In this issue, the article “Pulmonary Edema of an Unexpected Cause” depicts a most dramatic presentation of an enormous (presumed) cardiac myxoma, obstructing left atrial outflow.1 Although pathological confirmation was not possible in this case, the overwhelmingly probable diagnosis was atrial myxoma. While the most common cardiac malignancies are metastatic…
Objective: The purpose of this study was to determine the cost-effectiveness of requiring all recreational hockey players to wear facial protection. Methods: The authors randomly surveyed recreational hockey players at two indoor hockey rinks in Evendale, Ohio. Data were collected on face protection, injuries, demographic variables and attitudes about protective…
Introduction: The widespread use of complementary and alternative medicine modalities such as dietary supplements has prompted many medical schools to offer courses covering such topics. To date, little is known about the impact of these courses on medical graduates’ knowledge. This study was designed to evaluate resident physicians’ level of…
Background:National guidelines for identifying chronic kidney disease (CKD) have not been widely adopted in primary care settings. UnitedHealthcare (UHC) and United Resource Networks (URN) collaboratively identified barriers to and established solutions for achieving the guidelines’ outcome goals.Methods:UHC/URN identified primary care physicians (PCPs) with a high proportion of patients at risk…
Background: The use of postarrest variables to predict survival after discharge following in-hospital cardiopulmonary resuscitation has not been definitive. This study evaluates whether the duration of cardiopulmonary resuscitation (CPR) and other variables affect discharge rates and survival rates after discharge. Methods: Prospective cohort survival data and arrest variables were collected,…
Objectives: Described here is the clinical presentation and etiology of community-acquired meningitis in adult patients in a Baltimore community hospital from 1997 to 2006. Method: A retrospective chart review was performed. Data were collected regarding demographics, presenting symptoms, cerebrospinal fluid findings, and outcome. Results: Of 80 patients identified, 17 were…
Morbid obesity is a significant problem in the Western world. Recently, there has been an increase in the number of patients undergoing surgical weight loss procedures. Currently, the most widely performed procedure is the Roux-en-Y gastric bypass operation which combines restriction of food intake with malabsorption of calories and various…
Atrial myxoma is rarely seen in practice. We report a 67-year-old female who presented with acute cardiac insufficiency and pulmonary edema. Cardiac murmur was not detected on precordial examination. Urgent echocardiography, however, revealed atrial myxoma causing mitral valve obstruction. We point out that a normal cardiac examination does not exclude…
Dobutamine is commonly administered as a pharmacologic stressor in patients with limitations precluding exercise testing. The case report presented is one of transient complete heart block resulting from dobutamine sestamibi stress testing. Shortly after initiating the dobutamine infusion, the patient became pale and presyncopal, with hypotension and a heart rate…
Evidence suggests that sepsis is a systemic inflammatory condition complicated by dysequilibrium in coagulation and fibrinolytic homeostasis, with a shift in the balance towards increased coagulation over fibrinolysis. Protein C is a natural anticoagulant consumed and inactivated during sepsis. We present the case of a 33-year-old female, postsplenectomy, with pneumococcal…
Cavernous hemangiomas of the breast are rare and when present, are generally well defined. Their presentation in the axilla mimicking cancer is extremely rare. This report describes the case of a premenopausal woman with a cavernous hemangioma in the axillary region with clinical, mammographic, and sonographic characteristics strongly suggestive of…
Myiasis occurs mainly on exposed skin–typically on the face, scalp, arms or legs. What may be the first recorded case of umbilical myiasis in a healthy adult is herein presented. The underlying entomology is briefly discussed to explain the clinical presentation. Key Points * Myiasis is an infestation of living…
Fibrosing mediastinitis with bronchial artery hypervascularity is a rare cause of massive hemoptysis. Conventional therapies for massive hemoptysis include pulmonary or bronchial artery embolization, endobronchial tamponade, or lung resection. A patient with fibrosing mediastinitis presented with refractory massive hemoptysis associated with bronchial hypervascularity and was treated with external-beam radiotherapy (XRT)….
