Issue - Southern Medical Association

Editorial

Mounier-Kuhn Syndrome: Overcoming a Lack of Recognition

In 1897, Czyhlarz first described the finding of tracheobronchomegaly after noting the abnormality in an autopsy.1 Thirty-five years later, Mounier-Kuhn described the clinical presentation of cough with reduced effectiveness and large sputum production, with the radiographic appearance and bronchoscopic findings associated with enlarged major airways.2 The prevalence of the disease…

Editorial

Prevention of Adverse Effects of BCG Immunotherapy in Bladder Cancer

Approximately 54,000 new cases of bladder cancer are diagnosed annually in the US, with a mortality rate of 12,000.1 Most patients are diagnosed with superficial tumors which can be completely treated with transurethral resection (TUR). Noninvasive bladder cancer is well known to have a high recurrence rate, however, even after…

Original Article

Does Absolute Neutrophilia Predict Early Congestive Heart Failure After Acute Myocardial Infarction? A Cross-Sectional Study

Background: Acute myocardial infarction (AMI) is usually associated with increased neutrophil count. However, it has not clearly been defined whether neutrophilia can cause myocardial injury. In this study, we hypothesized that absolute neutrophilia can predict the occurrence of congestive heart failure (CHF) after AMI. Methods: A cross-sectional study was carried…

Original Article

Chaperones for Rectal and Genital Examinations in the Emergency Department: What do Patients and Physicians Want?

Background: The objective of this study was to compare patients’ preferences and physicians’ practice for the presence of chaperones during genitourinary examinations. Methods: A survey of 163 emergency department patients and 52 physicians was used to evaluate patients’ preferences and physicians’ practices for the presence and gender of a chaperone…

Original Article

Gastrointestinal Tract Bleeding in Intellectually Disabled Adults

Background: Gastrointestinal (GI) tract bleeding in intellectually disabled (ID) individuals presents peculiar diagnostic and management difficulties. This study details the experience of a tertiary referral teaching hospital in Central Saudi Arabia in the management of GI bleeding necessitating admission in ID adults. Patients and Methods: Prospective collection of data was…

Original Article

Seeding of the Percutaneous Endoscopic Gastrostomy Tract from Esophageal Squamous Cell Cancer Presenting as an Acutely Bleeding Malignant Gastric Ulcer: A Novel Clinicoendoscopic Presentation

Background: While the clinical presentation of cutaneous stomal metastases after percutaneous endoscopic gastrostomy (PEG) placed for pharyngoesophageal malignancy is well described, the clinicoendoscopic findings with gastric stomal metastases is insufficiently characterized. A novel clinicoendoscopic presentation is reported of significant gastrointestinal bleeding caused by an ulcerated gastric stomal metastasis. Methods: A…

Original Article

Dissemination of Community-Associated Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital

Background: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) was investigated at a tertiary care hospital, and relationship was made between the clinical and genetic definitions of community- and healthcare-associated MRSA. Methods: Nonduplicate isolates of S aureus were collected during 2004. Isolates were classified clinically as community-associated (CA) or healthcare-associated (HA)….

Original Article

Serum Potassium Changes with Initiating Low-Carbohydrate Compared to a Low-Fat Weight Loss Diet in Type 2 Diabetes

Objective: To evaluate the change in potassium after initiating a low-carbohydrate or low-fat weight loss diet. Methods: Participants randomized to a low-carbohydrate (low-CHO) or a low-fat diet had serum potassium measured at baseline, 3 days, 1 week, 2 weeks, and 1 month after dietary initiation. Paired t tests and repeated…

Expired CME Article

Perioperative Surveillance for Adverse Myocardial Events

Perioperative myocardial infarctions occur in 1 to 4% of unselected noncardiac surgical patients, and are associated with high mortality. Detection of these events can be challenging, because ‘typical’ symptoms of myocardial ischemia may not be present or may be masked in the perioperative period. Therefore, surveillance by means of intraoperative…

Expired CME Article

Systemic Sclerosis and Malignancy: A Review of the Literature

Malignancy is associated with systemic sclerosis in between 3.6 and 10.7% of patients diagnosed with systemic sclerosis. The diagnosis of systemic sclerosis may occur before, concurrent with, or after the diagnosis of malignancy. All published reports of malignancy with systemic sclerosis are reviewed. Lung cancer is the most frequent type…

Expired CME Article

Myasthenia Gravis Crisis

Myasthenia gravis (MG) is an autoimmune disorder resulting from the production of antibodies against acetylcholine receptors leading to the destruction of the postsynaptic membrane at the neuromuscular junction. In the US there are about 18,000 people with MG. Myasthenia gravis crisis (MGC) is defined as any MG exacerbation necessitating mechanical…

Case Report

Mounier-Kuhn Syndrome: Report of 8 Cases of Tracheobronchomegaly With Associated Complications

