Issue - Southern Medical Association

Expired CME Article

Diagnosis and Management of Migraine Headaches

Migraine headaches afflict approximately 6% of men and 18% of women in the United States, and cost billions of dollars each year in lost productivity, absenteeism, and direct medical expenditures. Despite its prevalence and the availability of therapeutic options, many patients do not seek treatment, and among those who do,…

Expired CME Credit Submission and Evaluation Form

CME Credit—November 2004 Featured CME Topic: Migraine Headaches

Expired CME Credit Submission and Evaluation Form – Migraine Headaches

Review Article

Type 2 Diabetes: Epidemiologic Trends, Evolving Pathogenic Concepts, and Recent Changes in Therapeutic Approach

The prevalence of type 2 diabetes has assumed epidemic dimensions. Children are now vulnerable to a disease that was once the exclusive domain of adulthood. Increased body weight and sedentary behavior accelerate insulin resistance and β-cell dysfunction, leading to the clinical manifestation of hyperglycemia. Other cardiovascular risk factors tend to…

Review Article

Achieving Glycemic Control in Type 2 Diabetes: A Practical Guide for Clinicians on Oral Hypoglycemics

Type 2 diabetes mellitus has reached epidemic proportions in the United States. Cardiovascular morbidity and mortality are particularly high in this patient population. Improved glucose control, especially early in the course of diabetes, can slow or prevent complications, preserve β-cell function, and improve long-term outcomes. Within the last decade, new…

Review Article

The Impact of Global Warming on Health and Mortality

Initial concern about the possible effects of global warming on infections has declined with the realization that the spread of tropical diseases is likely to be limited and controllable. However, the direct effects of heat already cause substantial numbers of deaths among vulnerable people in the summer. Action to prevent…

Review Article

Fibromatosis: The Breast Cancer Imitator

Fibromatosis of the breast is a rare benign tumor that should be included in the differential diagnosis for breast cancer. It is usually indistinguishable from malignancy on ultrasound, mammography, physical examination, and on gross evaluation. Distinction is easily made by histologic findings. This benign tumor does not metastasize, but is…

Case Report

Right Arm Pyomyositis and Necrotizing Fasciitis Complicated With Subcutaneous Emphysema and Pneumomediastinum in a Patient With Diabetes Mellitus and Iatrogenic Cushing Syndrome

We report a case of subcutaneous emphysema and pneumomediastinum secondary to pyomyositis and necrotizing fasciitis over the right arm of a woman with underlying diabetes mellitus and iatrogenic Cushing syndrome. Gas produced by the culprit pathogen extensively dissected the subcutaneous fat and fascia of the patient’s right arm and distantly…

Case Report

Diagnostic and Therapeutic Difficulties in Retroperitoneal Abscess

Abscesses developing within the retroperitoneal spaces are complicated and serious infections. These abscesses present insidiously, leading to considerable mortality and morbidity. A high clinical suspicion can help diagnose and treat this potentially fatal illness. Computed axial tomography is the best diagnostic modality for retroperitoneal abscess. Computed tomographic scan is useful,…

Case Report

Complementary Role of Positron Emission Tomography in Merkel Cell Carcinoma

Merkel cell carcinoma is a rare type of neuroendocrine tumor of the skin with approximately 470 documented new cases annually in the United States. These tumors have high metastatic and recurrence rates, making them aggressive and difficult to treat. Diagnostic workup usually includes computed tomography, magnetic resonance imaging, and scintigraphy…

Case Report

Spontaneous Bacterial Peritonitis with Pasteurella Multocida in Cirrhosis: Case Report and Review of Literature

Most Pasteurella multocida human infections involve skin and soft tissues and invariably develop after a bite or a scratch from a dog or a cat. However, other infections with this organism occur infrequently. Enteric microorganisms are the common cause of spontaneous bacterial peritonitis (SBP). We report a case of SBP…

Case Report

Toxic Epidermal Necrolysis as a Complication of Treatment with Voriconazole

An 81-year-old female received voriconazole in a 7-day treatment course for a symptomatic Candida krusei urinary tract infection. Four days after the last dose, she developed toxic epidermal necrolysis. She was treated with intravenous immunoglobulin, and her symptoms promptly resolved. Key Points * The most common mucosal membranes involved in…

Case Report

Cognitive Decline in an Elderly Hospitalized Patient With Primary Leptomeningeal Melanomatosis

Delirium is one of the most common disorders in hospitalized patients. The authors present the case of an elderly male patient with postoperative cognitive decline that did not resolve with the conventional treatment. The diagnosis was only established on autopsy. A 75-year-old man was evaluated after a fall. Initial evaluation…

Case Report

Painful Intramuscular Lipoma of the Thigh

Intramuscular lipomas of the extremities are most often found in the thighs and shoulders. They are usually painless, but described herein is a case of extreme leg pain that was relieved when a lipoma in the thigh was identified and surgically resected. Key Points * Deep lipomas may be intermuscular…

