Editorial
Early Postoperative Small Bowel Obstruction
In this issue of Southern Medical Journal, Zbar et al1 present an interesting case of adult postoperative intussusception as a rare cause of early postoperative small bowel obstruction.
SMJ // October 2007, Volume 100 - Issue 10
Original Article
Predictors of Endoscopic and Laboratory Evaluation of Iron Deficiency Anemia in Hospitalized Patients
Background: Many hospitalized anemic patients do not undergo appropriate evaluation. We hypothesized that specific clinical variables were likely to be important in triggering evaluation for iron deficiency anemia. Methods: We prospectively identified 637 consecutive anemic patients without acute gastrointestinal bleeding admitted over a three-month period to medical inpatient teams of…
Original Article
A Reliable and Valid Instrument to Assess Competency in Basic Surgical Skills in Second-Year Medical Students
Background: Despite calls for competency based education, a dearth of validated instruments for measuring basic skills currently exists. We developed an instrument to assess competency in basic surgical skills in second-year medical students and tested it for psychometric reliability and validity. Methods: From a review of the literature, an instrument…
Original Article
Differences in the Pre- and Post-Katrina New Orleans HIV Outpatient Clinic Population: Who Has Returned?
Background: Hurricane Katrina devastated the New Orleans area and dispersed the patient population of the HIV Outpatient Program (HOP) clinic of the Medical Center of Louisiana at New Orleans (MCLNO). Patients began returning to care following the clinic’s reopening in a temporary location in November 2005. Methods: Cross-sectional analyses were…
Expired CME Article
Pharmacologic Stress Myocardial Perfusion Imaging
Abstract: Pharmacologic stress agents (dipyridamole, adenosine and dobutamine) allow virtually all patients to be safely assessed for ischemic heart disease. These agents have mild but significant side effects, mandating a thorough knowledge of indications, contraindications, side effects and management before their use. Adjunctive exercise improves image quality in vasodilator pharmacologic…
Expired CME Article
Determining the Clinical Probability of Deep Venous Thrombosis and Pulmonary Embolism
Deep venous thrombosis and pulmonary embolism are potentially life-threatening problems that present diagnostic challenges. To employ objective diagnostic tests in an efficient, safe, and cost-effective manner, the clinical probability of these disorders should be estimated before testing. A number of clinical prediction rules are available for suspected deep venous thrombosis,…
Expired CME Article
Jugular Venous Pulse: Window into the Right Heart
Although physicians began associating conspicuous neck veins with heart disease almost three centuries ago, the jugular venous pulse remains an often ignored component of the physical examination. Many physicians have not invested in the necessary understanding of the technique, and there is a misconception that its examination is difficult and…
Case Report
Spigelian Hernia Presenting as an Appendicular Mass
Incarcerated spigelian hernias are a rare cause of acute abdomen. The clinical diagnosis of incarcerated spigelian hernia can be a challenge in the absence of definite signs. Reported here is a case of a strangulated spigelian hernia that mimicked an appendicular mass and was discovered on CT scan of the…
Case Report
Colorectal Intussusception Secondary to Sigmoid Carcinoma in an Adult
Although intussusception is relatively common in children, it is clinically rare in adults A 54-year-old woman who presented with cramping abdominal pain and rectal bleeding was found to have sigmoid rectal intussusception secondary to adenomatous polyps of the sigmoid colon. Following confirmation of intussusception by CT scan, surgical resection was…
Case Report
Adult Postoperative Intussusception: A Rare Cause of Small Bowel Obstruction
A case is reported of postoperative jejunojejunal intussusception in a 45-year-old Afro-Caribbean male following an emergency truncal vagotomy and pyloroplasty. This is a rare cause of postoperative small bowel obstruction, and the pathogenesis and diagnosis of postoperative intussusception in the adult is discussed. Differences between conventional childhood, postoperative childhood, adult,…
Case Report
Osteoid Osteoma of the Radial Styloid Mimicking de Quervain Tenosynovitis
A very unusual location of osteoid osteoma arising in the radial styloid is presented, which strongly mimicked de Quervain tenosynovitis, thereby resulting in the patient undergoing an additional unnecessary operation and a substantial delay of more than 2 years in diagnosis. Key Points * Osteoid osteomas are rare in the…
Case Report
Purple Urine Bag Syndrome: A Rare and Interesting Phenomenon
Discoloration of urine is not uncommonly encountered in clinical practice and may indicate a significant pathology. However, the majority of instances are benign and occur as the result of trauma to the urological system during procedures or ingestions of substances such as medication or food. Purple discoloration of a urinary…
Letter to the Editor
Dramatic Response to Uracil-Tegafur (UFT) in an Elderly Patient with Nonsmall Cell Lung Cancer
To the Editor: Uracil-tegafur (UFT) is an oral 5-fluorouracil derivative drug. However, few reports have demonstrated anti-tumor effects of UFT in patients with advanced nonsmall cell lung cancer (NSCLC), especially elderly patients with poor performance status. Here, we describe a case of an elderly patient with NSCLC whose tumor dramatically…
Rapid Response
To Prescribe or Not to Prescribe? Atypical Antipsychotic Drugs in Patients with Dementia
Antipsychotic Drug Use and Mortality in Older Adults with Dementia Gill SS, Bronskill SE, Normand ST, et al. Ann Intern Med 2007;146:775–786.Recent data regarding strokes and mortality associated with atypical antipsychotic medications in older adults with dementia have caused considerable confusion and anxiety among patients and their families, clinicians, and…
Letter to the Editor
Sweet Syndrome and Erythema Nodosum
To the Editor: I read with interest the letter by Kocabay et al1 reporting Sweet syndrome associated with erythema nodosum in a woman with culture-confirmed pulmonary tuberculosis whose general condition and skin lesions improved following treatment with a four-drug regimen of antituberculous therapy.
