Issue - Southern Medical Association

Case Report

Pleomorphic Basal Cell Carcinoma: Case Reports and Review

Pleomorphic basal cell carcinoma is a pathologic variant of basal cell carcinoma characterized by the presence of atypical-appearing, mononuclear or multinucleated giant cells. Including our 3 patients, a total of 52 pleomorphic basal cell carcinomas have been described in 48 individuals. The tumors usually present as a nodule on the…

Case Report

Celiac Disease Occurring in a Patient with Hypoparathyroidism and Autoimmune Thyroid Disease

Patients with an underlying autoimmune endocrine disorder are at an increased risk of developing other autoimmune diseases. We describe a patient with idiopathic autoimmune hypoparathyroidism who developed hyperthyroidism due to Graves disease and subsequently was diagnosed with celiac disease. Malabsorption of L-thyroxine was the only clue regarding the presence of…

Case Report

Patient with Markedly Elevated CA 19-9 Not Associated with Malignancy

A 66-year-old white male presented with jaundice, pruritus, and a 30-pound weight loss over two months. Physical examination revealed scleral icterus. Laboratory evaluation revealed ALT 161 U/L, AST 290 U/L, alkaline phosphatase 2004 U/L, GGT 2,552 U/L, total bilirubin 10.2 mg/dL, and a carbohydrate antigen 19-9 (CA 19-9) level of…

Case Report

Factitious Diarrhea Masquerading as Refractory Celiac Disease

A 23-year-old female with a history of a histologically confirmed diagnosis of celiac disease was referred to our institution for refractory celiac disease for consideration of immunosuppressive therapy. Full workup revealed an elevated fecal magnesium level, and a concurrent diagnosis of laxative abuse was confirmed after discussion with the family….

Expired CME Article

Colorectal Cancer Screening: Today and Tomorrow

Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced. Key Points * Everyone…

Original Article

Effect of Sildenafil Citrate on Postprandial Gallbladder Motility

Objective: Sildenafil stimulates the nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway through inhibition of type 5 phosphodiesterase. NO-cGMP pathway causes smooth muscle relaxation. The aim of this study is to evaluate the effects of sildenafil on gallbladder motility. Methods: Twenty healthy male volunteers (21–35 years old) participated in this randomized, double…

Case Report

Reversible Right Ventricular Dysfunction in Patients with HIV Infection.

Human immunodeficiency virus-related cardiomyopathy is characterized by global left ventricular (LV) dysfunction commonly associated with biventricular dilation. Human immunodeficiency virus (HIV) cardiomyopathy carries a poor prognosis, and the role of antiretroviral therapy in the reversal of heart failure is not very clear. We report two patients with HIV infection who…

Case Report

Lemierre Syndrome Complicating a Subcutaneous Neck Abscess

Lemierre syndrome is septic thrombophlebitis of the internal jugular vein caused typically by an oropharyngeal infection. We report a case of Lemierre syndrome complicating a subcutaneous neck abscess. Lemierre syndrome should be considered in the differential diagnosis of septic emboli and sepsis, especially in a patient with tenderness along the…

Case Report

Lithium-associated Hypothyroidism and Thyroid Papillary Carcinoma: A Case Report

Ionizing radiation, some hereditary factors, and chronic thyroid-stimulating hormone elevation increases the risk of differentiated thyroid carcinoma. Lithium salts are used in the treatment of affective (mood) disorders as well as a variety of other psychiatric conditions. There have been occasional reports of hematologic and solid neoplasms associated with lithium…

Case Report

Paradoxical Bronchospasm: A Potentially Life Threatening Adverse Effect of Albuterol

We report a case of paradoxical bronchospasm to both levalbuterol and albuterol. While the exact mechanism for this known adverse effect of albuterol is not known, awareness of this adverse effect can be life saving to the patient. To our knowledge, this is the first reported case of paradoxical bronchospasm…

Case Report

The Postcardiac Injury Syndrome: Case Report and Review of the Literature

The postcardiac injury syndrome (PCIS) includes the postmyocardial infarction syndrome, the postcommissurotomy syndrome, and the postpericardiotomy syndrome. Dressler reported a series of patients who developed a pericarditis-like illness days to weeks after a myocardial infarction. Postcardiac injury syndrome also has been observed after cardiac surgery, percutaneous intervention, pacemaker implantation, and…

Case Report

Suicide Attempt by the Intravenous Injection of Rattlesnake Venom

A 14-year-old male milked the venom from a rattlesnake and injected it with a syringe into his right antecubital vein in a suicide attempt. He immediately developed severe pain and vomiting, then hypotension, swollen lips and tongue, and coma. The injection site did not have the considerable tissue damage seen…

Case Report

Persistent Paranoid Delusions Following the September 11 Terrorist Attacks in a Man with No Pre-existing Mental Illness

The effects of modern day terrorism on mental health are not well understood. Described here is a 51-year-old male with no pre-existing mental illness who developed paranoid delusions related to the September 11, 2001, terrorist attacks shortly after they occurred. After about two years of treatment with quetiapine the patient…

Original Article

The Rectovaginal Examination: Physician Attitudes and Practice Patterns

Background: The value of screening with the rectovaginal examination (RVE) has not been validated. This study describes physician attitudes and practice patterns regarding the RVE. Methods: Cross-sectional survey of residents and faculty in general internal medicine and obstetrics/gynecology (OB/GYN) at a university hospital. Results: Thirty-four percent of physicians surveyed reported…

Editorial

Are We Missing Something? What Really Is the Post Cardiotomy Syndrome?

