Issue - Southern Medical Association

Expired CME Article

Abnormal Uterine Bleeding

Disorders of the menstrual cycle are common problems in ambulatory medicine. Abnormal uterine bleeding describes bleeding that is excessive or outside the normal menstrual cycle. In the premenopausal woman, the differential diagnosis is broad, and pregnancy must always be considered. Determining whether the bleeding is ovulatory or anovulatory is a…

Review Article

Rationale for Combination Therapy in Hypertension Management: Focus on Angiotensin Receptor Blockers and Thiazide Diuretics

Despite recognition that hypertension is a major risk factor for cardiovascular events and mortality, blood pressure control rates remain low in the US population. Reflecting clinical trial results, hypertension management guidelines assert the clinical benefit of achieving current blood pressure goals and indicate that most patients will require 2 or…

Review Article

Pulmonary Arterial Hypertension: Evaluation and Management

Pulmonary arterial hypertension (PAH), a rare disease involving the pulmonary vascular circuit, is defined as an elevation in pulmonary arterial pressures and is characterized by symptoms of dyspnea, chest pain, and syncope. If left untreated, the disease carries a high mortality rate, with the most common cause of death being…

Case Report

Primary Omental Pregnancy on the Gastrocolic Ligament

Omental pregnancy is an extremely rare form of abdominal pregnancy. Only 16 cases had been reported in the literature, and most were secondary omental pregnancies. We presented a case of primary omental pregnancy located on “gastrocolic ligament” diagnosed at surgical operation. The aim of this presentation is to remember that…

Case Report

High-riding Superior Pericardial Recess: Temporal Change Can Help Distinguish From Mediastinal Pathology

A high-riding superior pericardial recess is an infrequently encountered normal variant which may mimic mediastinal pathology. We present a patient in whom a high-riding superior pericardial recess could confidently be diagnosed on a neck CT due to its change in size and shape demonstrated on a chest CT which was…

Editorial

Should Clinicians Prescribe Forgiveness?

Most research on spirituality/religiousness and substance use disorders indicates an inverse relationship,1 for which many explanations have been proposed. Some authors have suggested that religions discourage substance use directly, and others that spirituality meets the needs that addicted individuals have for identity, integrity, an inner life, and/or interdependence.2 Obstacles to…

Letter to the Editor

The Body as a Battlefield: Stories from the Front Line of Spiritual Health

To the Editor: The following case discussions were informally presented at the Southern Medical Association’s Spirituality/Medicine Interface Conference in Atlanta, Georgia, on September 16, 2006.

Editorial

Adolescents’ Spirituality and Alcohol Use

Alcohol abuse is a significant public health problem in this country. Excessive alcohol consumption is the third leading cause of death in the US; more than 75,000 deaths annually are attributed to alcohol consumption. Unhealthy alcohol use has been found in 7 to 20% of adult outpatients, 30 to 40%…

Spirituality/Medicine Interface Project

On Forgiveness

This edition of the Southern Medical Journal includes a special section on spirituality and alcoholism and in a related scientific article, Knight and colleagues report on the importance of forgiveness as a protective factor for underage drinking. Among adolescents, forgiveness had a more significant effect than any other religious or…

Spirituality/Medicine Interface Project

Is Spirituality Important to Young People in Recovery? Insights from Participants of Self-Help Support Groups

While there is growing evidence concerning the relationship between spirituality and clinical outcomes among young people, there is limited understanding about the way young people who are in active recovery from mental health and substance use issues understand, embrace and value spirituality. This paper thus explores the notion of spirituality…

Spirituality/Medicine Interface Project

Developmental Research on Alcohol and Spirituality: What We Know and What We Don′t Know

For every viable government supported research area, there are three intertwined histories that evolve and interrelate to support the research scientists and to foster the field of study. There is the administrative history, the research history and the advocacy history. These histories are especially interesting and important for this field,…

