Issue - Southern Medical Association

Expired CME Credit Submission and Evaluation Form

CME Credit—August 2005 CME Topic: Hemodialysis for the Non-nephrologist

To request a CME certificate, complete all sections of this form and mail it with a check (payable to SMA) to: SMA, Attn: SMJ CME, PO Box 190088, Birmingham, AL 35219-0088. Deadline to submit and receive credit for this feature is August 1, 2006. Copies are acceptable. You may also…

Review Article

Cocaine Cardiovascular Toxicity

Cocaine abuse kills thousands every year. Preexisting coronary artery disease appears to account for many of the deaths, but often the mechanism is much more complex. There exists a widely held but utterly mistaken notion that cocaine-related deaths are due to drug overdose. Except in the case of drug couriers…

Review Article

The Lexington Physicians of General Robert E. Lee

General Robert E. Lee has been interpreted by history as one of the most intriguing personalities of the American Civil War era. In more recent years, there has been much speculation regarding General Lee’s health during the war and the possible influence this had on his decision making and performance….

Review Article

Aggressive Hypertension Management in Patients of Advancing and Advanced Age

Many older patients are not being aggressively managed for hypertension. Healthcare providers are often hesitant to start or even aggressively titrate antihypertensive medication, especially in the aged. Multiple studies have demonstrated that morbidity and mortality can be significantly reduced by appropriate intervention in all age groups. There are some clinical…

Case Report

Brugada Syndrome Mimicking Acute Coronary Syndrome

This report describes a 42-year-old man with Brugada syndrome (BRS) mimicking acute coronary syndrome. Chest pain, near-syncope, and electrocardiographic changes were thought initially to be due to ischemia. Cardiac catheterization was performed. The coronary arteries and left ventricular function were normal. Careful review of his electrocardiogram suggested a diagnosis of…

Case Report

Chest Wall Necrosis and Death Secondary to Hydrochloric Acid Infusion for Metabolic Alkalosis

Central line complications are common, and extravasation injuries related to infusion of caustic substances have been previously described. Although hydrochloric acid has been used for many years to treat metabolic alkalosis, there have been no reported fatal complications. We report the case of a 53-year-old female who received a fatal…

Case Report

Urachal Remnant Small Bowel Obstruction: Report of Two Adult Cases

This report describes two separate cases of adult patients with intestinal obstruction caused by an urachal remnant. While reports of infected urachal cysts causing intra-abdominal pathology are not uncommon, intestinal obstruction caused by urachal remnants is exceedingly rare in the pediatric population and has never been described in adults. Both…

Case Report

Rhabdomyolysis from Simvastatin Triggered by Infection and Muscle Exertion

A 42-year-old woman received a 6-month course of simvastatin (20 mg/d) for hypercholesterolemia. Despite an infection with fever, fatigue, myalgias, and lumbar pain, she continued to perform her regular sports activities. Neurologic examination revealed bilateral ptosis and slight upper limb weakness. Serum creatine kinase was 41,000 U/L. Needle electromyography was…

Case Report

Primary Hydatid Cyst of the Head and Neck Diagnosed with Ultrasound and Computed Tomography: A Report of Two Cases

Hydatid cysts of the head and neck are rare, even in countries where echinococcal infestation is endemic. This report presents two patients with hydatid cyst, diagnosed using ultrasonography and computed tomography, in whom the cysts were located between the right cervical paravertebral muscles and below the superficial muscles of the…

Case Report

Triplet Heterotopic Pregnancy After Gonadotropin Stimulation and Intrauterine Insemination Diagnosed at Laparoscopy: A Case Report

Heterotopic pregnancy has been traditionally considered a rare event; however, with the use of assisted reproductive technology, the incidence of heterotopic pregnancies is increasing. Diagnosing a heterotopic pregnancy can be challenging. This report describes a 30-year-old female at 11 weeks’ gestation with an intrauterine twin pregnancy after gonadotropin stimulation and…