Case Report

Acute Respiratory Distress Caused by Massive Thymolipoma

The authors present the case of a 40-year-old female with a massive anterior mediastinal tumor who presented with acute respiratory distress. She required emergent intubation and ventilatory support for respiratory compromise caused by lung compression. Preoperative computed tomographic scan results suggested a mediastinal lipomatous mass. Resection of the tumor resulted…

Case Report

Successful Treatment of Head and Neck Cancer Involving the Prevertebral Fascia

Chemotherapy with radiation has become more popular than radiotherapy alone for patients with locally advanced head and neck cancer because of the successful results associated with it. We report the case of a 67-year-old man with hypopharyngeal cancer invading the prevertebral fascia who became free of disease after chemoradiation. This…

Case Report

Unilateral Breast Enlargement as a Presenting Feature of Small Cell Carcinoma of the Lung

Breast enlargement associated with carcinoma of the lung is most commonly a paraneoplastic manifestation of non-small cell carcinoma. Hormonally mediated proliferation of the glandular component of the breast leads to unilateral or bilateral enlargement. This report describes a patient with small cell carcinoma of the lung who presented with unilateral…

Case Report

Multiple Endocrine Neoplasia Type 2 Syndrome Presenting With Bowel Obstruction Caused by Intestinal Neuroma: Case Report

We present the case of a 23-year-old male with a history since early childhood of lip and tongue mucosal neuromas. At the age of 19, he was diagnosed with both medullary thyroid carcinoma and pheochromocytoma within 1 year. These findings, with his marfanoid habitus, led to the diagnosis of multiple…

Case Report

Synchronous Tumors: Hodgkin Disease Presenting in Mesenteric Lymph Nodes from a Right Hemicolectomy for Colon Carcinoma

The authors report the case of a 56-year-old male diagnosed with Hodgkin disease involving the mesenteric lymph nodes recovered from a right hemicolectomy for colonic adenocarcinoma. The liver and bone marrow were also involved by Hodgkin disease. Synchronous colonic carcinoma and lymphoma in the same patient is a rare occurrence,…

Letter to the Editor

Environmental Tobacco Smoke and Children’s Use of Health Services

The health hazards of environmental tobacco smoke (ETS) exposure are well documented.1,2 However, there is a paucity of information on whether the adverse health effects of ETS exposure necessarily translate into increased use of health services among young children. We prospectively reviewed our experience of patients attending a private pediatric…

Original Article

Diabetes on a Cardiovascular Ward: Adherence to Current Recommendations

Objectives: Improving diabetes and blood pressure control decreases the incidence and progression of microvascular disease. Likewise, screening for microvascular complications is beneficial in the early detection and treatment of these disorders. However, adherence to practice guidelines for screening and treatment in patients with diabetes is suboptimal. This study describes a…

Original Article

Meckel Diverticulum: Ten-year Experience in Adults

Objectives: Meckel diverticulum, a congenital gastrointestinal anomaly, is well studied in pediatrics, but less so in the adult population. At the Charleston Area Medical Center (CAMC), in addition to the removal of Meckel diverticula in symptomatic patients, diverticula are commonly removed when found incidentally during other procedures. We present our…

Original Article

C1-C2 Transarticular Screw Fixation for Atlantoaxial Instability

Objectives: The atlantoaxial segment of the cervical spine is commonly destabilized in a variety of disorders. Transarticular screw fixation of the C1-C2 joint has been proposed as a biomechanically superior therapeutic modality. The authors present their experience with this technique. Methods: A retrospective analysis of 23 patients treated with this…

Original Article

Screening for Domestic Violence: Practice Patterns, Knowledge, and Attitudes of Physicians in Arizona

Objectives: Victims of domestic violence presenting for health care are frequently referred to medical specialists, but little is known about domestic violence screening among specialists. The aim of this study was to evaluate attitudes and behaviors concerning domestic violence of all physicians in Arizona. Methods: A cross-sectional survey of 2,244…

Original Article

Treatable Potential Cardiac Sources of Embolism in Patients with Cerebral Ischemic Events: A Selective Transesophageal Echocardiographic Study

Objectives: To characterize cardiac sources of emboli detected by transesophageal echocardiography (TEE) in patients without recognizable cause of transient ischemic attack (TIA) and/or ischemic stroke and TIA. Methods: We examined a prospective registry that included all patients with TIA and/or stroke evaluated by TEE between July 2000 and August 2001…

Original Article

Ice Storm-related Carbon Monoxide Poisonings in North Carolina: A Reminder

Severe winter weather, such as ice storms, that results in loss of electrical power, is frequently mentioned as a contributing factor in acute carbon monoxide (CO) poisoning. However, in our literature review, such events are infrequently reported. This article reports on such an event in which more than 200 patients…

Expired CME Article

Migraine Headaches

Expired CME Article – Migraine Headaches

Editorial

Meckel Diverticulum: “Too” Much Chatter?

