Anger is a “syndrome” of thoughts, feelings and physiologic reactions. Behavioral responses to anger are influenced by multiple contextual factors. Patients and family members may express anger in response to their own experiences of illness, the healthcare system, or the physician-patient/family relationship. Anger may evoke a variety of clinician responses…
Ulceration of the nose may be inadvertently induced by the patient. Although trigeminal trophic syndrome is an uncommon cause of chronic ulcers, healthcare providers should consider the possibility of this disorder when encountering a patient with nasal ulcerations. Trigeminal trophic syndrome most commonly occurs in older women following therapy for…
Chronic eosinophilic pneumonia (CEP) is a disease of unknown cause. The hallmark of CEP is eosinophil accumulation in the lungs. While the triggering factor is unknown, eosinophil accumulation in the lungs is now believed to be secondary to the actions of eosinophil-specific chemoattractants, including eotaxin and regulated upon activation, normal…
A healthy woman developed pancreatitis after starting a popular herbal supplement designed to boost female libido. Following cessation of the herbal supplement, her enzymes quickly normalized. The patient had no risk factors for pancreatitis and anatomic obstruction was later ruled out. The contents of the supplement and their history of…
Dysphagia in human immunodeficiency virus (HIV) patients is most commonly of infectious etiology; however, less common causes of esophageal injury, such as strictures and medication-induced injuries, should be considered in the differential process. We report a case of a 53-year-old man with a 6-year history of HIV on highly active…
Malignant pleural mesothelioma (MPM) is a rare and asbestosis-associated tumor. MPM commonly invades locally, mostly in the lung, heart, pericardium, chest wall, and vertebrae. Distant metastasis of MPM is very rare. Here we report a patient with MPM who presented with multiple unusual distant metastases. The patient’s thorax tomography demonstrated…
Prosthetic joint infection with Mycobacterium tuberculosis usually involves the hips or knees and can result from either local reactivation, or less often from hematogenous spread. Predisposing conditions include rheumatoid arthritis, chronic steroid use and pulmonary diseases. The most common symptom at presentation is pain, and the most common physical finding…
Gastrocutaneous fistula after gastrostomy tube removal may persist for a prolonged period. We present a case of a 58-year-old woman with a GCF that had persisted for 5 months following the removal of an endoscopically-placed gastrostomy tube (PEG). Conservative therapy with anti-acid medications and administering motility agents was unsuccessful. For…
Schwannomas are tumors arising from the nerve sheath. Because of their infrequent occurrence, nonspecific symptoms, and lack of distinguishing radiologic features, schwannomas are most often diagnosed histologically after surgical excision. We report herein a case of a perinephric, retroperitoneal schwannoma which, after evaluation by computed tomography, magnetic resonance, and angiography,…
To the Editor: Neural tube defects (NTDs) are among the most commonly occurring preventable birth defects. Preconceptional consumption of synthetic folic acid, in addition to the usual diet, will prevent 60 to 70% of NTDs.1 Hispanic infants are 1.5 to 3 times more likely to be born with a NTD.2…
Medicine is a unique profession: as the art of healing, it is charged with curing and caring for the patient as person; yet, as a progressively scientific and evidence-based discipline, it also benefits from the focused insights afforded by technology. It is at once art and science; both dimensions are…
Within organizations, how we name people encodes the status and the relationship that we have with them. Whether it is a hospital, a church, a university, or a practice, we have titles which identify us, our level of competence and authority, as well as our obligations. Titles also indicate expectations…
Behind most ethical reflections on enhancement remains a residual suspicion of the human tendency to pursue perfection. The problem lies, however, not with the question of whether we should pursue perfection, but rather what perfection we are pursuing. Here, I argue that perfection, properly understood, has a positive function in…
In this article, we will briefly discuss the scientific, socioethical, and religious implications of technologies that facilitate gene transfer, which is the enabling technology of gene therapy.1 The timeliness of this topic is predicated as a result of rapid breakthroughs in genetic research, which are facilitated by advances in molecular…
Gene therapy has been proposed to be the modern medical cure for multiple diseases such as cancer, genetic disorders, as well as a potentially potent mediator of behavior. In the early days of gene therapy, the primary purpose was to develop therapies that would cure monogenetic diseases. However, with rapid…
For centuries, couples have tried to choose the sex of their children. Italian men bit their wife’s left ears during intercourse to beget daughters; Swedish men hung their pants on the right bedpost to father boys; while German woodcutters took their axes to bed and chanted: “Ruck, ruck, roy, you…
The phrase “sex selection” is generally used as an umbrella term referring not to a single practice, but to a great variety of practices, which differ according to the means used, the goal, and the context in which it is practiced. As we shall see, these differences are ethically significant….
