Issue - Southern Medical Association

Editorial

New Opportunities and Old Responsibilities

It is an honor and a privilege to become the newest Editor-in-Chief of the Southern Medical Journal, whose longevity extends well beyond 100 years, back to the turn of the 20th century. Over these nearly 11 decades of medical publishing, the Journal has been a credible and dependable source of…

Editorial

Hydatid Cyst Disease Revisited: Optimal Management of Complex Liver Disease

Cystic echinococcosis, although uncommon in the United States, remains an important disease entity due to the growing number of immigrants from other parts of the world where it remains endemic. For this reason, it is important for physicians, especially surgeons, to be aware of its clinical features and management.

Editorial

Overweight and Psychiatric Illness in Children

In this issue of the Southern Medical Journal, Hasnain and colleagues1 report on the prevalence of overweight in a cohort of children with major mental illness. In the cohort of 795 children admitted to a large public psychiatric hospital from 2001 to 2003, 54.5% of 6- to 11-year-olds and 51.1%…

Editorial

Obesity: Where’s the Beef?

Stop reading for a moment to follow these instructions: get up from your chair and find a tape measure. Put it around your waist measuring the circumference at the level of the superior iliac crest. If the result you obtain is greater than 40 inches if you are male, or…

Editorial

Polyarteritis Nodosa: The Great Mimicker, Mimicked

“The physician should challenge, rather than accept, every diagnosis that the patient claims was made in the past by other physicians …. To blindly accept such proffered diagnoses as factual may be to start off with some very wrong assumptions, which, if challenged, occasionally reveal some excellent clues as to…

Editorial

Informed Society—Fact or Fiction? The Jelly Case

Often, the 21st century is described as the age of information. It is a common misconception that the availability of information will create informed people. There is no such easy one-way development. In the medical field, the informed patient is an ideal that does not reflect reality. In everyday life,…

Editorial

The Many Guises of Pheochromocytoma: Insights from a Case Report

Pheochromocytoma is a rare neuroendocrine tumor with heterogeneous and often deadly clinical manifestations. In this issue of the Southern Medical Journal, Anaforoglu et al1 report the first case in the literature of myoglobinuric acute renal failure in a patient with bilateral, probably familial, pheochromocytoma. The case not only adds to…

Original Article

Hepatobiliary Tuberculosis: A Review of Presentations and Outcomes

Hepatobiliary tuberculosis (HTB) is uncommon and can be difficult to diagnose. We present our experience with HTB (over a 10-year period). Fourteen patients were identified from a total of 1888 cases of tuberculosis (TB) infection during this period. Five patients had isolated organ involvement [hepatic (n=3) and biliary (n=2)], and…

Original Article

Sedation for Upper Endoscopy: Comparison of Midazolam Versus Fentanyl Plus Midazolam

ackground: The benefit of using one or two drugs for conscious sedation in upper endoscopy remains unproven. This study evaluates the adequacy of conscious sedation during upper endoscopy using midazolam alone compared with midazolam plus fentanyl. Methods: Patients older than 18 years of age who underwent elective, outpatient upper endoscopy…

Original Article

The Risk of Overweight in Children and Adolescents with Major Mental Illness

Objectives: To survey the charts of youths with major mental illness who may constitute a high-risk group (HRG) for overweight. Methods: We reviewed the charts of youths admitted to a public sector psychiatric hospital. For the 795 cases of patients 6 to 18 years old identified as the study cohort,…

Original Article

Sterile Water as an Irrigating Fluid for Transurethral Resection of the Prostate: Anesthetical View of the Records of 1600 Cases

Objectives: Absorption of the fluid used for bladder irrigation during transurethral resection of prostate (TURP) may disturb the circulatory system and lead to clinical symptoms known as the transurethral resection syndrome. The purpose of this study was to evaluate the changes in electrolytes in patients who had undergone TURP. Methods:…

Original Article

Lung Metastases Treated by CyberKnife® Image-Guided Robotic Stereotactic Radiosurgery at 41 Months

Objectives: Based on the reported success of stereotactic body radiotherapy in treating extracranial tumors, we used CyberKnife® (Accuray Incorporated, Sunnyvale, CA) to treat patients with metastatic lung cancer. Methods: This is a retrospective report of treatment details and outcomes of 35 patients, ranging in age from 33 to 91 years,…

