Issue - Southern Medical Association

Original Article

Dolichonychia in Women with Marfan Syndrome

Objectives: Dolichonychia refers to nails that are elongated and slender. This nail morphology has been described in single case reports of patients with Ehlers-Danlos syndrome, hypohidrotic ectodermal dysplasia, and Marfan syndrome. Methods: The length and width of fingernails were measured in patients with Marfan syndrome and in individuals without the…

Original Article

Incidence of Postdural Puncture Headache and Backache, and Success Rate of Dural Puncture: Comparison of Two Spinal Needle Designs

Objectives: The goal of this randomized study was to compare the incidence of postdural puncture headache (PDPH) and postdural puncture backache (PDPB), and the success rate between two small-gauge spinal needle designs used in women undergoing subarachnoid block anesthesia. Methods: After Institutional Review Board approval, 215 patients presenting for tubal…

Expired CME Credit Submission and Evaluation Form

CME Credit—April 2004 CME Topic: Hepatitis C Infection

Expired CME Credit Submission and Evaluation Form – Hepatitis C Infection

Review Article

Smallpox Vaccination in the Early 19th Century Using Live Carriers: The Travels of Francisco Xavier de Balmis

Realizing that the Spanish colonies were being devastated by epidemics of smallpox resulting in thousands of deaths, Charles IV, King of Spain, sent one of his court’s physicians to apply the recently discovered vaccine. Without refrigeration, the vaccine was passed from one child to another (boys taken out of orphanages)….

Case Report

The Prozone Phenomenon with Syphilis and HIV-1 Co-infection

The prozone phenomenon in syphilis testing refers to a false negative response resulting from overwhelming antibody titers which interfere with the proper formation of the antigen-antibody lattice network necessary to visualize a positive flocculation test. This prozone effect in syphilis testing can be expected in cases of disproportionately high antibody…

Case Report

Primary Esophageal Lymphoma: A Diagnostic Challenge in Acquired Immunodeficiency Syndrome—Two Case Reports and Review

Although extranodal presentation occurs in the majority of cases of acquired immunodeficiency syndrome-associated non-Hodgkin lymphoma, the esophagus is only rarely affected. We discuss two patients with acquired immunodeficiency syndrome who presented with dysphagia and weight loss, who were found to have human immunodeficiency virus-associated primary esophageal lymphoma. Both patients died…

Case Report

Leukemoid Reaction Due to Clostridium difficile Infection in Acquired Immunodeficiency Syndrome: Two Case Reports and a Review of the Literature

The clinical presentation of colitis associated with Clostridium difficile infection in immunosuppressed patients with acquired immunodeficiency syndrome (AIDS) has not been completely characterized. Previous reports suggest that these patients present with low blood leukocyte counts, consistent with the impaired myelopoiesis that can occur with human immunodeficiency virus (HIV) infection. In…

Case Report

Corynebacterium afermentans Lung Abscess and Empyema in a Patient with Human Immunodeficiency Virus Infection

Necrotizing pleuropulmonary infection in a patient with acquired immunodeficiency syndrome developed due to Corynebacterium afermentans subspecies lipophilum. Long-term combination antibiotic therapy was successful in eradicating the infection without surgery.

Case Report

Histoplasmosis in Two Human Immunodeficiency Virus-positive Immigrants to Italy: Clinical Features and Management in the Highly Active Antiretroviral Therapy Era

We report two cases of histoplasmosis occurring in human immunodeficiency virus-positive patients who immigrated to Italy, and focus our attention on the clinical features and therapeutic aspects, with particular emphasis on secondary prophylaxis. The patients had comparable human immunodeficiency virus baseline parameters, but had a completely different compliance over therapeutic…

Case Report

Hepatocellular Carcinoma in a Patient with Human Immunodeficiency Virus and Hepatitis B Virus Coinfection: An Emerging Problem?

Infections with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) have similar risk factors and routes of transmission. It is estimated that 64 to 84% of HIV-infected individuals have positive markers for anti-HBc antibodies, with the chronic HBV infection rate approaching 16%. There is, however, a paucity of information…

Case Report

Late Failure of Combined Recombinant Hepatitis B Vaccine and Lamivudine in Treatment of a Patient with Chronic Hepatitis B

We report the first case of a woman having chronic hepatitis B treated with a combination therapy of recombinant hepatitis B vaccine and lamivudine for 18 months. The main aims of such a combined therapy were to assess whether the concomitant anti-hepatitis B virus (HBV) vaccination might prevent the emergence…

Case Report

GALOP Syndrome: Case Report with 7-year Follow-up

An elderly woman complaining of a gait disorder was found to have the GALOP syndrome (gait ataxia, late-onset polyneuropathy). She exhibited mild distal weakness and sensory loss in the legs, a positive Romberg, and an unsteady gait. Serum immunofixation disclosed a monoclonal IgM-κ protein. There was specific IgM binding to…

Case Report

Acute Splenic Sequestration Crisis Resembling Sepsis in an Adult with Hemoglobin SC Disease

Acute splenic sequestration crisis (ASSC) is a common complication of sickle cell anemia in children. ASSC is generally not seen in adults with the SS genotype but occasionally can be seen in adults with the SC genotype. We present a case of fulminant ASSC in an adult with hemoglobin SC…

Case Report

Coccidioidomycosis of the Prostate Gland: Two Cases and a Review of the Literature

Coccidioidomycosis prostatitis is an uncommon presentation of disseminated coccidioidomycosis, a fungal disease endemic in the southwestern United States. Coccidioidomycosis prostatitis should be considered in the differential diagnosis of a patient from an endemic region with evidence of persistent sterile pyuria, prostatitis, or granulomatous disease of the prostate. Diagnosis is established…

