Issue - Southern Medical Association

Editorial

The Rise and Fall of Vancomycin

Since its development in the 1950s, vancomycin has had a prominent role in the treatment of staphylococcal infections. Soon after its debut, the first cases of methicillin-resistant Staphylococcus aureus (MRSA) were reported (1961),1 but remained a rarity until the late 1970s.2

Editorial

Myocardial Bridging

Muscle overlying the intramyocardial segment of an epicardial coronary artery is defined as a myocardial bridge, and the artery coursing within the myocardium is known as a tunneled artery. It is an inborn coronary abnormality that was recognized at autopsy by Reyman1 in 1737 and first identified angiographically by Portmann…

Editorial

Immunocompromised Host (Especially HIV-Positive) The Target of Pyomyositis in Temperate Regions

Pyomyositis is an acute endemic infection, initially seen in tropical areas. Over the last several years, however, more cases have been reported in temperate areas, especially among patients with immunodeficiency. This increase could reflect the use of more advanced imaging techniques, but also corresponds to a rising number of immunocompromised…

Original Article

Oxybutynin Effects on Staphylococcus epidermidis Biofilm Production

Background: Oxybutynin is a tertiary amine and has chemical similarities like protamine sulfate. Protamine sulfate’s effect on bacterial viability has been shown in some studies; however, there is scanty data regarding the effect of oxybutynin on bacterial viability. Accordingly, the aim of the present study was to investigate the effect…

Original Article

Clinical Evaluation and Power Doppler Sonography in Rheumatoid Arthritis: Evidence for Ongoing Synovial Inflammation in Clinical Remission

Objective: This study proposed to assess the relationship between power Doppler ultrasound examination and spectral Doppler analysis of hand joints with clinical and laboratory parameters in rheumatoid arthritis. Methods: Patients receiving disease-modifying antirheumatic drugs or biologics (infliximab) underwent joint examination and were assessed by a Health Assessment Questionnaire, Duruoz’s Hand…

Original Article

Echocardiographic, Electrocardiographic, and Clinical Correlates of Recurrent Transient Ischemic Attacks: A Follow-up Study

Background: Transient ischemic attack (TIA) is presumed to be of cardiovascular origin. The aim of the study was to evaluate the electrocardiographic, echocardiographic, and clinical signs for predicting TIA recurrence. Methods: A total of 100 consecutive patients presenting with a first episode of TIA without atrial fibrillation, previous stroke, and…

Original Article

Use of Conventional and Nonconventional Treatments for Osteoarthritis in the Family Medicine Setting

Background: The purpose of this study was to examine: (a) the extent to which patients report having used conventional and nonconventional treatments for osteoarthritis in family medicine settings and (b) how patient characteristics are related to the use of these treatments. Methods: A survey was sent to 2,178 patients with…

Expired CME Article

Cardiac Rehabilitation Programs Markedly Improve High-Risk Profiles in Coronary Patients with High Psychological Distress

Objectives: Adverse behavioral profiles, particularly depression and hostility, increase the risk of coronary artery disease (CAD) and affect recovery after CAD events. We sought to determine the effects of outpatient phase II cardiac rehabilitation and exercise training (CRET) programs in CAD patients with high levels of psychological distress. Methods: We…

Review Article

Role of Antiplatelet Agents in the Primary and Secondary Prevention of Atherothrombotic Events in High Risk-Patients

Atherothrombosis describes the superimposition of a thrombus on a ruptured atherosclerotic plaque, and is the primary cause of acute ischemic events. Atherothrombosis is a generalized and progressive process with an inflammatory component. Patients with disease in one vascular bed are at risk of disease in another, a concept known as…

Review Article

Vancomycin: Understanding Its Past and Preserving Its Future

The increase in vancomycin use in the 1980s to treat antibiotic-associated colitis and methicillin-resistant Staphylococcus aureus (MRSA) is largely responsible for the appearance of vancomycin-resistant enterococcus, which in turn spawned isolated cases of vancomycin-resistant S. aureus. Perhaps most worrisome to clinicians are strains of MRSA that are heteroresistant to vancomycin;…

Review Article

Central Nervous System Infections in Transplant Recipients by Cladophialophora bantiana

Cladophialophora bantiana, a dematiaceous fungus, is an uncommon pathogenic organism originally thought to more commonly affect immunocompetent patients. Increasing numbers of reports, however, describe the organism affecting immunocompromised patients. Like all dematiaceous fungi, Cladophialophora can be recognized in histopathologic sections by the golden-brown coloration in the walls of the hyphae….

