SMJ // February 2005, Volume 98 - Issue 2

Original Article

Low Utility of Endoscopy for Suspected Upper Gastrointestinal Bleeding Occurring in Hospitalized Patients

Objectives: To determine the clinical utility of upper endoscopy in patients who have upper gastrointestinal bleeding after hospitalization. Methods: Patients were studied who underwent upper endoscopy for an indication of suspected upper gastrointestinal bleeding that developed more than 48 hours after hospitalization. Demographic, clinical, and endoscopic data were extracted by…

Expired CME Article

Laboratory Testing in the Rheumatic Diseases: A Practical Review

Abstract:Laboratory testing for the rheumatic diseases can allow for rapid diagnosis and appropriate management, while false-positive tests can lead to inappropriate management and unnecessary concern for the patient. An evaluation of laboratory testing for rheumatic illnesses is discussed, including the well-known acute phase proteins, the use of ANA in screening,…

Expired CME Credit Submission and Evaluation Form

CME Credit—February 2005 Featured CME Topic: Arthritis

Expired CME Credit Submission and Evaluation Form – Arthritis

Review Article

Juvenile Rheumatoid Arthritis: Physical Therapy and Rehabilitation

Juvenile arthritis is one of the most prevalent chronic diseases in the childhood period (ages 0 to 16 years). This disease was first defined in the first half of the 16th century. In the course of time, its differential diagnosis and characteristics have been determined, and it has been classified….

Review Article

Ischemic Colitis: A Clinical Review

Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common…

Case Report

Lumbar Synovial Cyst as a Cause of Low Back Pain and Acute Radiculopathy: A Case Report

The authors report the case of a 69-year old female with a persistent history of low back pain. Plain lumbar radiographs, performed at symptom initiation, revealed lumbar spondylolisthesis. Low back pain was attributed to this, and the patient received conservative treatment with partial relief of symptoms. Four years later, and…

Case Report

A Case of Brucella Spondylodiscitis with Extended, Multiple-level Involvement

Brucellosis is a zoonosis that affects several organs and has a protean presentation. The authors report the case of a 61-year-old male patient with brucellar spondylodiscitis involving several vertebrae and a paravertebral abscess localized in the erector spinae muscle. Diagnosis was made by positive blood culture and MRI. No relapse…

Case Report

Mesenteric Venous Thrombosis in a Patient with Pancreatitis and Protein C Deficiency

Mesenteric vein thrombosis is an uncommon manifestation of hypercoagulable states. A case is reported of superior mesenteric vein (SMV) thrombosis in a patient with pancreatitis and protein C deficiency. A discussion of SMV thrombosis identification, management, and outcomes is included. The patient presented with a significant history of alcohol abuse…

Case Report

Cholesterol Emboli-induced Renal Failure and Gastric Ulcer After Thrombolytic Therapy

Cholesterol embolization syndrome is a rare but devastating complication of thrombolysis. Clinical presentations are variable, which has resulted in labeling this syndrome as the great masquerader. Almost every organ in the body may be affected, but the syndrome commonly involves the kidney, skin, central nervous system, and gastrointestinal tract. Treatment…

Case Report

Hepatic Plasmacytosis as a Manifestation of Relapse in Multiple Myeloma Treated With Thalidomide

Thalidomide and its analogs have been extensively studied in patients with multiple myeloma. We present the case of a 58-year-old female patient with immunoglobulin GA-κ multiple myeloma who was receiving thalidomide after failing an autologous transplant. She presented with profound asthenia and several space-occupying hepatic lesions, one of which was…

Case Report

Acute Liver Failure Due to Iron Overdose in an Adult

The vast majority of acute iron toxicity cases occur in children less than 5 years of age. Moreover, clinical hepatic injury is uncommon with most symptoms stemming from the intestinal tract (eg, nausea, vomiting, diarrhea). Therefore, physicians, particularly those who do not routinely treat pediatric patients, are often unfamiliar with…

