Issue - Southern Medical Association

Original Article

Sex Differences in Analgesia: A Randomized Trial of μ versus κ Opioid Agonists

Objectives: We sought to evaluate whether there is a sex difference in the analgesic response to μ versus κ opioids in the management of acute moderate to severe pain of injury in the emergency department. Methods: The study was a randomized, double-blind, clinical trial comparing the prototypical μ-receptor agonist, morphine…

Original Article

Intralesional Interferon-α-2B Injections for the Treatment of Peyronie’s Disease

Background: Intralesional therapies provide an alternative to surgical treatment of Peyronie’s disease (PD). This study examines the efficacy of intraplaque injections of interferon-α-2B (IFN-α-2B) in the treatment of PD. Methods: Twenty-five patients were enrolled in the study with 21 completing the study. The average age of the study participants was…

Review Article

Cardiopathia Fantastica: The Cardiac Variant of Munchausen Syndrome

Munchausen syndrome is a rare condition in which the patient repeatedly seeks medical care for factitious illnesses. Cardiac Munchausen syndrome was first reported in 1953 and later referred to as cardiopathia fantastica. It is characterized by clinical manifestations of acute cardiac disease that are feigned and recurrent. Cardiopathia fantastica can…

Expired CME Credit Submission and Evaluation Form

CME Credit—January 2004 Featured CME Topic: Cardiopathia Fantastica

CME Credit—January 2004 Featured CME Topic: Cardiopathia Fantastica: Expired CME Credit Submission and Evaluation Form

Review Article

Vasectomy: A “Seminal” Analysis

Vasectomy is one of the most reliable and cost-effective permanent methods of contraception. Despite its popularity, certain issues pertaining to the procedure remain unresolved. Appropriate selection of candidates for vasectomy requires thorough counseling and screening, though a foolproof method of eliminating dissatisfaction and regret remains a mystery. Debate continues over…

Review Article

Cerebellar Involvement in Legionellosis

The involvement of the cerebellum in Legionnaires’ disease has been noted in occasional case reports, but there have been no reviews on this subject to date. We report a previously healthy patient who contracted Legionella pneumonia and developed profound cerebellar dysfunction during his illness. He was treated with antibiotics with…

Case Report

Medication-associated Depersonalization Symptoms: Report of Transient Depersonalization Symptoms Induced by Minocycline

Patients with depersonalization disorder experience episodes in which they have a feeling of detachment from themselves. Symptoms of depersonalization may occur in individuals who have other mental disorders, or who have various medical conditions, or who have taken certain medications. A woman developed depersonalization symptoms after initiation of minocycline therapy….

Case Report

Septic Arthritis of the Ankle due to Salmonella enteritidis: A Case Report

Salmonella septic arthritis in healthy individuals is a rare phenomenon in the United States. This case report chronicles the clinical course of a 41-year-old male farmworker who presented with a 3-week history of fever, chills, night sweats with pain, and swelling and redness of his left ankle. He had an…

Case Report

Pigmented Villonodular Synovitis of the Knee in a 9-Year-Old Child

This report describes a 9-year-old girl with pigmented villonodular synovitis of the right knee. She presented with a chronic bloody effusion of the knee. The diagnosis of pigmented villonodular synovitis was suggested by the findings on magnetic resonance imaging and confirmed at the time of arthroscopic synovectomy. This report emphasizes…

Case Report

Neck Pain: Common Complaint, Uncommon Diagnosis—Symptomatic Clival Chordoma

Patients presenting with neck complaints, such as pain or stiffness, are not uncommon in the Emergency Department. Complaints of neck instability, however, are unusual. We report the case of a 30-year-old woman who presented with multiple neck complaints that included having a “wobbly” sensation of her neck on flexion, feeling…

Case Report

Risk-Factor Profile in Severe, Generalized, Obliterating Vascular Disease

A 74-year-old woman had a history over 25 years of endarterectomy of both renal arteries, iliac venous thrombosis, pulmonary embolism, left internal carotid artery endarterectomy, coronary angioplasty, aortocoronary bypass grafting, occlusion of the right axillary artery, lower-limb claudication due to common iliac artery aneurysm, external iliac artery stenosis, multiple femoral…

Case Report

Cytomegalovirus Enteritis in Common Variable Immunodeficiency

A woman with previously undiagnosed common variable immunodeficiency presented with diarrhea and volume depletion. Biopsies from upper and lower endoscopy revealed atrophic gastritis, villous atrophy, and an inflammatory bowel disease-like chronic colitis, with absence of plasma cells in all sites. Cytomegalovirus inclusions were demonstrated in the colon and small bowel…