Original Article

Urologic Injuries Sustained After Free Falls From Hunting Tree Stands

Objectives: Hunting is a popular recreational pastime in the United States. Injuries sustained from falls out of tree stands remain a significant cause of morbidity among hunters, often resulting in significant urological injury. The purpose of this study is to identify the type and pattern of urologic injuries sustained after…

Original Article

Faith-Based Intervention in Depression, Anxiety, and Other Mental Disturbances

Objective: To determine if the effects of using the Steps to Freedom would be beneficial for a group of individuals who attended a Christian Conference. Methods: A user-friendly 12-item questionnaire was used to monitor the outcomes of Steps to Freedom addressing six symptom/behavioral problems and six function areas. In addition,…

Expired CME Article

The Prevalence and Etiology of Nongenetic Obesity and Associated Disorders

The prevalence and etiology of nongenetic causes of obesity are reviewed, along with obesity-associated comorbidities of the metabolic syndrome. The role of nongenetic causes of obesity from environmental affluences, central nervous system developmental effects in adult obesity, and psychosocial disorders affecting obesity through central nervous system dysfunction are discussed. Obesity…

Expired CME Article

Status Epilepticus

Status epilepticus (SE) in adults is a state of continuous seizures lasting more than 5 minutes, or rapidly recurrent seizures without regaining consciousness. The overall US and European estimated crude incidence rate of SE ranges from 6.8 to 41/100,000/yr. The etiologies of SE include primary central nervous system pathologies and…

Expired CME Article

Capsule Endoscopy: A Review

Capsule endoscopy (CE) is a novel technology that allows direct noninvasive visualization of the entire small intestine. CE permits a detailed examination in the ambulatory setting, allowing identification of clinically relevant lesions, and it is appealing to both patients and providers. There are two types of capsules that are currently…

Review Article

The Kappa Lambda Society of Hippocrates: Historical Perspective on an Early Medical Professional Society

The Kappa Lambda Society of Hippocrates, an early medical professional organization, was founded circa 1819 in Lexington, Kentucky, amid the first economic depression in the United States. Its primary stated purpose was to elevate medicine as a profession. This article will reevaluate the acknowledged purposes and accomplishments of the Society…

Case Report

Polyarteritis Nodosa Complicated by Antiphospholipid Syndrome

Polyarteritis nodosa is a necrotizing vasculitis of small and medium-sized arteries that spares the smallest blood vessels (arterioles, venules, and capillaries). Antiphospholipid syndrome is an autoimmune disorder characterized by venous or arterial thrombosis and/or by fetal losses, associated with antiphospholipid antibodies. The association of both diseases is infrequent. This case…

Case Report

Acute Inflammatory Response of the Male Breasts Secondary to Self-injection of Petroleum Jelly: A Case Report

The injection of liquid foreign materials such as petroleum jelly and paraffin oil was used as an early medical intervention for the augmentation of body contour in the late 19th century. These practices were associated with severe late onset complications and they have been abandoned by plastic surgeons today. This…

Case Report

Rhabdomyolysis and Acute Myoglobinuric Renal Failure in a Patient With Bilateral Pheochromocytoma Following Open Pyelolithotomy

Rhabdomyolysis is an unusual manifestation of pheochromocytoma. Early diagnosis and prompt management are crucial, as it may have life-threatening consequences. This is the case of a 19-year-old man with bilateral pheochromocytoma complicated with rhabdomyolysis and acute myoglobinuric renal failure after surgery for nephrolithiasis. A massive catecholamine release during the procedure…

Case Report

A Lady with Rapid Onset of Swollen Parotid Glands

Iodide mumps can occur after administration of any iodinated contrast media, irrespective of the osmolality of the contrast preparation. This condition is characterized by acute salivary gland swelling shortly after contrast study, presumably secondary to toxic accumulation of iodide in salivary glands with high iodide concentration. In this article, a…

Case Report

Mechanical Bowel Strangulation Mimicking Mesenteric Vasculitis in a Systemic Lupus Erythematosus Patient

A case of systemic lupus erythematosus with jaundice and vague abdominal pain which did not respond to steroid pulse therapy is presented. Noninvasive examinations and imaging studies showed ileus. Two weeks later, an emergency laparotomy was performed because of severe refractory abdominal pain and hemodynamic decompensation. An ischemic part of…

