Issue - Southern Medical Association

Editorial

Myxoma: The Intracardiac Zebra

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…

Original Article

Is It Cost-Effective to Require Recreational Ice Hockey Players to Wear Face Protection?

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…

Original Article

Medical Residents’ Knowledge of Dietary Supplements

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…

Original Article

The ABCDEs of CKD: A Simple Approach to Early Detection and Management

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…

Original Article

Survival After In-Hospital Cardiopulmonary Resuscitation

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,…

Original Article

Causes and Presentation of Meningitis in a Baltimore Community Hospital 1997–2006

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…

Expired CME Article

Anemia Following Roux-en-Y Surgery for Morbid Obesity: A Review

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…

Case Report

Pulmonary Edema of an Unexpected Cause

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…

Case Report

Dobutamine-Induced Complete Heart Block

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…

Case Report

Pneumococcal Purpura Fulminans Successfully Treated with Activated Protein C

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…

Case Report

Cavernous Hemangioma in the Axillary Region Mimicking Malignant Neoplasia

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…

Case Report

Umbilical Myiasis in a Healthy Adult

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…

Case Report

External-Beam Radiotherapy for Massive Hemoptysis Complicating Mediastinal Fibrosis

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)….

Case Report

Exercise Intolerance and Multiple Conduction Abnormalities as First Manifestation of Cardiac Sarcoidosis

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…

Case Report

Rare Case of Breast Tumor Secondary to Rectal Adenocarcinoma

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…

Case Report

An Uncommon Cause of Abdominal Pain in an Adolescent

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…

Letter to the Editor

Hypersensitivity to Furosemide

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…

Letter to the Editor

Cyanoacrylate-Related Pulmonary Embolism Following Percutaneous Varicocele Embolization

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…

Editorial

Aggression and Visors in the National Hockey League

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…

Editorial

Anemia After Gastric Bypass: Still a Risky Business?

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),…

Case Report

Catamenial Pneumothorax with Umbilical and Diaphragmatic Endometriosis: A Case Report and Review of the Literature

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…

Case Report

Community-Acquired Methicillin Resistant Staphylococcus aureus in a Women’s Collegiate Basketball Team

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…

Case Report

Metastatic Prostatic Carcinoma Presenting as Fulminant Hepatic Failure

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…

Expired CME Article

Actinomycosis: Diagnosis and Management

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…

Expired CME Article

Psychologic Effects of Poor Outcome and Professional Liability Actions on Physicians

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,…

Expired CME Article

October 2008 CME Questions

&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….

Expired CME Article

CME Submission Form

Editorial

Thoracic Endometriosis Syndrome: Not So Rare After All?

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…

Editorial

Dobutamine Stress Myocardial Perfusion Imaging: Expect the Unexpected

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…

Editorial

Psychological Effects of Poor Outcome on Physicians

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…

Editorial

Continuing Medical Education on Nutritional Supplements: Breaking Through Ignorance and Indifference

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’…

Patient's Page

Airborne Allergens: Small Assailants

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…

Rapid Response

Conditional Organ Donation: Not All Conditions Are Morally Divisive

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…

Rapid Response

Are Statins Antihypertensive Agents?

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…

Rapid Response

Omega-3 Fatty Acids for Cardioprotection: Not Just Another Fish Story?

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,…

Rapid Response

Green Tea and Ovarian Cancer

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…

Rapid Response

Optimal Definition of Chronic Kidney Disease as a Cardiovascular Risk State

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…

Medical Webwatch

Medical Webwatch

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…

Letter to the Editor

Perforated Stercoral Ulcer of the Sigmoid Colon

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….

Letter to the Editor

Vitamin D Levels in Patients Seen in the Diabetes Unit of an Academic Medical Center

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…

Letter to the Editor

Could Sertraline Afford Protection Against Atherosclerosis? A Medical Hypothesis

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…

Letter to the Editor

Carisoprodol Should be Taken Off the Market

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…

Letter to the Editor

Further Indications for Capsule Endoscopy

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…

Letter to the Editor

Olanzapine-Induced Rabbit Syndrome

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…