Rapid Response
Atypical Antipsychotics, Elderly Patients, and Mortality Risk
Clinicians faced with the management of disturbed behavior in patients with dementia have a limited array of options. The risk of doing nothing will place the agitated patient at risk for harm to self or others, not to mention the discomfort of this often-dysphoric state. Second-generation, or atypical, antipsychotics such…
Editorial
Iron Deficiency Anemia: A Call for Aggressive Diagnostic Evaluation
Iron deficiency is a prevalent cause of anemia in the United States. It is easily diagnosed by readily available laboratory studies. Although most common in toddlers and women of reproductive age, iron deficiency anemia (IDA) is found in 1 to 2% of men and 2% of women over the age…
Editorial
Pharmacologic Stress Testing
Pharmacologic stress testing plays an important role in the diagnosis of patients with known or suspected coronary artery disease. In many busy nuclear cardiology laboratories, 30 to 40% of all nuclear stress tests are pharmacologic.1 This makes it particularly important for clinicians to understand the indications, complications, and optimal way…
Editorial
Colonic Intussusception
Abdominal pain in adults is a significant problem encountered by gastroenterologists and surgeons and makes up a considerable part of their clinical practice. The differential diagnosis is extensive, and the evaluation of a specific problem is plagued with many false leads, leaving room for error. Colonic intussusception is an example…
Case Report
Contrast-Induced Encephalopathy Following Coronary Angioplasty with Iohexol
Abstract: We report a case of a patient who developed acute encephalopathy following coronary angioplasty with iohexol contrast. The patient’s clinical condition was associated with slowing on the EEG. Studies did not reveal any other etiology or contributing cause for the encephalopathy. The patient recovered spontaneously in 24 hours with…
Case Report
A 41-Year-Old HIV-Positive Man with Acute Onset of Quadriplegia after West Nile Virus Infection
Most cases of West Nile encephalitis virus (WNV) infection are asymptomatic. In cases where WNV is symptomatic, patients usually experience high fever of sudden onset, myalgia, headache, and gastrointestinal symptoms, accompanied by a macular erythematous rash in a quarter to half of cases. More severe infections manifest as a poliomyelitis….
Expired CME Credit Submission and Evaluation Form
CME Questionnaire and Credit Form
CME Questionnaire and Credit Form
Editorial
Back to Basics: Editorial Review of “Jugular Venous Pulse: Window into the Right Heart”
“From a careful observation of the jugular pulsation in the neck and careful auscultation over the precordia, there is seldom much doubt as to the presence or absence of tricuspid regurgitation.” – —Sir William OslerDr. Devine et al2 are to be applauded for this eloquent review of the jugular venous…
Editorial
Spigelian Hernias Presenting as Surgical Emergencies
Spigelian hernia is a rare partial abdominal wall defect in the transversus abdominus aponeurosis or spigelian fascia. It is located between the semilunar line (which marks the transition from muscle to aponeurosis in the transversus abdominis muscle) and the lateral edge of the rectus muscle, below the arcuate line of…
Original Article
Why Current Medical Management Is Failing Victims of Hurricane Katrina: A Review of Past Successes and Failures in Postdisaster Psychosocial Treatment
Background: More than one year after Hurricane Katrina, victims exhibit symptoms of a “chronic disease,” representing the disruption of psychosocial health. This systematic review assesses the effects of trauma on multiple domains of health following a disaster. Method: Authors searched disaster-related literature from 1971 to present, focusing on recent literature…
Rapid Response
It is what we do not know that may hurt us most!
The sheer number of medical publications precludes most practicing clinicians from thoroughly reading, fully analyzing, adequately interpreting, and satisfactorily integrating into their practice a large amount of contemporary information contained in the published medical literature. This is further compounded by the often complicated statistical methods used to analyze and report…
Rapid Response
Antipsychotics in the Elderly
The United States Census Bureau estimates that the rate of growth of the elderly population (individuals 65 yr of age or older) has greatly exceeded the growth rate of the population of the country as a whole. In fact, the fastest growing segment of the elderly population is the oldest…
Medical Webwatch
Medical Webwatch
For the late Victorians, David Livingstone (1813–1873) was one of the great heroes of their era, and Livingstone Online http://www.livingstoneonline.ucl.ac.uk/ provides unique insights into the medical and scientific work of the missionary doctor and African explorer. Livingstone Online (which went live in May 2006) is based at the Wellcome Trust…
Patient's Page
Patient’s Page
Management of Chronic Pain Chronic pain, or pain lasting for longer than six months, occurs with a variety of disorders, including fibromyalgia, carpal tunnel syndrome, rheumatoid arthritis, osteoarthritis, cancer, and diabetes. The presence of chronic pain can limit your life both physically and emotionally, as approximately 58% of people who…
Letter to the Editor
Heparin-Induced Thrombocytopenia Presenting as Otalgia
To the Editor: A typical or unusual symptoms may signal the presence of a life-threatening condition,1 as the following case illustrates.A 72-year-old female with hypertensive nephropathy required placement of a temporary hemodialysis catheter into her right subclavian vein for symptomatic chronic renal failure. The catheter was placed via fluoroscopic guidance…
Review Article
Management of Chronic Noncancer Pain in the Primary Care Setting
While opioids are regarded as the mainstay of chronic pain management, their use is controversial in the minds of many primary care physicians due to clinical concerns about dependence, abuse, and addiction and medicolegal concerns regarding state and federal regulatory authorities. For patients with moderate to moderately severe pain, the…
