Issue - Southern Medical Association

Original Article

Group A Streptococcus: Another Resistant Pathogen

Objectives: In Greenville, South Carolina in 1992, erythromycin resistance in GAS was less than 5%, and there were no fully resistant strains. With a large increase in macrolide and azalide usage within the Greenville area, we again examined susceptibility patterns of pharyngeal GAS isolates in 2002 to 2003. Methods: Community…

Original Article

Early and Late Arrhythmogenic Effects of Doxorubicin

Background: To determine the incidence of early and late arrhythmogenic effects of doxorubicin-containing chemotherapy regimens. Patients and Methods: A prospective study including 29 patients who were treated with doxorubicin-containing regimens. Cardiac evaluation was based on 24-hour electrocardiographic monitorization (Holter), which was performed during the first cycle of doxorubicin-containing regimens, as…

Review Article

Small Bowel Capsule Endoscopy: A Systematic Review

Wireless capsule endoscopy offers a revolutionary diagnostic tool for small bowel diseases. Since its formal introduction, it has become an integral part of the diagnostic evaluation for obscure gastrointestinal bleeding. This relatively noninvasive imaging modality offered by small bowel capsule endoscopy is appealing to both patients and providers and consequently,…

Review Article

Gastroparesis

Gastroparesis is a symptomatic disorder of the stomach characterized by slow or delayed gastric emptying. Diabetes and idiopathic factors account for over 60% of gastroparesis cases. Symptoms associated with delayed gastric emptying include nausea, vomiting, abdominal bloating and early satiety. Delayed gastric emptying due to gastroparesis is managed by dietary…

Case Report

Four Cases of Patients with Gastrointestinal Granular Cell Tumors

We present four cases of gastrointestinal granular cell tumors (GCT) with a literature review. Gastrointestinal granular cell tumors, a benign neural tumor thought to arise from Schwann cells, can occur in several areas, including the gastrointestinal tract. Studies suggest that endoscopic ultrasound and endoscopic removal is the treatment of choice…

Editorial

Anaphylaxis: My “Top 10” List

Sooner or later, one of your patients is likely to experience a serious allergic reaction to a drug, food or insect. This frequently occurs when you least expect it. The article by Yong et al1 in this month’s Southern Medical Journal reminds us that the multisystem clinical features of anaphylaxis…

Case Report

Ulceroglandular Tularemia in a Nonendemic Area

Two patients present with the abrupt onset of fever, malaise, anorexia, fatigue, progressive skin lesions and lymphadenitis. These patients represent two of the six cases of tularemia reported in Alabama over the last decade. The cases illustrate how mode of acquisition (direct versus vector-mediated) influences the clinical manifestations of ulceroglandular…

Case Report

Massive Multilocular Cystic Leiomyoma of the Uterus: An Extreme Example of Hydropic Degeneration

A 49-year-old woman underwent laparotomy for an undiagnosed, extremely large abdominal mass. At surgery, this was discovered to be a uterine tumor and she was subjected to a subtotal hysterectomy. Pathologic examination of the uterus revealed a multilocular cystic mass containing over 18 L of fluid that was established on…

Case Report

McArdle Disease Presenting as Acute Renal Failure

In 1951, McArdle described a glycogen storage disorder which presents primarily as a myopathy. It is characterized by muscle pain, weakness and exercise intolerance with elevated creatine kinase from rhabdomyolysis. The pathophysiology involves a deficiency of myophosphorylase enzyme resulting in an inability to degrade glycogen stores. We present a novel…

Case Report

Emergency Liver Resection for Combined Biliary and Vascular Injury Following Laparoscopic Cholecystectomy: Case Report and Review of the Literature

Abstract:A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for elective laparoscopic cholecystectomy (LC). Intraoperatively, because of severe inflammation and dense adhesions in the region of the Calot triangle and bleeding arising from the porta hepatis which obscured the operating field, the method was converted to a…

Case Report

Unrecognized Delayed Toxic Lithium Peak Concentration in an Acute Poisoning with Sustained Release Lithium Product

A 32-year-old female with a history of bipolar disorder was admitted after taking approximately 16 g of an extended-release lithium carbonate formulation in an attempted suicide. Five hours after consumption, the lithium serum level was 3.2 mEq/L. Fourteen hours after consumption, the lithium level was 5.1 mEq/L and the patient…

Case Report

Fatal Passenger Vehicle Crashes 1999 to 2004 with Drivers Under Age 15: The Impact in Texas and Other Southern and Southwestern States