At the risk of not being quite fair, let me start with an admittedly heart-wrenching story told by a mother of three boys: “I dreamed of a daughter since I was 9 years old. I even started keeping a journal for ‘her’ when I was 10. Somehow it never occurred…
Cybernetics has historically been defined as “Communication and control in human and machine.” In modern terms, this clearly encompasses the increasingly important area of research in which human and technology are merged into an overall system. It is worth emphasizing that from a cybernetics viewpoint, it is the functioning of…
t can be said that Japanese culture is informed by both Buddhism, which made its way into the Japanese islands in the sixth century of the Common Era, and Shinto, the ancient indigenous tradition of Japan. Yet this facile distinction has only been made possible since the end of the…
A 40-year-old man came to the clinic recently for follow-up of his hypertension and reactive depression following his father’s murder a couple of months prior. This day he was more upbeat and told me he had met a woman whom he believed to be “the one” for him. This was…
Objective: Obesity is a major health problem among children and adolescents which is potentially affected by socioeconomic status (SES). The high risk group (HRG) comprises those youths with a body mass index (BMI) between the 85th and 95th percentile (at risk for overweight) and ≥95th percentile (overweight). We sought a…
Background: In 2003, the South Carolina Department of Health and Environmental Control established the Carolina Antibiotic Resistance Surveillance System (CARSS), an active sentinel surveillance system for antibiotic-resistant Streptococcus pneumoniae. Methods: CARSS includes twelve hospitals. Each hospital was assigned a weighted sample size. Minimum inhibitory concentrations were determined using the E-test…
Background: Chronic kidney disease (CKD) is one of the known risk factors for coronary heart disease (CHD). Though electrocardiograms (ECGs) have limited accuracy in determining the true prevalence of CHD, we wondered whether CKD and diabetes mellitus (DM) controlled for hypertension (HTN), had similar prevalences of ECG abnormalities that could…
Objective: Capecitabine exerts considerable therapeutic efficacy in metastatic breast cancer (MBC) patients previously treated with anthracyclines and taxanes. Materials and Methods: In this study, the efficacy and safety of lower dose capecitabine (2000 mg/m2/d) in patients with anthracycline- and taxane-pretreated MBC were studied with a special emphasis on the potential…
Mitochondrial encephalopathy with lactic acidosis and stroke-like syndrome (MELAS) is a progressive neurodegenerative disorder frequently complicated by diabetes mellitus and sensory neuronal hearing loss. This syndrome tends to present initially with stroke-like symptoms. These strokes are nonvascular in nature and are linked to mitochondrial defect such as transient oxidative phosphorylation…
Pheochromocytomas are rare neuroendocrine tumors that produce, metabolize, and usually secrete catecholamines. Although hypertension is a common presenting feature of pheochromocytoma, the tumors occur (or are present) in only 0.1% of patients with hypertension. The variability of symptoms and rarity of occurrence render these tumors difficult to diagnose; many are…
Women with sickle cell anemia are surviving longer and may desire pregnancy. Rare, life-threatening complications of sickle cell anemia, such as acute chest syndrome, may occur at the time of delivery. A 22-year-old woman with sickle cell (HbS/β+ thalassemia) at 35 weeks of gestation presented with shortness of breath and…
CME Questions: Difficult Conversations: Anger in the Clinician-Patient/Family Relationship
The paper by Hillesheim and Whitcomb describes an interesting report of a young female who develops pancreatitis after consuming a popular herbal supplement used for improving sexual libido. This case reminds us of two key issues: first of all, herbal products and supplements are becoming more important to our daily…
Most outpatient illnesses caused by S pneumoniae tend to be treated empirically, without identification of the organism. Accurate, community-specific drug-resistant S pneumoniae surveillance is critical in helping determine initial therapy. Consequently, clinicians in areas with a low percentage of high-level penicillin resistance might gain confidence in treating presumptive outpatient infections…
Cardiovascular morbidity and mortality are very important considerations in patients with chronic renal failure. For patients on dialysis, the probability of cardiovascular death is 50% after 10 years.1–4 For patients between the ages of 15 to 30 years, the incidence of cardiovascular death is 150 times greater than in the…
The threat of obesity to the physical and mental health of children is high and rising. Worldwide, about 1 child out of 4 is overweight or obese–nearly as many as are affected by undernourishment.1 In the United States, 28.2% of 2 to 19 year olds were overweight or obese in…
Peripheral or central damage to the trigeminal nerve is a relatively common occurrence, whether due to cerebrovascular disease, viral infections (such as varicella-zoster), idiopathic Bell palsy, or surgical ablation of the Gasserian ganglion to treat neuralgic pain.1 Rarely, such injury can be complicated by the development of a triad of…
Peritoneal dialysis is an established form of renal replacement therapy. With its increasing popularity, we are now encountering a variety of complications. Noninfectious complications are usually less common as compared with infectious complications. In this review, we discuss some of the common noninfectious complications of peritoneal dialysis such as hernias,…
Visit the Office of Medical History, Office of the Surgeon General, for an enthralling chronology of the Surgeons General of the US Army and Their Predecessors.
Religious traditions can play a significant role in the shaping of bioethical thought. In Japan, traditional Buddhist and Shinto thought continue to influence contemporary bioethical perspectives. To better define this relationship, this paper examines the correlation between Japanese bioethical perspectives and Buddhist and Shinto thought. An in-depth discussion explores how…
Selected Annotated Bibliography on Genetic, Reproductive and Cybernetic Technologies
At the start of any year, many people make New Year’s resolutions, many of which involve getting in shape or losing weight. While this is an admirable goal, the way in which this is achieved should be carefully considered. Many companies market herbal supplements as an effective and safe method…
To the Editor: Acute myocardial infarction may occur when the coronary arteries are normal or nearly normal. In patients with normal coronary arteries, there is strong evidence for the participation of thrombus formation in the pathogenesis of myocardial infarction. Coronary artery spasm may also play a role in initiating coronary…
To the Editor: Infective endocarditis is often a delayed diagnosis, many times secondary to difficulty in diagnostic modalities or lack of clinical consideration due to an atypical presentation. We present a case of viridans group streptococcus endocarditis that initially presented to a surgical trauma service as a splenic laceration.
To the Editor: Human tetanus is rare in the United States, with about 40 cases reported each year.1 We report a case of generalized tetanus in a patient with a generally accepted “protective level” of tetanus antibody (0.01 antitoxin units per milliliter (U/mL),2 and to stress the fact that tetanus…
To the Editor: The June 2006 issue of the Southern Medical Journal featured a special section arising out of the SMJ Spirituality/Medicine Interface Project. Several articles in this section highlighted the contribution of pastoral care professionals to the process of health care and healing. Referring to chaplains as “hidden assets,”…
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