Mounier-Kuhn syndrome is a rare congenital abnormality characterized by atrophy or absence of elastic fibers and thinning of smooth muscle layer in the trachea and main bronchi. These airways are thus flaccid and markedly dilated on inspiration and collapsed on expiration. First- to fourth-order bronchi are affected. There is an…

Case Report

Four Cases of Disseminated Mycobacterium bovis Infection Following Intravesical BCG Instillation for Treatment of Bladder Carcinoma

Intravesical BCG (bacillus Calmette-Guérin) instillation is a first-line treatment for superficial transitional cell carcinoma of the bladder. A rare but severe complication of BCG immunotherapy is the development of disseminated BCG disease, which can result in miliary pneumonitis, granulomatous hepatitis, soft tissue infections, bone marrow involvement, and sepsis. Symptoms can…

Case Report

An Unusual Presentation of Meckel Diverticulum as Strangulated Femoral Hernia

We report an unusual case of a patient with strangulated Meckel diverticulum in a femoral hernia. A 65-year-old woman presented with a nonradiating, constant pain in the right groin with associated nausea and anorexia. Physical examination revealed a tender, irreducible lump in the right groin area. At operation, a hernia…

Case Report

Embryonal Rhabdomyosarcoma Secondary to an Open Fracture of the Tibia: A Case Report and Review of Literature

Embryonal rhabdomyosarcoma (ERMS) is a highly malignant tumor in children and adolescents. It rarely occurs in adults. A 47-year-old patient presented with ERMS of the muscle flap transplant 20 years after an open type III-comminuted fracture of the lower leg. The affected leg was amputated. The patient refused adjuvant chemotherapy…

Case Report

Rhabdomyosarcoma Presenting With Destructive Large Lesion of the Face

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. RMS may be detected anywhere in the body, although the head and neck are the most involved areas. Prognostic factors of RMS include tumor status, primary tumor site, localization in the organ or tissue of origin, patient…

Letter to the Editor

Rinne Test Modified to Quantify Hearing

To the Editor: With the inception of audiometry, tuning fork tests have gradually lost their popularity. In the Rinne test, bone conduction (BC) is compared with air conduction (AC), but unlike audiometry, it does not quantify hearing. Therefore, in this study the Rinne test was modified to quantify hearing.

Letter to the Editor

Unique Mechanism for Tako-Tsubo Syndrome in an Adult Male

To the Editor: A 49-year-old male with a history of coronary artery disease, lung cancer with left pneumonectomy, chemotherapy and radiotherapy, presented with acute dyspnea and chest pain after straining during defecation. Troponin-T was 0.09 ng/mL (N: 0.00–0.04 ng/mL). He was diagnosed with acute coronary syndrome (ACS) and received aspirin…

Rapid Response

Lung Cancer Screening: A Clear Voice of Reason

Lung cancer screening has been for many years a topic of controversy and complexity which is confusing even to experts in the fields of pulmonary medicine and oncology. On the one hand, lung cancer is by far the most devastating cancer killer in the world and we have made little…

Case Report

Severe Stomatitis Complicating Treatment With Pegylated-Interferon α-2a and Ribavirin in an HCV-Infected Patient

Objective:To report a case of severe stomatitis probably induced by peginterferon α-2a. Methods and Results:A 42-year-old man with chronic hepatitis C genotype 1b commenced treatment with peginterferon α-2a 180 &mgr;g subcutaneously weekly and ribavirin 1000 mg/d orally. Twenty-eight days after commencing treatment, the patient experienced difficulties with swallowing, dryness of…

Case Report

Pantoea agglomerans Bacteremia in a 65-Year-Old Man With Acute Myeloid Leukemia: Case Report and Review

A 65-year-old man with a recent history of acute leukemia was admitted with complaints of chills and rigors. He had a long-standing Hickman catheter which was removed following the isolation of a Gram negative rod later identified as Pantoea agglomerans. The patient recovered with antimicrobial therapy. Pantoea species are rare…

Expired CME Article

January 2008 CME Questions

January 2008 CME Questions

Expired CME Article

CME Topic Form

CME Topic Form

Editorial

Gastrointestinal Bleeding in the Intellectually Disabled

Lower gastrointrstinal bleeding (LGIB) is defined as any bleeding originating distal to the ligament of Treitz. Gastrointestinal bleeding in persons with intellectual disability (ID) has been covered in the literature by different case reports,1–4 including the present article by Khalid et al.

Editorial

Spontaneous Reports as Evidence of Adverse Drug Reactions

In this issue of the Southern Medical Journal, Borras-Blasco et al1 describe a case of possible severe stomatitis complicating treatment with peginterferon α-2a (PEG-IFN) and ribavirin in a patient infected with the hepatitis C virus. This adverse drug reaction (ADR) occurred four weeks after initiation of therapy. Discontinuing both the…

Editorial

Systemic Sclerosis and Malignancy

A meticulous review of the malignancies diagnosed in patients affected by systemic sclerosis (SSc) is presented in this issue of the Southern Medical Journal; all the cases of coexistent SSc and cancer described have been cataloged.1 The incidence of neoplasm in SSc seems to be higher than in the general…

Editorial

The Medical Chaperone: Outdated Anachronism or Modern Necessity?