Wessman and Stafford1 in this issue of the SMJ review the conundrum of the post–cardiac injury syndrome (PCIS). Many physicians have said that since we treat the myocardial infarction (MI) patients so aggressively, we minimize muscle damage, hence the syndrome is rarely seen. We did an informal and unscientific survey…

Editorial

CA 19-9: Not a Magic Marker for Pancreatic Cancer

Serum carbohydrate antigen (CA) 19-9 is considered to be the most sensitive/specific marker for pancreatic cancer, although it has also been associated with biliary, hepatocellular, gastric, colonic and nongastrointestinal malignancies.1 For pancreatic adenocarcinoma, CA 19-9 is reported to have a sensitivity of 70 to 90%, specificity of about 90%, a…

Editorial

Future Physicians and Firearms: The Need for Additional Training in Firearm Injury Prevention Counseling

Firearm injury is a major public health issue, with a significant impact on society in both economic and human terms.1–5 Physicians can be involved in the prevention of firearm injuries and many professional medical organizations have policy statements with firearm injury prevention strategies.1–8 One role outlined for physicians in many…

Editorial

Improving Inpatient Vaccinations: A Long Road Ahead

Physician compliance with established immunization guidelines continues to be an ongoing challenge in the effort to improve the quality and consistency of medical care. In this issue of Southern Medical Journal, Alagappan et al1 report their experience with emergency room physicians’ compliance with The Advisory Committee on Immunization Practices (ACIP)…

Editorial

Pleomorphic Basal Cell Carcinoma

Basal cell carcinoma (BCC) is arguably the most common cancer in the United States. In 2006, there will be approximately one million new BCCs diagnosed meaning that almost 50% of new cancers will be a BCC. Because of its ubiquitous nature, a general knowledge of this tumor is important for…

Editorial

Reversible Right Ventricular Dysfunction In HIV-infected Patients

The introduction of highly active antiretroviral therapy (HAART) has significantly improved the clinical outcome of HIV disease with increased survival rates. However, the introduction of HAART has generated a contrast in the cardiac manifestations of AIDS. In developed countries, we observed an approximate 30% reduction in the prevalence of HIV-associated…

Editorial

Stressors and the Fine Line Between Normal and Psychopathology

The terrorist attacks of September 11, 2001, were a sudden and extreme stressor that affected many people.1,2 We all responded to this high level of trauma in different ways. In extreme circumstances, the otherwise adaptive defenses that we use no longer provide us the means to “make sense” of our…

Editorial

To View or Not to View: Television and Mental Health

Fogel and Carlson1 report in this issue of the Southern Medical Journal that talk shows or soap operas as a favorite television category were associated with poorer scores on various cognitive measures in a cross-sectional analysis of 289 older women. While several observational studies have reported on the association between…

Expired CME Article

CME Questions: Colorectal Cancer Screening: Today and Tomorrow

Expired CME Article Questions: Colorectal Cancer Screening: Today and Tomorrow

Expired CME Credit Submission and Evaluation Form

CME Credit – March 2006 CME Topic: Colorectal Cancer Screening: Today and Tomorrow

Expired CME Credit Submission and Evaluation Form – Colorectal Cancer Screening: Today and Tomorrow

Letter to the Editor

Intestinal Ascariasis: CT Findings and Diagnosis

Intestinal ascariasis is a disease most commonly diagnosed through stool studies along with traditional imaging studies. Radiographic findings in Ascaris infection have been described in multiple modalities, as well as two descriptions of computed tomography (CT) findings.1,2 In this letter, we describe an incidental finding on abdominal CT of Ascaris…

Letter to the Editor

L-carnitine Reduces Severity of Physical and Mental Fatigue and Improves Daily Activities in the Elderly

Chronic fatigue syndrome is a disabling illness that afflicts the elderly and influences their daily activities.1 The evaluation and treatment of fatigue has been fraught with frustration and oftentimes, a sense of failure. Patients diagnosed with fatigue are often disappointed when advised to merely, “get more rest.”

Letter to the Editor

Patient Approval of Insulin Therapy in Type 2 Diabetic Patients

The primary goal of therapy in diabetes mellitus is to reach and sustain near-normal glycemic levels to prevent acute metabolic complications.1 When insulin is initiated early in the disease process, this therapy has the potential to preserve β-cell function and delay disease progression.2,3 However, the discomfort and inconvenience of self…

Letter to the Editor

Vitamin D Deficiency in Primary Aldosteronism*

Alterations in calcium metabolism have been reported in hypertensive patients and animal models. However, there is no report on the presence of vitamin D deficiency in salt-sensitive hypertension of primary aldosteronism in the literature. We report a patient who presented with primary aldosteronism associated with vitamin D deficiency. We discuss…

Medical Webwatch

Medical Webwatch

Who Named It http://www.whonamedit.com/index.cfm is a biographical dictionary of medical eponyms. The entries describe the syndromes, signs, tests, reactions, and reflexes that we all know so well, with the added interest of short biographies of the associated persons. The website has been constructed by Ole Daniel Enersen, Oslo, Norway, and…

Acknowledgment

Patient’s Page

Colorectal Cancer Screening Colorectal cancer is the second leading cause of cancer-related death in the United States, with approximately 55,000 people dying every year from this disease. Although early detection is crucial, a recent study found that the number of people undergoing routine screening for this deadly disease remains low,…

SMA Centennial

Anesthesia: Looking Back at the Last Century and Forward to the Next

Unlike many other subspecialties, most anesthesiologists can tell you when our specialty began: October 16, 1846, when the first ether anesthetic was delivered by Dr. William Morton in what is now affectionately called the “Ether Dome” of the Massachusetts General Hospital. From that day and certainly over the past 100…