Spirituality/Medicine Interface Project

Spirituality and Addiction

A Mysterious Overlap Drug use and spirituality have a curiously intertwined history. Some world religions eschew or prohibit the use of certain drugs, for example, the banning of alcohol within Islam and Mormonism. The ancient aphorism spiritus contra spiritum implies a mutual incompatibility of alcohol and spirituality: each drives out…

Spirituality/Medicine Interface Project

Spirituality and Alcoholics Anonymous

Strong opinions, both pro and con, have been voiced about Alcoholics Anonymous (AA). It has been argued that AA is the most effective method to arrest alcoholism.1 In contrast, it has also been argued that AA is helpful to only 5% of the people who choose to affiliate with the…

Spirituality/Medicine Interface Project

Medicine, Spirituality, and Alcoholics Anonymous: A Personal Story

Editor’s Note:According to the history of Alcoholics Anonymous (AA), the very first AA meeting occurred when Bill Wilson, the fellowship’s cofounder, was transferred to Akron, Ohio, for business reasons a short time after he became sober.1 Wilson reported he finally became sober as a result of a “spiritual awakening” during…

Spirituality/Medicine Interface Project

Eye on Religion: The Bahá’í Faith

Central Teaching The Bahá’í faith is the youngest of the world’s independent religions. By an independent religion, we mean a religion with its own prophet-founder which is not a sect or offshoot of another religion. The Faith finds it source in the teachings of Bahá’u’lláh. The name Bahá’u’lláh means the…

Spirituality/Medicine Interface Project

Helping as Healing Among Recovering Alcoholics

The importance of helping others is recognized in most major religions. A famous example in Christianity is the Golden Rule (Matthew 7:12), Jesus’ dictum that “Therefore all that you wish men to do unto you, even so you do also to them.” Judaic scriptures maintain that Jewish people have an…

Spirituality/Medicine Interface Project

Meditation and Alcohol Use

A model of alcohol use that has been supported by a substantial body of research is the self-medication hypothesis.1 Based on this hypothesis, alcohol use often arises as a means of coping with or medicating other psychiatric problems, and individuals with psychiatric disorders use alcohol to reduce and manage their…

Editorial

Is This Medicine REALLY Involved in a Drug Interaction?

In today’s advanced medical profession, there is an ever increasing amount of evidence developing in relation to a myriad of drug-drug interactions,1,2 a trend which is set to continue with an aging population and further development of pharmaceutical technologies in the future. This begs to question as to whether it…

Original Article

Alcohol Use and Religiousness/Spirituality Among Adolescents

Background: Previous studies indicate that religiousness is associated with lower levels of substance use among adolescents, but less is known about the relationship between spirituality and substance use. The objective of this study was to determine the association between adolescents’ use of alcohol and specific aspects of religiousness and spirituality….

Original Article

Analysis of HLA Antigens in Turkish Sarcoidosis Patients

Background: Sarcoidosis is a systemic granulomatous disorder associated with high CD4+cell activity, without any detectable pathogen. Clustering in families occurs, and the existence of a genetic predisposition to sarcoidosis is widely accepted. There are differences among different ethnic groups. Methods: We studied HLA polymorphisms in 64 Turkish patients with biopsy…

Original Article

Comparison of Propofol and Sevoflurane for Laryngeal Mask Airway Insertion in Elderly Patients

Background: Sevoflurane and propofol have been widely used for anesthesia induction. This study compared the efficacies of sevoflurane and propofol inductions for laryngeal mask airway (LMA) insertion in elderly patients. Methods: Ninety patients, aged 60 or more, received anesthesia induction with propofol and with sevoflurane 8% using the vital capacity…

Original Article

Treatment of Ankylosing Spondylitis with Moxifloxacin

Ankylosing spondylitis (AS) is a human leukocyte antigen (HLA)-B27-associated chronic inflammatory disease of unknown etiology. There are few effective treatments for ankylosing spondylitis, which causes substantial morbidity. The relationship between AS and enterobacteria, especially Klebsiella pneumoniae, has been reported from several groups in several countries. We performed an open-label trial…