SMA Leader Earns Prestigious Duke University Medical Center Award

Case Report

Hyalinizing Spitz Nevus: Spindle and Epithelioid Cell Nevus with Paucicellular Collagenous Stroma

Hyalinizing spindle and epithelioid cell nevus (Spitz nevus) is an uncommon melanocytic lesion. The histologic features of this benign tumor can mimic those of certain benign (dermatofibroma and desmoplastic cellular blue nevus) and malignant (metastatic carcinoma and malignant melanoma) neoplasms. We report a woman with a hyalinizing Spitz nevus and…

Original Article

Medical Comorbidity in Black and White Patients with Alzheimer’s Disease

Background: Little is known about co-medical illnesses in black and white patients with probable Alzheimer’s disease (AD). Methods: To address this question, we used two methods. In the first (Group I), black and white probable AD patients were matched on age at presentation to the clinic, age of onset of…

Original Article

Surgical Treatment of Achalasia in the 21st Century

Background: Achalasia is a primary motility disorder of the esophagus characterized by poor mid-esophageal motility and failure of the lower esophageal sphincter to properly relax. The optimal treatment of the disease would improve esophageal peristalsis and promote lower esophageal sphincter relaxation. Currently, such therapy is not possible, so treatment of…

Original Article

Tonsillectomy Using the Colorado Microdissection Needle: A Prospective Series and Comparative Technique Review

Tonsillectomy remains one of the most common surgical procedures performed worldwide. Recent advancements in equipment technology have ushered in several new tonsillectomy techniques. Among these is the Colorado tip electromicrodissection needle. In this report, we describe the technical aspects of this modality and report our results in a prospective study…

Original Article

Four-cut Sinus Computed Tomographic Scanning in Screening for Sinus Disease

Objective: We sought to calculate the sensitivity, specificity, negative predictive value, and positive predictive value of a limited sinus computed tomographic (CT) scan for sinus disease. Methods: We conducted a retrospective case series. Inclusion criteria included a sinus CT scan obtained between April 1999 and November 2000. From the complete…

Original Article

Changes in Transcutaneous Carbon Dioxide, Oxygen Saturation, and Respiratory Rate after Interscalene Block

Background: We used transcutaneous (TC) carbon dioxide (CO2) monitoring to prospectively evaluate changes in respiratory status after interscalene anesthesia in 45 adults (40 successful and 5 unsuccessful blocks). Methods: TC-CO2 oxygen saturation and respiratory rate were recorded every minute for 5 minutes before block and every 2 minutes for a…

Original Article

Handgrip Strength, Pulmonary Function Tests, and Pulmonary Muscle Strength in Fibromyalgia Syndrome: Is There Any Relationship?

Objective: It has been reported that patients with fibromyalgia syndrome (FMS) have lower maximal respiratory pressures than healthy subjects, indicating reduced pulmonary muscle strength. It has also been reported that patients with FMS have reduced grip strength. In this study, we aimed to examine the possible relationship between handgrip strength…

Original Article

Prevalence of Occult Celiac Disease in Patients with Iron-Deficiency Anemia: A Prospective Study

Background: Occult celiac disease has been reported in 0 to 6% of adults presenting with iron-deficiency anemia. Most prior studies have been retrospective or screened only a selected population of patients with small bowel biopsies. To more accurately define the true prevalence of this disorder in patients presenting with iron-deficiency…

Case Report

Capgras Syndrome Related to Diazepam Treatment

Capgras syndrome, the delusion that identical-appearing impostors have replaced familiar people, is an unusual phenomenon usually seen in schizophrenia or dementia. We recently cared for a 78 year old man who seemed to develop Capgras syndrome as an adverse reaction to diazepam. An iatrogenic cause should be considered in the…

Case Report

Celiac Disease as a Manifestation of Munchausen by Proxy

In typical cases of Munchausen by proxy maltreatment, a mother feigns or produces illness in her child. Her primary goal is to accrue emotional gratification, and no mental disorder better accounts for the behavior. We present the first published case in which the principal manufactured ailment was celiac sprue. In…

Case Report

Septic Arthritis Caused by Chryseobacterium meningosepticum in an Elbow Joint Prosthesis

Chryseobacterium meningosepticum is a Gram-negative bacillus historically associated with meningitis and sepsis in premature neonates. Clinicians should suspect this organism when Gram-negative bacilli are seen on Gram-stain and culture, particularly in immunocompromised patients, and in cases of disrupted host tissue integrity. We report the first case of septic arthritis due…

