Issue - Southern Medical Association

Case Report

Acute Pericarditis and Renal Failure Complicating Acute Hepatitis A Infection

Abstract:Hepatitis A infection may result in acute hepatitis, and rarely, fulminant hepatitis may ensue. Extrahepatic manifestations of hepatitis A are uncommon. The authors present the case of a 77-year-old male who had development of acute renal failure and pericarditis during the clinical course of acute hepatitis A infection. He died…

Original Article

Correlation of High-sensitivity C-reactive Protein and Plasma Fibrinogen with Individual Complications in Patients with Type 2 Diabetes

Objective: We investigated the correlation between acute-phase reactants, ie, high-sensitivity C-reactive protein (hsCRP) or fibrinogen and diabetic complications. Methods: In 73 patients with type 2 diabetes, we investigated associations between both markers and carotid artery intimal medial complex thickness (IMT), heart rate variability, or urinary albumin excretion (UAE). Results: Log…

Original Article

Hydralazine-induced Lupus: Maintaining Vigilance with Increased Use in Patients with Heart Failure

Objective: To review data concerning the incidence and danger of hydralazine-induced systemic lupus erythematosus (SLE) and review how best to monitor patients placed on chronic hydralazine therapy. Data Sources: Literature was sought utilizing PUBMED (1960 to present) and MEDLINE (1966 to present). Search terms included hydralazine, drug-induced systemic lupus erythematosus,…

Case Report

Refractory Hypoxemia in Right Ventricular Infarction: A Case Report

Abstract:Right ventricular infarction has many clinical features. Although hypoxemia is a common presenting symptom with multiple causes in the setting of myocardial infarction, the authors present a case resulting from an acute right-to-left shunt secondary to a previously dormant patent foramen ovale. A 74-year-old male presented to the hospital after…

Original Article

Comparison of Ilioinguinal-iliohypogastric Nerve Block Versus Spinal Anesthesia for Inguinal Herniorrhaphy

Objective:This study was carried out to determine the optimal anesthetic technique for use in elective herniorrhaphy. Methods:We retrospectively analyzed 126 inguinal hernia repairs. The patients were allocated to one of two groups: an ilioinguinal-iliohypogastric nerve block group (IHNB group, n = 63) and spinal anesthesia group (SA group, n =…

Case Report

Complete Heart Block and Cardiac Tamponade Secondary to Merkel Cell Carcinoma Cardiac Metastases

Abstract:This is a unique case of Merkel cell carcinoma, a rare neuroendocrine tumor, metastasizing to the heart and inducing a progression of cardiac complications such as new-onset atrial fibrillation, malignant pericardial effusion with tamponade physiology, first-degree heart block, and complete heart block. Metastases to the heart are relatively rare but…

Case Report

Treatment of Painful Neuroma of Amputated Phalanx with Distal Toe Transfer: A Case Report

Abstract:A painful neuroma in the amputation stump of a finger can be psychologically and physically disabling. Numerous surgical procedures have been attempted to prevent and treat amputation neuromas of the finger, but the results are inconsistent. Microsurgical transfer of the distal second toe to the amputated stump of the finger…

Case Report

Multiple Adverse Effects of Pyridium: A Case Report

Abstract:Pyridium (phenazopyridine hydrochloride) is often prescribed as an analgesic in patients following trauma, surgery, or infections of the urinary tract. Pyridium toxicity has been previously reported, however, most cases result in a single adverse effect. Herein the authors describe an elderly patient who presented with simultaneous multiple adverse effects, including…

Original Article

Effect of Ciprofloxacin and Levofloxacin on the QT Interval: Is This a Significant “Clinical” Event?

Background:The widespread use of the fluoroquinolones has raised the question of the cardiac safety of these medications. This widespread use of this class of antibiotics has displayed their safety profile, which is actually more favorable than many other drug classes. The cardiac toxicity issue at the center of this discussion…

Expired CME Article

Inflammatory Aspects of Sleep Apnea and Their Cardiovascular Consequences

Abstract: Obstructive sleep apnea (OSA) is a common medical condition that occurs in a considerable percentage of the population. Substantial evidence shows that patients with OSA have an increased incidence of hypertension compared with individuals without OSA, and that OSA is a risk factor for the development of hypertension. It…

Case Report

A Rare Case of Tako-tsubo Cardiomyopathy Complicated by a Left Ventricular Thrombus

Abstract:Tako-tsubo cardiomyopathy is a rare stress-related cardiomyopathy usually seen in postmenopausal women after an emotional stressor. Patients generally present with angina-like substernal chest pain. The electrocardiogram (ECG) shows ST segment elevation or T wave inversions across the anterior precordial leads. Cardiac markers are minimally elevated, without evidence of coronary artery…

Original Article

Varicocele and Antisperm Antibody: Fact or Fiction?

