Issue - Southern Medical Association

Article

CME Questions: Psychosomatic Pain: New Insights and Management Strategies

Expired CME Questions – Psychosomatic Pain: New Insights and Management Strategies

Original Article

Analysis of Diagnostic Error in Paid Malpractice Claims with Substandard Care in a Large Healthcare System

Objective: Although claims databases are not representative of all care delivery, their predisposition toward serious unintended injury can complement resource-intensive chart reviews and guide patient safety initiatives. Materials and Methods: Non-Veterans Health Administration (VA) practitioners reviewed 1,949 VA malpractice claims paid during fiscal years 1998 through 2003. The portion associated…

Original Article

Late Stage (III and IV) Non-small Cell Cancer of the Lung: Results of Surgical Resection at Inova Fairfax Hospital

One hundred forty-two patients underwent surgery and related treatment for advanced stage (III, IV) non-small cell cancer of the lung. One hundred seventeen patients underwent up-front surgery, with a hospital mortality rate of 1.7% (2/117). Kaplan-Meier 5-year survival in this group was 31% (± 5). Twenty-five patients underwent neoadjuvant therapy…

Original Article

Effect of N-Acetyl Cysteine on Helicobacter pylori

Background: Use of mucolytic agents that result in reduced mucous viscosity of the gastric mucous has been suggested to have an additive effect in curing Helicobacter pylori infection. Methods: Seventy H pylori–positive patients were given either eradication treatment consisting of 500 mg clarithromycin bid and 30 mg lansoprazole bid for…

Expired CME Credit Submission and Evaluation Form

CME Credit—November 2005 CME Topic: Psychosomatic Pain: New Insights and Management Strategies

Expired CME Credit Submission and Evaluation Form – Psychosomatic Pain: New Insights and Management Strategies

Review Article

PTH (1–34): A Novel Anabolic Drug for the Treatment of Osteoporosis

The management of osteoporosis has in the past included providing patients with an adequate source of calcium and vitamin D and consideration of some type of antiresorption therapy such as hormone replacement, SERM therapy, or bisphosphonate therapy. However, patients who have very low bone density and continue to have fractures…

Review Article

Acetaminophen Overdose in Pregnancy

Acetaminophen (APAP) is the most common drug overdose in pregnancy. Available data regarding APAP overdose in pregnancy is limited to case reports and a small prospective case series. APAP has been demonstrated to cross the placenta and in toxic doses may harm the fetal and maternal hepatocytes. Fetal hepatocytes metabolize…

Review Article

A Comprehensive Review of Disseminated Salmonella arizona Infection with an Illustrative Case Presentation

Salmonella arizona is known to cause infection in reptiles and other animals. Disseminated human infection is rare, except in the setting of a deficient immune system. The following is a unique account of disseminated infection including pericardial involvement. Unusual features include nonreptile vector transmission and eastern seaboard (rather than southwestern)…

Case Report

Methicillin-resistant Staphylococcus aureus Empyema Necessitatis in an Eight-month-old Child

Empyema necessitatis is a rare complication of empyema characterized by a spontaneous extension of pus from the pleural space into adjacent soft tissues. It is uncommon in the pediatric population and is usually caused by Mycobacterium tuberculosis. This report describes the youngest reported case of empyema necessitatis. The clinical examination…

Case Report

Klippel-Feil Syndrome Associated With Pneumatocyst of the Right Cervical Rib

A patient with Klippel-Feil syndrome reported with a pneumatocyst of the proximal epiphysis of a right cervical rib. There was no additional skeletal abnormality except for fusion of the C3 and C4 vertebral bodies. To the best of our knowledge, this is the first reported instance of this particular association….

Case Report

Unusual Case of Pyopneumothorax in Tennessee

Rupture of a coccidioidal pulmonary cavity with subsequent pyopneumothorax is a rare clinical event, even in areas endemic for coccidioidomycosis. Our encounter with a patient diagnosed with this condition in northeast Tennessee serves notice to clinicians that coccidioidomycosis is indeed a traveling fungal disease, and practitioners must be alert to…

Case Report

Disseminated Cat Scratch Disease With Vertebral Osteomyelitis and Epidural Abscess

A 5-year-old boy with cat scratch disease presented with fever of unknown origin and osteomyelitis of the thoracic spine and epidural abscess. He did not have localizing signs or symptoms. Computed tomography of the abdomen, which was initially negative, showed hepatosplenic disease. Cat scratch disease has variable systemic presentations and…

Case Report

Isolated Acetabular Osteoporosis in TOH in Pregnancy: A Case Report

Transient osteoporosis of the hip (TOH) is a rare, self-limiting syndrome characterized by hip pain in the 2nd or 3rd trimester of pregnancy. Conventional radiography shows demineralization of the femoral head. Diagnosis is confirmed by MRI scan. Over the course of a few months, the radiological abnormalities and the pain…

Case Report

Acute Progressive Bilateral Carpal Tunnel Syndrome After Upper Respiratory Tract Infection

This report describes the case of a 32-year-old male presenting with acute progressive bilateral carpal tunnel syndrome after a benign upper respiratory tract infection. Serial nerve conduction studies confirmed progressive entrapment of the median nerves in the carpal tunnel to the point of axonal damage. Surgical decompression relieved the entrapment,…

