SMJ // September 2003, Volume 96 - Issue 9

Original Article

Parental Perception of Waiting Time and its Influence on Parental Satisfaction in an Urban Pediatric Emergency Department: Are Parents Accurate in Determining Waiting Time?

Objective The objective of this study was to determine whether parental perception of waiting time in an urban pediatric emergency department (ED) is accurate and whether the actual waiting times or their perception of waiting times impact on parental satisfaction. Methods A prospective convenience sample study in which the on-duty…

Original Article

Parental Presence During Invasive Procedures in Children: What Is the Physician's Perspective?

Introduction Invasive procedures may be frightening and painful experiences for children and their parents. Many parents prefer to be present when procedures are performed in their children. Allowing parents to be present during procedures decreases procedure-related anxiety. Few if any studies have addressed the physician's perspective on this issue. We…

Review Article

Infectious Causes of Adrenal Insufficiency

More than 150 years ago, Thomas Addison first described the clinical features and pathogenesis of adrenal insufficiency. At that time, tuberculosis was the most common cause of this disease. The pathway to diagnosis and treatment of Addison's disease has been well described. However, determining the cause of the disorder remains…

Review Article

Preeclampsia and Eclampsia Revisited

Hypertensive disorders during pregnancy, which account for approximately 15% of pregnancy-related deaths, represent the second-leading cause of morbidity and mortality in the United States. New classifications recommended by the National Institutes of Health's Working Group on High Blood Pressure in Pregnancy have decreased the confusion often associated with these disorders….

Review Article

Necrotizing Soft Tissue Infections: A Guide to Early Diagnosis and Initial Therapy

Necrotizing skin and soft tissue infections are caused by many different bacteria, are frequently polymicrobial, and may have a deceptively innocent early clinical presentation. Clostridial and nonclostridial necrotizing infections are frequently similar in their early presentation. The initial presentation of these infections can be insidious, which results in delay in…

Expired CME Article

Severe Acute Respiratory Syndrome: An Overview

Severe acute respiratory syndrome (SARS) is a severe pulmonary infection that has been identified in multiple outbreaks around the world after emerging from mainland China in early 2003. The syndrome is caused by SARS-associated coronavirus, a novel human infection. SARS-associated coronavirus is spread by multiple mechanisms, including direct contact and…

Expired CME Credit Submission and Evaluation Form

CME Credit—September 2003 Featured CME Topic: Severe Acute Respiratory Syndrome

Expired CME Credit Submission and Evaluation Form – Severe Acute Respiratory Syndrome

Case Report

Large Dopamine-secreting Pheochromocytoma: Case Report

Pheochromocytomas are rare tumors that typically present with catecholamine-stimulated symptoms. Some pheochromocytomas secrete dopamine in addition to or in the absence of other catecholamines. Patients with these tumors are frequently normotensive. We describe a normotensive 26-year-old woman with a large pheochromocytoma that secreted multiple catecholamines, including dopamine.

Case Report

Coexistence of Sarcoidosis and Malignancy

In 1974, Brincker and Wilbek noted a statistically significant increase of malignant tumors among sarcoid patients and speculated that immunologic deficiencies stemming from sarcoidosis may predispose such patients to malignancy. In this article, we describe three additional cases of sarcoidosis and coexisting malignancy. The temporal presentation, radiographic features, and histologic…

Case Report

An Unusual Case of Poisoning

The case of a 49-year-old alcoholic man with obtundation is presented. The patient was presumptively diagnosed with methanol intoxication due to the presence of metabolic acidosis with high anion and osmolar gaps. Laboratory testing revealed toxic levels of propylene glycol instead. An exercise in estimating the concentration of toxic alcohols…

Case Report

Staphylococcus aureus Pericardial Abscess in a Patient with Liver Cirrhosis: Case Report

Pericardial abscess is a rare complication of Staphylococcus aureus bacteremia. We report the case of a 40-year-old man with hepatitis C and liver cirrhosis who presented with high-grade fever and chest pain. Transthoracic echocardiography showed a pericardial mass and computed tomographic scanning and transesophageal echocardiography confirmed the presence of a…

Case Report

Deep Fascial Space Infection of the Neck: A Continuing Challenge

We present our clinical experience with two complex cases of deep fascial space infections of the neck. The first was a case of cervical necrotizing fasciitis involving the submental space. The second was an infection beginning at the soft palate and extending to the anterior mediastinum. Both infections emanated from…

Case Report

Thyrotropin-secreting Pituitary Tumor and Hashimoto’s Disease: A Novel Association

A 69-year-old man was referred for elevated thyroid hormone levels. He had no symptoms apart from mild hyperhidrosis and heat intolerance with occasional headaches. Past medical history included a right hemithyroidectomy for a multinodular goiter and Hashimoto's disease. At presentation the patient had a firm, slightly enlarged left thyroid lobe….

Case Report

Necrotizing Fasciitis Caused by Erysipelothrix rhusiopathiae

A woman with diabetes mellitus type 2 had a thigh infection that drained foul-smelling pus. Necrotizing fasciitis was diagnosed surgically and histopathologically, with Erysipelothrix rhusiopathiae being the predominant organism. A pet goldfish might have been the source.

