November 2008, Volume 101 - Issue 11

The Brugada Syndrome: An Elusive Diagnosis


Abstract: In 1992, the brothers Brugada described a rare electrocardiographic pattern of right bundle branch block associated with ST-segment elevation in leads V1 to V3.1 Clinical (Table) and electrocardiographic criteria are delineated, and diagnosis is made when one from each...

(pp 1089-1090)

Drug-Induced Sexual Problems

James M. Wooten, PharmD

Abstract: Adverse drug reactions have become a major cause of morbidity to all patients. This is no wonder, since the number of medications approved by the United States Food and Drug Administration (FDA) has risen exponentially over the years. With the increasing pressure of...

(pp 1092-1093)

Blood B-Type Natriuretic Peptide and Dialysis: Present Assessment and Future Analyses

Mark Flemmer, MD, Hussein Rajab, MD, Tracy Mathena, MD, James Paulson, PhD, Susan Perkins, MS, Thomas Whelan, MD, Ritche Chiu, MD, Peter A. McCullough, MD, MPH

Abstract: Brain natriuretic peptide (BNP) is elevated in hemodialysis (HD) patients and predicts increased mortality. Intra- and interdialytic changes in BNP have not been fully described. End-stage renal disease (ESRD) patients were prospectively recruited at three dialysis centers....

(pp 1094-1100)

Influenza Vaccine: Awareness and Barriers to Immunization in Families of Children with Chronic Medical Conditions Other than Asthma

Ayesha Mirza, MD, Asad Subedar, BA, Sandra L. Fowler, MD, Dennis L. Murray, MD, Sandra Arnold, MD, Debra Tristram, MD, Motasem Abuelreish, MD, Peter Wludyka, PhD, Thomas T. Chiu, MD, Mobeen H. Rathore, MD

Abstract: Objectives: Children with chronic medical conditions (CMCs) are considered to be at increased risk for influenza and its related complications. Despite this, influenza immunization rates in the United States for children with CMCs in the primary care setting remain between...

(pp 1101-1105)

Parental Report of Medication Acceptance Among Youth: Implications for Everyday Practice

Jodi Polaha, PhD, William T. Dalton, III, PhD, Blake M. Lancaster, PhD

Abstract: Objective: Evidence-based interventions for pill swallowing training exist but are primarily implemented in pediatric specialty hospitals. Given increasing interest in the translation of brief and effective interventions to the wider population, there is a need to examine...

(pp 1106-1112)

The Role of Ankle-Brachial Index as a Screening Test for Coronary Artery Disease in the Hispanic Population

Agunanne Enoch, MD, Agunanne Ijeoma, MD

Abstract: Objectives: This study evaluated the role of ankle-brachial index (ABI) as an effective screening test of coronary artery disease (CAD) in the Hispanic population. Methods: This was an observational cross-sectional study, based on a retrospective review of the medical...

(pp 1117-1120)

Avian Flu: How Informed are Children in Greece?

Ioanna Vasileiou, MD, George Marinos, MD, Athanasios Katsargyris, MD, Chris Georgiou, MD, Kostas Vlasis, MD, Gerasimos Siasos, MD, Elias Gialafos, MD, Chris Klonaris, MD, Kostas Konstantopoulos, MD, Athanasios Giannopoulos, MD

Abstract: Objectives: The current cluster of avian influenza outbreaks in birds has occurred in areas where humans live in proximity to poultry. Dissemination of accurate information may be the cornerstone for proper community preparation. In the herein presented study, we attempted...

(pp 1121-1125)

Patient’s Page

Lindy Russell, BA, Melissa Bright, BA

Abstract: OsteoporosisOsteoporosis, meaning “porous bones,” is a silent disease.1 Though not yet fully understood, osteoporosis is thought to be the result of a process called “remodeling,” or “bone turnover.” In the course of bone turnover, your bones are constantly...

(pp 1077-1078)

Prophylactic Antibiotics in Necrotizing Pancreatitis: A Meta-analysis

Phil A. Hart, MD, Matthew L. Bechtold, MD, John B. Marshall, MD, Abhishek Choudhary, MD, Srinivas R. Puli, MD, Praveen K. Roy, MD

Abstract: Purpose: Prophylactic antibiotics have been used in acute necrotizing pancreatitis with mixed results. This meta-analysis analyzes the effects of prophylactic antibiotics in necrotizing pancreatitis. Methods: Multiple databases and abstracts were searched for randomized...

