Issue - Southern Medical Association

Case Report

Hypertrophic Cardiomyopathy and Symptomatic Conduction System Disease in Cardiac Amyloidosis

Cardiac involvement is the most important prognostic factor in primary amyloidosis (AL). The clinical presentation of amyloid cardiomyopathy is varied and may manifest as heart failure, brady or tachyarrhythmias, syncope, angina and rarely with features of hypertrophic cardiomyopathy and advanced symptomatic conduction system disease. The management of amyloid cardiomyopathy has…

Case Report

Metastatic Malignant Pleural Mesothelioma to the Breast

A 51-year-old woman suffered from dyspnea for several days before she came to an outside clinic for help. Pleura biopsy was performed and the histologic diagnosis was malignant mesothelioma. Sixteen months later, a palpable left breast lump was noted. Physical examination revealed a firm mass in the breast, measuring about…

Case Report

A Case of Skin Hypopigmentation Secondary to a Corticosteroid Injection

A 47-year-old African-American male presented complaining of Achilles tendon pain. The patient was treated for three weeks with a nonsteroidal anti-inflammatory agent with minimal pain relief. The tendon was subsequently injected with triamcinolone acetonide and five months later, the patient presented with an area of hypopigmentation around the injection site….

Case Report

Lipid Lowering Inefficacy of High-dose Statin Therapy Due to Concurrent Use of Phenytoin

HMG-CoA reductase inhibitors (“statins”) are the most commonly prescribed lipid lowering agents. Most of the statins are metabolized by the CYP450 cytochrome system. A number of medications either induce or inhibit this system which leads to changes in the bioavailability of the statins and the potential for either an increase…

Original Article

Chart Documentation of Informed Consent for Operative Vaginal Delivery: Is It Adequate?

Objectives: To determine the documentation frequency of informed consent for women undergoing a trial of nonemergent instrumental delivery. Study Design: A retrospective chart review of instrumented vaginal deliveries from 1992 to 2005 was performed. Cases were identified from a Labor and Delivery database and hospital records were reviewed for documentation…

Review Article

Pharmacologic Management of Chronic Insomnia

Chronic insomnia is a common disorder that is under recognized, under diagnosed and under treated. Initial assessment should focus on identifying and treating, if present, any secondary causes of insomnia. Primary insomnia can be treated with behavioral and/or pharmacological therapy. A thorough sleep history can identify the type of insomnia…

Original Article

Hurricanes Katrina and Rita: Evacuee Healthcare Efforts Remote from Hurricane Affected Areas

Hurricanes Katrina and Rita produced the largest evacuation due to a natural disaster in United States history. Many people were evacuated or rescued from New Orleans and the Gulf Coast, resulting in a need for mass disaster shelters and medical care for months following the storms. The shelter healthcare system…

Case Report

Recurrent Acute Pancreatitis Probably Secondary to Lisinopril

Objectives: Few data exist about the incidence of drug-induced acute pancreatitis in the general population. Although angiotensin-converting enzymes are generally well tolerated, acute pancreatitis has been reported in a few subjects treated with captopril, enalapril, and lisinopril. However, to our knowledge, there is no published data regarding recurrent pancreatitis secondary…

Spirituality/Medicine Interface Project

Promethean Medicine: Spirituality, Stem Cells, and Cloning

Every ethos implies a mythos. That is, every ethical system depends upon some fundamental story disclosing its assumptions about human nature, freedom, good and evil, and the workings of the universe. A romanticized version of the myth of Prometheus, who stole fire from the gods and was punished by being…

Original Article

Facing the Malpractice Crisis: Academic Physicians’ Willingness to Accept Quick Fix Solutions

Background: We sought to determine the willingness of academic physicians to accept strategies to contain institutional malpractice costs. Methods: We surveyed all 270 Department of Medicine physicians at a large academic center. Respondents were asked about their knowledge regarding malpractice premiums, willingness to reduce patient-care activities and accept decreases in…

Case Report

Primary Mucosa-associated Lymphoid Tissue (MALT) Lymphoma Occurring in the Rectum: A Case Report and Review of the Literature

The primary extranodal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast; however, colorectal involvement is rare. To the best of our knowledge, only 30 cases of primary rectal MALT…

Review Article

Advances in the Endoscopic Management of Patients with Pancreatic and Biliary Malignancies

