Issue - Southern Medical Association

Editorial

The Brugada Syndrome: An Elusive Diagnosis

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 category is present. Individuals with this condition, many with apparently structurally…

Editorial

Drug-Induced Sexual Problems

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 pharmaceutical companies to have their product approved…

Original Article

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

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. At five visits, over a 6-week period, pre- and postdialysis BNP levels were…

Original Article

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

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 7–10%. This was a survey study looking at the barriers…

Original Article

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

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 medication acceptance in a normative sample. Methods: Participants (N = 304) completed the…

Original Article

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

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 management of the study patients using already available data. The study…

Original Article

Avian Flu: How Informed are Children in Greece?

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 to asses the information level among Greek children regarding avian…

Acknowledgment

Patient’s Page

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 being rebuilt, so to speak. Just like skin cells and taste buds,…

Original Article

Prophylactic Antibiotics in Necrotizing Pancreatitis: A Meta-analysis

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 trials comparing treatment with prophylactic antibiotics to treatment without prophylactic antibiotics in necrotizing pancreatitis. Prophylactic antibiotics’ effects…

Expired CME Article

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

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 severity assessment and prognosis in older patients. Mortality increases with age and functional…

Expired CME Article

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

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 to look at the characteristics of pneumonia in…

Review Article

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

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. Five out of 1386 (0.3%) major trauma patients…

Case Report

Woman with Brugada Syndrome and Epilepsy: A Unifying Diagnosis?

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. Her antiepileptic medications were adjusted while she was…

Case Report

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

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 discuss available treatment options.

Case Report

Esophageal Squamous Cell Carcinoma with a Solitary Phalangeal Metastasis

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 bone scan taken before esophagectomy. Physicians must be aware…

Case Report

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

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 circumflex artery. Stenting of the left main coronary artery…

Case Report

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

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 tomography scan revealed a small solid lesion in the left hepatic lobe. The…

Case Report

Entecavir Therapy in a Hepatitis B-Related Decompensated Cirrhotic Patient

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, he developed a progressive rise in prothrombin time/international normalized…

Case Report

Right Atrial Intramural Hematoma Associated with Aortic Dissection

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 right atrial mass. A computed axial tomography scan showed an atrial…

Case Report

Multiple Painful Cutaneous Facial Papules

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 mapped to the fumarate hydratase gene.

Editorial

Pneumonia in the Elderly: Understanding the Characteristics

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 the respiratory system increase the susceptibility of…

Case Report

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

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, showing high titers of serum anti-Ro (SS-A) antibody. To…

Case Report

Peyronie Disease in Association with Carvedilol: A Case Report

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 in this case. It…

Case Report

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

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 from the inferior vena cava (IVC) filter and migrated…

Case Report

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

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) type.

Expired CME Article

CME Submission Form

Expired CME Article

November 2008 CME Questions

“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 patients are more likely to have which clinical feature compared to younger adults?A. ShockB. Acute onset to…

Editorial

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

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, nonhypertensive, and nonhyperlipidemic young male is difficult for a general physician…

Editorial

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

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 relatively cardiac-specific 32-amino acid polypeptide released following increased cardiomyocyte…

Editorial

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

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 catabolic reactions (citric acid cycle, oxidative phosphorylation and beta-oxidation), unlike the enzymes…

Editorial

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

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 response to volume and pressure overload.2 BNP…

Editorial

Pneumonia in the Elderly: Whose Friend Is It Anyway?

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 “bacterial and viral diseases will have been virtually wiped out” by…

Original Article

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

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 large (>6 cm) AAA along with significant CAD treated over the past fifteen years at…

Rapid Response

Eggs: How Much Is Safe?

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 unrelated to egg consumption, the consumption of five or…

Rapid Response

Body Mass Index Is Not Predictive of Ovarian Cancer Survival

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 of evidence that obesity does not have…

Rapid Response

Safe Filler Injections Should Be Done By Expert Cosmetic Dermatologic Surgeons

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. Unfortunately, there have been many instances of fillers injected by…

Rapid Response

A Cancer Vaccine That Works

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 importance of tobacco control as a means…

Medical Webwatch

Medical Webwatch

Poisoning http://www.merck.com/mmpe/sec21.html 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 categories on this page are equally interesting. A full list of the 22 other Merck Manual sections…

Letter to the Editor

Brugada Syndrome, Epilepsy and Pemphigus Vulgaris

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 and lamotrigin 100 mg daily had been established several years…

Letter to the Editor

Myocarditis Due to Bartonella henselae

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 examination disclosed enlargement of the axillary lymph node (3…

Letter to the Editor

Niemann-Pick Disease Type B Presenting with Hepatosplenomegaly and Thrombocytopenia

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 sphingomyelinase deficiency, whereas groups C and D have normal sphingomyelinase levels.1We report…

Letter to the Editor

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

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 papillomavirus (HPV) infection with cervical neoplasia…

Letter to the Editor

Outcome Predictors of Chronic Renal Disease Patients with Parapneumonic Empyemas

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 outcome predictors of parapneumonic empyemas in patients with stage 4 or 5…

Letter to the Editor

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

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 regurgitation, and pulse deficit. Common electrocardiographic changes, if any, are due to…

Letter to the Editor

Single Metastasis in the Gallbladder Arising from Adenocarcinoma of the Rectum

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 primary findings. An extended perineal rectum amputation was performed. Coexistent cholecystolithiasis necessitated cholecystectomy…

Letter to the Editor

Secondary Psoas Abscess

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 groups, e.g….