(pp 1126-1131)

Pneumonia in the Elderly: A Review of Severity Assessment, Prognosis, Mortality, Prevention, and Treatment

Carol P. Chong, FRACP, Philip R. Street, FRACP

Abstract: Pneumonia is an increasingly common disease in the elderly due to an aging population. This is a comprehensive literature review outlining the severity assessment, morbidity, mortality, prevention and treatment options. Several models have been postulated to predict...

(pp 1134-1140)

Pneumonia in the Elderly: A Review of the Epidemiology, Pathogenesis, Microbiology, and Clinical Features

Carol P. Chong, FRACP, Philip R. Street, FRACP

Abstract: Pneumonia is a common and important disease in the elderly. The incidence is expected to rise as the population ages, and, therefore, it will become an increasingly significant problem in hospitals and the community. A comprehensive literature review was performed in order...

(pp 1141-1145)

Acute Acalculous Cholecystitis Complicating Major Trauma: A Report of Five Cases

Nasim Ahmed, MD, FACS

Abstract: The purpose of this study was to identify the clinical characteristics of the patients in our institution who developed acute acalculous cholecystitis (AAC) after major trauma. Data of all trauma patients who developed AAC from January 2001 through June 2006 were analyzed....

(pp 1146-1149)

Woman with Brugada Syndrome and Epilepsy: A Unifying Diagnosis?

Scott Girard, DO, Alberto Cadena, MD, Yuba Acharya, MD

Abstract: A woman with a past medical history of epilepsy was transferred to our hospital for episodic changes in mental status, jerking movements, and decreased hearing that were thought to represent seizure activity. While in the hospital, she was diagnosed with Brugada syndrome....

(pp 1150-1153)

Popliteal Cystic Adventitial Disease Causing Intermittent Claudication in a Young Athlete: A Case Report

Paritosh Sharma, MRCS, Nat Padhiar, MSc, PhD, FCPodS, Constantinos Kyriakides, MD, FRCS

Abstract: Cystic adventitial disease (CAD) is a rare condition that usually affects the popliteal artery and presents with symptoms of intermittent claudication in the younger population. Here, we present the case of a young athlete with popliteal cystic adventitial disease and...

(pp 1154-1156)

Esophageal Squamous Cell Carcinoma with a Solitary Phalangeal Metastasis

Ching-Yun Hsieh, MD, Li-Yuan Bai, MD, Woei-Chung Lo, MD, Hsin-Hui Huang, MD, Chang-Fang Chiu, PhD

Abstract: A patient with pathologically proven acrometastasis of his left thumb presented 3 months after esophagectomy for esophageal squamous cell carcinoma. Interestingly, there was indeed a faint uptake in his left thumb that was initially considered an artifact in the whole body...

(pp 1159-1160)

Stenting for Coronary Intervention-Related Dissection of the Left Main Coronary Artery with Extension to the Aortic Root: A Case Report

Cheng-Chung Cheng, MD, Tien-Ping Tsao, MD, Bing-Hsiean Tzeng, MD, Shu-Meng Cheng, PhD, Shih-Ping Yang, PhD

Abstract: Retrograde aortocoronary dissection is a rare but devastating complication of coronary angioplasty. It occurs most frequently in the right coronary artery, rarely in the left. This is a case report of an aortic dissection complicated by coronary angioplasty of the left...

(pp 1165-1167)

Gastric Carcinoid Tumor in Association with Hepatocellular Carcinoma: A Case Report

Athanasios Petrou, MD, Papalambros Alexandros, MD, Papaconstantinou Ioannis, MD, PhD, Sigala Frangiska, MD, PhD, Xiromeritis Kostantinos, MD, Felekouras Evangelos, MD, PhD, Papalambros Efstathios, MD, PhD

Abstract: A second primary malignancy (SPM) can occur in patients with gastrointestinal carcinoids. A patient underwent endoscopic resection of a gastric carcinoid. Repeat gastroscopy revealed recurrence of the lesion and multiple nodular gastric lesions, while an abdominal computed...

