SMJ // May 2006, Volume 99 - Issue 5

Case Report

Significant Absorption of Oral Vancomycin in a Patient with Clostridium difficile Colitis and Normal Renal Function

Orally-administered vancomycin is poorly absorbed in most patients, usually producing minimal or subtherapeutic serum concentrations. Bowel inflammation may enhance absorption of oral vancomycin, particularly in those with renal failure. A 77-year-old female with Clostridium difficile (C difficile) colitis and normal renal function was treated with high doses of oral vancomycin…

Case Report

Anterior Uveitis, Inflammatory Bowel Disease, and Ankylosing Spondylitis in a HLA-B27-positive Woman

A woman developed anterior uveitis at age 24, inflammatory bowel disease at age 29, and ankylosing spondylitis at age 45 by history. There were frequent recurrences. An HLA-B27 test was positive at age 53. The literature indicates that all of these conditions together in a HLA-B27-positive woman are uncommon. Physicians…

Case Report

Acute Bowel Ischemia Following Spinal Surgery

Acute mesenteric ischemia is a morbid condition that may be difficult to diagnose due to nonspecific nature of its symptoms. To our knowledge, such a complication has not previously been reported after spinal surgery via the posterior approach. We describe the case of a 43-year-old woman who developed acute mesenteric…

Case Report

Incidental Finding of Congenital Thoracic Malformations in Adult Population

Objective: Evaluation of abnormal adult chest computed tomography (CT) scans. Study Design: Retrospective series of 3 cases. Setting: Two University-based hospitals. Intervention: Three adult patients (age range 56 to 61) underwent chest CT scans. Two were trauma patients and one complained of chest pain with a negative cardiac workup. One…

Case Report

Massive Fecal Impaction Presenting with Megarectum and Perforation of a Stercoral Ulcer at the Rectosigmoid Junction

A 25-year-old male with lifelong constipation presented to the emergency department with an acute abdomen. Initial resuscitation was performed, and the patient underwent urgent laparotomy. He was found to have feculent peritonitis with megabowel involving the rectum and sigmoid colon and a stercoral ulcer with full thickness erosion, and perforation…

Case Report

Epstein Barr Virus Hepatitis: Case Series and Review

Epstein Barr virus (EBV) infection causes asymptomatic liver-associated enzyme abnormalities in 80 to 90% of cases which are often unrecognized. Patients with acute EBV infections may also develop cholestatic hepatitis with associated jaundice and hepatitis with moderate elevations in the transaminase levels. Other gastrointestinal complications associated with EBV may include…

Case Report

Fecal Impaction and Systemic Inflammatory Response Syndrome in A Young Male with Cerebral Palsy

Symptoms of fecal impaction extend from constipation, anorexia, nausea, vomiting and abdominal pain, to full blown sepsis. We present the case of a patient with cerebral palsy and mental retardation, who presented to the Emergency Department with a 3-day history of diffuse abdominal pain and fecal incontinence. Evaluation revealed severe…

Case Report

Flail Chest in a Neonate Resulting from Nonaccidental Trauma

The authors present a 21-day-old infant who sustained a flail chest as a result of nonaccidental trauma. Initial treatment included endotracheal intubation and mechanical ventilation for hypoxemic respiratory failure followed by the administration of continuous positive airway pressure by nasal cannula. Further evaluation resulted in the identification of nonaccidental as…

Original Article

Omental Plugging for Large-sized Duodenal Peptic Perforations: A Prospective Randomized Study of 100 Patients

Background: Due to friable margins and the moribund state of the patient, managing giant duodenal perforations (>20 mm in diameter) is a challenging task. Methods: A prospective randomized study of 100 patients with large-sized (> 20 mm) duodenal peptic perforation comparing omental plugging (study group) with omentopexy (control group) was…

Original Article

Pain Outcome and Vertebral Body Height Restoration in Patients Undergoing Kyphoplasty

Introduction: Kyphoplasty, a minimally invasive technique, has recently been developed to provide immediate pain relief, biomechanical stabilization, prevention of fracture progression, vertebral height restoration, and prevention or reversal of kyphosis to patients with osteoporotic vertebral compression fractures (VCF). Materials and Methods: We retrospectively reviewed 24 patients treated with kyphoplasty. A…

