Issue - Southern Medical Association

Case Report

Metoclopramide-Induced Encephalopathy in Parkinson Disease

A case of prolonged encephalopathy and worsened parkinsonism in a Parkinson disease patient exposed to a short course of metoclopramide is described. Parkinson disease (PD) is the second most common neurodegenerative disease in the United States. Because of the increased susceptibility to adverse drug effects, PD presents a special challenge…

Editorial

Lyme Carditis: Another Diagnostically Elusive Spirochetal Disease

The differential diagnosis of acquired atrioventricular cardiac conduction disturbances includes pharmacologic agents as well as collagen-vascular, infiltrative, and infectious diseases.1 Commonly prescribed cardiac medications such as beta and calcium blockers, in addition to digoxin, are well-known negative chronotropes. Conduction defects can be observed in up to 50% of ankylosing spondylitis…

Editorial

Is It Time for Carisoprodol to Become a Controlled Substance at the Federal Level?

Carisoprodol (N-isopropyl-2 methyl-2-propyl-1,3-propanediol dicarbamate; N-isopropylmeprobamate; Soma) is a commonly prescribed, centrally acting skeletal muscle relaxant. As the chemical nomenclature suggests, carisoprodol is structurally related to meprobamate. In fact, the primary active metabolite of carisoprodol is meprobamate. Meprobamate is a schedule IV controlled substance at the federal level with a known…

Original Article

Viewing Professional Wrestling on Television and Engaging in Violent and Other Health Risk Behaviors

Background: This study examined the relationships between watching wrestling on television (TV) and engaging in health risk behaviors among an older multi-state sample of adolescents. Methods: In 2001, a random sample of 2,307 youth ages 16 to 20 years from 138 communities in 17 US states completed telephone surveys as…

Original Article

Patients’ Perception of Physician-Initiated Prayer Prior to Elective Ophthalmologic Surgery

Background: Prayer is an important part of many patients’ and physicians’ lives. There is little data in the literature regarding patients’ perception of prayer from or with their doctors. Objective: To assess in a masked fashion patients’ impression of prayer’s role in a medical setting, and their perception of being…

Original Article

Risk-Based Screening for Latent Tuberculosis Infection

Background: National guidelines recommend targeted tuberculin testing and treatment of latent tuberculosis infection (LTBI) among high-risk groups but discourage testing low-risk persons. Methods: We determined the LTBI prevalence (tuberculin skin test [TST] reaction ≥10 mm) among adults with and without TB exposure risk factors screened in Tennessee from 1/2/2002 to…

Original Article

Evaluation of the Effects of Obesity on Heart Functions Using Standard Echocardiography and Pulsed Wave Tissue Doppler Imaging

Objectives: This study aimed to investigate abnormalities in right and left ventricular function in older obese patients with no left ventricular (LV) hypertrophy. Design: Subjects with normal coronary angiography were included in this study. They were divided into two groups according to their body mass index (BMI): Group I =…

Expired CME Article

Osteonecrosis of the Jaw

The first bisphosphonate (etidronate) was approved by the FDA in 1977; alendronate was approved in 1995 for the prevention and treatment of osteoporosis. Bisphosphonates have emerged as the agents of choice for the treatment of osteoporosis and have proved useful in the treatment of skeletal complications of malignancy (hypercalcemia, bone…

Expired CME Article

Resistant Hypertension: Identifying Causes and Optimizing Treatment Regimens

Management of resistant hypertension (RH), defined as uncontrolled blood pressure on three or more antihypertensive medications including a diuretic, begins initially with identifying and addressing contributors such as medication adherence, lifestyle factors and the use of interfering substances. Evaluation for the “white-coat” phenomenon, or associated conditions and secondary causes such…

Expired CME Article

Safety and Efficacy of the Drug-Eluting Stent: A Double-Edged Sword?

Like the introduction of bare metal stents (BMS), that of drug-eluting stents (DES) represented a quantum leap in the interventional cardiology community’s ongoing efforts to conquer restenosis. However, recent concerns over late thrombosis (LT) have tempered the initial enthusiasm. Nonetheless, when compared with BMS, the slightly higher DES-LT is counterbalanced…

Review Article

From the Neurobiologic Basis of Alcohol Dependency to Pharmacologic Treatment Strategies: Bridging the Knowledge Gap

Alcohol dependence (AD) is a complex disease involving biologic, psychosocial, and environmental factors. Increasing evidence shows that the development of AD involves changes in neurotransmitter function in the areas of the brain associated with alcohol craving and reward. Although AD is gaining acceptance as a medical disease, management of AD…

Review Article

Treatment Options for the Relief of Chronic Idiopathic Urticaria Symptoms

Chronic urticaria is a cutaneous condition in which recurrent pruritic wheals (hives) manifest on the body and typically last for longer than 6 weeks. Chronic urticaria, including physically induced urticarias, such as cold, solar exposure or delayed pressure urticaria, is estimated to occur in approximately 25% of urticaria patients. Of…