Original Article

Consecutive Autopsies on an Internal Medicine Service

Objectives: Autopsy rates continue to decline in the United States despite the demonstrated value of this procedure in many different settings. We sought to review clinical pathologic discordance information generated by autopsies on an internal medicine service in the urban United States and to determine whether resident services appear to…

Original Article

Treatment of HIV/AIDS in the Nursing Home: Variations in Rural and Urban Long-term Care Settings

Objectives: With the increased use of antiretroviral therapy, more patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are surviving for long periods of time. The aim of this study was to determine the availability of specialty HIV/AIDS services in long-term care facilities, and to determine differences in the…

Original Article

Gender Differences in Knowledge and Perceptions of HIV Resources Among Individuals Living with HIV in the Southeast

Objectives: Ancillary services have been associated with beneficial health utilization outcomes among individuals infected with the human immunodeficiency virus (HIV), including greater retention in medical care and greater likelihood of antiretroviral use. Our primary objectives were to examine gender differences in barriers to ancillary services among people living with HIV…

Original Article

Relationship Between Some Acute Phase Reactants and the Bath Ankylosing Spondylitis Disease Activity Index in Patients with Ankylosing Spondylitis

Objectives: The aims of this study were to investigate a possible relationship between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and some acute phase reactant (APR) levels in patients with ankylosing spondylitis (AS). Methods: Twenty outpatients who fulfilled the modified New York criteria for AS were included in the…




Case Report

Otogenic Fusobacterium Meningitis, Sepsis, and Mastoiditis in an Adolescent

Fusobacterium necrophorum is a strict anaerobic organism responsible for a number of clinical syndromes known as necrobacillosis. Although meningeal infections with anaerobes are rare, delayed diagnosis and treatment can be potentially fatal. We report a unique case of Fusobacterium meningitis, mastoiditis, and sepsis in a previously healthy adolescent. Diagnosis and…

Case Report

Primary Human Immunodeficiency Virus Infection Presenting as Acute Pancreatitis

Primary human immunodeficiency virus (HIV) infection can present in a variety of ways. It is important to recognize acute HIV infection, for personal and public health reasons. We present an unusual case of primary HIV infection manifesting as acute pancreatitis.

Expired CME Article

CME Topic: Hepatitis C Infection

Expired CME Article – CME Topic: Hepatitis C Infection


The Prozone Phenomenon in Syphilis Testing

Syphilis, a genital ulcerative disease, remains an important public health concern in the United States. In addition to facilitating the transmission of human immunodeficiency virus (HIV), untreated syphilis may progress to cause neurologic, cardiovascular, and musculoskeletal complications and in pregnancy may lead to serious complications including stillbirth, neonatal death, prematurity,…


Primary Esophageal Lymphoma: A Diagnostic Challenge

In this issue of the Southern Medical Journal, Dr. C. Namal Weeratunge’s article entitled “Primary Esophageal Lymphoma: A Diagnostic Challenge in Acquired Immunodeficiency Syndrome”1 reports two cases of primary esophageal lymphoma in patients with acquired immunodeficiency syndrome (AIDS). The first cases of AIDS-related non-Hodgkin lymphomas (NHL) were described in 1982….


GALOP Syndrome: A Treatable Immune-mediated Late-age Onset Polyneuropathy With Gait Ataxia

Various studies have established an association between elevated titers of antibodies against sulfatide (the main acidic glycosphingolipid component of the myelin sheath) and a number of systemic and neurologic disorders. These auto-antibodies have been reported in patients with idiopathic thrombocytopenic purpura, 1 autoimmune chronic active hepatitis, 2 human immunodeficiency virus,…


AIDS—No Longer a Death Sentence, Still a Challenge

The human immunodeficiency virus (HIV) is now found in every country of the world, infecting 56 million persons worldwide. 1 Twenty million persons have died as a result of HIV alone. In the United States 1.1 million persons are infected with HIV. Before the advent of antiretroviral drugs in 1987…


Autopsy—The Lost Opportunity

Mortui vivos docent, “the dead teach the living.” The body of medical knowledge has expanded tremendously through painstaking autopsies performed by meticulous pathologists under the keen eye of clinicians eager to determine the cause of death and verify the accuracy of their diagnostic skills. Many clinicians have been humbled at…

Letter to the Editor

False-positive Human Immunodeficiency Virus Test and Trypanosoma cruzi Infection in Eastern Colombia

Immunodeficiency, either human immunodeficiency virus (HIV)-positive or HIV-negative, is associated with several coinfections, including Trypanosoma cruzi. 1 However, several concerns regarding the true cause of some of these illnesses have arisen because many cross-reactions have been found with either enzyme-linked immunosorbent assay (ELISA) or Western blot (WB) testing for HIV…

Letter to the Editor

What Goes Around, Comes Around

In reading the article “Addisonian Crisis Precipitated by Thyroxine Therapy: A Complication of Type 2 Autoimmune Polyglandular Syndrome,”1 I was reminded of Dr. John Eager Howard’s warning to us some 35 years ago, when I was a resident at Union Memorial Hospital in Baltimore, about the dangers of thyroid replacement…

Review Article

Hepatitis C Infection: A Clinical Review

Nearly three million persons in the United States are viremic with hepatitis C (HCV). Despite a decreasing incidence of HCV in this country, the prevalence of HCV-related chronic liver disease is increasing. Most infections in the United States are acquired by intravenous drug use. The chronicity rate of HCV is…


NIH Asks Participants in Women’s Health Initiative Estrogen-Alone Study to Stop Study Pills, Begin Follow-up Phase

The National Institutes of Health (NIH) has instructed participants in the estrogen-alone study of the Women’s Health Initiative (WHI), a large multi-center trial, to stop taking their study pills and to begin the follow-up phase of the study.