Issue - Southern Medical Association

Case Report

Topical Ocular Drug Delivery to Inner Ear Disease and Sinusitis

Oral steroids are the main therapy for sensorineural deafness. We present the rare case of a patient whose hearing loss associated with inflammation of the inner ear and chronic sinusitis were improved with topical steroid therapy. A 68-year-old male presented with scleritis in the left eye, inflammation of the inner…

Case Report

Giant Cell Arteritis Mimicking Multiple Myeloma; Diagnosed by PET Scan

This case report describes a patient who presented with severe anemia, monoclonal gammopathy, a high erythrocyte sedimentation rate and significant weight loss. These features were highly suggestive of multiple myeloma. Bone marrow aspiration was negative for myeloma on two occasions. A positron emission tomography (PET) scan showed extensive 2-flourodeoxy-glucose uptake…

Case Report

Postpartum Hemoperitoneum Due to Avulsion of Pelvic Uterine Adhesion Band

A 31-year-old nulliparous woman presented in labor with preterm rupture of membranes at 35 weeks of gestation. The ensuing intrapartum course was uneventful, and she delivered a healthy infant (birth weight, 2,850 g) vaginally. Four hours after delivery, the patient had a syncopal episode due to hypovolemic shock. At laparotomy,…

Original Article

Rural-urban Differences in Factors Associated with Poor Blood Pressure Control Among Outpatients

Background: The purpose of this study was to determine which patient-related factors are most strongly associated with having uncontrolled hypertension among outpatients. Methods: A sample of 300 outpatients with diagnosed hypertension from three different settings was reviewed, focusing on demographics, comorbidity, adherence, and treatment factors. Regression analyses were conducted to…

Original Article

Overuse of Antihypertensives in Patients with Acute Ischemic Stroke

Background: The Stroke Council of the American Heart Association/American Stroke Association (AHA/ASA) recommends conservative management of hypertension (HTN) during acute ischemic stroke (AIS), although clinicians often manage blood pressure more aggressively. Our hypothesis was that aggressive management of HTN in patients with AIS is associated with hypotensive events and worsened…

Case Report

Osborn Waves in Sepsis

A patient with severe sepsis, who presented with moderate hypothermia and the classical electrocardiographic findings that have been described in patients with accidental hypothermia is presented. Rewarming was associated with proportional improvement of the initial electrocardiographic abnormalities. A brief discussion is included about the electrophysiologic mechanisms of Osborn waves, the…

Review Article

Exenatide: A Novel Approach for Treatment of Type 2 Diabetes

Exenatide (synthetic exendin-4) is the analog of glucagon-like peptide 1 (GLP-1), the major physiologic incretin. The latter is an intestinal hormone that enhances glucose-induced insulin secretion after meals. In addition, GLP-1 stimulates insulin synthesis, inhibits glucagon secretion, delays gastric emptying, and may promote satiety. These glucoregulatory actions help control plasma…

Original Article

Intracerebral Hemorrhage due to Hemorrhagic Disease of the Newborn and Failure to Administer Vitamin K at Birth

In infants, intracerebral hemorrhage (ICH) is most likely the result of trauma or disturbances of coagulation function. Routine and standard care of the newborn includes the administration of vitamin K to prevent hemorrhagic disease of the newborn. We present two infants, the products of home deliveries, who did not receive…

Expired CME Article

Irritable Bowel Syndrome: A Practical Review

The epidemiology and current understanding of the pathophysiology of irritable bowel syndrome is reviewed, beginning with a historical perspective. The roles of genetics, environment, allergy, infection and inflammation, bacterial overgrowth, hormones and motility abnormalities are discussed. Using the current evidence-based literature, the practical approach of diagnosis and treatment is outlined,…

Review Article

Minimal Change Disease: A Review

Minimal change disease (MCD) is a histopathological lesion in the kidney that is most commonly associated with nephrotic syndrome. The majority of the cases are idiopathic. Pathogenesis is not well understood, although T-cell-related mechanisms are implicated. Massive proteinuria leads to hypoalbuminemia, salt retention, disorder of hemostasis, hyperlipidemia and increased susceptibility…

Review Article

An Updated Review of the Literature: Risk Factors for Bladder Cancer with Focus on Occupational Exposures

Workplace exposures account for 5 to 25% of all bladder cancer cases. A critical review of the literature between 1938 and 2004 was performed, with a focus on occupational exposures. Occupational exposure to bladder carcinogens, particularly to β-naphthylamine occur in a number of industries, including aromatic amine manufacture, rubber and…

