We would do Birmingham a great disservice if we dreamed too little dreams.Joseph F. Volker, DDS, PhD, UAB president, 1969–1976 During the height of World War II, there was a growing movement in the South, especially in Alabama, to upgrade medical education opportunities. With that as a backdrop, Alabama Governor…
Background The objective of this study was to explore physician and practice characteristics according to sex. Method All graduates of a southeastern state's family practice residency programs were surveyed. Results Seven hundred fourteen (53.5%; 79.7% men, 20.3% women) surveys were returned and analyzed. Practice arrangements and practice settings did not…
Background Trauma surgeons have observed an increased rate of penetrating trauma during periods of increased unemployment. Methods During a 10-year period, the rate of unemployment in a metropolitan area was compared with the rate of intentional penetrating trauma at two Level I trauma centers. The total number of trauma cases…
Objective This study compares the primary health care quality of community health centers (CHCs) and health maintenance organizations (HMOs) in South Carolina to elucidate the quality of CHC performance relative to mainstream settings such as the HMO. Methods Mail surveys were used to obtain data from 350 randomly selected HMO…
Cellulitis is usually caused by organisms such as β-hemolytic streptococci and Staphylococcus aureus. Citrobacter are gram-negative bacilli that can cause opportunistic infections in immunocompromised hosts. They are rarely implicated in skin or soft tissue infections. The genus Citrobacter has been respeciated according to genetic relatedness. Citrobacter braakii refers to the…
Primary cardiac lymphoma is a rare disease with a high mortality rate due to the advanced stage of myocardial involvement at presentation. The diagnosis is extremely difficult to make because of the rarity of the disease, variability of clinical manifestations, limited noninvasive diagnostic techniques available, and difficulties and/or delays in…
Valproic acid is a carboxylic acid used for the treatment of both seizure and mood disorders. Its association with pleural fluid eosinophilia has been reported once in the English language literature. We present another case of valproic acid-induced pleural fluid eosinophilia associated with fever and peripheral blood eosinophilia. Extensive evaluation…
Angiosarcoma arising from chronic lymphedema is referred to as Stewart-Treves syndrome. It typically occurs as a complication of long-lasting lymphedema of the arm after mastectomy and/or radiotherapy for breast cancer. Angiosarcoma associated with idiopathic lymphedema of the lower extremity is extremely rare. We report a case of diffuse angiosarcoma of…
Epidural anesthesia is commonly used in patients undergoing revascularization procedures of the lower extremities and other surgical procedures. Complications of epidural anesthesia are uncommon and are usually related to dural puncture or side effects of the medications being infused. Epidural hematoma is a rare complication of epidural anesthesia. Patients who…
Comamonas species are environmental Gram-negative rods that grow forming pink-pigmented colonies. Despite their common occurrence in nature, they rarely cause human infection. We present a case of Comamonas bacteremia that we think may have been related to tropical fish exposure. The patient was treated successfully with levofloxacin.
A 56-year-old man with diabetes mellitus and cadaveric renal transplantation had vancomycin-resistant Enterococcus faecium tricuspid valve endocarditis. Relapse followed 6 weeks of treatment with intravenous gentamicin and high-dose ampicillin. On the basis of previous data suggesting the potential for synergistic activity of quinupristin/dalfopristin plus high-dose ampicillin, therapy with this combination…
We present the case of a 63-year-old woman with metastatic, high-grade pleomorphic sarcoma who had recurrent, bilateral pneumothorax while on a regimen of doxorubicin and dacarbazine. We postulate that her doxorubicin-based chemotherapy induced rapid cell lysis and necrosis of peripherally located, metastatic pulmonary nodules, leading to the pneumothoraces. Other potential…
Hypothyroidism is a common condition. Rarely, it may occur in combination with autoimmune failure of other endocrine glands (autoimmune polyendocrinopathy syndrome type 2, previously known as Schmidt's syndrome). In such cases, restoring normal thyroid function may precipitate adrenal failure. Clinicians should have a high index of suspicion for this condition…
Myocardial infarction is a common life-threatening condition. Multiple agents can be used to treat acute coronary syndrome (ACS). These therapeutic agents pose potential life-threatening complications when used outside the realm of the acute coronary syndrome. Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder, occurring in 1 in 500 individuals,…
Sporadic Creutzfeldt-Jakob disease (CJD) is the most common prion disease. The diagnosis can be confirmed only by histological examination of brain tissue obtained at biopsy or at autopsy. Because of the transmissible nature of the disease, autopsy or brain biopsy cannot be performed at many institutions, which poses numerous challenges…
An 18-year-old student was evaluated for generalized lymphadenopathy with unexplained weight loss. Diffuse large B cell lymphoma was confirmed by pathologic examination of the neck lymph nodes. Further systemic evaluation by computed tomography disclosed extensive submental, subaxillary, mediastinal, and paraaortic lymph node enlargement and a tumor in the liver as…
Infection with influenza presents as a spectrum of disease ranging from patients who are asymptomatic to those with fulminant primary viral pneumonia, depending on host immune status and the dose of virus. There is generally an abrupt onset of symptoms after an asymptomatic incubation period of a few days. Uncomplicated…
The clinical course of influenza may be characterized by complications that include not only lower respiratory tract infections but also nonrespiratory manifestations. The mechanisms by which influenza induces many of these complications remain for the most part unclear. The most frequent complications are shown in Table 1.