Case Report

Celiac Sprue Presenting as Advanced Liver Disease

This case report describes the complexity of diagnosing celiac sprue in a patient who presented with features predominantly resembling that of advanced liver disease in the absence of diarrhea. Key Points * Highly variable clinical presentations make the diagnosis of celiac sprue challenging. * The association between celiac sprue and…

Case Report

Liver Metastasis Presenting as Pneumoperitoneum

A 63-year-old man presented to the emergency department with sudden-onset abdominal pain. Chest radiography demonstrated pneumoperitoneum. At surgery, the source was found to be a ruptured hepatic abscess. Cultures grew Clostridium perfringens, and biopsies confirmed metastasis of a previously resected pancreatic cancer. We document this rare cause of pneumoperitoneum and…

Case Report

Cutaneous Draining Sinus Tract of Odontogenic Origin: Unusual Presentation of a Challenging Diagnosis

A 44-year-old woman presented with a chronically draining lesion on her cheek just lateral to the nasofacial sulcus. The lesion was refractory to treatment with oral antibiotics. Physical examination revealed poor dentition, and a panoramic radiograph demonstrated periapical abscesses in the maxillary right lateral incisor and canine. A diagnosis of…

Case Report

Fatal Hypermagnesemia Caused by an Epsom Salt Enema: A Case Illustration

The authors describe a case of fatal hypermagnesemia caused by an Epsom salt enema. A 7-year-old male presented with cardiac arrest and was found to have a serum magnesium level of 41.2 mg/dL (33.9 mEq/L) after having received an Epsom salt enema earlier that day. The medical history of Epsom…

Letter to the Editor

Colistin-associated Acute Renal Failure: Revisited

Sodium colistimethate (colistin) is a parenterally administered polymyxin antibiotic that acts by disrupting bacterial cell membranes. It has been primarily used in the treatment of life-threatening infections caused by multidrug-resistant Gram-negative bacteria, particularly Pseudomonas aeruginosa. The drug has a very narrow therapeutic ratio, with neurotoxicity and nephrotoxicity being the limiting…

Original Article

Impact of National Low Back Pain Guidelines on Clinical Practice

Objectives: The purpose of this study was to assess the impact of the 1994 Agency for Health Research and Quality (AHRQ) clinical practice guidelines on the management of acute low back pain. Methods: From the National Ambulatory Medical Care Service database, the authors abstracted data on patients being seen in…

Original Article

Anaerobic Spondylodiscitis: Case Series and Systematic Review

Background: Bacterial spondylodiscitis is rarely caused by anaerobic organisms. We describe two patients with lumbar vertebral osteomyelitis and discitis caused by anaerobic bacteria, including an unusual occurrence after an endodontic procedure, and review the salient clinical features and outcomes of 31 previously reported cases. Methods: Case reports and review of…

Original Article

Health Status in the Mississippi River Delta Region

Objectives: The purpose of the study was to determine if and where there were counties with significantly better or poorer health than others in the region. Methods: Using Z scores for 6 mortality-related measures, this study identifies counties within the Delta states with the highest and lowest rates. Results: Although…

Original Article

Association of Clinical and Laboratory Variables With Ultrasound Findings in Right Upper Quadrant Abdominal Pain

Background: The purpose of this study was to determine how laboratory values and physical examination findings correlate with ultrasound findings in the setting of right upper quadrant pain. Methods: Patients undergoing emergent ultrasound for the evaluation of biliary disease between November 1999 and April 2000 were included. Physical examination findings,…

Original Article

Daily Interferon Monotherapy for Chronic Hepatitis C in Patients with Normal or Near-normal Serum Alanine Transaminase Levels: A Comparison of Two Protocols

Objectives: Up to 30% of the 5 million patients with chronic hepatitis C in the United States have normal serum alanine transaminase (ALT) levels. These individuals have not been treated aggressively, and reported response rates have been low. No study has targeted patients treated in a community practice setting. Methods:…

Case Report

Vertebral Osteomyelitis Caused by Prevotella (Bacteroides) Melaninogenicus

A 35-year-old, previously healthy female presented with severe low back pain, fever, and a high erythrocyte sedimentation rate 1 week after a routine dental cleaning. Technetium-labeled leukocyte scanning and magnetic resonance imaging scan of the spine were negative for osteomyelitis. The patient underwent biopsy, cultures from which grew Prevotella (Bacteroides)…