Original Article

Factors Associated with Delayed Initiation of HIV Medical Care Among Infected Persons Attending a Southern HIV/AIDS Clinic

Background: Despite the proven benefits conferred by early human immunodeficiency virus (HIV) diagnosis and presentation to care, delays in HIV medical care are common; these delays are not fully understood, especially in the southern United States. Methods: We evaluated the extent of, and characteristics associated with, delayed presentation to HIV…

Case Report

Cardiogenic Shock in Hypothyroidism

A patient with minimal coronary artery disease presented in cardiogenic shock when her previously undiagnosed hypothyroid state was complicated by an episode of AV nodal re-entrant tachycardia. She did not respond to multiple pressors, and recovered dramatically after starting thyroid supplementation. Hypothyroidism caused her lack of responsiveness to pressors and…

Original Article

Sleep Disturbance in Patients with Lichen Simplex Chronicus and Its Relationship to Nocturnal Scratching: A Case Control Study

Background: Lichen simplex chronicus (LSC) is a common pruritic disorder resulting from repeated rubbing and scratching. Nighttime pruritus is a common feature in LSC and may disrupt the sleep pattern. The aim of this study is to determine whether there are sleep abnormalities in patients with LSC. Patients and Methods:…

Original Article

Primary Care House Staff Attitudes Toward Osteoporosis Management

Objective: This study assessed possible institutional and patient-related factors influencing the delivery of postmenopausal osteoporosis (PMO) care and the diagnostic priority placed on addressing PMO, relative to other common medical conditions, by primary care house staff at our institution. Methods: A questionnaire was designed and distributed to eligible house staff…

Case Report

Transient Blindness Due to Posterior Reversible Encephalopathy Syndrome Following Ephedra Overdose

Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome (RPLS), is most often associated with hypertensive emergencies and is characterized by seizures, mental status changes and visual disturbances. We report a case of a previously healthy young man who developed multiorgan failure and transient cortical blindness following…

Case Report

Chest and Abdominal Injuries Caused by Seat Belt Wearing

The authors report an original case of seat belt syndrome. Sternal fractures are common in patients with seat belt injuries. Its association with blunt bowel trauma is rarely related in the literature. Distracted injury has contributed to delay the diagnosis of intestine injury. The presence of a seat belt sign…

Review Article

Sudden Cardiac Death

Sudden cardiac death (SCD) due to ventricular tachyarrhythmias is a leading cause of death in the United States. Various etiologies, including ischemic and nonischemic cardiomyopathies, hypertrophic cardiomyopathy, valvular or congenital heart diseases and other less common disorders, may result in SCD. Beta blockers are the only class of medications that…

Expired CME Article

Thrombocytopenia in Adults: A Practical Approach to Evaluation and Management

With the widespread use of automated cell counters, clinicians in any field of medicine may encounter thrombocytopenia. The symptomatology may vary greatly and the underlying cause may be either inconsequential (pseudothrombocytopenia) or life threatening. It is important to be aware of common conditions leading to thrombocytopenia and have a systematic…

Original Article

Follow-up Study of Medication Errors Reported to the Vaccine Adverse Event Reporting System (VAERS)

Background: A study was done to determine if the apparent medication errors found in the Vaccine Adverse Event Reporting System (VAERS) database are true errors, and if true errors are found, to determine what corrective action was taken. Furthermore, if a true error did not occur, we wanted to determine…

Editorial

Augmentation Procedures for Osteoporotic Vertebral Fractures-An Ongoing Experiment or Emerging Standard of Care?

The history of vertebral augmentation procedures is an interesting one. Vertebroplasty was first performed in France in 1984 and reported in a French language journal in 1987.1 This publication did not create great international attention, but served to initiate further investigation by others. It was not until 1994 that the…

Editorial

Establishing Causality from Case Reports: Was Ephedra to Blame?