Letter to the Editor

Lessons Learned from the Women’s Health Initiative Study

I read with great interest the views of the Editor1 and those of different specialists regarding the results of Women’s Health Initiative (WHI) study,2 which showed an overall harm of using postmenopausal hormonal replacement therapy (HRT). I would like to comment on the implications of the previous study on the…

Centers of Excellence

Innovations in Medical Education: The Medical College of Georgia School of Medicine Experience

Picture two community-based physicians instructing seven student apprentices in two borrowed rooms in the City Hospital of Augusta, GA (http://www.mcg.edu/history/index.asp). That was the setting when the Georgia state governor signed a charter for a state medical academy in 1828. The original curriculum consisted of a 1-year lecture series. Two more…

Original Article

Georgia Prenatal Care Providers’ Perceptions of Barriers to Sexually Transmitted Disease Screening

Background Evidence suggests that sexually transmitted disease (STD) screening during pregnancy is not optimal. No published studies have systematically examined barriers that hinder routine STD screening. This study examines prenatal care providers’ perceptions about barriers to routine STD screening of pregnant women. Methods Using a conceptual framework, four a priori…

Original Article

Potentially Preventable Care: Ambulatory Care-sensitive Pediatric Hospitalizations in South Carolina in 1998

Objective We examined pediatric hospitalizations to assess personal and community factors affecting potentially preventable ambulatory care-sensitive condition (ACSC) hospitalizations. Methods Data came from the South Carolina 1998 Hospital Inpatient Encounter Database, which yielded 10,156 ACSC discharges among 81,808 pediatric hospitalizations. Analyses were performed at three levels: ACSC as a percentage…

Original Article

Preschool Vision Screening in Primary Care after a Legislative Mandate for Diagnostic Eye Examinations

Background Kentucky legislation now requires that children entering public school receive a diagnostic eye examination. Methods Mail survey of randomly selected office-based primary care pediatricians (PDs, n = 221) and family physicians (FPs, n = 207) in Kentucky to assess the impact of the mandated eye examination. Results The response…

Original Article

Chlamydia Screening in a Metropolitan Atlanta Primary Care Clinic

Background Chlamydia is the most commonly reported infectious disease in the United States, yet many women at risk for chlamydia infection are not being tested. Methods We conducted a chlamydia screening study (Phase I) and retrospective medical chart review (Phase II) of 199 women from 16 to 40 years of…

Original Article

Experience with Necrotizing Fasciitis at a Burn Care Center

Necrotizing fasciitis is a soft tissue infection that causes necrosis of subcutaneous tissue and fascia but usually spares skin and muscle. Management of this condition consists of early diagnosis, broad-spectrum antibiotic coverage, aggressive surgical debridement, wound closure, and intensive supportive care. Mortality estimates reported in the literature have ranged from…

Original Article

Additional Experience with Dexmedetomidine in Pediatric Patients

Purpose This study evaluates the efficacy of dexmedetomidine in clinical scenarios other than sedation during mechanical ventilation. Methods We conducted a retrospective chart review and presentation of case series of children in the pediatric intensive care unit and the postanesthesia care unit who received dexmedetomidine. Results Dexmedetomidine was administered by…

Original Article

Ambulatory Internal Medicine Education: Use of an Urgent Care Center

Background Internal medicine residency programs have increased the time devoted to ambulatory medicine and the range of nonmedical areas in which expertise is expected. Whether existing teaching locations can provide residents with appropriate training in educationally targeted specialty (ETS) conditions (otolaryngology, urology, dermatology, ophthalmology, and orthopedics), is unknown. Methods An…

Case Report

Acute Neutrophilic Meningitis Treated Successfully with Corticosteroids

This report describes a cocaine user who presented with polymorphonuclear pleocytosis in cerebrospinal fluid mimicking bacterial meningitis. Thorough investigation of the cerebrospinal fluid did not reveal evidence of bacteria or fungi. Clinical deterioration was observed in spite of empiric treatment with antibiotics. The patient had a favorable outcome after corticosteroid…

Editorial

Ubi Pus Ibi Evacua: Staphylococcus aureus Pericardial Abscess—One More Dreadful Complication of this Pathogen

Pericardial abscess is an extremely rare complication of Staphylococcus aureus bacteremia, with very few case reports published in the English literature. Delayed diagnosis of this entity may carry severe complications to the patient. The main treatment of a pericardial abscess is percutaneous drainage under echocardiographic or tomographic guidance, or surgical…

Errata

ERRATUM

Miller P. Analysis of 1-year vertebral fracture risk reduction data in treatments for osteoporosis. South Med J 2003; 96: 478–485. On page 484 of the May 2003 issue of Southern Medical Journal, the last sentence of this review article should have read as follows: In post hoc analyses, both alendronate…

Expired CME Article

Severe Acute Respiratory Syndrome

Expired CME Article – Severe Acute Respiratory Syndrome

Letter to the Editor

Quinolone Interactions with Divalent or Trivalent Cations: Have You Checked the Medication Administration Report Lately?

To the Editor: Because of the significant interaction between quinolone antimicrobial agents and several divalent or trivalent cations, 1–4 we recently changed our computer-generated nurses’ medication administration report (MAR) to schedule quinolones automatically 2 hours before products with these cations. Although we had previously included a preprinted note to the…

Letter to the Editor

Lightning Injuries: In Reply

In Reply: My colleagues and I appreciate Dr. Soran’s letter and his comments about our article. 1 We welcome the opportunity to address his suggestion that all lightning strike victims be admitted to the hospital. In doing so, we point out that few case series addressing lightning strikes have been…

Letter to the Editor

Lightning Injuries

To the Editor: Whitcomb et al 1 discussed lightning injuries in a recent case report and review in the Southern Medical Journal. My colleagues and I published an article on the same topic in the International Journal of Clinical Practice in 2001. 2 In our comprehensive review article, we presented…

Letter to the Editor

Two Cases of Spontaneous Epidural Abscess in Patients with Cirrhosis

To the Editor: We read with interest the recent case report by Cross and Howell 1 regarding the association of cirrhosis and spinal epidural abscess (SEA). In the introduction, the authors stated, “To our knowledge, chronic liver disease has not previously been identified as a condition predisposing to epidural abscesses”…

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