Case Report

Esophageal Foreign Body Aspiration Presenting as Asthma in the Pediatric Patient

This report describes three cases of foreign body ingestion incorrectly diagnosed as asthma and/or upper respiratory tract infection. These cases demonstrate the need for further clinical investigations in any child who does not improve with adequate therapy. Many of our patients had symptoms of asthma and/or respiratory tract infection for…

Expired CME Article

Cardiopathia Fantastica

Cardiopathia Fantastica: Expired CME Article


Alzheimer’s Disease: To Tell or Not to Tell

A sentence stood out in the letter: “I will not allow you to examine me unless you promise not to, under any circumstance, disclose my diagnosis without my prior consent.” The author of the letter wanted to find out whether our Clinic could help her. The letter was succinct: only…

Book Review

The Behavioral Sciences and Health Care

As the practice of medicine becomes more technical, specialized, and firmly anchored in evidence-based data, clinicians may be tempted to concentrate on diseased organs and neglect the patient as an individual who interacts with a community. Often the patient’s psychosocioeconomic background modulates the predisposition to diseases, the clinical presentation, and…

Book Review

Glaucoma: A Guide for Patients—An Introduction for Care-Providers: A Quick Reference

Glaucoma is well recognized but often misunderstood by the medical and lay communities. The National Eye Institute estimates that 2.2 million Americans older than 40 years of age have been diagnosed with glaucoma and that another 2 million do not know that they have the disease. This underscores a major…

Book Review

Cover Your Assets: Lawsuit Protection—How to Safeguard Yourself, Your Family, and Your Business in the Litigation Jungle

It is unfortunate that in American society, more than 90 million lawsuits are filed each year. Regrettably, many of these lawsuits are not the result of the individual’s actions but are filed as a result of acts of omission because the individual who is sued did not take appropriate actions…

Book Review


There is good news and bad news as far as human immunodeficiency virus (HIV) infection is concerned. The bad news is that there is an increase in the number of patients with HIV infection. The good news is that for many patients, HIV infection is now a treatable chronic medical…

Book Review

In the Wake of Terror: Medicine and Morality in a Time of Crisis

The events triggered by the September 11, 2001, destruction of the World Trade Center in New York City have had profound effects on the concept of the individual’s freedom and the relationship between the individual and society. Independence, liberty, freedom of belief and expression, and freedom of choice were held…

Book Review

Practice without Fear: A Physician’s Guide to Asset Protection and Liability Reduction

In the present socioeconomic climate, physicians may become the target of lawsuits and may find that jury verdicts often far exceed the lifetime earnings of the entire practice group. Excessive malpractice claims and exorbitant insurance premiums have forced many physicians to leave their favorite state and to either change specialty…

Book Review

Psychoneuroendocrinology: The Scientific Basis of Clinical Practice

The disciplines of endocrinology and psychiatry have a strong historical link. The description of Myxedema madness by Richard Asher is one striking example. Thyroid function tests are routinely ordered in patients admitted to psychiatry services. The book Psychoneuroendocrinology by Drs. Wolkowitz and Rothschild attempts to bridge the disciplines of neuroendocrinology…

Book Review

Cross-Cultural Medicine

The diversity of the U.S. population is expected to increase significantly within the next few decades. It is projected that by 2050, compared with the year 2000, the white, non-Hispanic population will decrease from 71.8 to 52.8%, that the Hispanic population will increase from 11.4 to 24.5%, and that the…

Book Review

Atlas of the Musculoskeletal Examination

This 128-page book truly fulfills the expectations of its title. There are more pictures than text, and the photographs are mostly self-explanatory. The text merely emphasizes specific points. The book is divided into four chapters: general principles, upper extremities, spine and gait, and lower extremities. In addition, a section on…

Book Review

Office Practice of Medicine

Clinicians who provide primary care are expected to be knowledgeable about a wide variety of medical problems and to make diagnostic and therapeutic decisions within a relatively short period of time. During the past few decades, the corpus of medical knowledge has expanded to such a degree that it is…

Book Review

The Quotable Osler

The practice of medicine has changed significantly during the past few decades. The enormous increase in the corpus of knowledge makes it virtually impossible for any one physician to be fully knowledgeable about all aspects of one’s primary specialty. Objective, sophisticated tests with high specificity and high sensitivity relentlessly replace,…


Official Positions of the International Society for Clinical Densitometry

With the increasing use of bone density testing for diagnosing osteoporosis and establishing fracture risk, inconsistencies have arisen in the way in which bone densitometry is performed and the results interpreted. Differences in indications for bone mass testing, acquisition techniques, interpretation of results for different ages, genders, and ethnicity, quality…