Ephedra has a long history of being associated with severe cardiovascular events, often in young, healthy patients. The Food and Drug Administration (FDA), which officially banned the sale of ephedra products in April 2004, had issued warnings about it dating back to September 1994.1 Numerous case reports have documented adverse…

Editorial

Management of Acute Duodenal Peptic Perforations

In this issue of the Southern Medical Journal, Jani et al1 present a prospective randomized study of 100 patients with acute duodenal perforations. The patients were randomized to either Graham omentopexy or omental plugging technique. The primary endpoint of the study was postoperative mortality. The secondary endpoints were postoperative suture…

Editorial

Osteoporosis: We Are Neglecting Our Own

In the dawn of the twenty-first century, we claim with pride to practice evidence-based medicine, but when it comes to osteoporosis, what we practice is different from the available evidence. The evidence we have gathered about the disease, its implications and treatment, has not yet affected our practice. Osteoporosis is…

Editorial

Thrombocytopenia

For the benefit of busy general practitioners who are likely to encounter thrombocytopenia in everyday practice, Sekhon and Roy,1 in this issue of the Journal, have provided a review of causes and a practical approach to the management of thrombocytopenia in adults.The principal goal in the management of thrombocytopenia is…

Expired CME Article

CME Questions: Thrombocytopenia in Adults

Expired CME Article Questions – Thrombocytopenia in Adults

Expired CME Article

Thrombocytopenia in Adults

Expired CME Article – Thrombocytopenia in Adults

Expired CME Credit Submission and Evaluation Form

CME Credit-May 2006 CME Topic: Thrombocytopenia in Adults

Expired CME Credit Submission and Evaluation Form – Thrombocytopenia in Adults

Letter to the Editor

A Case of Occult Oropharyngeal Dysphagia

Requests for feeding tube placement, in those newly diagnosed with dysphagia, is a common request of the gastrointestinal medicine service. Most dysphagia is either oropharyngeal or esophageal. The prevalence of oropharyngeal dysphagia is very high in patients with neurologic diseases such as cerebral vascular accidents (CVA), Parkinson disease, and amyotrophic…

Letter to the Editor

Hospitalist Physicians as Educators in a Community Hospital: The Trainee”s View

Hospitalists are playing an increasing role in inpatient care. In teaching institutions, hospitalists supervise patient care and participate in teaching conferences for residents.1 This educational role is well established in university hospitals where residents prefer teaching by hospitalist physicians over General Medicine Unit (GMU) physicians.2,3 That success, however, has not…

Letter to the Editor

Normal Chest Radiograph in Terminal Respiratory Failure Due to Amyotrophic Lateral Sclerosis

We report the case of a patient with terminal respiratory failure due to amyotrophic lateral sclerosis (ALS) who had a normal chest radiograph (CXR) 13 hours before respiratory arrest and death. This case shows that a normal CXR in the setting of severe neuromuscular disease cannot be used as evidence…

Letter to the Editor

Talc Pleurodesis for Recurrent Pleural Effusions: Is Cure Worse Than the Actual Insult?

A 79-year-old Vietnamese male presented to our facility with shortness of breath. Past medical history was significant for hypertension, hypercholesterolemia and coronary artery disease. He had undergone coronary artery bypass grafting 3 months earlier, which had been complicated by recurrent exudative pleural effusions. His chest x-ray on this admission revealed…

Letter to the Editor

Unilateral Pulmonary Edema Secondary to Idiopathic Rupture of Mitral Chordaea Tendinae

Pulmonary edema is an uncommon form of unilateral pulmonary infiltrate.1 Rupture of mitral chordae tendineae may result in severe mitral regurgitation, and may cause pulmonary edema. Although unilateral pulmonary edema (UPE) secondary to mitral regurgitation has been reported in the literature,2 to the best of our knowledge, UPE secondary to…

Medical Webwatch

Medical Webwatch

BestBETs (Best Evidence Topics) http://www.bestbets.org was initiated by consultants in the Emergency Department, Manchester Royal Infirmary, UK, to provide physicians with rapid access to the best current evidence on a wide range of clinical topics. “Browse” or “Search” will display structured literature reviews relating to carefully worded three-part questions. The…

Acknowledgment

Patient’s Page

Osteoporosis: The Silent Disease Are you under 30? Think osteoporosis doesn’t affect you? Think again.Although most people think that osteoporosis only affects the elderly, it is a disease that is best prevented before the age of 30. Bone is a living, growing tissue, and until the age of 30, bone…

SMA Centennial

My Perspective on the History of Emergency Medicine

One hundred years ago, virtually all medicine was emergent and nearly all physicians were generalists. Patients sought out physicians for pain relief or for treatment of injuries. Therapy was much more likely to be given in a patient’s home or a physician’s office than in a hospital setting.

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