New agents for the treatment of influenza have changed the therapeutic approach for individuals with this age-old disease. The exact role of these antimicrobial agents remains to be defined, but they seem to be effective in shortening the duration of symptoms in most patients. They are more expensive than the…
Influenza is arguably the most important cause of acute upper respiratory tract infection in humans. Epidemics associated with influenza viruses are responsible for more deaths in the United States than any other vaccine-preventable disease. 1–4 Approximately 20,000 excess deaths and 200,000 hospitalizations each year in the United States occur as…
The viruses that lead to influenza are members of the Orthomyxoviridae family, which consists of enveloped viruses with a single, segmented, negative-strand ribonucleic acid (RNA) genome. Four genera have been defined, including influenza A, B, and C and Thogotovirus (or influenza D). Although these viruses possess similar proteins, each virus…
Expired CME Credit Submission and Evaluation Form – Influenza
We describe the case of a newborn infant with duplication of the testis and absence of the contralateral testis. The patient also had bilateral indirect inguinal hernias and an ipsilateral undescended testicle.
In keeping with our dedication to meeting the educational and professional needs of our readers and to broaden their knowledge of the numerous excellent medical facilities available, we are adding a feature to the Southern Medical Journal titled “Centers of Excellence.” By highlighting various medical centers in the Journal, we…
The abstract of the article beginning on page 93 of the January issue of Southern Medical Journal (Knox-Macaulay H, Ayyaril M, Nusrat N, Daar A. Colonic pseudo-obstruction in sickle cell disease. South Med J 2003;96:93–95.) contained an important typographical error. The abstract is reprinted below with the correction incorporated:Abstract: A…
Influenza-like illness results in greater health care costs and contributes to more deaths than any other viral illness in the United States. In recent years, the combination of influenza and pneumonia was the fifth leading cause of death in adults 65 years of age and older. In epidemic years, influenza…
Although pandemics of influenza seem to have occurred throughout history, the first well-recorded pandemic occurred in 1580. 1 This outbreak seems to have originated in Asia and subsequently spread to Africa, Europe, and America. Mortality estimates were staggering, and several European cities experienced huge losses in their citizenry.
I concur with Stricker and Goldberg, who reemphasize the need for caution when it comes to prescribing statin therapy. Because 10- to 20-year follow-up data are lacking for 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, the possibility of carcinogenicity-related risk must be a concern when prescribing these agents for extended periods of time….
In his excellent editorial on statins, Dr. Sinatra1 touched on the issue of carcinogenicity related to these medications. He noted the association between lipid-lowering drugs and carcinogenicity in rodents, and he mentioned the increased rate of breast cancer reported in the Cholesterol and Recurrent Events Trial (CARE) of postmenopausal U.S….
Concerns have been raised about the role that hospitalists may have in changing the educational process for medical students and residents, especially with regard to the primary care specialties. Methods We implemented rotating hospital and office duties within our five-physician group. Results Resident and student satisfaction increased, and additional faculty…
Background: Since 1970, the National Health Service Corps (NHSC) has worked to increase primary care access among underserved groups. This study examined whether NHSC alumni physicians were likely to treat a high proportion of Medicaid patients in their practices. Methods: Using licensure files and hospital discharge data, we identified all…
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