Case Report

A Case of Metoclopramide-induced Oculogyric Crisis in a 16-year-old Girl with Cystic Fibrosis

Oculogyric crisis is a neurologic reaction characterized by bilateral dystonic elevation of visual gaze as well as hyperextension of the neck. This reaction is most commonly explained as an adverse effect of numerous medications, such as dopamine receptor blocking agents or neuroleptic medications and traditional antipsychotic or antiemetic drugs, such…

Case Report

Pneumothorax Secondary to Acupuncture Therapy

A 27-year-old medical student seeking acupuncture therapy for a right levator scapular muscle spasm developed acute dyspnea, chest pain, and nonproductive cough within minutes following the treatment. The patient was later diagnosed with a 30% pneumothorax of the right lung. Pneumothorax is a well-known adverse effect of medical procedures such…

Case Report

Macroprolactinemia in a Patient with Infertility and Hyperprolactinemia

A significant number of patients with hyperprolactinemia have macroprolactinemia, a condition characterized by the preponderance of big-big prolactin with normal levels of free prolactin. As macroprolactin does not have biologic activity, such patients do not require further investigations or treatment for hyperprolactinemia. The case of a patient with hyperprolactinemia diagnosed…

Case Report

Extraprostatic Papillary Cystadenocarcinoma of the Prostate

A 62-year-old man was evaluated for lower urinary tract symptoms. Imaging studies showed a normal prostate and multiple cysts between the rectum and bladder with no evident communication to the prostate. On pathology, papillary cystadenocarcinoma with positive immunohistochemical staining for PSA was confirmed. Key Points * Papillary cystadenocarcinoma of the…

Original Article

Impact of Treatment with Infliximab on Anticyclic Citrullinated Peptide Antibody and Rheumatoid Factor in Patients with Rheumatoid Arthritis

Objective: To investigate the impact of infliximab treatment on anticyclic citrullinated peptide (anti-CCP) antibody and rheumatoid factor (RF) levels in patients with rheumatoid arthritis (RA). Methods: Sera from 33 RA patients receiving infliximab and disease modifying antirheumatic drugs were tested for anti-CCP antibody, IgA-, IgG- and IgM-RF using a commercially…

Case Report

Thalidomide-induced Organizing Pneumonia

Twenty medications are associated with drug-induced organizing pneumonia; however, thalidomide is not listed as a potential causative agent. Thalidomide (Thalomid, Celgene Corp., Summit, NJ), an angiogenesis inhibitor and immunomodulator that reduces tumor necrosis factor-alpha, is used for the treatment of multiple myeloma. We report a case of organizing pneumonia in…

Original Article

Total Thyroidectomy for the Treatment of Thyroid Diseases in an Endemic Area

Introduction: Thyroidectomy is a common operation with very low mortality and an acceptable morbidity rate. Total thyroidectomy has become the predominant type of surgery used today for the treatment of thyroid diseases. In this retrospective study, we analyzed the complications of thyroid surgery according to the operative technique used in…

Case Report

Drotrecogin Alfa (Activated) for Nonmenstrual Toxic Shock Syndrome Associated with Methicillin Resistant Staphylococcus aureus Infection

Nonmenstrual toxic shock syndrome (TSS) due to Staphylococcus aureus can lead to significant morbidity and mortality. While drotrecogin alfa (DA) has been employed in patients with Methicillin-resistant Staphylococcus aureus (MRSA) severe sepsis and septic shock, its utility in TSS remains unclear. The authors report a case of severe sepsis in…

Article

Patient’s Page

Do you suffer from chronic constipation, frequent diarrhea, stomach cramps, gas, or bloating? If so, you may have a condition called irritable bowel syndrome (IBS). The prevalence of IBS has received much attention recently, especially with the development of new drugs specifically designed to relieve the symptoms of IBS. Between…

Editorial

“Silent” Giant Cell Arteritis

Giant cell (temporal) arteritis (GCA) is a large and medium-sized blood vessel systemic vasculitis characterized by the granulomatous involvement of the aorta and its major branches, with predilection for the extracranial branches of the carotid artery.1 GCA is the most common vasculitis in the elderly in white individuals.2

Editorial

Can Anticyclic Citrullinated Peptide Antibodies be Used to Successfully Monitor Treatment in Rheumatoid Arthritis Patients?