Brief Review

Vitamin D Deficiency in the Southern United States

Vitamin D is an essential nutrient for optimal calcium homeostasis for the body. Vitamin D is a secosteroid hormone (“seco” meaning “cut”) with two forms: D2 found in the diet, and D3, which is either found in the diet or made in the skin from 7-dehydrocholesterol (7-DHC) upon exposure to…

Case Report

Omeprazole-associated Digoxin Toxicity

Omeprazole is a commonly prescribed inhibitor of the gastric proton pump and has numerous indications in the treatment of gastrointestinal diseases. It is primarily metabolized through the CYP2C19 enzyme, a member of the P450 mixed-function oxidase group, although a minor pathway of metabolism is through CYP3A4, another P450 enzyme. Digoxin…

Case Report

Ezetimibe-induced Acute Pancreatitis

Ezetimibe is a lipid-lowering agent that inhibits the intestinal absorption of cholesterol and other related phytosterols. It is used alone or in combination with other lipid-lowering agents in the treatment of various forms of hypercholesterolemia. Since its FDA approval in 2002, there are no known citations of ezetimibe-induced pancreatitis. Key…

Expired CME Credit Submission and Evaluation Form

CME Questionnaire and Credit Form

CME Questionnaire and Credit Form

Editorial

Abdominal Pregnancy—An Obstetrical Enigma

Abdominal pregnancy is defined as an IP implantation of an ectopic pregnancy exclusive of tubal, intraligamentous or ovarian permeation.1 Its incidence worldwide varies from 1:1320 to 1:10,200 births.1 The condition is associated with significant maternal mortality, with rates reported in the literature from 0.5 to 30%, and a perinatal mortality…

Editorial

Fixed-dose Combination Therapy in the Treatment of Hypertension: Ready for Prime Time

Hypertension, defined as a systolic blood pressure (BP) ≥140 mm Hg or a diastolic BP ≥90 mm Hg, remains the most common reason that physicians see patients on a continuous outpatient basis and prescribe chronic prescription medication. Patients with hypertension are at a two- to fourfold increased risk for cardiovascular…

Medical Webwatch

Medical Webwatch

TRAUMA.ORG http://www.trauma.org/resus/moulage/moulage.html is an excellent and well-structured presentation of trauma moulage scenarios. The serious pedantic experience is lightened by humorous let-downs following incorrect responses to the questions posited at every stage – there are no passengers on this journey! But the exhilaration of correctly handling an extremely ill patient is…

Spirituality/Medicine Interface Project

Case Discussion: Do Not Neglect the Spiritual History

Case Report A 56-year-old woman with multiple myeloma who has received chemotherapy, is now in the hospital for a bone marrow transplant. She is depressed and is being treated with an anti-depressant. One day on rounds, she is particularly melancholy. When asked about how she is feeling that day, she…

Spirituality/Medicine Interface Project

A Program of Research on Spirituality and American Indian Alcohol Use

In this brief report we summarize a pattern of findings that has emerged from our research on American Indian (AI) alcohol use and spirituality. With funds from the National Institute of Alcohol Abuse and Alcoholism and the Fetzer Institute (AA 13 053; P. Spicer, PI) we have used both epidemiologic…

Spirituality/Medicine Interface Project

Selected Annotated Bibliography on Subtance Use and Abuse

As an aid to readers, this annotated bibliography is divided into two parts. Part one includes three seminal reviews of spirituality and addiction, each taking a different scholarly and/or clinical perspective to understanding this vast empirical literature. The second portion identifies a number of empirical studies, chosen to reflect the…

Patient's Page

Patient’s Page: Facts about Abnormal Uterine Bleeding

Many women visit their primary care physician or gynecologist because of abnormal uterine bleeding (AUB)—bleeding that is excessive or occurs outside of a woman’s normal menstruation cycle. There are many causes for AUB, including benign growths, medications, infection, cancer, or pregnancy; likewise, there are several treatment options available for most…

Letter to the Editor

Complicated Inguinal Hernia of Amyand

To the Editor: The presence of acute appendicitis in the sac of inguinal hernia is an extremely rare condition, and very few cases have been reported in the literature. The condition, called Amyand hernia, was named for Claudius Amyand, who first described this disorder in an 11-year-old boy in 1735.