Although an uncommon intraoperative finding, Meckel diverticulum garners substantial attention in the medical literature. A quick PubMed search for Meckel diverticulum yields nearly 3,000 entries since 1951 for the disease governed by the “rule of twos.” We remember Meckel diverticulum for its association with the number two: 2% of the…

Editorial

Stabilization of the C1-C2 Articulation

When assessing a new technique or a modification of an existing one, surgeons very rarely have the luxury of high level randomized prospective studies on which to base their decisions. This is certainly the case when considering the surgical options for stabilization of the C1-2 articulation.

Editorial

Is the Future Bright for Diabetes?

There is no doubt that there is an epidemic of diabetes raging in the United States. Type 2 diabetes is characterized by decreased sensitivity to insulin action in muscle, liver, and fat cells, as well as a progressive decline in pancreatic insulin production. The precise causes of insulin resistance and…

Original Article

Emergency Room Neurosurgery: Modern Time Errors

The young neurosurgery resident was heading for another on-call in a large tertiary medical center. His duties for the next 12 consecutive hours would include, besides caring for the neurosurgical floor and neurologic intensive care unit patients, numerous emergency room consultations. No easy access to primary health care was afforded…

Book Review

Violence Against Women: A Physician’s Guide to Identification and Management

Violence against women occurs frequently and is a sentinel event. Ten to fifteen percent, or 6 million women in the United States experience either physical or sexual assault annually, and the lifetime rate is 51% nationally, significantly higher than other developed countries. Women are far more likely to experience violence…

Book Review

Books Received

Books Received

Book Review

Medicinal and Aromatic Plants of Indian Ocean Islands

The relentless march of the “civilized” world is making irreversible changes to the delicate equilibrium that allowed the proliferation of biodiversity. Even remote islands are not spared. For instance, the present day flora of some islands in the Indian Ocean represents a fraction of the number of species in existence…

Letter to the Editor

Multi-organ Failure Associated with Acute Parvovirus Infection and Exercise in a Patient with Sickle Beta Thalassemia

Multi-organ failure is a rare and life-threatening complication of sickle cell anemia and sickle thalassemia.1–3 To our knowledge, this is the fourth reported case of multi-organ failure associated with sickle thalassemia.1 Patients present with abrupt, precipitous drops in hemoglobin and platelet counts, fever, and respiratory and liver failure.

Letter to the Editor

Acute Bacterial Parotitis due to Methicillin-resistant Staphylococcus aureus

Acute bacterial parotitis (ABP) is an inflammation of the parotid gland that results from stasis of salivary flow and retrograde bacterial contamination of the Stenson duct. Despite some case reports of Gram-negative1 and anaerobic bacteria,2 Staphylococcus aureus remains the most common pathogen of ABP.3 We report two cases in which…

Letter to the Editor

“SIDS” and Its Preventable Risk Factors: Do Parents Know?

Sudden infant death syndrome (SIDS) is the leading cause of death in infants more than 1 month old. Infant sleeping position has been strongly linked with SIDS.1,2 Despite the impressive decline in the incidence of SIDS since the nationwide “Back to Sleep” campaigns, and the recommendation to avoid the prone…

Letter to the Editor

Primary Aldosteronism in Type 1 Diabetes Mellitus

Alterations in the renin-angiotensin-aldosterone system have been documented in patients with diabetes mellitus. Their blood potassium levels are usually high or in normal ranges. The syndrome of hyporeninemic hypoaldosteronism or renal tubular acidosis (RTA) type IV is most frequently seen in diabetes mellitus, usually with concomitant nephropathy. It is characterized…

Letter to the Editor

Tadalafil and Palpebral Edema

Tadalafil is a selective and reversible type 5 phosphodiesterase (5PDE) inhibitor. Therefore, its effect is greater on 5PDE than on other phosphodiesterases. It is indicated in the treatment of erectile dysfunction but still requires sexual stimulation to be effective. Tadalafil has a longer elimination half-life than sildenafil (17.5 versus 3.7…

Letter to the Editor

Women’s Health and Hormone Replacement Therapy

Hormone therapy is one of the greatest advances in women’s health over the past 100 years.

Letter to the Editor

Hypoglycemia Unawareness and Type 1 Diabetes

Hypoglycemia is a major limiting factor in treating patients with type 1 diabetes and may have serious, life-threatening consequences. Patients with repeated hypoglycemic episodes can have hypoglycemia unawareness, a condition characterized by a progressive loss of the symptoms associated with the autonomic response to hypoglycemia, for example, sweating, tremor, anxiety,…

Medical Webwatch

Medical Webwatch

We are pleased to introduce another new feature to the Southern Medical Journal—Medical Webwatch. In an effort to better serve our readers, each issue will include a listing of recommended medical- and health-related websites that have been carefully examined and critiqued. We hope that the websites analyzed in this feature…

Acknowledgment

The Patient’s Page

We’ve all heard that the elderly are vulnerable to cold weather, but do you know why? Almost all cold-related deaths are due to common illnesses which are increased by cold weather, such as blood clots and respiratory diseases. So, make sure you stay warm during the winter months. Wear layers,…