(pp 1170-1172)

Entecavir Therapy in a Hepatitis B-Related Decompensated Cirrhotic Patient

Badar Muneer, MD, Giuliano Testa, MD, J M. Millis, MD, Smruti R. Mohanty, MD, MS

Abstract: A 58-year-old Arab-American male with HBeAg-negative chronic hepatitis B (HBV), presented with decompensated cirrhosis and a high HBV DNA level. He responded to entecavir with a significant reduction in serum HBV DNA level after 15 weeks of therapy with entecavir. However,...

(pp 1173-1176)

Right Atrial Intramural Hematoma Associated with Aortic Dissection

Rajiv N. Thakkar, MD, MBA, Vaishali B. Popat, MD, MPH, Carlos Orbegoso, MD

Abstract: A 75-year-old male presented with shortness of breath and abdominal pain; he had undergone coronary artery bypass graft surgery three months ago and had a history of coronary artery disease, hypertension, and end-stage renal disease. Transthoracic echocardiogram showed a...

(pp 1177-1179)

Multiple Painful Cutaneous Facial Papules

Claudia Hernandez, MD, Carmen M. Rivera, BA

Abstract: A 21-year-old female with linear, flesh-colored papules on her face was diagnosed with cutaneous piloleiomyoma. Important associations for physicians to be aware of include uterine leiomyomas, leiomyosarcomas, and renal cell carcinoma. Mutations for this syndrome have been...

(pp 1180-1182)

Pneumonia in the Elderly: Understanding the Characteristics

Jun Shu, MD, PhD

Abstract: In this issue of the Southern Medical Journal, Chong and Street review the characteristics of pneumonia in the elderly,1 which is more common and severe than in younger patients. The potential decrease of body immunity and the gradual anatomical and physiological changes of...

(pp 1086)

Systemic Lupus Erythematosus Associated with Paclitaxel Use in the Treatment of Ovarian Cancer

Constantin A. Dasanu, MD, PhD, Doru T. Alexandrescu, MD

Abstract: Over the last years, scleroderma-like skin changes have been reported with two of the taxanes, docetaxel and paclitaxel, but specific antibodies were not found in any of those cases. Recently, paclitaxel was linked to cutaneous lupus erythematosus in two cancer patients,...

(pp 1161-1162)

Peyronie Disease in Association with Carvedilol: A Case Report

David S. H. Bell, MB, FACE, FACP

Abstract: Beta blockade is associated with the onset and progression of Peyronie disease (PD). To date, there has not been a report of PD occurring with the alpha/beta blocker carvedilol. It remains unproven but likely that carvedilol was the cause of the PD in the patient described...

(pp 1157-1158)

Cardiac Tamponade Caused by Fracture and Migration of Inferior Vena Cava Filter

Preeti A. Chandra, MD, Chibuzo Nwokolo, MD, Dmitry Chuprun, MD, Abhinav B. Chandra, MD

Abstract: A 53-year-old male presented to the emergency room with acute cardiopulmonary compromise. Echocardiography revealed cardiac tamponade. The patient was taken emergently for surgery and a 28 gauge wire of 1.5 cm was retrieved from his right ventricle. A section had fractured...

(pp 1163-1164)

Nonpolypoid Intestinal Mantle Cell Lymphoma Resembling MALT Lymphoma with Successful Response to Rituximab

Antonio D’Antonio, MD, PhD, Amedeo Boscaino, MD, Maria Addesso, MD, Giuseppina Liguori, MS, Oscar Nappi, MD

Abstract: Two unusual cases of mantle cell lymphoma are reported. They involved the ileum and right colon without multiple lymphomatous polyposis and morphologically resembled an extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)...

(pp 1168-1169)

CME Submission Form


Abstract: ...

(pp 1133)

November 2008 CME Questions


Abstract: “Pneumonia in the Elderly: A Review of the Epidemiology, Pathogenesis, Microbiology, and Clinical Features”1. Aging is associated with:A. Increased elastic recoil of the lung.B. Decreased functional residual capacity.C. Decreased chest wall compliance.2. Elderly...