Letter to the Editor

Sweet Syndrome Associated With Erythema Nodosum: Are They Different Manifestations of the Same Disease?

To the Editor: Sweet Syndrome (SS, acute febrile neutrophilic dermatosis)is a rarely seen disease that includes abruptly developing painful papullonodular or plaque-shaped erythematous lesions associated with systemic findings such as malaise, fever, arthralgia, conjunctivitis and episcleritis, and histologically characterized by edema on the upper dermis and intense neutrophilic infiltration. SS…

Letter to the Editor

Oxcarbazepine Treatment of Refractory Bipolar Illness

To the Editor: Numerous studies over the past 25 years have demonstrated the efficacy of carbamazepine in bipolar illness.1 Unfortunately, carbamazepine can be a difficult medication to use, due to significant drug-drug interactions, laborious titration related to enzyme autoinduction (both due to induction of the cytochrome P450 system), potential for…

Letter to the Editor

Vertebral Gout and Ambulatory Dysfunction

To the Editor: A 77-year-old male with a history of hypertension presented with progressively worsening bilateral leg weakness and difficulty walking, along with right knee pain and severe back pain for a week. Outpatient medications included hydrochlorothiazide. He had occasional alcohol intake. Physical examination was significant for effusion in the…

Letter to the Editor

Response to Dr. Paraskevas’ Comments

To the Editor: Dr. Paraskevas and colleagues1,2 present an interesting and important alternative modality for the treatment of Complex Regional Pain Syndrome (CRPS) with the utilization of intravenous (IV) guanethidine. Guanethidine is available for IV use in other countries but is not commercially available in the United States. Guanethidine exerts…

Letter to the Editor

Regarding “Knowledge, Attitudes, and Use of Emergency Contraception Among Rural Western North Carolina Women”

To the Editor: We read the article by Fagan et al1 and the subsequent editorial on emergency contraception (EC)2 with interest and agree wholeheartedly with the authors. In recent years, the Medical Center of Louisiana HIV Outpatient Program (HOP) clinic has become increasingly proactive in offering EC as a choice…

Letter to the Editor

Regarding “Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome”

To the Editor: We read with interest the article by Ackerman and Zhang1 examining the efficacy of stellate ganglion blockade (SGB) in patients with complex regional pain syndrome type I (CRPS I) of the hand.

Letter to the Editor

“But Doctor, Medicine Has Changed!”

To the Editor: Virtually any gathering of physicians predictably evokes the many aspects and ramifications of this phenomenon that “medicine has changed,” especially concerning the following issues: * The complaint that many physicians do not spend sufficient time with patients relative to history taking, the physical examination, and answering questions.

Case Report

Use of Amiodarone in a Patient With a Shellfish Allergy

A 65-year-old Caucasian male with a shellfish allergy developed atrial fibrillation and hypotension after coronary artery bypass and duodenal ulcer surgery. Following electrical cardioversion, oral amiodarone was continued chronically without an allergic reaction. There is a common misconception that a shellfish allergy correlates to an iodine allergy. There is little…

Original Article

A Descriptive Analysis of Authorship Within Medical Journals, 1995–2005

Introduction: The emphasis on publications for promotion in academic medicine would lead one to the theory that authorship numbers would increase proportionally with this emphasis. To investigate authorship trends across a number of periodicals, we performed a descriptive study comparing two full years of published articles spaced ten years apart…