Rheumatoid arthritis (RA) is a systemic, inflammatory autoimmune disease characterized by joint inflammation that often leads to joint destruction, severe disability and increased mortality. Up to 40% of patients with rheumatoid arthritis experience progression toward an erosive pattern in the early stages of the disease.1 It is known that most…

Editorial

Hypertensive Men Living in a Southern City: Is it a Recipe for Disaster?

Hypertension affects over 65 million Americans; nearly 30% of the adult population, with the highest prevalence in the southeastern part of the United States.1 Furthermore, this region has higher complication rates of hypertension-related diseases, such as stroke, cardiovascular events, and kidney failure.1 It has been well documented that effective control…

Editorial

Occupational and Nonoccupational Causes of Bladder Cancer

An estimated 57,400 new cases of bladder cancer were diagnosed in the US in 2003, and an estimated 12,500 people died as a result of the disease.1 Cancer of the urinary bladder, as well as in the lower urinary tract lined with transitional cells, can be caused by toxicants contained…

Editorial

Role of Total Thyroidectomy in the Treatment of Thyroid Diseases

Surgery on the thyroid gland has usually been reserved for patients with goiters accompanied by obstructive manifestations, malignancy and/or failed medical management. In their interesting paper, Misiakos et al1 discuss some of the potential benefits of using a total thyroidectomy in the management of both benign and malignant thyroid disease…

Editorial

Solving the Mystery of Blood Pressure in Acute Stroke

In acute ischemic stroke, the most intuitive therapeutic approach is to restore perfusion to the ischemic territory, typically downstream from an occluded artery. Hemodynamic variables such as systemic blood pressure are seemingly obvious factors that may influence the evolution of ischemic injury and neurologic outcome. The impact of systemic blood…

Editorial

The Macroprolactinemia Problem and Its Solution

Symptoms of the hyperprolactinemic syndrome (menstrual disturbance, infertility and galactorrhea in women, impotence and loss of libido in men) are common and nonspecific and in the investigation of patients with these symptoms much depends on the measurement of serum prolactin (PRL) concentration. This is especially true of the diagnosis of…

Editorial

Vitamin K and Hemorrhagic Disease of Newborns

First described by Charles Townsend in 1894,1 hemorrhagic disease of newborns (HDN) is undoubtedly linked to vitamin K deficiency and can cause bleeding in infants in the first few weeks of life. It is one of the causes of acquired hemostatic disorder in early infancy. Vitamin K is a cofactor…

Errata

Erratum

We regret that there was a statistical error in the September issue of the Southern Medical Journal. In the article titled “Adult Health Screening and Referral in the Emergency Department,” by Drs. Zun and Downey, the number of referrals for Pap smears was listed as 2.6% (39 of 157 patients)….

Expired CME Article

CME Questions: Irritable Bowel Syndrome: A Practical Review

Expired CME Article Questions: Irritable Bowel Syndrome: A Practical Review

Expired CME Article

Irritable Bowel Syndrome

Expired CME Article – Irritable Bowel Syndrome

Expired CME Credit Submission and Evaluation Form

CME Credit – November 2006 CME Topic: Irritable Bowel Syndrome

Expired CME Credit Submission and Evaluation Form – Irritable Bowel Syndrome

Letter to the Editor

A Case of Squamous Cell Lung Carcinoma with Gastric Metastasis

Lung cancer usually metastasizes the bone, adrenal glands, and brain. It is uncommon in the digestive system, particularly in the stomach. The most common sites of primary malignancy in patients who presented with gastric metastasis is malignant melanoma, breast cancer, and lung cancer.1 Reported incidences of lung cancer metastasis to…

Letter to the Editor

An Incidental Finding of Occult HIV Infection

A 45-year-old woman presented with a 6-month history of progressively worsening leg swelling. The patient was otherwise previously healthy. On physical examination, jugular venous pressure was elevated to the angle of the jaw. There were fine crackles at her lung bases. Precordial examination demonstrated a parasternal heave and a loud…

Letter to the Editor

Atypical Presentation of Crohn Disease in an Asian-Indian Patient

Crohn disease (CD) is rare in Asian-Indian populations compared with developed countries; however, recent reports have suggested that the incidence is on the rise.1 Acute massive gastrointestinal hemorrhage is a rare complication of CD and is very rarely the first presenting feature.2 We hereby report the first case of acute…