Case Report

Thymoma-associated Hypocalcemic Crisis

A previously healthy male was diagnosed with a malignant thymoma. During the workup, he had syncope, which was due to severe unrecognized hypocalcemia. Additional workup was suggestive of parathyroid failure. In particular, there was no evidence of autoimmune parathyroid failure due to antibodies against the calcium-sensing receptor. Literature review reveals…

Case Report

Retention of Extended Release Nifedipine Capsules in a Patient with Enteric Stricture Causing Recurrent Small Bowel Obstruction

Medication bezoars from extended release medication have been reported in the literature. This has become an increasing phenomenon with the popularity of extended release formulations, which aim to increase therapeutic compliance. We report on a patient who experienced recurrent bouts of small bowel obstruction, necessitating surgical exploration. Key Points *…

Letter to the Editor

Orbital Metastasis from Adenocarcinoma of the Colon

Orbital metastases from malignant neoplasms are rare, accounting for between 2.5% and 8.1% of all orbital space-occupying lesions that can originate from anywhere in the body.1,2 Here we report a patient with a history of colon adenocarcinoma who had recurrence in the orbit.

Original Article

How Are Religion and Spirituality Related to Health? A Study of Physicians’ Perspectives

Background: Despite expansive medical literature regarding spirituality and medicine, little is known about physician beliefs regarding the influence of religion on health. Methods: Semistructured interviews with 21 physicians regarding the intersection of religion, spirituality, and medicine. Interviews were transcribed, coded, and analyzed for emergent themes through an iterative process of…

Original Article

Intraventricular Administration of rt-PA in Patients with Intraventricular Hemorrhage

Objective: Intraventricular hemorrhage (IVH) represents a clinicopathologic entity with a dismal prognosis. The associated mortality rate has been reported as high as 80%; the morbidity is also quite high. The use of various fibrinolytic agents (streptokinase, urokinase, and recombinant tissue-type plasminogen activator [rt-PA]) has been reported in a small number…

Original Article

Shigellosis Among Swimmers in a Freshwater Lake

Objective: Shigella infection is highly communicable; however, outbreaks associated with swimming in recreational fresh water are rarely identified. Materials and Methods: A cohort study of lake visitors was performed. Results: Seventeen (24.6%) case patients among 69 persons who visited the lake over the holiday weekend were identified. Attack rates increased…

Original Article

Descriptive Epidemiology of Infant Ingestion Calls to a Regional Poison Control Center

Objective: This study was designed to describe the epidemiology of ingestions in infants 6 months of age or younger. Methods: A retrospective chart review from a convenience sample of poison center cases in infants younger than 6 months of age from December 28, 2002, to December 28, 2003, was reviewed….

Expired CME Article

Hemodialysis for the Non-nephrologist

Hemodialysis is now routinely provided to more than 300,000 patients in the United States. An epidemic of end-stage renal disease will nearly double this number by 2010. Patients undergoing chronic hemodialysis have high morbidity and mortality rates. Given these facts, most medical providers will be involved in the care of…

Case Report

Bilateral Upper Extremity Thrombophlebitis Related to Intravenous Amiodarone

A 47-year-old male had bilateral upper extremity thrombophlebitis after use of intravenous amiodarone for sustained ventricular tachycardia complicating myocardial infarction. Intravenous amiodarone has been widely used since it was introduced 20 years ago for severe intractable arrhythmias. Superficial thrombophlebitis was frequently noted in the early case reports when high-dose intravenous…

Case Report

Two Probable Cases of Serious Drug Interaction Between Clarithromycin and Colchicine

Although colchicine is a commonly used medication in patients with gouty arthritis and various multisystem disorders, its safety margin in therapeutic use is not well understood. This report describes two fatal cases of agranulocytosis presumed to result from a drug interaction involving colchicine and clarithromycin. Key Points * Clinician should…

