Objectives: In the present study, the authors comment on their experience with anterior odontoid screw fixation in the management of odontoid fractures, in an attempt to further assess the safety and the efficacy of this procedure. Materials and Methods: A retrospective analysis of 50 consecutive patients with reducible type II…
Expired CME Credit Submission and Evaluation Form – Insulin Resistance and Inflammation in Polycystic Ovarian Syndrome
Imiquimod, an imidazoquinoline amine, is an immune response modifier first FDA-approved for the treatment of external genital and perianal warts in 1997. Since its appearance on the market, its antiviral and antitumor properties have been used in the treatment of a variety of dermatologic conditions. In this review article, the…
Fournier gangrene is a life-threatening necrotizing fasciitis of the perineal-scrotal area that occurs in diabetic males. Patients typically present with systemic toxicity and significant inflammatory changes in the scrotum and perineum. Most cases of Fournier gangrene are polymicrobic and require urgent surgical débridement and broad-spectrum antibiotic therapy. We describe a…
A 65-year-old male with peripheral neuropathy and small lymphocytic lymphoma presented with erythema and edema of the left foot. A Charcot midfoot was diagnosed and treated with a total contact cast and restricted weight bearing. However, subsequent analysis of bone and synovial fluid months later revealed Mycobacterium tuberculosis infection. Key…
Enterobius vermicularis has the broadest geographic range of any helminth and is the most common intestinal parasite seen in the primary care setting. Underappreciated is the fact that it is not always a benign disorder and could even cause life-threatening medical problems. Visualization of the actual worms during endoscopy is…
Primary care physicians in the Eastern United States rarely consider coccidioidomycosis in the differential diagnosis of pulmonary infections or febrile illnesses. However, the mobility of the population mandates consideration of this diagnosis, particularly in patients with fever and cough that do not resolve rapidly and in patients with adenopathy on…
Kaposi sarcoma commonly occurs in HIV-positive and immunocompromised patients. We describe a case of Kaposi sarcoma that developed in an HIV-negative patient with tuberculosis. The Kaposi sarcoma completely regressed with antituberculous therapy without the institution of chemotherapy. The patient remained disease-free after a follow-up period of 20 months. Patients with…
Sarcoidosis rarely involves the genitourinary system or the spinal cord. This report describes a case of sarcoidosis with a scrotal mass, a mass compressing the spinal cord, and lesions in the liver and spleen. This case illustrates an uncommon manifestation of sarcoidosis, which may mimic disseminated testicular cancer. Key Points…
A 32-year-old black female was started on phenytoin for seizure prophylaxis following the clipping of an aneurysm. This was stopped after 3 weeks when she developed a generalized skin rash. Over the next week she developed fever, sore throat, dysphagia, and headache. She had an erythematous throat with white exudates…
Progressive facial hemiatrophy, also known as Parry-Romberg syndrome (PRS), is characterized by slowly progressive atrophy of one side of the face, primarily involving the subcutaneous tissues and fat. Involvement of the central nervous system with impairment of neurologic function occurs infrequently. At present, there is no agreement as to whether…
The case of a 57-year-old male with a history significant for myeloproliferative disease, chronic renal failure, hypertension, and prostate cancer is described. His complete blood count was remarkable for neutrophilia and, notably, eosinophilia. Subsequent to two syncopal episodes, a transthoracic echocardiogram was performed as part of the workup, which showed…
We present a very rare case of quadruple cancers in a 65-year-old male patient. It is a case of both synchronous and metachronous primary malignant neoplasms occurring in four different organs. Immunohistochemical stains showed tumor cell nuclei to be negative for p53 over-expression. To our knowledge, this is the first…
A 22-year-old male with cerebral palsy and respiratory failure had acute reversible ST-segment elevation in the inferior leads during acute collapse of the left lung, which resolved with re-expansion of the left lung several hours later. This suggests that major lung actelectasis needs to be added to the group of…
Trichosporon species are found in nature; predominantly in soil, water, and on plants. They have been cultured from many animal droppings, including cattle, sheep, and goat.1 The six Trichosporon species associated with human infection are Trichosporon asahii, Trichosporon mucoides, Trichosporon asteroides, Trichosporon cutaneum, Trichosporon inkin, and Trichosporon ovoides. Of these,…
In the last 12 years, governmental reports indicate that 1,381 people living in Ciudad Juárez, México have been intoxicated, and 167 killed by carbon monoxide (CO) poisoning.1 Studies in the U.S. have identified low temperatures and small heating and cooking appliances as risk factors2–4 but have not addressed northern Mexico….
