Issue - Southern Medical Association

Original Article

Concentrations of B Vitamins and Homocysteine in Children with Sickle Cell Anemia

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…

Expired CME Article

A Review of Postpartum Depression for the Primary Care Physician

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

CME Credit—February 2004 CME Topic: Postpartum Depression

Expired CME Credit Submission and Evaluation Form – Postpartum Depression

Review Article

Varied Clinical Presentations of Vibrio vulnificus Infections: A Report of Four Unusual Cases and Review of the Literature

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…

Case Report

Vogt-Koyanagi-Harada Syndrome and Ulcerative Colitis

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…

Case Report

Isolated Gastrointestinal Histoplasmosis: Case Report and Review of the Literature

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…

Case Report

Actinomycotic Tumor of the Abdominal Wall

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.

Case Report

Methimazole-induced Cholestatic Jaundice

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…

Case Report

Spontaneous Cholecystocutaneous Fistula

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.

Case Report

Endoscopic Treatment of Duodenal Perforation Using a Clipping Device: Case Report and Review of the Literature

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…

Case Report

Nanobacteria-caused Mitral Valve Calciphylaxis in a Man with Diabetic Renal Failure

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…

Case Report

Central Retinal Vein Occlusion in Sickle Cell Disease

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…

Case Report

A “Fishy Remedy”: An Unusual Transmission of Vibrio vulnificus Infection

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…

Letter to the Editor

Electroconvulsive Therapy-associated Acute Coronary Syndrome in the Absence of Coronary Artery Disease

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…

Original Article

Ischemic Colitis Revisited: A Prospective Study Identifying Hypercoagulability as a Risk Factor

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…

Original Article

Gallbladder and Gastric Motility in Patients with Idiopathic Slow-transit Constipation

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:…

Original Article

Incidence of Constipation Associated with Long-acting Opioid Therapy: A Comparative Study

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…

Original Article

Effectiveness of Esophageal Dilation in Relieving Nonobstructive Esophageal Dysphagia and Improving Quality of Life

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…

Original Article

The Prevalence of Leisure-Time Physical Activity Among Diabetics in South Carolina

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…

Original Article

Prevalence of Patients with Type 2 Diabetes Mellitus Reaching the American Diabetes Association’s Target Guidelines in a University Primary Care Setting

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…

Case Report

Intestinal Pseudo-obstruction as a Presenting Manifestation of Systemic Lupus Erythematosus: Case Report and Review of the Literature

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…

Case Report

Metastatic Insulinoma: Case Report and Review of the Literature

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…

Expired CME Article

Postpartum Depression

Postpartum Depression – Expired CME Article

Editorial

Vibrio vulnificus Infection: Epidemiology, Clinical Presentations, and Prevention

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….

Editorial

The Many Faces of Depression

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…

Original Article

Unexpected Economics of Ulcer Care Protocols

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…

Letter to the Editor

Lactic Acidosis During Nucleoside Antiretroviral HIV Therapy

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…

Letter to the Editor

Side Effects of Conventional Nonsteroidal Anti-inflammatory Drugs and Celecoxib: More Similarities than Differences

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…

Letter to the Editor

Post-partum Hemodynamics in Mitral Insufficiency

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,…

Letter to the Editor

“Why I Love Reading the Southern Medical Journal”

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 …

Letter to the Editor

Worship Attendance Frequency

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…

Letter to the Editor

Onset of Action of Orally Disintegrating Olanzapine versus Conventional Olanzapine

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…

Letter to the Editor

Thymic Carcinoma Presenting as Cardiac Tamponade

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…

Letter to the Editor

Virchow’s Triad Revisited

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.