Issue - Southern Medical Association

Original Article

Clostridium difficile: Association with Thrombocytosis and Leukocytosis

Background: Apart from leukocytosis, few laboratory markers suggestive of Clostridium difficile infections have been described. Methods: We retrospectively analyzed the association between thrombocytosis, leukocytosis and C difficile infections at the Atlanta Veterans Affairs Medical Center. Results: Of 162 patients with C difficile infection, 36 (22%) had thrombocytosis, and 97 (60%)…

Original Article

Texas Coral Snake (Micrurus tener) Bites

Background: The clinical features of bites from Texas coral snakes (Micrurus tener) have not been well studied. Our goal was to review the largest number of victims of Texas coral snakebites to determine their characteristics, effects, treatment, and outcome. Methods: Retrospective case series of Micrurus tener exposures reported to the…

Expired CME Article

Local Biological Factors that Influence Amputations in Diabetic Patients

Lower extremity amputation is one of the worst complications of diabetes, as it usually has a life expectancy that is below that of most cancers. Four local biologic factors—ulcer, ischemia, neuropathy, and infection—have been shown to be related to amputation. These factors interact with one another, such that neuropathy has…

Review Article

Physiological and Behavioral Aspects of Glycemic Control and Hypoglycemia in Diabetes

Abstract:Homeostatic mechanisms that maintain blood glucose concentration within a narrow physiologic range are complex and redundant. Elaborate feedback loops involving insulin, glucagon, sympathoadrenal mediators, growth hormone, amylin, and incretins normally operate synchronously to keep blood glucose within a narrow set point. Individuals with diabetes have defects in glucose homeostatic pathways,…

Editorial

The Challenge of Vaccinating Hospitalized Patients for Influenza and Pneumococcus

Each year, an estimated 35,000 older Americans die of pneumonia and influenza-like illness.1 These figures have remained constant over the past several decades, despite the availability of vaccines to prevent both influenza and Streptococcus pneumoniae infections. Following reports of deaths due to influenza or pneumonia among older, previously hospitalized patients…

Errata

Erratum

Sheen-Chen S-M, Liu, Y-W, Eng H-L, et al. Metastatic Malignant Pleural Mesothelioma to the Breast. South Med J 2006;99:1395–1397. The legends for Figures 1 and 2 which appeared on page 1396 of the December 2006 issue of the Southern Medical Journal were incorrect as published. Below are Figures 1 and…

Case Report

Rhodotorula mucilaginosa Catheter-related Fungemia in a Patient with Sickle Cell Disease: Case Presentation and Literature Review

Rhodotorula mucilaginosa (formerly Rhodotorula rubra) is a ubiquitous, environmental, urease-positive yeast that does not ferment sugars and can assimilate various carbohydrates. Characterized by the salmon-pink to coral-red color of its colonies, Rhodotorula mucilaginosa can disseminate and cause significant disease. We present a case of sustained Rhodotorula mucilaginosa catheter-related fungemia in…

Case Report

Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications

There are multiple reports in the literature of serious and at times fatal complications after cervical spine manipulation therapy (CSMT), even though CSMT is considered by some health providers to be an effective and safe therapeutic procedure for head and neck pain syndromes. We report a case of a young…

Case Report

Camphor Ingestion in a 10-year-old Male

A 10-year-old male with a history of oppositional defiant disorder and attention deficit disorder suffered from mental status changes, nausea, vomiting and tremulousness after intentional ingestion of three over-the-counter cold remedy transdermal patches. Each patch contained approximately 100 mg of camphor. While in the hospital, the patient was treated supportively,…

Case Report

Fatal Reactive Hemophagocytosis Related to Disseminated Histoplasmosis with Endocarditis: An Unusual Case Diagnosed at Autopsy

Reactive hemophagocytic syndrome (RHS) is an uncommon life-threatening disorder. It is believed to be caused by widespread non-neoplastic proliferation and inappropriate activation of mature macrophages, resulting in excessive cytokine activation which leads to hematophagocytosis by cells of the macrophage-monocyte lineage and multiorgan dysfunction. RHS may be associated with infections caused…

Case Report

Mycoplasma pneumoniae Associated with Hemolytic Anemia, Cold Agglutinins, and Recurrent Arterial Thrombosis

A 40-year-old white male developed Mycoplasma pneumoniae pneumonia (IgM titer 1:256) as well as autoimmune hemolytic anemia due to cold agglutinins (titer of 1:512). Four days after admission to the hospital, he developed an acute superior mesenteric artery (SMA) thrombosis. Four feet of ischemic small bowel were resected. A follow-up…

Case Report

A Case of Right Isomerism Showing Long Survival Without Surgery

We report an autopsy case of right isomerism in a 42-year-old Japanese man. Although he had not undergone any surgical intervention, he was healthy and did not exhibit any symptoms of heart failure. The cardiac findings indicated right isomerism with complex and severe cardiac malformations, including a morphologically common atrium,…