(pp 1132)

Cystic Adventitial Disease: A Cause for Intermittent Claudication in Young Ages

Konstantinos A. Filis, MD, Fragiska Sigala, MD

Abstract: Intermittent claudication in a healthy, middle-aged man who does not present with any of the traditional risk factors for arterial disease is rare and often misdiagnosed. In fact, a diagnosis of peripheral obstructive arterial disease in a nonsmoker, nondiabetic,...

(pp 1091)

B-Type Natriuretic Peptide in End-Stage Renal Disease: A Neurohormone Rather Than a Volume Status Monitor

Micha T. Maeder, MD, David M. Kaye, MD, PhD

Abstract: A biomarker assisting in estimating volume status in patients with end-stage renal disease (ESRD) would be very helpful in clinical practice. In this issue of the Southern Medical Journal, Flemmer et al1 evaluated whether changes in B-type natriuretic peptide (BNP), a...

(pp 1081-1082)

Acute Acalculous Cholecystitis After Trauma: The Role of Microcirculatory Failure and Cellular Hypoxia

Robert B. Sanda, FRCSI

Abstract: Critical illness is expensive. Neural transmission, ion transport, vasoconstriction, glandular and hormonal secretions are highly endergonic processes that are amplified in the face of trauma, sepsis, or both. It is not surprising, therefore, that the enzymes that drive...

(pp 1087-1088)

Brain Natriuretic Peptide (BNP): A New Risk Marker in Hemodialysis Patients?

Sofia Jorge MD, José António Lopes MD, Fernando Neves MD, António Gomes da Costa MD, M Martins Prata MD, PhD

Abstract: In this issue of the Southern Medical Journal, the authors raise the issue of B-type natriuretic peptide changes in end-stage renal disease.1 Brain natriuretic peptide (BNP) is a natriuretic hormone present in the brain and heart which is released from myocardial cells in...

(pp 1083)

Pneumonia in the Elderly: Whose Friend Is It Anyway?

Muthiah P. Muthiah, MD, FCCP

Abstract: According to current thinking, pneumonia begins when pathogens invade the sterile lower respiratory tract, a process that leads to activation of the innate immune response to produce local and systemic inflammation.1,2 A 1960s article in Time magazine speculated that...

(pp 1084-1085)

Abdominal Aortic Aneurysm and Significant Coronary Artery Disease: Strategies and Options

Jean Marie Ruddy, MD, William Yarbrough, MD, Thomas Brothers, MD, Jacob Robison, MD, Bruce Elliott, MD

Abstract: Objectives: The optimal treatment for patients requiring intervention for coronary artery disease (CAD) and concomitant large or symptomatic abdominal aortic aneurysm (AAA) remains problematic. Methods: Retrospective analysis was performed of 32 patients with symptomatic or...

(pp 1113-116)

Eggs: How Much Is Safe?

Helena Gylling, MD, PhD

Abstract: Eggs: How Much Is Safe?Egg consumption was related to cardiovascular disease and mortality in the study performed by Djoussé and Gaziano, which looked at a population of 21,327 male physicians and included a 20-year followup. While myocardial infarctions and strokes were...

(pp 1079)

Body Mass Index Is Not Predictive of Ovarian Cancer Survival

Catherine M. Olsen, PhD, MPH, BSc, Christina M. Nagle, PhD, MPH, BappSc

Abstract: Body Mass Index Is Not Predictive of Ovarian Cancer SurvivalIn the largest ovarian cancer survival study to date, Barrett et al found no association between body mass index at first treatment and progression-free or overall survival. These findings add to the growing body...

(pp 1079)

Safe Filler Injections Should Be Done By Expert Cosmetic Dermatologic Surgeons

Rhoda S. Narins, MD

Abstract: Safe Filler Injections Should Be Done By Expert Cosmetic Dermatologic SurgeonsInjections of fillers should be done by licensed and trained physicians with expertise in the use of all fillers who can choose the best filler(s) for each particular patient’s needs....

(pp 1079-1080)

A Cancer Vaccine That Works

K Michael Cummings, PhD, MPH, Andrew Hyland, PhD

Abstract: A Cancer Vaccine That WorksSmoking causes more than just lung cancer. The paper by Batty and colleagues published in the April 2008 issue of the Annals of Oncology reveals that cigarette smoking is associated with several types of malignancies, which further reinforces the...