Major advances in endoscopic techniques to diagnose and manage pancreatic biliary diseases have fundamentally changed the approach to these difficult clinical challenges. The diagnosis of benign and malignant pancreatic-biliary diseases is much more readily obtained through a combination of cross-sectional imaging and endoscopic procedures. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic…

Review Article

Patent Foramen Ovale: Assessment, Clinical Significance and Therapeutic Options

Foramen ovale plays an important function in the fetus but is of no physiologic significance after birth and closes in most individuals. In about one fourth of the population, however, foramen ovale remains open for life and has been associated with cerebrovascular accidents, especially in younger patients, presumably through paradoxical…

Original Article

Spirituality and Depressive Symptoms in Primary Care Outpatients

Background: Although many studies have examined the relationship between religiosity and depressive symptoms in patient populations, there has been little work to understand and measure the effect of spirituality on depressive symptoms. Objective: The purpose of this study was to examine the association of spirituality and symptoms of depression in…

Article

Patient’s Page

Many patients feel hesitant to talk to their physician about spiritual matters, but when religion or spirituality is an important part of a person’s life, doctors should be made aware of this fact, especially if one’s faith or religious beliefs may not support certain treatment options. If this is the…

Editorial

Angiotensin-converting Enzyme (ACE) Inhibitor-induced Acute Pancreatitis: In Search of the Evidence

Drug-induced pancreatitis is estimated to be responsible for nearly 2% of cases of acute pancreatitis.1 Angiotensin-converting enzyme (ACE) inhibitors are some of the most widely prescribed medications. The occurrence of acute pancreatitis with several different ACE inhibitors including captopril,2–3 lisinopril,4–8 quinapril,9 ramipril,10–11 perinodpril,12 enalapril13–17 has been described in case reports….

Editorial

Drug-drug Interactions and Statin Therapy

Drug-drug interactions (DDIs) among widely and chronically prescribed medications are a relevant health issue in clinical practice. Reported incidences in outpatients range from 9.2% to 70.3% for drug interactions of any severity and from 1.2% to 23.3% for those considered of major relevance.1–3 Due to the progressive population ageing in…

Editorial

Integrated, Collaborative Disaster Response Networks

Following the one year anniversary of Hurricanes Katrina and Rita, and the recent and current publications in the Southern Medical Journal regarding medical preparedness during times of disaster1,2 it is appropriate to reflect on what we have learned and what we should we do differently next time.The immediate response to…

Editorial

MALT Lymphomas – A Closer Look in the Genomics Era

In 1832, an article titled “On some morbid appearances of the absorbent glands and spleen” was published in the journal ‘Medico-Chirurgical Transactions’.1 The author was Thomas Hodgkin (Fig. 1). Thus began an era of the study of a distinct group of tumors involving the lymphatic system, what we refer to…

Expired CME Article

CME Questions: Update in the Approach to and Management of Heart Failure

Expired CME Article Questions: Update in the Approach to and Management of Heart Failure

Expired CME Article

Heart Failure Management

Expired CME Article – Heart Failure Management

Expired CME Credit Submission and Evaluation Form

CME Credit – December 2006 CME Topic: Heart Failure Management

Expired CME Credit Submission and Evaluation Form – Heart Failure Management

Letter to the Editor

An Adolescent with Chest Pain

Chest pain in adolescents and young adults is a common presentation in the emergency department. Chest pain in children is rarely caused by organic conditions; however, it requires careful evaluation as many noncardiac conditions may present with chest pain. This report describes the presence of spontaneous pneumomediastinum with minimal exertion…

Letter to the Editor

Baseline Electrocardiographic Changes as Determinants in the Prognosis of Cerebrovascular Accidents

The effect of brain injury on the heart was demonstrated in experimental animals in the 1930s.1 Subsequently, several studies have investigated the effect of brain injury on the heart, but few have addressed the prognostic significance of these changes.2 This study was carried out (1) To determine if patients with…

Letter to the Editor

Closure of Round Cutaneous Postoperative Wounds with the Purse String Suture

The intradermal1–3 and cuticular4 purse string sutures are inexpensive, rapid procedures which are easily learned and can be useful for the complete1,2 or partial3,4 closure of cutaneous surgical wounds. They are especially suited for the repair of round, postoperative defects following local excision of a melanoma,2,4 nonmelanomatous skin cancer (such…