Letter to the Editor

Baclofen-induced Neurotoxicity in Chronic Renal Failure Patients with Intractable Hiccups

Intractable hiccups (>48 h) are unsatisfactorily treated with most medications. Currently, baclofen—a γ–aminobutyric acid (GABA) agonist which is eliminated predominantly by the kidneys—has been documented as one effective therapy for the treatment of intractable hiccups.1 One of the disturbing side effects of baclofen, however, is neurotoxicity, which is often overlooked…

Letter to the Editor

Coxiella burnetii and Lobar Pneumonia

A 32-year-old woman was admitted to our department with high fever, headache, myalgia, back pain and dry cough of three days’ duration. Her past history was unremarkable. On physical examination, the patient was very ill, febrile to 39.5°C and with inspiratory coarse crackles at the base of the right lung….

Letter to the Editor

Erosive Temporomandibular Joint Involvement: A Rare Manifestation of Arthropathies Associated with Ulcerative Colitis

Temporomandibular joint (TMJ) involvement in patients with enteropathic arthropathy is an unusual feature. To the best of our knowledge, there is only one report in the literature mentioning a patient in whom ankylosing spondylitis (AS) and ulcerative colitis (UC) were seen concurrently with involvement of TMJ. In this case, TMJ…

Letter to the Editor

Hearing Loss in Patient with Neurobrucellosis

Brucellosis is a multisystemic infection that can affect any organ system in the body. Neurobrucellosis is an uncommon, but serious complication of brucellosis. It occurs in less than 5% of patients and usually presents as acute or chronic meningitis in patients with brucellosis.1–3 Neurologic manifestations of brucellosis include meningitis, encephalitis,…

Letter to the Editor

Postpartum Syncope and Noncompaction in Suspected Encephalomyopathy

Left ventricular hypertrabeculation (LVHT), also known as noncompaction, is an increasingly recognized cardiac manifestation of various neuromuscular disorders (NMDs) and other rare genetic disorders.1–3 To our knowledge, detection of LVHT following diagnostic workup after syncope has not been reported.A 39-year-old, HIV-negative woman experienced syncope 1 hour after delivering a healthy…

Letter to the Editor

Pulmonary Lymphangioleio-myomatosis in Combination with Uterine Leiomyoma in a Postmenopausal Woman

Lymphangioleiomyomatosis (LAM) is a rare lung disease of unknown etiology characterized by the nonneoplastic proliferation of smooth muscle-like cells (LAM cells) that can grow to obstruct airways, lymphatics and blood vessels within the lung parenchyma, mediastinum and elsewhere.1 It exclusively affects women at reproductive age and may be worsened by…

Letter to the Editor

Real-time PCR for Quantification of Helicobacter felis in Mouse Stomach

Helicobacter pylori is the most common cause of chronic bacterial infections, affecting at least 50% of the world’s population and leading to gastritis, peptic ulcer disease and gastric adenocarcinoma. Development of a vaccine to control this infection has become a priority, and preclinical testing of potential products includes inoculation of…

Letter to the Editor

Redesigning Payment of Internal Medicine: A Financial Challenge

In the recent position paper of the American College of Physicians on “Reform of the Dysfunctional Healthcare Payment and Delivery System,” various recommendations were made to improve compensation of cognitive versus procedural medicine.1 Current financial compensation for generalists is a main factor in the decline of new residents entering the…

Letter to the Editor

Subacute Combined Degeneration of the Spinal Cord in a Young African-American Man

Subacute combined degeneration (SCD) of the spinal cord arises from deficiency of cobalamin and may be induced by pernicious anemia (PA) which typically affects patients of Northern European ancestry and tends to occur in the sixth decade of life. We recently cared for a 27-year-old African-American man who presented with…

Medical Webwatch

Medical Webwatch

The sounds on the McGill University Virtual Stethoscope http://sprojects.mmip.mcgill.ca/mvs/ are accessed via the “Respiratory” or “Cardiac” drop-down menus. Also available from the drop-downs are their “Pathophysiology” and “Physical Examination” illustrated notes with an emphasis on auscultation. The Virtual Stethoscope material is presented as brief synopses placed above a spectral illustration…

SMA Centennial

American Plastic Surgery in the South Since 1906

When the Southern Medical Association was founded in 1906, specialization in American medicine was uncommon and subspecialization was incredibly rare. To be a good physician at that time required a very broad knowledge but less of the in-depth knowledge that is the hallmark of the medical or surgical specialist today….