The word “chaperone” derives figuratively from the French word chaperon meaning “hood” and later a kind of hat. The term was first borrowed into English in the 1700s and came to refer to an “escort,” commonly an older woman who accompanied a young, unmarried woman in public to provide protection….

Editorial

Neutrophils and Myocardial Injury: Cause or Effect—That is the Question!

Inflammation is increasingly being associated with the pathogenesis of coronary heart disease (CHD).1 It is therefore not unusual to assume that leukocytosis is an acute phase reactant during acute myocardial infarction (AMI). This association between leukocytosis and AMI was made nearly five decades ago.2 Since that time, numerous studies have…

Rapid Response

Poor Attitudes About Preparation, But What’s Good for Colonoscopy Is Not Good for Advanced Imaging

Colon cancer is the second leading cause of malignant death in the United States. In 2007, there will be over 150,000 cases and 50,000 deaths. The natural history of colon cancer, with slow growth, precursor lesions (adenomatous polyps), and available prevention tests, makes it ideal for screening.1 Compelling data from…

Rapid Response

Echinacea Use and the Need for More Studies

The use of echinacea in the general population is common despite the continued debate on its efficacy in the scientific community. A previously published meta-analysis by Melchart et al1 and a new analysis by Shah et al2 seek to clarify the controversy on the benefits of echinacea in treating and…

Rapid Response

Vitamin E and Prostate Cancer

Wright et al1 recently published a prospective study that examined the relationship of vitamin E intake to prostate cancer (PC) risk in the NIH-AARP Diet and Health Study. Among 295,344 men who completed a questionnaire on diet, supplement use, and other factors, 10,241 developed prostate cancer during 5 years of…

Rapid Response

Do Phytoestrogens Have a Role in the Management of Postmenopausal Osteoporosis?

Isoflavones, lignans, and coumestans are three classes of phytoestrogens– plant constituents with a chemical structure similar to 17β-estradiol. Phytoestrogens exert weak estrogenic and anti-estrogenic effects that vary according to the target tissue, and are mediated through binding to estrogen receptors α (ERα) and β (ERβ). Phytoestrogens, therefore, fall into the…

Rapid Response

Isoflavones and Bone: More Questions Than Answers

It is estimated that 1 of every 2 women age 50 and older will suffer an osteoporotic fracture in her remaining lifetime.1 Many FDA-approved medications for the prevention and treatment of osteoporosis exist, including estrogen, calcitonin, raloxifene, bisphosphonates, and teriparatide. However, the adverse effects of these therapies range from increased…

Review Article

Looking Into the Future of Cell-Based Therapy

Recent research points to the future of regenerative medicine. In the past year, a handful of research groups have demonstrated that mature, adult cells could be “reprogrammed” to a very primitive, embryonic state via the forced expression of four genes (Oct-3/4, c-Myc, Klf4, and Sox2). These induced pluripotent cells (or…

Special Section

Medical Webwatch

The Australian Venom Research Unit http://www.avru.org/index.html is based at the University of Melbourne and is described as being “An internationally recognized interdisciplinary research unit focused on the problem of venomous injury in Australia and the Asia-Pacific,” and that “A key activity of the Unit is to provide medical advice on…

Special Section

Patient’s Page

Dealing with Seasonal Affective Disorder: How to Beat the “Winter Blues” I leant upon a coppice gate When Frost was spectre-grey, And Winter’s dregs made desolate The weakening eye of day. The tangled bine-stems scored the sky Like strings of broken lyres, And all mankind that haunted nigh Had sought…

Letter to the Editor

Shorter Treatment for Hepatitis C Genotype 4 May Be a Possibility

To the Editor: Hepatitis C Genotype 4 (HCV-4) is predominantly found in the Middle East and North Africa. It is now spreading in Europe and the USA, especially among drug users and HIV-positive individuals.1 Because most of the large randomized controlled trials of antiviral therapy for chronic hepatitis C were…

Letter to the Editor

Elevated Cardiac Enzymes and ECG Changes After Blunt Trauma in an Elderly Woman

To the Editor: We evaluated an 83-year-old woman brought to the emergency department following a single car motor vehicle collision. She did not recall the events leading up to the crash and complained of chest pain, but could not remember if this pain was present before the crash. She was…

Review Article

Antiplatelet Agents for Stroke Prevention Following Transient Ischemic Attack

Regardless of extent or duration of acute effects, transient ischemic attack (TIA) is a marker for cerebrovascular ischemia and carries risk for secondary stroke comparable to that associated with ischemic stroke. Pharmacologic and nonpharmacologic interventions aimed at reducing risk of secondary stroke should be implemented as soon as possible after…