Sarcoidosis is a multisystem disorder of unknown cause, characterized pathologically by noncaseating granulomas. It is more commonly seen in younger adults and African Americans. Myocardial involvement occurs in at least 25% of patients with sarcoidosis and is associated with poor prognosis. In spite of recent advances in imaging modalities, early…
Primary breast cancer is the most common malignancy in women. Metastatic cancer to the breast is very rare. Colorectal cancers usually metastasize to the liver and the lung; other sites of metastasis from colon cancer are uncommon and are usually found in association with extensive liver and/or lung metastases. This…
Imperforate hymen is a rare congenital anomaly which emergency physicians often forget to include in the differential diagnosis of lower abdominal pain in a pubescent girl. These patients often remain asymptomatic until puberty and present in early adolescence with cyclic abdominal pain. This case report reviews the presentation and treatment…
To the Editor:“Drug eruptions are probably the most frequent of all manifestations of drug sensitivity.”1 They range from mild, short-lived maculopapular rashes that subside, despite continuation of the medication, to severe forms such as Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). In fact, “cutaneous drug eruptions occur in 2–3% of…
To the Editor:As an effective means of varicocele treatment, percutaneous embolization has been shown to be equal to surgical spermatic vein ligation. It is also associated with less postprocedure discomfort. Cyanoacrylates are the main liquid adhesives used in endovascular procedures and have an important role in managing vascular abnormalities.1We report…
Ice hockey is inherently physical in nature, and physical contact is an expected and desirable part of the game.1,2 Because hockey is played on a closed surface at high speeds, there exists a significant risk of injury resulting from collisions with other players and objects. Of particular concern are injuries…
Morbid obesity is one of the most common causes of morbidity and mortality in the United States. In the next 20 years, 40% of the population will be obese with a body mass index (BMI) greater than 30. Operations for morbid obesity (BMI >35), such as Roux-en-Y gastric bypass (RYGBP),…
A 44-year-old female presented with a history of recurrent right-sided pneumothoraces, uterine fibroids, and a palpable lump in her navel. Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) and resection of the umbilical nodule was performed. Intraoperative inspection of the right hemidiaphragm revealed adherent brownish-blue nodules without any associated diaphragmatic defects…
Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) infections are becoming increasingly frequent, and cutaneous disease with this organism is often seen in otherwise healthy organized sports participants. A case of CA-MRSA skin and soft tissue infection in a female collegiate basketball player is presented, and screening and management of her team…
A 68-year-old male presented with progressive abdominal pain, dyspnea, weight loss, and dysuria. Lab work revealed elevated creatine phosphokinase levels, prostate-specific antigen level (approximately 60 ng/mL), and elevated liver enzymes. He was admitted to the intensive care unit for worsening respiratory distress and confusion. He continued to deteriorate, and his…
Actinomycosis is an uncommon, chronic bacterial infection that induces both suppurative and granulomatous inflammation. Localized swelling with suppuration, abscess formation, tissue fibrosis, and sinus drainage characterizes this disease. The infection spreads contiguously, often forming draining sinuses that extrude characteristic but not pathognomonic “sulfur granules.” Infections of the oral and cervicofacial…
Objectives: Little is known about the psychologic effects on obstetricians and gynecologists of adverse maternal or fetal outcome and malpractice claims. Methods: An anonymous survey regarding the psychologic effects of professional liability claims, as measured by 19 items which were used to create four composites rated on a 5-point scale,…
&NA;Actinomycosis: Diagnosis and Management1. The most common form of actinomycosis is:A. Pelvic regionB. Central nervous systemC. CervicofacialD. Thoracic regionE. Abdominal-pelvic region2. The drug of choice for treating an infection caused by actinomycetes is:A. CeftriaxoneB. MetronidazoleC. AztreonamD. PenicillinE. Imipenem3. The origin of cervicofacial actinomycosis is most often found in:A. Dental infectionB….