Case Report

Bilateral Perinephric Diffuse Large B-Cell Lymphoma and Synchronous Renal Oncocytoma

An elderly patient who presented with bilateral perinephric diffuse large B-cell lymphoma and concomitant oncocytoma of the same location is reported. To our knowledge, the anatomic proximity of the two tumors at the level of kidneys has not been previously described. Because of the patient’s other medical conditions, systemic chemotherapy…

Case Report

Amyloid Tumor of the Breast Mimicking Breast Carcinoma

Amyloid tumors of the breast are extremely rare. Few isolated cases have been reported to date. Amyloid involvement of the breast has no specific diagnostic features on mammography; on occasion, this causes diagnostic challenges. In this paper, the case of a 58-year-old woman with an amyloid tumor of the breast,…

Case Report

Chest Pain in a Military Recruit

Lyme borreliosis remains an important and common vector-borne illness in the United States, Europe, and Asia. In the majority of cases, it presents as a localized rash that seldom causes further complications with antibiotic treatment. If left undetected however, various neurologic, cardiovascular, and musculoskeletal manifestations may occur. Reported here is…

Case Report

A Case Report of an Ovarian Lipoma

Background: Ovarian lipomas are a rare entity, with most being described as part of a teratomatous origin. This is a case report of a lipoma of an ovary not associated with a teratoma or an hyperandrogenic state. Case: A 66-year-old female underwent an exploratory laparotomy and a left ovarian tumor…

Case Report

Surgical Repair of Idiopathic Scrotal Elephantiasis

Scrotal lymphedema (scrotal elephantiasis) is uncommon outside of filariasis endemic regions. We present a case of a 65-year-old with idiopathic lymphedema of the scrotum and functional impairment of the penis. The patient underwent surgical excision of the edematous subcutaneous tissues and plastic reconstruction of his penis and scrotum. Three years…

Letter to the Editor

Life-Threatening Ventricular Arrhythmia Induced by Hypokalemia During Sodium Bicarbonate Infusion

To the Editor: Sodium bicarbonate is commonly used for short-term relief of severe metabolic acidosis or testing for renal tubular acidosis. However, rapid serum alkalization can result in a variety of complications, including fluid overload, cardiac arrhythmia, seizure, hypokalemia, and hypocalcemia. Hypokalemia results from promoting potassium movement into cells by…

Editorial

Physician-Initiated Preoperative Prayer

The idea of physician-initiated prayer has emerged along with the growing interest in the integration of spiritual care with the more traditional healthcare modalities. While there is a growing body of literature suggesting that patients rely on their faith as a part of the healing process, and that many appreciate…

Case Report

Similar Effects of Tramadol and Venlafaxine in Major Depressive Disorder

he analgesic tramadol has many characteristics in common with the antidepressant venlafaxine. The drugs are structurally similar, share both serotonergic and noradrenergic properties, and undergo a similar metabolic fate. In this study, a patient, who developed significant depression following cessation of tramadol after several years of therapy, is described. Her…

Expired CME Article

February 2008 CME Questions

February 2008 CME Questions

Expired CME Article

CME Submission Form

CME Submission Form

Editorial

Media Exposure: The Link with Adolescent Health Risk Behaviors

It is estimated that US children 2 to 18 years of age spend an average of 5.5 hours, daily, using media of all types.1 During these years, it is estimated they will have viewed over 200,000 acts of violence just on television.2 In this issue of the Southern Medical Journal,…

Editorial

Live by the Sword, Die by the Sword

Binary angiographic restenosis (BAR, development of a >50% stenosis at the site where a coronary lesion has been treated) occurs in 20 to 50% of cases after coronary angioplasty.1 Different devices, such as rotational atherectomy, directional atherectomy, intracoronary laser, sonotherapy, and cutting balloon, did not reduce the risk of restenosis…

Editorial

Treating Addiction, Seriously

The scope of the addiction problem is enormous. Alcohol abuse in the United States is particularly common, with 22.6% of Americans reporting binge drinking and 6.8% reporting repetitious heavy drinking within the past 30 days. A well-crafted, wonderfully phrased and readable manuscript, such as the article by Dr. Christopher Shea,…

Original Article

Pregnancy Loss after First Trimester Viability in Women with Sickle Cell Trait: A Preliminary Report

Background: Traditionally, sickle cell trait has not been associated with a higher risk of fetal death, but we noted several, which led us to assess all such pregnancies. Methods: In this retrospective study, 131 patients with sickle cell trait were analyzed over a two-year period. The Institutional Review Board approved…

Rapid Response

Acupuncture of the Knee

Acupuncture, a treatment modality of traditional Chinese medicine, involves not only needle administration but also a strong patient-acupuncturist relationship.1 The European League against Rheumatism (EULAR) recommends acupuncture as part of a multidisciplinary approach to treat osteoarthritis (OA) of the knee2; however, the current literature regarding efficacy of acupuncture is inconclusive.