Case Report

Walking Donor Transfusion in a Far Forward Environment

This case report details the walking donor transfusion (WDT) option for management of exsanguinating hemorrhage performed in an austere environment. It has civilian application in situations in which local blood supply is overwhelmed by demand due to a natural or manmade (ie, terrorist) disaster. WDT is discussed in light of…

Expired CME Article

Questions for CME: Hemodialysis for the Non-nephrologist

Expired CME Questions – H emodialysis for the Non-nephrologist

Editorial

Religion and the Attending Physician’s Point-of-view

Over the course of recent years, matters of spirituality and religion have become a topic of great interest and debate in the medical world; the Southern Medical Journal, in fact, will investigate this debate in some detail in the months to come. In the vast majority of instances the issue…

Editorial

To Feed or Not to Feed: Terri Schiavo and the Use of Artificial Nutrition and Fluids

The recent events surrounding the case of Terri Schiavo have illuminated the moral implications of modern medicine in regards to artificially sustaining life. Among the issues raised by Terri’s parents against the withdrawal of the feeding tube was that such an action would be euthanasia and would violate their daughter’s…

Editorial

Intracerebral Hemorrhage: The Least Treatable Form of Stroke

Stroke is the third leading cause of death in the United States. There are important regional disparities with patients in the South having the highest stroke hospitalization rates.1 Intracerebral hemorrhage (ICH) is one of the least treatable and most debilitating forms of stroke. In addition, profound morbidity and mortality occurs…

Letter to the Editor

Ferritin Levels in Postmenopausal Women Do Not Seem to Play a Significant Role in Osteoporosis

Osteoporosis and its complications are increasingly becoming worldwide public health concerns. Lower ferritin levels are a sign of iron deficiency anemia. We investigated levels of ferritin in osteoporotic postmenopausal women.

Letter to the Editor

Brucella melitensis in a Married Couple After a Trip Through Sicily

Brucellosis, which has dramatically decreased in France, remains a public health problem in Mediterranean countries. We report the case of a 59-year-old man who presented with isolated fever one month after returning from Italy. He related the consumption of local products in Sicily. Laboratory tests showed inflammation, thrombocytopenia, and cytolysis….

Letter to the Editor

Dysphonia Induced by Selective Serotonin Reuptake Inhibitors

Dysphonias are speech disorders resulting from voice disturbances, and iatrogenic dysphonias should be considered in the differential diagnosis of any patient presenting with a voice disorder. The most frequently cited medications that may cause dysphonia include corticosteroids, androgens, progesterone, diuretics, and tricyclic antidepressants.1 We report two cases of dysphonia related…

Letter to the Editor

Syncope: An Unusual Presentation of Acute Pulmonary Embolism

We describe an unusual case of acute pulmonary embolism (PE) with syncope. A 79-year-old female presented in the emergency room with complaints of dizziness and one episode of losing consciousness. She had a history of coronary artery disease with an angioplasty one year ago, as well as noninsulin-dependent diabetes mellitus,…

Letter to the Editor

Proton-pump-inhibitor-induced Hepatitis

A 39-year-old woman presented to the hospital with upper abdominal pain, vomiting, and malaise for two days. Two weeks before admission her primary physician prescribed pantoprazole for gastroesophageal reflux symptoms. She denied the intake of other medications or herbal products. Her past medical history was remarkable for anemia secondary to…

Article

Medical Webwatch

DermNez NZ and the Royal New Zealand College of General Practitioners presents Dermatology CME Quizzes, at http://old.dermnetnz.info/doctors/quizzes/index.html, which they describe as being “especially suitable for family physicians and dermatologists in training.” Nine quizzes, each with 10 cases, ask you to suggest appropriate investigations, diagnosis, treatment, management, etc, for the conditions…

Article

The Patient’s Page

Medication Overdose in Children: Giving your infant medication can be a challenge for any parent, but it is extremely important that care be taken when providing the appropriate dosage. A recent study found that a large percentage of calls to poison control centers are due to incorrect dosages given to…