gaur, MD, Vani Shukla, MD

Abstract: 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...

(pp 106)

Acute Inflammatory Demyelinating Polyneuropathy Concurrent with Evans Syndrome

Sumit Gaur, MD, Sudhathi Reddy, MD, Michael A. Baumann, MD

Abstract: 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...

(pp 106-107)

Hypertension: A Turning Point

David H. Jacobson, PhD

Abstract: 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...

(pp 107)

Itching without a Rash

Richard Martin, MD

Abstract: 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...

(pp 107-108)

Absolute versus Relative Values

Joseph K. Neumann, PhD, Kenneth E. Olive, MD, Arthur R. Ellis, PhD

Abstract: 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...

(pp 108)

Parasitic Chyluria

Ana M. Palacio, MD, Daniel M. Lichstein, MD, Carlos A. Vaamonde, MD, Leonardo Tamariz, MD, MPH

Abstract: 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...

(pp 110-111)

Elective Removal of an Intramyocardial Bullet

Michael S. Hickey, MD

Abstract: 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...

(pp 111-112)

Persistent Staphylococcal Bacteremia, Lest We Forget the Old Catheter Site

Terri Richardson, MD, Phillip S. Mehler, MD

Abstract: 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...

(pp 112-113)

Society's Price for Endangered Clinical Research

H. J. Roberts, MD, FACP

Abstract: 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...

(pp 113)

Is There a Role for Thiamine in the Management of Congestive Heart Failure?

Muhammad Wasif Saif MD, MBBS

Abstract: 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...

(pp 114-115)

Refractory Pulmonary Embolism and Right Atrial Thrombus Despite Treatment With 3 Thrombolytic Regimens

Michael J. Dacey, MD, Mieke Weaver, MD, Jason Moore, MD, Paul E. Marik, MD

Abstract: 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...

(pp 115-116)