Glioblastoma multiforme (GBM) is the most common and aggressive of the malignant adult primary brain tumors.1 Despite significant advances over the last several years in imaging capability, neurosurgical techniques, and radiation treatments, the prognosis for individuals diagnosed with malignant primary brain tumors remains poor. The median survival for patients with…
I recently read with interest the Rizvi article in the November issue of the Southern Medical Journal.1 The author neatly outlined some important issues regarding epidemiology and pathophysiology of type 2 diabetes. A discussion about the treatment of this disease was also presented. Although the merits of combining insulin to…
Objective: Telithromycin, the first approved ketolide antibiotic, was developed to treat community-acquired respiratory tract infections, including acute bacterial maxillary sinusitis (ABMS). A previously published study showed that a 5-day course of 800 mg telithromycin once daily is as effective as a 10-day course in the treatment of ABMS. Materials and…
Objective: Although the use of complementary and alternative medicine (CAM) in children is increasing, little is known about its use in children with human immunodeficiency virus (HIV) infection. This study investigated the use of CAM by parents of children with HIV infection (H), children with asthma (A), and well children…
Background: Planning for voluntary smallpox vaccination of health and safety officials began in December 2002. Materials And Methods: Surveys were conducted among physicians and fire and police department personnel in Atlanta, Georgia. Information on demographics, willingness to receive smallpox vaccine, self-reported knowledge level, and potential vaccine contraindications was analyzed. Results:…
Background: Benchmarking techniques were implemented to optimize operating time and charges associated with laparoscopically assisted vaginal hysterectomy (LAVH). Materials and Methods: The baseline LAVH profile over a period of 4 years (167 cases) was compared with 1-year data (47 cases) after a benchmarking educational program (disseminating data ranking performance by…
Objective: Senior medical students (n = 2,433) from 21 accredited medical schools in New England and the mid-Atlantic states were surveyed to evaluate their knowledge of and compliance with principles of judicious antimicrobial use, as defined by the Centers for Disease Control and others. Materials and Methods: A self-administered questionnaire…
Expired CME Article – Insulin Resistance and Inflammation in Polycystic Ovarian Syndrome
Expired CME Article Questions – Insulin Resistance in Polycystic Ovarian Disease
The classic polycystic ovarian syndrome (PCOS) was originally described by Stein and Leventhal as the association of amenorrhea with polycystic ovaries and, variably, hirsutism and/or obesity. It is estimated that 5 to 10% of women of reproductive age have PCOS. Although insulin resistance is not part of the diagnostic criteria…
In this issue of the Southern Medical Journal, Yuchi Chang and Stephen Tyring present an interesting review of the dermatologic product imiquimod (Aldara, 3M Pharmaceuticals) in their article “Current and Potential Uses of Imiquimod”. Although approved by the United States Food and Drug Administration since 1997 as a topical treatment…
In our modern technologically sophisticated age, the right to life has all but overwhelmed the right to live. Preoccupied with delaying death, the inherent value of life is often compromised. Earlier this spring, the media was suffused with coverage of Terri Schiavo, and, indeed, the Southern Medical Journal recently added…
Hematogenous vertebral osteomyelitis (HVO) is becoming increasingly common in the developed Western countries. An aging population, frequent use of intravascular catheters for diagnostic and therapeutic procedures with complicating bacteremia, hemodialysis, frequent invasive procedures, and IV drug abuse are important predisposing factors.1 Staphylococcus aureus is the most important pathogen in HVO.2…
To access Critical Appraisal of Biomedical Literature by Alan O’Rouke of the Wisdom Centre, Sheffield University, free registration is required at http://www.wisdomnet.co.uk/ with the seminar residing at http://www.wisdomnet.co.uk/ebpsem2.html. The appraisal provides algorithms for the evaluation of primary research and review articles. It also introduces critical evaluation of web sites. The…
Cast Care If you’ve ever had to wear a cast, you know that it won’t be long before it begins to itch. It can be maddening and relentless, and despite your physician’s warnings about scratching it with, say, a coat hanger, sometimes the urge can be overwhelming. Giving in to…
Patients who present with fractures are often given the choice of treatment with nonoperative casting or surgery. While surgery is invasive and carries the risk of infection, casting is considered to be conservative, and the risk of infection is often thought to be eliminated. Complications inherent to cast applications that…
The article by Hamid et al1 regarding the numerous medical and slang terms used to describe various types of substance abuse is quite comprehensive. One area not discussed is the implication of recognizing these terms for diverse cultural populations. Culture and language are important factors for predicting substance abuse.2 An…
Prostate carcinoma is one of the most common malignancies in men,1 and spreads most frequently to bone, lung, and liver.2 Pleural involvement is rare. Pleural effusion as determined by autopsy ranged from 2.3 to 5%.3,4We describe two elderly male patients with adenocarcinoma of the prostate and secondary pleural effusion. Our…
Objective: Staphylococcus aureus is the most common cause of hematogenous vertebral osteomyelitis in adults. To better define clinical features and therapeutic outcomes, the charts of 40 adult patients with S aureus hematogenous vertebral osteomyelitis were retrospectively reviewed. Methods: Retrospective chart review using standardized data collection form. Results: S aureus hematogenous…
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