Texas has more fatal crashes involving unlicensed drivers under age 15 than does any other US state. Numbers and rates of such crashes are also above the national mean in many southern and Southwest states. Data on fatal passenger vehicle crashes from 1999 through 2004 were obtained from the online…

Case Report

Yellow Skin Discoloration Associated with Sorafenib Use for Treatment of Metastatic Renal Cell Carcinoma

This report describes a patient with metastatic kidney cancer who developed a deep yellow skin discoloration while on therapy with the oral multitargeted tyrosine kinase inhibitor (TKI), sorafenib. A significant hand-foot syndrome, featuring acral skin desquamation and tender erythema at pressure points, was also present. A thorough clinicolaboratory investigation did…

Editorial

The Impact of Wireless Capsule Endoscopy on Gastrointestinal Diseases

The M2A video capsule endoscope (Pillcam SB, Given Imaging LTD, Yokneam, Israel) is a wireless capsule (11 mm × 27 mm) comprised of a light source, lens, CMOS imager, battery and a wireless transmitter. The capsule moves via peristalsis from the mouth to the anus. The current battery provides 7…

Letter to the Editor

Glioblastoma Multiforme Disguised as Sarcoidosis: Pitfalls in Diagnosis

To the Editor: Sarcoidosis is a multisystem granulomatous disease that can involve any part of the nervous system. About 5 to 15% of patients with sarcoidosis will have clinical involvement of the nervous system. Neurologic features of sarcoidosis are nonspecific and include cranial neuropathy, aseptic meningitis, increased intracranial pressure, hydrocephalus,…

Letter to the Editor

Do No Harm to the Arm!: Hypertension and Unilateral Hand Rash

To the Editor: Sophisticated monitoring may not always be better for the patient ….Ambulatory blood pressure monitoring is often utilized in the healthcare setting for a multitude of indications including the evaluation of episodic hypertension. It is a convenient diagnostic tool due to its precision, lack of observer bias and…

Editorial

Gastric Sarcoidosis

Sarcoidosis is a systemic disorder of uncertain etiology, characterized by accumulation of mononuclear inflammatory cells followed by the formation of noncaseating epithelioid granulomas at the site of involvement. The disease has a female preponderance, and is more common in the African-American population.1 Virtually all organs of the body have been…

Editorial

Ode to the Hospitalist

As this nation’s leading cause of death, cardiovascular disease is a major issue confronting emergency room physicians, hospitalists, as well as cardiologists. The recent paradigm of ambulatory evaluation with chest pain clinics has received much enthusiasm. Nonetheless, misdiagnosed myocardial infarctions constitute the highest paid malpractice judgment against emergency physicians in…

Editorial

Effects of Noise Contribute to Physicians’ Challenges

Goines and Hagler1 correctly point out that noise is exceptionally common and not just an annoyance. It imposes on rights guaranteed to US citizens. In this regard it is no different from air and water pollution which are unarguably necessary to regulate to safeguard human health.

Original Article

How to Improve the Management of Chest Pain: Hospitalists and Use of Prediction Rules

Background: Three percent of patients with acute myocardial infarction are still missed despite the excess number of admissions with chest pain. The purpose of this study was to review the characteristics of patients who were admitted with chest pain, to evaluate the appropriateness of admissions and the outcomes. We also…

Original Article

Trauma: Life in the ER—Education or Entertainment? The Patient’s Perspective

Objectives: To determine whether patients felt that the show Trauma: Life in the ER has primarily educational or entertainment value. To determine if people felt that this show violated privacy. Methods: Survey in an academic emergency department. Subjects were asked to participate in an initial survey, then asked to watch…

Original Article

Hyperglycemia and Mortality in Elderly Patients with Staphylococcus aureus Bacteremia

Objective: To investigate the association between hyperglycemia and in-hospital mortality in elderly patients with Staphylococcus aureus bacteremia (SAB). Methods: We reviewed the medical records of 135 elderly patients with SAB admitted to two tertiary medical centers from January 2003 until December 2004. Patients were stratified into two groups: those with…

Original Article

Elevated Red Cell Distribution Width in the Diagnosis of Thrombotic Thrombocytopenic Purpura in Patients Presenting with Anemia and Thrombocytopenia

Objective: To determine if red cell distribution width (RDW) is elevated in thrombotic thrombocytopenic purpura (TTP) and to evaluate the sensitivity and specificity of such elevation in the diagnosis of TTP. Methods: We retrospectively studied red cell distribution width at presentation in 25 consecutive patients with newly diagnosed TTP who…

