Background: Elevated concentration of serum homocysteine contributes to thrombosis, a frequent event in patients with sickle cell anemia. We aimed to test whether children with sickle cell anemia have elevated concentrations of serum homocysteine with diminished levels of folate or B vitamins from accelerated blood cell turnover. Methods: We conducted…
Postpartum depression (PPD) occurs more commonly in U.S. women than most physicians realize. PPD is present in at least 10% and up to 20% of women in the United States within the first 6 months of delivery. The rate may be 25% or higher in women with a history of…
Expired CME Credit Submission and Evaluation Form – Postpartum Depression
Vibrio vulnificus is a Gram-negative, motile, curved bacillus of the family Vibrionaceae that is a rare cause of gastroenteritis, septicemia, and wound infections in humans. V. vulnificus is halophilic, flourishes in warm temperatures, and is part of the bacterial flora of the marine environment. The location of our health care…
The Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon disorder characterized by uveitis and neurologic and cutaneous abnormalities, including tinnitus, vertigo, headache, meningoencephalitis, vitiligo, alopecia, and poliosis. The VKH syndrome has been reported to occur in association with other autoimmune disorders. We report a case of a patient with severe ulcerative colitis…
The usual manifestation of histoplasmosis is in the form of respiratory illness. We report the case of a 67-year-old man who presented with chronic diarrhea and did not respond to the conventional treatment, including that for Clostridium difficile. He was found to have isolated colonic histoplasmosis infection, which was treated…
We present the case of an elderly patient with abdominal pain, weight loss, and subjective fever in whom a magnetic resonance imaging study revealed a perihepatic abscess without invasion. After drainage, anaerobic cultures yielded Actinomycosis israelii. We discuss Actinomycosis species, with an emphasis on its pathology and multiple presentations.
Methimazole is a widely used and generally well-tolerated antithyroid agent. A 43-year-old woman had severe jaundice and itching 1 month after receiving methimazole (10 mg tid) and propranolol (20 mg tid) for treatment of hyperthyroidism. The patient continued treatment for another 4 days after the appearance of jaundice until she…
Spontaneous cholecystocutaneous fistula is rarely observed today because of the early diagnosis and management made possible by ultrasonography, broad-spectrum antibiotics, and effective surgical management of biliary tract disease. We present a case of spontaneous cholecystocutaneous fistula due to cholecystitis.
The standard treatment for gastrointestinal perforation secondary to an endoscopic procedure is surgical repair. Some authors advocate a conservative medical management. However, this approach may be associated with increased morbidity and mortality. We describe a case of duodenal perforation secondary to snare polypectomy that was successfully treated with endoclipping. Additional…
We have found that nanobacteria, recently discovered Gram-negative atypical bacteria, can cause local calciphylaxis on the mitral valve in a setting of high-calcium X phosphorous product in the blood. We present the case of a 33-year-old man with diabetic renal failure on continuous ambulatory peritoneal dialysis who died as a…
Central retinal vein occlusion has not been reported previously in patients with sickle cell anemia. We describe the case of a 31-year-old man with sickle cell anemia who developed this complication. The search for risk factors for central retinal vein occlusion in this young patient revealed protein S deficiency and…
This case report describes a unique transmission of Vibrio vulnificus infection. A 38-year-old woman with recurrent cellulitis and chronic ulcer on her leg developed necrotizing cellulitis and sepsis caused by V. vulnificus. Meticulous history investigation revealed the link to contaminated fish blood that had been applied on the ulcer by…
Electroconvulsive therapy (ECT)-related cardiac complications have been documented extensively in the literature and include circulatory collapse, arrhythmias, hypertensive responses, transient left ventricular dysfunction, and transient ST abnormalities. The rate of ECT-induced cardiac complications has been estimated to be as high as 28%;1 however, many reports either do not delineate the…
Background: Although causes for ischemic colitis have been identified, many cases are deemed idiopathic. Some reports suggest an association between ischemic colitis and coagulation disorders. Our purpose was to explore the relationship of ischemic colitis and clotting abnormalities. Methods: Eighteen patients consented to undergo a hypercoagulability evaluation. Tests included protein…
Objective: Idiopathic slow-transit constipation (STC) has been suggested to be a pangastrointestinal motility disorder. We investigated scintigraphically whether motility in the gallbladder and stomach was impaired in slow-transit constipation. Methods: Twenty-four patients with STC were studied. Colon transit time, gallbladder motility, and solid-phase gastric emptying were measured by scintigraphy. Results:…