Review Article

Pitfalls in Percutaneous Dilational Tracheostomy Using the Ciaglia® One-Step Technique

Surgical tracheostomy was first described in 1909. Since then, it has become a standard procedure for patients requiring prolonged mechanical ventilation. More recently, bedside percutaneous tracheostomy has been shown to be as safe and effective as the surgical technique, but with the added advantage of also being technically straightforward and…

Case Report

Sternal Tuberculosis Presenting as Multiple Cutaneous Sinuses

Isolated involvement of the sternum with tuberculosis is rare. Only a few cases of sternal tuberculosis have been reported in literature. Tubercular sternal osteomyelitis presenting as multiple cutaneous sinuses over the anterior chest wall is extremely rare. We present a patient with sternal tuberculosis presenting as multiple cutaneous sinuses over…

Case Report

Alarming ST-Segment Elevation in a Young Male with Left Anterior Descending Coronary Artery Myocardial Bridging

Chest pain continues to be one of the leading emergency department presentations. Acute coronary syndrome is the most dreaded chest pain scenario, as “time is myocardium” in this situation. Numerous benign and less life-threatening diseases like early repolarization, acute pericarditis, and vasospastic angina can present with a similar clinical picture….

Case Report

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Clinical Profile of Four Patients and Review

Four patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) are described. Two patients presented with sustained ventricular tachycardia and two with cardiac arrest from which they were successfully resuscitated. All four patients had typical electrocardiographic and echocardiographic features and fulfilled the task force criteria for diagnosis of ARVD/C. All four patients…

Case Report

Streptococcus agalactiae Myositis in a Child with Perinatally Acquired Human Immnodeficiency Virus

Pyomyositis is a musculoskeletal infection with formation of an intramuscular abscess. Endemic in tropical climates, it is being reported with increasing frequency in temperate climates such as the United States. The most common causative organism is Staphylococcus aureus, present in greater than 90% of reported cases. Risk factors include underlying…

Case Report

Disseminated Fusarium Infection in a Multiple Trauma Patient

The hyalohyphomycetes (especially Fusarium sp.) have emerged as significant pathogens in severely immunocompromised patients. Human infections by Fusarium sp. can be superficial or limited to single organs in otherwise healthy patients. Such infections are rare and tend to respond well to therapy. By contrast, disseminated fusarial hylohyphomycosis affects the immunocompromised…

Case Report

Asymptomatic Massive Subdural Hematoma in a Patient with Bitemporal Agenesis and Bilateral Temporal Arachnoid Cysts

The case of a 38-year-old man with a history of chronic migraine is reported. Despite a 3 week history of changes in his migraine pattern, a normal neurologic examination led to conservative treatment. He later presented with worsening headaches and imbalance; tendon reflexes were increased on the right side, and…

Editorial

Off the Rack

Core competencies. Pay for performance. Physician, hospital, and health plan “report cards.” In medicine, we are growing accustomed to having our performance measured, rather than having it simply assumed. Society wants to be able to choose the best provider in the best system by evaluating objective evidence rather than just…

Editorial

Open or Percutaneous Tracheostomy?

The article by Sarani et al1 published in this issue of the Southern Medical Journal illustrates how important it is to understand the different steps of the percutaneous techniques, the different potential complications, and the pitfalls of this operation. This is an article that will be beneficial both for surgeons…

Expired CME Article

March 2008 CME Questions

&NA;Cardiac Rehabilitation Programs Markedly Improve High-Risk Profiles in Coronary Patients with High Psychological Distress (pages 262–267).1. Psychological stress has been: A. Associated with cardiovascular health, especially coronary events. B. Associated with major cardiovascular risk factors, including obesity, diabetes, dyslipidemia, and hypertension. C. Recently associated with inflammatory biomarkers. D. All of…

Expired CME Article

CME Submission Form

CME Submission Form

Expired CME Article

Management of Status Epilepticus in Infants and Children Prior to Pediatric ICU Admission: Deviations from the Current Guidelines

Objectives: Despite the availability of guidelines for the treatment of status epilepticus (SE), there may be variability in the initial stabilization, evaluation, and pharmacologic treatment of infants and children with SE. To improve the treatment of such patients, documentation of these problems is needed. The current study is a prospective…

Editorial

Cardiac Rehab in the Quest for a Happier and Healthier Heart

Over the course of the millennia, cultures from around the world independently came to the same erroneous conclusion that emotions originate in the heart. Indeed, the words anger, angst, anguish, and angina all derived from the same Greek root word meaning constriction. Though emotions emanate from the brain, they resonate…

Rapid Response

When the Thyroid is Sick, the Heart is Broken

To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, Iervasi et al evaluated 3,121 cardiac patients with euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3). After mean follow-up of 32 months, there were 65 and 140 cardiac and…

Rapid Response

What’s a Clinician to Think? What’s a Clinician to Do?