Letter to the Editor

Spontaneous Regression of Hepatocellular Carcinoma: Potential Promise for the Future

To the Editor: Worldwide there are approximately 1.2 million new cases of hepatocellular carcinoma (HCC) that arise annually, making this one of the most prevalent malignancies in the world.1 The incidence of HCC in the United States and Europe is on the rise with the increasing number of hepatitis B…

Letter to the Editor

Superdominant Right Coronary Artery Giving Rise to Left Circumflex Coronary Artery as a Terminal Extension

To the Editor: Coronary artery anomalies are generally discovered incidentally during coronary angiograms. The failure to visualize a coronary artery in its expected anatomic site may be misinterpreted as a total occlusion. It is essential that cardiothoracic surgeons and interventional cardiologists be familiar with abnormal coronary anatomy to perform accurate…

Letter to the Editor

Coexistence of a Tuberculous Bronchoesophageal Fistula and Intracranial Tuberculosis in an Immunocompetent Patient

To the Editor: Extrapulmonary involvement of tuberculosis increases with the rise of the incidence of immunocompromised host, especially in acquired immunodeficiency syndrome, and it can occur even in immunocompetent patients.1 We report an immunocompetent case with coexistence of a tuberculous bronchoesophageal fistula and intracranial tuberculosis, successfully managed by antituberculous chemotherapy…

Letter to the Editor

Primary Embryonal Rhabdomyosarcoma of the Breast

To the Editor: Rhabdomyosarcoma is the most common sarcoma of the soft tissues in children and young adults, and comprises around 5% of malignant neoplasia in this age group.1–3 Its location in the breast is rare and generally represents metastatic disease from a primary site in another part of the…

Letter to the Editor

Subdeltoid Bursitis: An Unusual Presentation of Streptococcus pneumoniae Bacterial Endocarditis

To the Editor: A 68-year-old man presented to the ER with complaints of sudden onset, nonradiating right shoulder pain and fever for 10 days. There was no history of antecedent trauma or shoulder overuse. His past medical history was significant for medication-controlled chronic obstructive airway disease. On initial examination, temperature…

Letter to the Editor

Permanent Visual Loss Despite Appropriate Therapy in Tuberculous Meningitis

To the Editor: Tuberculous meningitis (TBM) is one of the most serious forms of tuberculous disorders with considerable complications and mortality.1 Ocular complications may result from optochiasmatic arachnoiditis, hydrocephalus, development of tuberculoma which presses on optic pathways, or anti-TB therapy.2 We herein report a case of TBM causing sudden onset…

Editorial

The Impact of Diabetes Mellitus On Endothelial Dysfunction

Coronary artery, cerebrovascular and peripheral vascular disease (PVD) are the principal causes of morbidity and mortality in type 2 diabetes mellitus (DM).1 The augmented risk of macrovascular disease in DM is partly due to the considerably higher incidence of conventional cardiovascular risk factors, such as hypertension, obesity and dyslipidemia.2 However,…

Editorial

Spinal Manipulation: Risks vs. Benefits

“Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications”1, in this issue of the Southern Medical Journal details the tragic events that occurred with a young female after her procedure. It requires a critical analysis pertaining to the risks and benefits associated with cervical spine manipulation techniques. For…

Original Article

Levofloxacin Treatment in Patients with Rheumatoid Arthritis Receiving Methotrexate

Background: Sulfasalazine and tetracyclines are effective against rheumatoid arthritis (RA). Levofloxacin, the bacteriologically active isomer of ofloxacin, is used in the treatment of infections caused by periodontopathic bacteria and facultative anaerobic bacteria. The aim of this study is to evaluate the clinical efficacy, safety, and tolerability of levofloxacin in patients…

Original Article

Impact of Two Different Models on Influenza and Pneumococcal Vaccination in Hospitalized Patients

Objective: The Centers for Disease Control (CDC) recommends trivalent influenza (TIV) and pneumococcal (PPV) vaccination for eligible hospitalized patients. We conducted a retrospective study comparing two different methods of assessment and its impact on TIV and PPV vaccination in hospitalized patients. Design: Two sequential models were compared in a community…

Original Article

Benefits of Boarding Home Placement in Patients with Schizophrenia

Objective: To determine if boarding home placement of patients with schizophrenia decreases the need for acute inpatient treatment, during and after the placement. Method: Data was collected from the medical records of 74 patients initially diagnosed with schizophrenia in our hospital from July 2001 to June 2002. The progress of…

Brief Review

Male Breast Cancer: A Different Disease than Female Breast Cancer?