Case Report

Anaphylactic Shock: The Great Mimic

Anaphylaxis, acute coronary syndrome and pulmonary embolism are conditions commonly seen in the acute medical setting which can be difficult to diagnose. Delay in establishing the correct diagnosis can result in either delayed or inappropriate treatment, and subsequent morbidity and mortality. The cases we present highlight the necessity of good…

Case Report

Gastric Sarcoidosis: A Case Report and Review of the Literature

Sarcoidosis is a systemic granulomatous disease of unknown etiology that is characterized by the formation of noncaseating granulomas. Gastrointestinal (GI) tract involvement in sarcoidosis is rare. Gastric sarcoidosis, particularly involving the antrum, affects approximately 10% of patients with systemic disease.1 GI sarcoidosis commonly occurs subclinically, with clinical manifestations present in…

Expired CME Article

CME Questionnaire and Credit Form

CME Questionnaire and Credit Form

Expired CME Article

Reflux, Dyspepsia, and Disorders of the Foregut

Disorders of the foregut are an increasingly common cause of symptoms in Western populations. This review summarizes recent advances in the understanding and treatment of gastroesophageal reflux disease, dyspepsia and celiac disease. Key Points * The majority of patients with reflux and dyspepsia can be safely treated without endoscopy, as…

Medical Webwatch

Medical Webwatch

Background Briefings http://www.wiredinitiative.com/backgroundbriefings.htm is authored by Professor David Clark, Director of WIRED http://www.wiredinitiative.com/. His 41 briefings focus on a wide variety of issues concerning substance use and misuse. He has also produced a series of 17 introductory lectures http://www.wiredinitiative.com/educationtraining.htm. WIRED publishes Daily Dose “The World’s leading drug and alcohol news…

Patient's Page

Patient’s Page: Learning to Manage Heartburn and Acid Indigestion (Reflux)

Take this quick quiz by checking all that apply to you: * I am white. * I am overweight. * I drink alcohol. * I am over the age of 40. * I smoke. * I am male. * I often take antacids.

Letter to the Editor

Bleeding Meckel Diverticulum Responds to Intravenous Pantoprazole

To the Editor: Meckel diverticulum (MD) is the most common developmental anomaly of the gastrointestinal tract, affecting 2% of the general population. Although it is often noted as an incidental finding during laparotomy, in 5% of cases it may present with serious complications such as massive bleeding, intussusception, obstruction and…

Letter to the Editor

Pneumocystis carinii jiroveci Pneumonia Following Infliximab Infusion for Crohn Disease: Emphasis on Prophylaxis

To the Editor: Pneumocystis carinii pneumonia (PCP) is known to be associated with immunodeficiency states such as AIDS, malignancies and chemotherapy. Lately the occurrence of PCP has increased as the indications for use of immunosuppressive/immunomodulator therapies have broadened.1,2 PCP following infliximab therapy for Crohn disease, although still uncommon, is increasing…

Letter to the Editor

Lung Cancer Metastasis Mimicking Gluteal Abscess

To the Editor: Lung cancer is one of the most commonly diagnosed cancers in both men and women worldwide. The most common metastatic sites encountered in patients with nonsmall cell carcinoma are the pleura, central nervous system, liver, adrenal glands, and skeletal system.1 It is unusual for it to present…

Letter to the Editor

The Role of Positron Emission Tomography for the Diagnosis and Follow up of a Patient with Sarcoidosis and Takayasu Arteritis

To the Editor: Takayasu arteritis (TA) is an uncommon chronic granulomatous disease of the large vessels. Sarcoidosis is also a systemic granulomatous disorder occasionally associated with vasculitis. Although it is not clear whether there is a pathogenetic association, the concurrence of sarcoidosis and TA has been previously described in 5…

Letter to the Editor

A Rare Cause of Rhabdomyolysis

To the Editor: Rhabdomyolysis is an acute condition involving skeletal muscle injury and release of potential toxic contents into plasma. Common etiologies include trauma, muscle ischemia, excessive exertion, bacterial and viral sepsis, electrical burns, other injuries related to heat or cold, prolonged muscle compression as often seen in the unconscious…

Review Article

Noise Pollution: A Modern Plague

Noise is defined as unwanted sound. Environmental noise consists of all the unwanted sounds in our communities except that which originates in the workplace. Environmental noise pollution, a form of air pollution, is a threat to health and well-being. It is more severe and widespread than ever before, and it…