Background: Opioid therapy plays a key role in the management of chronic pain. Constipation is one of the more frequently occurring adverse effects associated with opioid therapy. Methods: A retrospective cohort design study was conducted to determine the incidence of constipation in chronic pain patients who received three different long-acting…
Objectives: The role of empiric esophageal dilation in improving esophageal dysphagia with nonobstructive esophageal lumen is not clear. We wished to determine the impact of esophageal dilation with a large-diameter dilator on dysphagia and quality of life in such patients. We also assessed relative prevalence of esophageal versus oropharyngeal dysphagia…
Background: Diabetes is the seventh leading cause of death among South Carolinians. The benefit of physical activity on the control and prevention of diabetes has been established. This study determined the prevalence of leisure-time physical activity among South Carolinians with and without diabetes and compared the physical activity of those…
Background: The success with which primary care physicians are able to meet American Diabetes Association (ADA) clinical goals is unknown. Methods: Charts of 218 randomly sampled type 2 diabetic patients were abstracted to assess the attainment of six ADA treatment goals and receipt of four ADA-recommended health services. Results: The…
A case of intestinal pseudo-obstruction as a presenting manifestation of systemic lupus erythematosus is presented. Systemic lupus erythematosus is an autoimmune disease with a wide spectrum of unpredictable multisystemic presentations. A case of systemic lupus erythematosus that was diagnosed in a patient whose initial presentation for the disease was acute…
A 64-year-old nondiabetic woman presented with spells of lightheadedness and diaphoresis associated with lethargy and hunger of 2 weeks’ duration. Physical examination was unremarkable; however, her fasting plasma glucose was 66 mg/dl, with concurrent plasma insulin of 171 μIU/ml (normal, 5–27 μIU/ml). Her C-peptide and proinsulin levels were elevated, with…
V ibrio vulnificus accounts for approximately 95% of all deaths associated with seafood consumption in the United States. The organism was first reported as a cause of human illness in 1979. 1 It is ubiquitous in marine bacterial flora along the Gulf of Mexico and the Atlantic and Pacific coasts….
Mr. John Sneed was only 62, but appeared much older. I thought he looked about 75 years old. He was neatly dressed: a well-pressed, dark blue pin-striped suit, shining black shoes, a white shirt, an impeccable tie knot, and gold cufflinks. He was wearing bifocal glasses and must have shaved…
The cost of managing chronic ulcers, both venous leg and decubiti (sacral pressure), was reviewed using 36 randomized, controlled studies with a focus on saline, hydrocolloid, and a human skin construct. When one includes the labor intensiveness of dressing changes three to four times per day, the application of hydrocolloid…
Morbidity and mortality associated with human immunodeficiency virus (HIV) have decreased with the administration of nucleoside reverse transcriptase inhibitors (NRTIs) in the setting of highly active antiretroviral therapy (HAART). However, the use of NRTIs has been increasingly recognized as a cause of lactic acidosis. We report a case of fatal…
Cyclooxygenase-2 (COX-2) inhibitors are a new class of nonsteroidal anti-inflammatory drugs (NSAIDs) with a reported benefit of less gastric and duodenal ulceration. Nevertheless, it has been shown that COX-2 inhibitors are not completely “ulcer-proof.”1 Whereas the gastrointestinal side effects of NSAIDs are a matter of concern and interest, the cardiovascular…
In their article outlining potential consequences of postpartum hemodynamics in mitral insufficiency, Khanlou et al 1 rightly underscored the importance of puerperal increases in systemic vascular resistance (SVR). Their patient experienced difficulties on postpartum Day 7, including an increase in SVR associated with increased mitral valve regurgitation, left atrial enlargement,…
Do you know why I love reading Southern Medical Journal month after month?Where else would you read in the past few months a mystery uncovered by a sleuth masquerading as a medical doctor? 1 …
Essinger 1 reported that three primary factors influence the attitudes of Tennessee physicians toward euthanasia and assisted death: ethics, religion, and the role of the physician in relieving pain and suffering. Those physicians with strong self-reported theistic religious values were less approving of euthanasia or assisted death than were those…
Our article in the July 2003 issue of Southern Medical Journal1 discussed the advantages of orally disintegrating olanzapine for the treatment of behavioral disturbances associated with dementia. On the basis of information available at that time, we noted that orally disintegrating olanzapine does not have a faster onset of action…
Thymic carcinoma is a rare malignancy of the thymus gland accounting for less than 0.06% of thymic neoplasms. As opposed to the more common and relatively benign thymoma, it is characterized by an aggressive course and a poor prognosis. 1 We describe a case of lymphoepithelioma-like thymic carcinoma that presented…
Three factors predispose patients to thrombosis—stasis, hypercoagulability, and vessel wall injury—which have commonly been termed Virchow’s triad. However, this is not what Rudolf Virchow originally described.
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