Issue - Southern Medical Association

Expired CME Credit Submission and Evaluation Form

CME Credit—November 2003 Featured CME Topic: Allergy

Expired CME Credit Submission and Evaluation Form – Allergy

Original Article

Transitions in Health Status in Older Patients with Heart Failure

Background We aimed to determine transitions in health perception and functional status in older Medicare patients with heart failure. Methods We used 1991 to 1994 data from the Medicare Current Beneficiary Survey, a database that combines Medicare claims with yearly longitudinal surveys. We identified 872 patients 65 years or older…

Original Article

Original Articles

FIGURE Figure. Publication of original works of art coordinated by the American Physicians Art Association. Artwork graciously supplied through the courtesy of APAA members. Lemons and Limes, Oil on Linen Richard E. Goldberg, MD Huntingdon Valley, PAC

Original Article

Evaluation of Lactate and C-Reactive Protein in the Assessment of Acute Myocardial Infarction

Purpose The purpose of this study was to assess the usefulness of lactate and C-reactive protein as early markers of acute myocardial infarction (AMI) in conjunction with established markers, such as creatine phosphokinase (CPK)-MB and troponin I. Methods The study population consisted of all patients admitted with suspected AMI regardless…

Original Article

Clinical Predictors of 30-day Cardiac Events in Patients with Acute Coronary Syndrome at a Community Hospital

Objective We sought to determine predictors of coronary events (cardiac death, acute myocardial infarction, and urgent revascularization) within 30 days after admission. Methods We prospectively collected data on 400 patients admitted through our emergency room for unstable angina and acute coronary syndromes. Patients with ST-segment elevation myocardial infarction and those…

Original Article

Bioimpedance-derived Differences in Cardiac Physiology during Exercise Stress Testing in Low-risk Chest Pain Patients

Background Little has been written about the utility of thoracic electrical bioimpedance (TEB)-derived cardiac physiologic variables in evaluating patients with low-risk chest pain syndromes. Noninvasive bioimpedance can monitor cardiac physiology while a patient is performing an exercise stress test. In addition, the demographics of patients with chest pain, the incidence…

Original Article

Reflux Esophagitis in the Pathogenesis of Paroxysmal Atrial Fibrillation: Results of a Pilot Study

Background We sought to assess whether proton pump inhibitor (PPI) therapy of gastroesophageal reflux disease (GERD) in patients with lone paroxysmal atrial fibrillation (PAF) leads to a reduction of PAF-related symptoms. Methods The records of patients with reflux esophagitis were screened for the diagnosis of lone PAF. All patients with…

Original Article

Usefulness of a Hypertension Education Program

Background Our objective was to assess knowledge about hypertension, its medical consequences in hospitalized patients with hypertension and in their relatives, and to evaluate the usefulness of a simple education program to improve such knowledge. Method As part of a cohort study, six clinical physicians reviewed the medical charts of…

Original Article

Confirmatory Chest Radiographs after Central Line Placement: Are They Warranted?

Objectives This study was designed to determine the ability of physicians to predict complications associated with the placement of central venous access devices and to decide whether a confirmatory chest radiograph is warranted after placement. Methods Patients receiving central venous access on an inpatient and outpatient gynecologic oncology service were…

Review Article

Imaging of the Vulnerable Plaque: New Modalities

Atherosclerosis is currently considered to be an inflammatory and thus a systemic disease affecting multiple arterial beds. Recent advances in intravascular imaging have shown multiple sites of atherosclerotic changes in coronary arterial wall. Traditionally, angiography has been used to detect and characterize atherosclerotic plaque in coronary arteries, but recently it…

Case Report

Endocarditis during Pregnancy

The incidence of infective endocarditis during pregnancy has been reported to be 0.006%. The maternal mortality rate can reach 33%, with most deaths related to heart failure or an embolic event. The rate of fetal mortality can reach 29%. Heart diseases are the most important nonobstetric causes of maternal death…

Case Report

Embolus in Transit

A patient who presented with recurrent syncopal episodes was discovered to have a right-sided heart mass, which was revealed as an embolus in transit resulting in a lethal pulmonary embolic event. The initial focus of etiology on tumor rather than thrombus was misleading. A higher index of suspicion of thrombus…

Case Report

Innominate Artery Compression of the Trachea: An Unusual Cause of Apnea in a 12-Year-Old Boy

Innominate artery compression of the trachea is a common cause of airway obstruction in infants and young children. The clinical significance of this lesion, even when compression is documented endoscopically or radiographically, is controversial. Obstructive respiratory symptoms occur in only a fraction of such cases, and symptomatic patients are most…

Case Report

Endovascular Brachytherapy for the Treatment of Renal Artery In-Stent Restenosis Using a β-Emitting Source: A Report of Five Patients