An estimated 1,450 new cases of male breast cancer were diagnosed in the United States in 2004 compared with 215,990 new cases of breast cancer in women and only 470 men as compared with 40,110 women died as a result of breast cancer.1 These facts show the lower incidence of…

Brief Review

Functional Paragangliomas Presenting as Primary Liver Tumors

Paragangliomas are rare neuroendocrine tumors derived from the extra-adrenal paraganglia. They can present anywhere along the sympathetic paraganglia chains from the neck to the pelvis, but they occur most often intra-abdominally in the periaortic region and the organ of Zuckerkandl. They also have been reported in other unusual sites, such…

Case Report

Oxycodone Accumulation in a Hemodialysis Patient

Oxycodone and oxycodone-containing analgesics are often used for the relief of pain. In the presence of renal dysfunction, the half-life of oxycodone and metabolites can be prolonged. We describe the case of a 41-year-old chronic hemodialysis patient who received multiple doses of oxycodone/acetaminophen resulting in accumulation of the medication and…

Expired CME Article

Factors that Influence Amputations in Diabetic Patients

Date of Original Release: February 1, 2007 Term of Approval: 1 Year • Credit Expires: February 1, 2008 Estimated Time for Completion: 1 Hour Credit Designation: 1 AMA PRA Category 1 Credit™

Expired CME Article

CME Questions: Factors that Influence Amputations in Diabetic Patients

CME Questions: Factors that Influence Amputations in Diabetic Patients

Editorial

Camphor—A Lesser-known Killer

In this issue of the Southern Medical Journal, Ragucci et al1 describe camphor poisoning in a 10-year-old male who presented to the emergency department. For centuries, camphor has been used as an antiseptic, antipruritic, rubefacient, abortifacient, contraceptive, lactation suppressant and aphrodisiac.2 The strong aroma associated with camphor has attracted its…

Editorial

Healthcare-associated Fungal Infections: Beyond Candida and Aspergillus

Healthcare-associated invasive fungal infections are an important cause of morbidity and mortality in the United States.1,2 Candida and Aspergillus cause most healthcare-associated fungal infections, and are associated with crude mortality rates of 40 to 61% (for invasive candidiasis3,4) and 40 to 88% (for invasive aspergillosis5). Increasingly immunocompromised patient populations, more…

Editorial

Early Use of Insulin in the Management of Type 2 Diabetes—The Time is Now

Recently the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have published guidelines that describe a consensus approach to the management of hyperglycemia in patients with type 2 diabetes.1 While effective weight loss, increased physical activity, and dietary control remain the pillars of therapy,…

Review Article

Management of Diabetes-related Hypoglycemia

Iatrogenic hypoglycemia is the main factor limiting aggressive and optimal diabetes management. Rather than being an inevitable consequence of optimal glycemic control, however, hypoglycemia is avoidable and generally straightforward to manage when it occurs. Professional caregivers, patients, and their families are often fearful of hypoglycemia, even though most episodes are…

Medical Webwatch

Medical Webwatch

Heart Center Encyclopedia, http://www.cincinnatichildrens.org/health/heart-encyclopedia/default.htm, is produced by the Cincinnati Children’s Hospital and provides patients with detailed explanations of cardiac pathologies and associated treatment options. This is a comprehensive education package with menu options for “Congenital,” “Heart Diseases,” “Signs and Symptoms,” and “Diagnostic Methods.” In addition to textual explanations, many pages…

Patient's Page

Patient’s Page

Managing Diabetes and Hypoglycemia (Low Blood Sugar) Over the past 25 years, diabetes has been on the rise, and many patients with diabetes face the risk of hypoglycemia or low blood sugar. Although most drops in blood sugar levels are minor and easily corrected, when left untreated, the condition can…

Letter to the Editor

Hyponatremia Due to an Additive Effect of Carbamazepine and Clarithromycin

To the Editor: Both carbamazepine (CBZ) and clarithromycin are commonly prescribed drugs. CBZ is a first-line antiepileptic drug and has multiple other off-label uses. CBZ-induced hyponatremia has been described in the literature.1,2 However, to our knowledge, a possible interaction between CBZ and clarithromycin for hyponatremia has not been described.

Letter to the Editor

The Misuse of Social Security Disability Income on Drug and Alcohol Abuse

To the Editor: The Supplemental Security Income (SSI) program was signed into law by President Nixon in 1972 with the goal of improving the quality of life for persons who are elderly or have a disability by providing financial support, incentives to work, and access to medical care via Medicaid….

Review Article

Why and How to Use Insulin Therapy Earlier in the Management of Type 2 Diabetes

Most patients with type 2 diabetes are inadequately controlled on their current therapy. Suboptimal glycemic control can have devastating consequences, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease that may ultimately lead to mortality. Most patients eventually need insulin therapy, and initiating insulin earlier in the course of type 2…

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