(pp 1079)

Medical Webwatch

Jim Young

Abstract: Poisoning is part of the “Injuries” section in the Merck Manual. It is presented in 11 extensively cross-referenced sections which consider the signs, symptoms, diagnosis, treatment, and pathophysiology of poisoning. The other...

(pp 1189)

Brugada Syndrome, Epilepsy and Pemphigus Vulgaris

Marzia Caproni, MD, Daniele Torchia, MD, Leonardo Parigi, MD, Paolo Fabbri, MD

Abstract: To the Editor:A 67-year-old man was affected for 18 years by pemphigus vulgaris; he was maintained on oral methylprednisolone 8 mg daily. He was also taking enalapril, potassium canrenoate and butizide for arterial hypertension. Prophylactic therapy with phenytoin 100 mg...

(pp 1183)

Myocarditis Due to Bartonella henselae

Chrisoula Pipili MD, Konstantinos Katsogridakis MD, Evangelos Cholongitas MD

Abstract: To the Editor:A 22-year-old male presented with chest pain that lasted six hours, a low fever, and systemic symptoms including malaise and anorexia of three days’ duration. His medical history was unremarkable and he had not been receiving any medication. Clinical...

(pp 1186)

Niemann-Pick Disease Type B Presenting with Hepatosplenomegaly and Thrombocytopenia

Ebru Uz, MD, Handan Cipil, MD, Faruk H. Turgut, MD, Arif Kaya, MD, Ayse Kargili, MD, Nüket Bavbek, MD, Akcay Ali, Assoc Prof, Kosar Ali, Prof

Abstract: To the Editor:Niemann-Pick disease (NPD) comprises an autosomal recessively inherited group of congenital lipidoses in which sphingolipids accumulate in cells. NPD is a clinically and biochemically heterogeneous disorder, with four variants. Type A and B have a generalized...

(pp 1188)

Anal Pap Smear in High-Risk Patients: A Poor Screening Tool

Ambra Ferraris, MD, Kanakasabai Narasimhan, MD, Ifad Rahman, MD, Irving Jorge, MD

Abstract: To the Editor:Anal cancer and anal intraepithelial neoplasia are rare in the general US population, with an incidence of 0.8 per 100,000.1 This incidence is increased by 25 to 50 times in homosexuals, and further increased in patients with AIDS. The association of human...

(pp 1185-1186)

Outcome Predictors of Chronic Renal Disease Patients with Parapneumonic Empyemas

Chia-Hung Chen, MD, Chih-Yen Tu, MD, Yi-Heng Liu, MD

Abstract: To the Editor:Bacterial infections are a well-documented complication in chronic kidney disease (CKD) patients,1 but to our knowledge, no study has focused on parapneumonic empyemas in these patients. We designed a retrospective study to investigate the bacteriology and...

(pp 1187)

Aortic Dissection Presenting with New Onset Atrial Fibrillation: A Very Unusual Presentation

Abhijeet Dhoble, MD, MPH, Dwarakraj Soundarraj, MD, Ralph Watson, MD, FACP

Abstract: To the Editor:Acute aortic dissection (AAD) is a cardiovascular emergency, and is usually fatal unless treated promptly. Presenting symptoms are generally chest or back pain, and elevated blood pressure (BP). Other common presentations are syncope, murmur of aortic...

(pp 1184-1185)

Single Metastasis in the Gallbladder Arising from Adenocarcinoma of the Rectum

Christof Abächerli, MD, Jürg Metzger, MD

Abstract: To the Editor:An 83-year-old man was admitted to our hospital for the surgical treatment of a locally advanced adenocarcinoma of the rectum. Initial staging showed strong evidence for mesorectal lymphadenopathy. Neoadjuvant radiochemotherapy achieved a regression of the...

(pp 1183-1184)

Secondary Psoas Abscess

Weekitt Kittisupamongkol, MD

Abstract: To the Editor:Lin et al1 report an interesting case of a man with psoas abscess. They cited that 80% of secondary psoas abscess cases derived from the alimentary tract, with Crohn disease as the most common cause. I disagree. The incidence of Crohn disease is low in many...

(pp 1187-1188)