Letter to the Editor

Edematous Obstructive Sleep Apnea Patients Have Low Normal Serum Albumin Levels

Previous research has shown that unexplained edema is associated with obstructive sleep apnea (OSA) in women.1 Moreover, OSA has been shown to cause edema, for nasal continuous positive airway pressure reduces the amount of edema in OSA patients.2 It is unclear why only some individuals with OSA develop edema. Since…

Letter to the Editor

Hepatotoxicity After Low-dose Cyclophosphamide Therapy

Hepatotoxicity during high-dose cyclophosphamide (CYC) therapy has been reported,1,2 but hepatitis due to low-dose CYC treatment has rarely been described.3 We report a 40-year-old male patient diagnosed with primary scleroderma, treated with D-penicillamine (D-PEN) followed by cyclophosphamide. The patient was treated with D-PEN for 1.5 years and responded well to…

Letter to the Editor

Invasive Aspergillosis in Immunocompetent Patients

We read with interest the case report by Garcia and colleagues regarding an apparently immunocompetent individual.1 As the authors state, invasive aspergillosis is mainly encountered in patients suffering from severe immunodeficiency, such as hematologic malignancy, or in patients receiving chemotherapy or immunosuppressive therapy following solid organ transplantation. However, we disagree…

Letter to the Editor

Payment as Motivator in Iranian Medical Students’ Attitudes Toward Research

We performed a study regarding medical student attitudes toward research at Shiraz University in Iran. We found that the majority of Iranian medical students believed that payment was an important factor in encouraging research activities.

Letter to the Editor

Percutaneous Computed Tomography-guided Needle Aspiration Drainage of Spinal Epidural Abscess

Spinal epidural abscess is an uncommon disease but one with potentially devastating neurologic consequences if not diagnosed and treated appropriately. Historically, surgical intervention has been widely accepted as the mainstay of treatment in most instances. However, accumulated clinical experience indicates that selected patients with spinal epidural abscess can be managed…

Letter to the Editor

Post Abortion Survivor Syndrome (PASS): Signs and Symptoms

Observations of psychiatric patients led me to believe that some were deeply affected by pregnancy losses, particularly abortion; both theirs and their parents’. It appeared that there were deep existential conflicts, experienced by survivors that result in many psychiatric symptoms and psychophysiologic illnesses when they were spared, but those who…

Letter to the Editor

Primary Aldosteronism and Secondary Hyperparathyroidism of the Vitamin D Deficiency

The relationship between vitamin D, parathyroid hormone (PTH) and hypertension has been discussed in the literature. However, to our knowledge, primary aldosteronism associated with vitamin D deficiency has not been reported. We present a patient with simultaneous hyperparathyroidism from vitamin D deficiency and aldosteronism.

Letter to the Editor

Prolonged Livestock Exposure and Elevated Serum IgE Associated with Pulmonary Fibrosis

A 48-year-old man presented to the pulmonary clinic with a 2-year history of a persistent dry cough, dyspnea, and an abnormal chest x-ray. The patient smoked 20 cigarettes daily for 20 years. He worked in an animal research laboratory for 12 years. He was exposed to primates, mice, dogs, pigs,…

Letter to the Editor

Recovery from Munchausen Syndrome

In 1998, I published an article in the SMJ entitled, “Breaking the Silence of Factitious Disorder.”1 Through the article, a patient, dubbed “Cathy,” sought to inform physicians not only about the range of factitious illness behaviors in which she had engaged, but also about her reasons for doing so. She…

Medical Webwatch

Medical Webwatch

The three icons on the front page of The Neurological Exam http://icarus.med.utoronto.ca/NeuroExam/ are hyperlinked to short audiovisual tutorials that describe cranial, motor, and sensory examination technique. The explanations progress slowly through each procedure and are excellent for students. The continuity of presenter and simulate patient induce a relaxed pedantic experience….

SMA Centennial

A Historical Look at Hypertension: Celebrating 100 Years with the Southern Medical Association

As the Southern Medical Association (SMA) celebrates its 100th year anniversary, it is appropriate to look back on how the Southern Medical Journal (SMJ) has influenced the diagnosis and treatment of hypertension over the past century.