Rapid Response

Walking Works

Recently, Ogilvie et al1 reviewed walking interventions to determine resulting changes in walking behavior and health outcomes. Authors analyzed a total of 48 interventions resulting in 60 publications. Strict inclusion criteria were applied, resulting in the limited number of studies examined. Studies ranged from small, randomized trials to large, community…

Rapid Response

Orchiopexy: The Earlier the Better to Decrease Testis Cancer Risk

Testicular cancer is almost exclusively a disease of younger men and hence has major public health impact. Despite the availability of effective therapies for this cancer, prevention of this disease certainly remains a worthwhile goal. Cryptorchidism is one of the factors associated with increased risk of testicular germ cell cancer.

Rapid Response

Physician-Initiated Counseling Regarding Smoking Cessation

Nicotine dependence is life threatening and avoidable. An estimated 440,000 Americans die each year from diseases caused by smoking. Each day, nearly 6,000 children under the age of 18 start smoking; of these, 2,000 will become regular smokers. An estimated 4.5 million US adolescents are cigarette users, and approximately 90%…

Rapid Response

Thyroid Function Test: Thinking Outside the Box (of Guidelines)

Physicians order thyroid function tests to evaluate a wide range of clinical conditions; however, there is no clear consensus on how to do this and what to do with certain results.

Rapid Response

Time to Expand Gonorrhea and Chlamydia Screening With Retesting for Those With Previously Positive Results

Sexually transmitted infections (STIs) with Chlamydia trachomatis and Neisseria gonorrhea are a major public health problem in the United States (US).1 However, the number of reported cases underestimates the true prevalence of these STIs, as many cases can be asymptomatic2 and often occur in populations who either have limited access…

Special Section

Medical Webwatch

Complementary therapies http://www.csh.umn.edu/modules/index.html is part of the “Healthcare Professional Series” at the University of Minnesota, Center for Spirituality & Healing. It describes itself as “… offering healthcare professionals and students an introduction to the field of complementary therapies and healing practices,” with the “Content written by subject matter experts and…

Special Section

Patient’s Page

Are the Kids “All Right?” Virginia Tech massacre, 2007. Red Lake High School shooting, 2005. Santana High School shooting, 2001. Columbine High School massacre, 1999. Jonesboro massacre, 1998. Parents and teachers will undoubtedly recognize the names of these schools, and will remember the violence that took place there. Over the…

Letter to the Editor

Defending Local RSV Virology: Rebuttal Letter to Hampp and Winterstein

To the Editor: We welcome this opportunity to respond to the questions raised by Hampp and Winterstein concerning our analysis of RSV seasonality data for Florida published in the Journal.2 Hampp and Winterstein comment on 1) the data selection criteria we used to interpret RSV seasonality data for various regions…

Letter to the Editor

Pandemic Influenza and Community Medical Care

To the Editor: Over the last three decades, community-based infectious disease practice has undergone major changes. Imaging techniques (eg, computed tomography [CT] and ultrasound) and modern medicines have revolutionized patient care. If history is a guide, with pandemic influenza, we will face the challenge of treating seriously ill patients without…

Letter to the Editor

Response to Respiratory Synctial Virus

To the Editor: With great interest, we read the article “Respiratory Syncytial Virus: Seasonal Data for Regions of Florida and Implications for Palivizumab” by Bauman and colleagues in the July 2007 issue of the Journal.1 However, consistent with the editorial by Ian Mitchell,2 we would like to caution against the…

Letter to the Editor

Acute Infection with Human Monocytic Ehrlichiosis: The Tip of the Iceberg?

To the Editor: In their excellent case report of human monocytic ehrlichiosis (HME), Prince et al1 describe the difficulty in diagnosing this potentially life-threatening tick-borne disease. In the accompanying editorial, Openshaw and Swerdlow2 mention that, in contrast to the fulminant presentation in the case report, HME infection may be “asymptomatic.”…

Letter to the Editor

Letter to the Editor in Response to “An Epidemic that Deserves More Attention: Epidemiology, Prevention, and Treatment of Smokeless Tobacco”

To the Editor: Overall, Dr. Arabi provides a more balanced review of smokeless tobacco (ST) use than is typical in the public health and medical literature.1 However, we would like to correct a few points that he discussed: 1) The ST products used in India often contain lime or betel…

Letter to the Editor

Response to Drs. Phillips and Heavner

To the Editor: I would like to thank Dr. Phillips and Dr. Heavner for their review. However, I would like to clarify a few points that they made. First of all, Dr. Phillips and Dr. Heavner listed in their letter as a correction that “The smokeless tobacco (ST) products used…