Editorial

Clinical Diagnostics Versus A Theoretic Algorithm in Diagnosing Abdominal Pain

n the United States, approximately half a million people are affected annually by gallbladder disease. Accurate diagnosis of acute cholecystitis versus a bad case of biliary colic is not always obvious, but distinguishing between the two has important therapeutic implications. Mills et al1 have performed a sophisticated statistical study relating…

Editorial

Juvenile Arthritis: “No Child Left Behind” Fits Here, Too

Contrary to the perception that arthritic diseases are the domain of older patients, a large share of the pediatric population is afflicted with inflammatory arthritic diseases. Estimates of the prevalence of juvenile inflammatory arthritis have a wide range: Whereas Lawrence et al1 estimate 30,000 to 50,000 cases of juvenile arthritis…

Editorial

Practice Guidelines: Friends or Foes?

As evidence-based medicine becomes established, the scope for individuality in the management of patients is decreasing. Not too long ago, reaching a diagnosis was often a challenge because of the absence of reliable diagnostic modalities. The accuracy, sensitivity, and specificity of many tests were so low that the results were…

Expired CME Article

Arthritis

Expired CME Article – Arthritis

Expired CME Article

Treatment of Osteoarthritis

Objectives: Although cyclooxygenase-2 inhibitors (coxibs) were developed to cause less gastrointestinal hemorrhage than nonselective nonsterodial antiinflammatory drugs (NSAIDs), there has been concern about their cardiovascular safety. The relative risk of acute myocardial infarction (AMI) was studied among users of celecoxib, rofecoxib, and NSAIDs in Medicare beneficiaries with a comprehensive drug…

Expired CME Article

CME Questions: Arthritis

Expired CME Article Questions – Arthritis

Original Article

Do Gastroenterologists Notify Polyp Patients that Family Members Should Have Screening?

Objective: The objective of this study was to determine whether patients found to have adenomatous polyps or cancer were notified that their relatives should have screening, due to an increased risk of developing colorectal cancer. Methods: Consecutive (n = 121) colonoscopy patients from December of 1999 to October of 2001…

Letter to the Editor

Is Japan Sufficiently Prepared to Deal With Bioterrorism?

A wide range of pathogenic microorganisms can be used for bioterrorism. Anthrax bacteria were used for such a purpose in the United States. Other pathogenic microorganisms that can be used for bioterrorism include smallpox virus, plague bacteria, and botulinus toxin. The problem in dealing with infections caused by such microorganisms…

Letter to the Editor

Parotid Gland Involvement in Sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown cause that may involve virtually any organ, including the parotid gland. Involvement of the parotid gland has been reported in 6 to 30% of patients with systemic sarcoidosis.1–3 We retrospectively evaluated the general clinical features of 26 patients with sarcoidosis with parotid…

Announcement

Hologic Introduces RVA, a New High-resolution Spinal Imaging Modality Available Exclusively on Discovery Series Bone Densitometers

Hologic Inc, today announced that Discovery Series Densitometers will include a new modality called RVA, an acronym for Radiologic Vertebral Assessment. RVA is a vital companion procedure to the conventional bone mineral density (BMD) measurement, affording a superior assessment of a patient’s osteoporotic fracture risk

Medical Webwatch

Medical Webwatch

The University of Texas Medical Branch hosts Dr. Quinn’s Online Textbook of Otolaryngology (www.utmb.edu/otoref/Grnds/GrndsIndex.html), edited by Drs. Francis B. Quinn Jr. and Matthew W. Ryan. The “Grand Rounds” archive (1995–2004) lists synopses of otolaryngology conditions in HTML, PDF, and PowerPoint formats. According to the website, these are designed to “stimulate…

Acknowledgment

The Patient’s Page

Have you ever been diagnosed with colon polyps? If you have, it’s important that you share this information with your family. Researchers have found that family members of patients with some types of colonic polyps may be at increased risk for developing colon cancer. So, if your physician diagnoses you…

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