Spirituality/Medicine Interface Project

“No” to Embryonic Stem Cells

There are two types of human embryonic stem cell (hESC) research: one using embryos left over from in vitro fertilization (IVF) treatment, the other using cloned embryos. In the United Kingdom (UK), the Human Fertilisation and Embryology Authority (HFEA) has granted licenses to clone embryos to undertake so-called therapeutic cloning…

Spirituality/Medicine Interface Project

“Yes” to Adult Stem Cells

Every life, especially every human life, is precious to God. Even the human embryo that comes into existence in the laboratory is precious to God. Hence, it is not for us to take the life of a human embryo, whatever its provenance.An ethical alternative to the use of embryonic stem…

Spirituality/Medicine Interface Project

Cloning: US and Global Perspectives

It has been said that the cloning of Dolly the sheep in 1996 bifurcates the history of the world. It announces to humankind that we are in line to become not only the creators of our own selves, but, in sad tandem, also its creatures, the products of our own…

Spirituality/Medicine Interface Project

Current Status of Research Using Human Embryonic Stem Cells

Stem cells are undifferentiated and pluripotent–they are able to transform into a number of mature cell types, given the correct environment. A stem cell culture is capable of self-replication and, hence, has a theoretically infinite capacity for self-renewal. In essence, stem cells can be obtained from three sources: adult, fetal…

Spirituality/Medicine Interface Project

Eye on Religion: Buddhism and Medicine

For those not familiar with Buddhism and seeing Buddhism as a religion, they might be fascinated by some common threads that inform both medicine and Buddhism. We will explore both the commonality and differences of emphasis or perspective.Crucial to both Buddhism and medicine is the importance of practice. Practice, the…

Spirituality/Medicine Interface Project

Eye on Religion: By the Brush and by the Sword: Daoist Perspectives on the Body, Illness, and Healing

Daoism (Taoism) has been called China’s indigenous high religion, and stands alongside Confucianism and Buddhism as one of the Three Teachings (sanjiao) of that civilization. While many readers in the West may possess at least a passing familiarity with classical texts such as the Daode jing (Tao Te Ching) and…

Spirituality/Medicine Interface Project

Eye on Religion: Understanding the Cultural/Religious Melange in Treating Japanese Patients

Until late 19th century, Japanese health care was closely tied to medical practices that migrated from China. Herbal preparations and poultices, external physical manipulations, moxibustion, astrology, divining procedures, shamanism, and appealing to ancestors and deities were all methods for dealing with illness. The focus on preventive care left the Japanese…

Spirituality/Medicine Interface Project

Human Embryonic Stem Cells: A Justification for Their Use in Medical Therapeutics

It seems widely accepted that the United Kingdom (UK) has led the way in introducing legislation to regulate clinical practice in assisted reproduction. The UK Human Fertilization and Embryology Act was passed in 1990 and has been mimicked by similar legislation in many other countries. The Act, and the Human…

Spirituality/Medicine Interface Project

Integrative Research: The Approach at the Harvard Stem Cell Institute

Perhaps no area of biologic research has so excited the public imagination in the past decade as stem cell science, which both the general public and scientific community believe holds great promise for future therapies for disease and traumatic injury. Even though the science is in its early stages, it…

Spirituality/Medicine Interface Project

Internal Morality of Motherhood and Integrity of Physicians in the Era of Assisted Reproductive Technologies (ARTs)

Assisted reproductive technologies (ARTs)1 have posed significant new ethical challenges about the characteristics, meaning and values of creation of human life and human person, parenthood, medicine, and society. By increasing reliance on ARTs,2 human procreation may become a technological manufacturing project reflecting the interests of the parents-to-be guided by the…

Spirituality/Medicine Interface Project

Selected Annotated Bibliography on Stem Cell Research and Cloning

More questions than answers exist surrounding the powers and potential of stem cells. A great deal of uncertainty abounds about both embryonic and adult stem cells, much of which has been furthered by a flurry of recent publications and a loose set of definitions. Rigorous definitions in stem cell research…

Spirituality/Medicine Interface Project

The Sound of Science: The Power to Bless or to Burn

Throughout history, but particularly over the course of recent years, advances in the biomedical sciences have granted humankind an ever-greater understanding and mastery over itself. In this perpetual revolution, perhaps there has been no greater chapter than that of the much-heralded “Promethean promise”1 of stem cell research. However, while its…

Spirituality/Medicine Interface Project

To Condone or to Condemn? On the Ethics of Stem Cell Research

Depending on the origin of the cells, stem cell research can be classified into embryonic or nonembryonic stem cell research. In the latter group, cells are harvested from a variety of hosts without detriment to the donor. Embryonic stem cell research, on the other hand, entails the deliberate destruction of…