Article

Patient’s Page

Acetaminophen is the most widely prescribed analgesic for use during pregnancy. Although this medication is approved for use in pregnant women, excessive amounts are known to cause liver failure, in both the mother and the fetus. It is therefore imperative that expectant mothers strictly monitor their intake of acetaminophen. Although…

Original Article

Widespread Emergence of Methicillin Resistance in Community-acquired Staphylococcus aureus Infections in Denver

Background: Increasing rates of methicillin resistance among outpatient Staphylococcus aureus infections led us to assess the epidemiology and outcome of a local outbreak. Methods: A retrospective cohort study of outpatient skin and soft tissue infections due to S aureus in 2003. Results: From 2002 to mid-2004, the percentage of outpatient…

Original Article

Population-based Study of the Geographic Variation in Colon Cancer Incidence in Alabama: Relationship to Socioeconomic Status Indicators and Physician Density

Objectives: The objective of this population-based study was to examine the relationship between race, socioeconomic characteristics (socioeconomic status, SES), physician density, and colon cancer incidence in Alabama. Methods: Data for 5,788 colon cancer cases from 1996 to 1999 provided by the Alabama Statewide Cancer Registry are linked to county-level measures…

Case Report

A Case of Allergic Bronchopulmonary Aspergillosis Leading to Pneumonia with Unusual Organisms

We describe the case of a 50-year-old male with a history of asthma and seizure disorder who presented with a 5-month history of dyspnea. The patient had been treated with multiple courses of antibiotics for presumed community-acquired pneumonia before being determined to have allergic bronchopulmonary aspergillosis (ABPA) by serologic and…

Expired CME Article

Psychosomatic Pain: New Insights and Management Strategies

Expired CME Article – Psychosomatic Pain: New Insights and Management Strategies

Editorial

Psychosomatic Reasons for Chronic Pains

In this issue of the Southern Medical Journal, the review by J. Rubin on psychosomatic pain1 quoted a study2 in which it was found that “college students with chronic pain yielded a history of abuse (physical and/or sexual) in 43.5% of the females (275 subjects) and 23.8% of the males…

Editorial

Salmonella Infections in the Setting of AIDS: A Serpentine Course

Infectious complications of the acquired immunodeficiency syndrome (AIDS) tend to be caused by organisms that fall into two broad categories: 1) opportunistic pathogens prevalent in the natural environment but rarely causing serious disease in normal hosts (Pneumocystis, Toxoplasma, Mycobacterium avium complex, Cytomegalovirus), and 2) pathogens that predictably cause disease in…

Editorial

Methicillin-resistant Staphylococcus aureus Pneumonia in Children: A Call for Increased Vigilance

During the past two decades in the United States, Staphylococcus aureus pneumonia has been infrequently encountered in healthy children. However, that trend may be changing, given the emerging reports from several parts of the country.1–3 These reports suggest that the organism may be playing an increasing role, not only as…

Editorial

Treatment of Late Stage Non-small Cell Lung Cancer: We Have More Work to Do

The successful treatment of non-small cell lung cancer (NSCLC), like most solid tumors, still relies on complete surgical resection. However, a meaningful disease-free interval with surgery alone has been typically restricted to early stages I and II. Over the years, we have made slight improvements in the overall survival and…

Editorial

Community-acquired MRSA: A Notable Adversary

In this issue, Clancy et al1 describe their findings from a retrospective cohort study conducted in 2003 on 193 patients evaluating the epidemiology, outcomes, and molecular characterization of community-acquired Staphylococcus aureus (CA-SA) infections from an integrated health care system serving the center of metropolitan Denver. Their data confirm the observation…

Editorial

Helicobacter pylori Treatment

Helicobacter pylori is a Gram negative bacterium that was isolated in 1983 and has since been shown to be associated with peptic ulcer disease as well as gastric adenocarcinoma and gastric lymphoma. It has a worldwide prevalence. The rate of infection varies among different ethnic groups and socioeconomic strata. The…

Editorial

Malpractice Claims: Finding the Silver Lining

In this issue of SMJ, Holohan and colleagues present findings from their review of 1,949 paid malpractice claims in the Veterans Health Administration from 1998 to 2003. The article nicely highlights that diagnostic errors are an important quality problem in the US healthcare system. Diagnostic errors were common, they were…

Article

Medical Webwatch

PDQ (Physician Data Query) http://www.cancer.gov/cancertopics/pdq/cancerdatabase from the National Cancer Institute is a comprehensive database containing peer-reviewed summaries on cancer treatment, screening, prevention, genetics, supportive care, complementary, and alternative medicine. There are separate access points for patients and health professionals. It also has a registry of approximately 2,000 open and 13,000…

Letter to the Editor

Does Olanzapine-Fluoxetine Combination Increase the Risk of Mania in Poorly Compliant Bipolar Depressed Patients?

Fluoxetine is useful for the treatment of depression and olanzapine for the treatment of schizophrenia and acute bipolar mania. In 2001, olanzapine-fluoxetine combination was found to be effective in a small sample of patients with nonbipolar depression.1 Subsequently, a controlled study demonstrated olanzapine to be more effective than placebo and…

Letter to the Editor

Percutaneous Intervention of Left Main Coronary Artery Disease: A Fresh Look at a Class III Recommendation

Percutaneous intervention of left main coronary artery (LMCA) disease is a class III recommendation per the latest guidelines published by the American Heart Association/American College of Cardiology.1 As techniques, technologies, research, and pharmaceuticals advance, intervention on LMCA disease has become a more feasible option. We present two cases, both with…