Clinicians are often faced with the dilemma of how to treat osteoarthritis patients who are not completely satisfied with the conservative therapy outlined in the guidelines issued by the American College of Rheumatology and other organizations. Doctors and patients have hoped that glucosamine might be the answer for added pain…

Rapid Response

Blood Pressure Reduction Is More Important than Renin-Angiotensin System Blockade to Improve Diastolic Function

Diastolic dysfunction occurs in up to 50% of patients with hypertension. Characterized by abnormalities of left ventricular (LV) filling, it is often associated with clinical heart failure. Antihypertensive agents that inhibit the renin–angiotensin-system (RAS) have been shown to improve diastolic function, but whether this is related to their blood pressure…

Rapid Response

Soft Drink Consumption Is Associated with an Increased Risk of Metabolic Syndrome and Its Components in Adults

In a recent analysis of Framingham data, Dhingra et al1 demonstrate that baseline consumption of at least one soft drink a day is associated with an approximately 45% increase in the incidence and prevalence of the metabolic syndrome as defined by National Cholesterol Education Program (NCEP) guidelines, compared with subjects…

Rapid Response

Do We Need Better Lipid Tools for Cardiovascular Risk Assessment?

Cardiovascular diseases still represent the major cause of death in most developed countries and ultimately kill as many men as women.1 In the last decades, the management of a number of “traditional” risk factors (including obesity, diabetes, smoking, hypertension, and hypercholesterolemia) has led to a significant reduction in cardiovascular morbidity…

Rapid Response

Highlights of the Advisory Committee on Immunization Practices’ Prevention and Control of Influenza for 2007–2008

Seasonal epidemics of influenza and influenza-like illnesses continue to have a major impact upon the population of the United States, resulting in approximately 36,000 deaths and over 200,000 hospitalizations each year during recent decades.1,2 The Advisory Committee on Immunization Practices (ACIP)3 published its recommendations for the upcoming 2007–2008 influenza season…

Special Section

Medical Webwatch

Profiles in Science and Medicine http://profiles.nlm.nih.gov/browse/, from the National Library of Medicine, has profiles of 26 leaders in biomedical research and public health. Each of these multifaceted biographies expands to offer a selection from alphabetical listing, chronological presentation, or “Exhibit,” which is a standard format biography. There is a “What’s…

Patient's Page

Patient’s Page

The Facts About MRSA There is a growing number of MRSA cases in the United States, with the infection appearing more and more frequently in hospitals, schools, and nursing homes. With this increase in outbreaks comes an increase in fear: what should I do to prevent this potentially deadly infection?…

Letter to the Editor

Why Should We Avoid the Use of Rosiglitazone?

To the Editor: The recent release of data regarding the cardiovascular (CV) safety of rosiglitazone (Avandia) raised major public concern. The author presents herein an updated summary of CV safety data of rosiglitazone and provides a rationale for avoiding its use outside the setting of clinical trials.

Letter to the Editor

Adenosine-induced Respiratory Arrest in an Asthmatic Patient

To the Editor: Inhaled adenosine is well known to produce bronchoconstriction in asthmatic patients. However, there have been few case reports and studies describing the airway effects of intravenous (IV) adenosine in the asthmatic population. Adenosine is a frequently used agent in pharmacologic cardiac stress testing, due to its effects…

Letter to the Editor

A Giant Gastric Ulcer Mimicking Carcinoma in a Renal Transplant Recipient with CMV Infection

To the Editor: Cytomegalovirus (CMV) infection is of major concern in transplant patients, and can mimic many diseases including gastric carcinoma, colon carcinoma, ischemic colitis, and intestinal pseudoobstruction. We report a case of a renal transplant recipient developing a CMV-related giant gastric ulcer mimicking carcinoma.

Letter to the Editor

The Role of Serum Vascular Endothelial Growth Factor and Matrix Metalloproteinase-9 in Predicting Response to Chemotherapy in Patients with Advanced Nonsmall Cell Lung Cancer

To the Editor: The resistance to chemotherapy is a very important clinical issue in advanced stage nonsmall cell lung cancer (NSCLC), and because of this resistance, some patients unnecessarily receive chemotherapy despite adverse toxicities.

Article

Research & Education Endowment Fund: gratefully acknowledges the following individual support for 2007

Dr. Luis M. Alvarado Franklinton, LA Dr. Michael Amsden Orange, TX Dr. William Anderson Charleston, SC Dr. Ignacio Andueza Coral Gables, FL Dr. Abdallah Askar Raleigh, NC Dr. Jeanne Attrep Avondale, AZ Dr. Janos Bacsanyi Chevy Chase, MD Dr. James Baker Williamsburg, VA Dr. Willie Banks Washington, DC Dr. &…