Objective: To study the level of antisperm antibodies (ASAB) in the serum and semen of infertile men with varicocele before and 6 months after varicocelectomy. Materials and Methods: We performed a prospective study of 81 infertile men undergoing microsurgical inguinal varicocelectomy. Female factor was excluded. Semen analysis and seminal and…

Editorial

Antisperm Antibodies and Varicocele

A male factor alone is responsible for greater than 20% of infertile couples and contributes to another 30 to 40% of cases.1 The aim of the male infertility evaluation is to identify correctable causes, note irreversible conditions that are amenable to assisted reproductive techniques (ARTs) using the sperm of the…

Editorial

Cardiac Tamponade: Still Being Newly Described

As clinicians, we are intrigued by unusual cases and challenged by rapid management decisions required by difficult diagnoses. This case presented by Conley et al1 proves no exception and is remarkable as an uncommon cause of relatively common presentations that occur with metastatic disease to the heart. The authors succinctly…

Editorial

Drug-induced QT Prolongation

What do the following drugs all have in common?—grepafloxacin (Raxar), terfenadine (Seldane), cisapride (Propulsid), and astemizole (Hismanal). Each of these were once commercially available products, approved by the US Food and Drug Administration (FDA) to treat a variety of ailments. Unfortunately, postmarketing surveillance revealed that each of these agents could…

Editorial

Fluctuating Blood Glucose Levels in an Elderly Diabetic Patient

I read with great interest the letter by Bobba et al,1 entitled “Hyperglycemia in an elderly diabetic patient: Drug-drug or drug-disease interaction?” in which an elderly patient experienced loss of glycemic control potentially due to the use of gatifloxacin, a newer fluoroquinolone antibacterial agent. The case report does emphasize the…

Editorial

Hiding in Plain Sight: A New Paradigm for “Opportunistic Infections”

Kosseifi et al1 presented a case of Aspergillus esophageal ulceration occurring in a man treated with radiation and chemotherapy for tracheal carcinoma. Although the patient was recognized as immunocompromised, two diagnostic procedures were needed to make the diagnosis, and several treatment courses were undertaken before resolution of the infection was…

Editorial

Hydralazine-induced Lupus

Nearly 50 years after the first published case report of hydralazine-induced lupus was described,1 scientists are still grappling with the mysteries of drug-induced autoimmunity.2A drug-induced lupus-like syndrome may present with arthralgias, myalgias, fever, and serositis but is distinguished from systemic lupus erythematosus by several characteristics. Sex ratios are nearly equal…

Editorial

Patent Foramen Ovale

Patent foramen ovale is common in the general population and even more common in patients with cryptogenic stroke or stroke of unknown cause. The most common causes of stroke in people over the age of 50 are atherosclerosis and atrial fibrillation. In patients under the age of 50 who develop…

Editorial

Pathological Gambling

Over the past several decades, access to and participation in gambling has increased dramatically in this country. In 1996, gross revenues from gambling venues, an estimated $48 billion, were more than box office, cruise, record, sports, and concert revenues combined. By 2001, gambling revenues had increased by a third to…

Editorial

The “Tako-tsubo” Phenomenon and Myocardial Infarction

Over the past 10 years there has been increasing evidence that acute emotional stress can induce myocardial infarction (MI) in individuals without overt coronary artery disease.1,2 The lay population has recognized this phenomenon for centuries, and phrases like “scared to death” and “died as a result of a broken heart”…

Editorial

The Role of Inflammation in Diabetes and Its Complications

The contribution of inflammation to morbidity in the closely related conditions of cardiovascular disease, obesity, the metabolic syndrome, and type 2 diabetes has been the focus of extensive research and intense speculation over the past decade.1,2 Many inflammatory markers such as C-reactive protein (CRP), fibrinogen, the interleukins, tumor necrosis factor-α,…

Editorial

The SMA Celebrates Its Centennial Anniversary

The practice of medicine has witnessed tremendous progress and dramatic changes during the past 100 years. Although the main goals of medicine as spelled out by Hippocrates to first do no harm, and second to do good, have not changed for the past 3 millennia, the practice of medicine itself…

Editorial

What We Know About Ourselves: Changing Attitudes About Treating Patients with Substance Use Disorders

Patients with substance use disorders (SUD) are prevalent in most schools, hospitals, emergency departments, and in the criminal justice system.1 Society has come more and more to view substance abuse and dependence as an illness and to implement programs that help people recover and lead productive lives. Treatment of SUD…

Expired CME Article

CME Questions: Inflammatory Aspects of Sleep Apnea and Their Cardiovascular Consequences

Expired CME Article Questions: Inflammatory Aspects of Sleep Apnea and Their Cardiovascular Consequences

Expired CME Article

Sleep Apnea and Cardiovascular Consequences

Expired CME Article – Sleep Apnea and Cardiovascular Consequences

Expired CME Credit Submission and Evaluation Form

CME Credit – January 2006 CME Topic: Sleep Apnea and Cardiovascular Consequences

Expired CME Credit Submission and Evaluation Form – Sleep Apnea and Cardiovascular Consequences

Letter to the Editor

Breast Cancer Metastasis to the Gasserian Ganglion

To the Editor:In an autopsy study of 309 patients with breast carcinoma metastases to the central nervous system, the brain was most frequently affected, followed by the meninges and the spinal cord.1 In this letter, we describe a patient with breast cancer who had metastatic tumor in the gasserian ganglion.