We report five cases of renal artery in-stent restenosis treated with endovascular brachytherapy. This procedure has been previously used extensively for the treatment of coronary artery in-stent restenosis with successful results. Therefore, it follows logically that noncoronary in-stent restenoses would also be successfully treated in this manner. Though our experience…

Expired CME Article

Molecular Mechanisms of Allergic Disease

Interaction of allergen with T-cells is associated with patterns of cytokine release by immunocompetent cells characterized as T-helper Th1 or Th2 T-immune responses. The Th2 pattern of inflammation induced by this cytokine release is associated with allergic diseases. The molecular mechanisms underlying allergic inflammation are the signals for immunoglobulin (Ig)…

Expired CME Article


History, physical examination, and allergy testing may distinguish the syndromes of rhinitis, classified as allergic, infectious, perennial, nonallergic, and miscellaneous. All may be associated with sinusitis, probably on the basis of obstruction of the osteomeatal complex. Although topical nasal steroids are useful in the treatment of all forms of rhinitis,…

Expired CME Article


This article is a comprehensive review of asthma that discusses risk factors, diagnosis, and management. Guidelines for choosing appropriate asthma therapy are discussed. Key aspects of patient education are described. Reasons for the failure of asthma therapy with potential remedies are presented. Regular follow-up for good asthma care is emphasized.

Expired CME Article

Atopic Dermatitis

Atopic dermatitis is a common, chronic skin condition characterized by xerosis, pruritus, and inflammation. Numerous factors place individuals at increased risk for developing this disease. T-helper cells and their cytokines, in addition to immunoglobulin E and eosinophils, play a major role in the pathogenesis of atopic dermatitis. Various hypotheses including…

Expired CME Article

Allergic Reactions to Insect Stings and Bites

Insect stings are an important cause of anaphylaxis. Anaphylaxis can also occur from insect bites but is less common. Insect venoms contain several well-characterized allergens that can trigger anaphylactic reactions. Effective methods to diagnose insect sting allergy and assess risk of future sting reactions have been developed. Management strategies using…

Expired CME Article

Allergic and Nonallergic Drug Reactions

Allergic drug reactions may be difficult to distinguish from nonallergic reactions. In this article, we review a pragmatic approach to the management of adverse drug reactions on the basis of knowledge of the classification and patterns of these reactions. Algorithms for management of patients with a previous adverse drug reaction…

Case Report

Acute Rheumatic Fever Presenting as Unstable Angina

The most common presentation of acute rheumatic fever in adults is a febrile illness with an additive or migratory polyarthritis that is present on average in 92%; of patients (range, 43–100%), or tenosynovitis usually of the wrists and ankles (67%. 1,2 Carditis, present in 15 to 35% of patients, is…

Case Report

Ethacrynic Acid Can Be Effective for Refractory Congestive Heart Failure and Ascites

Ethacrynic acid is a loop diuretic little used today because of its side-effect profile and the availability of multiple alternative agents. However, in our clinical experience, ethacrynic acid can alleviate acute congestive heart failure and ascites resistant to other diuretics. Two patients aged 89 and 94 in life-threatening pulmonary edema…

Case Report

Fatal Cardiac Rupture during Stress Exercise Testing: Case Series and Review of the Literature

Mortality rates of exercise testing are low and cardiac rupture and sudden death are rare. Three cases of fatal cardiac rupture that occurred during exercise stress testing are reported. Once thought to be a fatal complication, there are increasing reports of ante-mortem diagnosis and survival. Cardiac rupture is a stuttering…



Mulla ZD, Leaverton PE, Wiersma ST. Invasive group A streptococcal infections in Florida. South Med J 2003; 96: 968–973. Because of an editing error, the table citation in line 9 at the end of the second full sentence in the second column on page 972 of the October issue of…


The Three R’s: Radiation for Restenotic Renals?

Revascularization of renal artery stenosis in an effort to control hypertension and preserve renal function is becoming more widely accepted. Peripheral intervention of atherosclerotic renal arteries by balloon angioplasty with stenting is the preferred means of revascularization. Stenting induces a proliferative response, sometimes producing enough neointimal hyperplasia within the lumen…

Expired CME Article


Expired CME Article – Allergy

Expired CME Article

Selected Community Resources*

Expired CME Article – Selected Community Resources

Expired CME Article

Featured CME Topic Introduction – Allergy

The increasing prevalence of allergic diseases throughout the world has been established by the publication of more than 10 national and multinational epidemiologic studies during the past 10 years. 1 The prevalence for allergic rhinitis ranges from 3 to 40% of the population, depending on the geographic area and the…

Expired CME Article

Selected Books*

Expired CME Article – Selected Books

Expired CME Article

Selected Ongoing Clinical Trials*

Expired CME Article – Selected Ongoing Clinical Trials*