Pneumothorax or hemoptysis that recurs with the onset of menses (ie, catamenial) is strongly supportive of thoracic endometriosis syndrome (TES), which arises as a consequence of ectopic endometrial tissue localized outside the pelvis. In this issue of the Southern Medical Journal, Arunthari et al1 report a 44-year-old woman who presented…
Dobutamine stress myocardial perfusion imaging (DSMPI) is a pharmacologic stress test in combination with radionuclide myocardial perfusion imaging. DSMPI is the alternative method for evaluation of patients with known or suspected coronary artery disease who are unable to perform adequate exercise testing, and who also have contraindications to the vasodilators…
The authors in this study sought to assess the psychological effects of adverse maternal or fetal outcomes and malpractice claims on obstetricians and gynecologists. They used a two-page questionnaire which was mailed to 897 board-certified physicians who were members of the Central Association of Obstetrics and Gynecologists (CAOG). Among the…
In the United States, the supplement business grew at a 5% rate to $22.4 billion in 2006.1 Public use of dietary supplements and herbs is indisputably a huge factor in contemporary medical practice. Perhaps the most concerning statement in the article in this issue by Ashar et al,2 “Medical Residents’…
Allergies are signals from the body’s immune system that a harmful substance is present. Airborne allergens, while not deadly like food and chemical allergies, can still cause a chain reaction of uncomfortable symptoms for allergic people. In most cases, the only form of control is avoidance, but airborne allergens make…
Conditional Organ Donation: Not All Conditions Are Morally DivisiveA recent focus on organ donation and transplantation in the United Kingdom has given way to an international debate on the ethics of the conditional donation of deceased organs for transplantation. Currently in the UK, no conditional donations are accepted. However, while…
Are Statins Antihypertensive Agents?Golomb et al performed a double-blinded, randomized, controlled trial of six months’ duration that compared simvastatin 20 mg/d and pravastatin 40 mg/d with placebo. It included 973 subjects with a low density lipoprotein cholesterol level of 115 to 190 mg/dL. Baseline systolic blood pressure (BP) and diastolic…
Omega-3 Fatty Acids for Cardioprotection: Not Just Another Fish Story?Research studies support that consumption or administration of fish oils rich in omega-3 fatty acids reduces cardiovascular disease risk. The article by Lee et al describes the evidence leading to the conclusion that omega-3 fatty acids provide cardiovascular “protection.” In general,…
Green Tea and Ovarian CancerConcerns about the ovarian cancer risks associated with coffee drinking should be allayed by the well-designed study by Song et al, which compares 761 cases with 1263 controls. Whereas risks were unaffected by consumption of black tea, coffee, cola or Yerba mate, caffeinated or noncaffeinated, green…
Optimal Definition of Chronic Kidney Disease as a Cardiovascular Risk StateThis study and others suggest two simple and complementary measures should be done to identify chronic kidney disease (CKD). The random urinary albumin-creatinine ratio ≥30 mg/g and the estimated glomerular filtration rate <60 mL/min per 1.73 m2 identify CKD in…
Critical Care Medicine Tutorials http://www.ccmtutorials.com/ was developed to help residents during their critical care rotation in the surgical intensive care unit at the University of Pennsylvania. The website has 6 gateways on the home page that lead to a cascade of multi-layered tutorials. The resource is authored by Patrick Neligan…
To the Editor:Stercoral ulcer formation and perforation of the colon is a rare condition affecting patients with severe chronic constipation. There may be an underestimation of the incidence, since many stercoral ulcer-related colon perforations may be incorrectly identified as spontaneous, idiopathic, or secondary colonic perforations related to diverticulitis, ischemia, etc….
To the Editor:Although several studies have looked at vitamin D status in patients with diabetes, there is a paucity of data from practices specializing predominantly in diabetes. We assessed 25-hydroxyvitamin (OH) D levels in 133 patients (116 with type 2 and 17 with type 1 diabetes) seen in an outpatient…
To the Editor:The local oxidation of low density lipoprotein (LDL) within atherosclerotic lesions is widely believed to be of importance in the pathogenesis of atherosclerosis.1 The oxidized LDL promotes adhesion of monocytes to endothelial cells,2 causes an increase in the production of metalloproteinase that would probably destabilize the fibrous caps…
To the Editor:In an editorial in the February edition of the Southern Medical Journal, Reeves and Burke1 advocate that carisoprodol (Soma® Meda Pharmaceuticals, Inc; Somerset, NJ) should become a controlled substance. During the last few years, three other papers have been published by American researchers addressing the possible abuse of…
To the Editor:In their excellent review from the April 2008 issue of the Southern Medical Journal, Sachdev and Ismail1 briefly allude to the possibility of a role for capsule endoscopy in the follow up of celiac disease. In the latter context, capsule endoscopy has proven useful in the evaluation of…
To the Editor:Rabbit syndrome (RS) is a distinct antipsychotic-induced extrapyramidal syndrome characterized by fine, rhythmic, and rapid movements of the perioral muscles along a vertical axis at a frequency of about 5 Hz, mimicking the chewing actions of a rabbit.1 Although the exact prevalence of RS is unknown, it has…
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