Letter to the Editor

Distribution of Pleural Effusion in Congestive Heart Failure

To the Editor:The recent article by Woodring questioned the classic statement of predominantly right-sided pleural effusions in patients with congestive heart failure (CHF), on the basis of a study of 120 patients whose cardiac pleural effusions were equally distributed between the right and the left hemithorax.1 More importantly, the author…

Letter to the Editor

Errata

In the December 2005 issue two author’s names were misspelled. In the Table of Contents, the first author under “Religious Awareness Training for Medical Students: Effect on the Clinical Behavior” should have read John T. Chibnall. The author of the “Selected Annotated Bibliography” (South Med J 2005;98:1251–1254) should have read…

Letter to the Editor

Extreme Hyperkalemia

To the Editor:Hyporeninemic hypoaldosteronism was one of the postulated mechanisms mediating hyperkalemia in the case report by Dr. H. A. Tran published in the July 2005 issue of the Southern Medical Journal.1 I would add that emergency treatment of intractable hyperkalemia should include not only routine measures such as calcium…

Letter to the Editor

Hyperglycemia in an Elderly Diabetic Patient: Drug-drug or Drug-disease Interaction?

To the Editor:The use of gatifloxacin is increasing as the result of convenient dosing and efficacy in a wide range of infectious diseases. Gatifloxacin is generally well tolerated; however, recently there have been several reports of alterations in glucose levels in patients receiving gatifloxacin.

Letter to the Editor

Localized Amyloidosis of Cardiac and Skeletal Muscle: Investigate Promptly Where It Manifests

To the Editor:A negative biopsy may not rule out amyloidosis, as seen in the following case. We report the case of a patient with cardiac and muscular manifestations of amyloidosis, who had a normal rectal mucosal biopsy. The diagnosis of amyloidosis was only established at autopsy.

Letter to the Editor

Pedometer-measured Walking and Risk Factors for Disease

To the Editor:Research documenting the health benefits of exercise is convincing, but finding ways to encourage sedentary patients to become more active remains a challenge. Adherence to vigorous, structured exercise programs is particularly low. One generally inactive subgroup is older women, and postmenopausal women who do exercise tend to engage…

Letter to the Editor

Primary Sternal Osteomyelitis Caused By Actinomyces israelii

To the Editor:Primary sternal osteomyelitis (PSO) is a rare entity. Diagnosis is usually difficult due to the nonspecific clinical picture and late radiological findings. We describe a case of PSO due to Actinomyces israelii and how ultrasonography (US), CT, and MRI helped to make the diagnosis and guide treatment.

Letter to the Editor

Response to Hypoglycemia-An Enigmatic Dilemma

I agree with Dr. Ranjodh Gill, author of the editorial published in the July 2005 issue of the Southern Medical Journal entitled “Hypoglycemia-An Enigmatic Dilemma,” that “for best diagnostic yield, patients should undergo testing during an episode of spontaneous hypoglycemia.”1 In addition, I contend that this includes taking simultaneous blood…

Letter to the Editor

Serum Lipid Profile in Postmenopausal Women with Osteoporosis or Osteopenia

To the Editor:Clinical studies have suggested that atherosclerosis is also associated with reduced bone density. Data propose that lipid oxidation, which plays such a central role in the pathogenesis of atherosclerosis, may also promote osteoporosis, thereby linking lipid metabolism and inflammation to regulation of bone density.1 We performed a study…

Medical Webwatch

Medical Webwatch

It is well worth registering for a free subscription to the professional edition of Medcyclopaedia http://www.amershamhealth.com/medcyclopaedia/medical/index.asp from Amersham Health. This encyclopedia of medical imaging contains in excess of 18,000 key words that accompany more than 10,000 illustrations. Text and images can be copied for noncommercial use in lectures, articles, etc.,…

Editorial

Is Ilioinguinal-iliohypogastric Nerve Block an Underused Anesthetic Technique for Inguinal Herniorrhaphy?

The common anesthetic techniques for inguinal hernia herniorrhaphy in adult patients are general anesthesia, spinal anesthesia, and occasionally epidural anesthesia. Ilioinguinal-iliohypogastric nerve block has rarely been used as an anesthetic technique for hernia repair in adult patients, although it is a popular choice in infants and children in many operation…

Article

Physicians-in-training Attitudes Toward Caring For and Working with Patients with Alcohol and Drug Abuse Diagnoses

Introduction: Physicians in all specialties commonly encounter patients who abuse alcohol or illegal drugs. Working with these patient populations can be challenging and potentially engender negative attitudes. This study is designed to identify the progression of attitudinal shifts over time of physicians-in-training toward caring for substance abusing patients. Methods and…