Background Recognition of the importance of early diagnosis and aggressive, definitive surgical intervention has brought about a dramatic decline in mortality related to distal esophageal perforation. Methods We retrospectively analyzed all cases of thoracic esophageal perforation diagnosed at our hospital from September 1, 1979, through April 1, 2001. The study…
Background Previous studies of the incidence and the most common causes of cutaneous metastasis have not led to a consensus. We compiled data from many retrospective studies and from patient data registries and autopsies to increase the total number of cases available for a larger analysis of this subject. This…
Background: Mississippi was selected as a pilot state in the national breastfeeding promotion campaign titled Loving Support Makes Breastfeeding Work (LSMBW). To reinforce the national LSMBW project, the Mississippi Women, Infants and Children (WIC) Breastfeeding Promotion Project Team developed a comprehensive program that included patient and family education, staff training,…
Background: We identified risk factors and clinical outcomes associated with ambulatory care-sensitive conditions requiring intensive care unit (ICU) admission. Methods: This prospective cohort study included 4,144 patients admitted to the medical ICU of an urban teaching hospital during a 3-year period. Results: A total of 627 patients were classified as…
CME Credit—February 2003 Featured CME Topic: Lipodystrophy Syndrome in HIV Infection
Glucagonomas are rare functional endocrine tumors of the pancreas that classically present with symptoms of glucagon excess, including rash, hyperglycemia, diarrhea, and weight loss. Metastatic disease at presentation is common but is often limited to the liver and regional lymph nodes. We describe an unusual case of a patient with…
The need for reliable vascular access remains the Achilles heel of hemodialysis. Complications of vascular access are a leading cause of morbidity and mortality in patients who undergo hemodialysis, especially in those patients with end-stage renal disease. Among methods of vascular access, arteriovenous fistulae have the lowest rate of infection…
A 26-year-old woman presented at our hospital with pretibial edema, swelling, and vaginal bleeding. She had nephrotic-level proteinuria and was diagnosed with choriocarcinoma after a histologic examination of her uterine curetting was performed. The renal biopsy specimen was compatible with membranous glomerulonephritis. The renal pathology in this case was thought…
Phenytoin is a highly effective and widely prescribed anticonvulsant agent, but it can be associated with dose-related side effects and hypersensitivity reactions. We present a case of phenytoin-induced cholestatic hepatotoxicity in a 47-year-old woman who had exfoliative dermatitis, an increase in liver enzymes with a cholestatic pattern, and eosinophilia after…
Kluyvera is an opportunistic pathogen that can occur in immunosuppressed as well as immunocompetent hosts. We report a case of Kluyvera species infection involving a central venous catheter, and we review the literature on Kluyvera infections in children. Our case demonstrates that removal of the central venous catheter was necessary…
In these days of increasing medical costs, the health care system is paying more attention to resource use and cost avoidance. Nowhere is this effort more tangible than in the intensive care unit (ICU), where costs account for as much as 20% of health care expenditures in the United States….
Background: Left ventricular function evaluation and angiotensin-converting enzyme (ACE) inhibitor use are the two basic indicators of heart failure quality of care. In this retrospective follow-up study, we analyzed the association between these two quality indicators and mortality in elderly hospitalized heart failure patients. Methods: The patients in our study…
Background: In this study, we examined the personal breast-feeding behaviors of female physicians in Mississippi. Method: Two hundred fifteen of 350 female physicians responded to a survey inquiring of their personal breast-feeding behaviors. Results: One hundred fifty-five mothers (74%) reported having biologic children, and 146 (94.2%) breast-fed at least 1…
Background: Infection of pancreatic pseudocysts is a potentially fatal complication that must be treated immediately. Despite numerous published reports about percutaneous treatment, the effectiveness of percutaneous catheter drainage (PCD) of infected pancreatic pseudocysts is still under discussion. Methods: In this study, 30 patients (17 women) with 30 infected pancreatic pseudocysts…
Background: Previous studies have reported an increase in psychiatric symptoms in seriously ill patients who were placed in resistant organism isolation. We conducted this study to assess whether there is an increase in symptoms of anxiety and depression in patients who are not critically ill and are placed in isolation….
Background: Venous thromboembolism (VTE) has historically remained a risk factor for obstetric patients, particularly those requiring cesarean section. The objective of this survey was to assess the response of general obstetricians to risk factor considerations for VTE prophylaxis and cesarean section. Methods: A survey regarding VTE prophylaxis and cesarean section…
Background: The location and identification of health professionals’ practice sites is the first step in enhancing the availability of quality medical care to all regions of the state. Identification of specific areas of need is difficult, as provider data is often collected and housed separately through multiple organizations. This study…
Background Between 1995 and 1997, a tuberculosis outbreak occurred in a large, urban jail. We investigated whether the outbreak strain of Mycobacterium tuberculosis (M. tuberculosis) was circulating in the surrounding community after that outbreak. Methods We performed a retrospective cohort study of people with tuberculosis in Shelby County, TN, from…
Fabry’s disease is an X-linked disorder of glycosphingolipid catabolism related to the defective activity of glycosphingolipid, mainly ceramide trihexoside, in the vascular smooth muscle, myocardium, cells of the sympathetic central nervous system, and epithelial cells of renal glomeruli. We describe a young man who had Fabry’s disease and unusual electrocardiographic…
Tumors of the thyroid and parathyroid glands may develop together or separately in patients who previously have been exposed to head and neck irradiation. Whether cranial irradiation confers an increased risk for pituitary adenoma remains unknown. We report the case of a 52-year-old woman who was treated during childhood for…
Acute acalculous cholecystitis is inflammation of the gallbladder in the absence of gallstones. It usually occurs in critically ill patients and is rare in the pediatric age group. We describe a 12-year-old boy who presented with fever, jaundice, and abdominal pain and was found to have acute acalculous cholecystitis, sacroiliitis,…
Central hypothyroidism is an exceedingly rare form of hypothyroidism that results from a variety of conditions affecting the hypothalamus and the pituitary gland. The classic biochemical abnormality seen in these patients includes a low serum level of circulating thyroxine (T4) concomitant with an inappropriately low level of thyrotropin. Because patients…
Venous thromboembolism is extremely underrepresented in the obstetric literature, yet it is the leading cause of obstetric death. Cesarean section remains a significant contributing factor in thromboembolic disease, yet textbooks 1,2 currently emphasize treatment and fail to address the prevention of venous thromboembolism adequately. The long-term sequelae of venous thromboembolism…
Southern Medical Journal Featured CME Topic: Lipodystrophy Syndrome in HIV Infection
Human immunodeficiency virus (HIV) infection affects approximately 900,000 individuals in the United States. 1 The development of highly active antiretroviral therapy (HAART) has led to significant reductions in morbidity and mortality rates in HIV-infected patients. 2 Unfortunately, the use of these agents—particularly protease inhibitors (PIs)—has given rise to the metabolic…
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