Case Report

Use of the CellSearch™ Circulating Tumor Cell Test for Monitoring Urothelial Cancer: Two Case Reports of Metastatic Urothelial Cancer

Until now, there have been no reliable serum markers for monitoring urothelial cancers. However, it has been reported that it is possible to detect circulating urothelial cancer cells using the CellSearch™ Circulating Tumor Cell (CCTC™) Test (Immunicon, Huntingdon Valley, PA). (1) This case report is a representative example of the…

Case Report

Spontaneous Coronary Artery Dissection

A 45-year-old female athlete with no history of cardiovascular disease or coronary risk factors presented with a non–ST-segment elevation myocardial infarction due to spontaneous right coronary artery dissection. She was treated medically with resolution of her symptoms. Repeat angiography due to recurrent exertional chest discomfort showed TIMI-3 flow and no…

Letter to the Editor

An Unrecognized Cause of Acute Abdomen in Peripartum Cardiomyopathy

To the Editor: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure of unknown cause with a reported incidence of 1 in 3,000 to 1 in 4,000 live births.1 Onset is usually between the last month of pregnancy and up to 5 months postpartum in previously healthy women, with…

Letter to the Editor

Methicillin-Resistant Staphylococcus aureus: Fatal Prostatic Abscess in an AIDS Patient

To the Editor: A 51-year-old male presented with a history of fever, dysuria, and suprapubic pain for 1 week. The patient had not been sexually active for the last 4 years. His medical history was unremarkable, and he denied any ongoing IV drug abuse (IVDA). On rectal examination there was…

Letter to the Editor

Benign Esophageal Schwannoma

To the Editor: A large number of esophageal submucosal tumors have been reported, but the majority of them are leiomyomas. Esophageal schwannoma is extremely rare. Here we report a woman with an esophageal schwannoma.

Editorial

A Diagnostic Surprise

In the series of hepatobiliary tuberculosis cases reported from Brunei in this issue of the Southern Medical Journal,1 the presence of tuberculosis (TB) caught the patients and attending physicians by surprise. Most people consider TB a disease of the past, under control and not worthy of attention.

Editorial

Choosing Sedation for Upper Endoscopy

In this issue, Barriga1 describes a small randomized comparison of sedation by midazolam alone with sedation by midazolam plus fentanyl for uncomplicated diagnostic upper endoscopy. Like all good studies, this one raises as many questions as it answers. The author studied patients undergoing nontherapeutic upper endoscopy who were relatively young…

Case Report

Rumination Syndrome: An Emerging Case Scenario

This article describes the case of a 19-year-old woman presenting with repetitive episodes of effortless vomiting, which started within 3 weeks of her naval boot camp training. She underwent a battery of costly investigations before the diagnosis of rumination syndrome could be made. One of the reasons for her delayed…

Expired CME Article

April 2008 CME Questions

April 2008 CME Questions

Expired CME Credit Submission and Evaluation Form

CME Submission Form

CME Submission Form

Patient's Page

Patient’s Page

Obesity and You Lately the topic of obesity has been everywhere; talk shows like Oprah and Dr. Phil, and reality shows like Celebrity Fit Club and The Biggest Loser have highlighted what the Centers for Disease Control and Prevention has rated America’s no. 1 health threat. And it’s not just…

Rapid Response

“And Now a Word from Our Sponsor”… Big Pharma

“And Now a Word from Our Sponsor”… Big Pharma A recent CBS News commentary reported that the United States makes up only 5% of the world population yet accounts for a whopping 42% of the world’s spending on prescription drugs.1 Americans, as a whole, not only take more medications (an…

Rapid Response

Antioxidant Vitamins—No Benefit for CVD Prevention

Antioxidant Vitamins—No Benefit for CVD Prevention A 2005 report from the Institute of Medicine estimated that total sales of supplements in the United States amounted to over $18 billion annually, a substantial proportion of which is spent on vitamins.1 Many individuals purchase vitamin supplements for the explicit purpose of preventing…

Rapid Response

Is Routine Antimicrobial Prophylaxis Justifiable in Prepubescent Children With Recurrent Urinary Tract Infections?

Is Routine Antimicrobial Prophylaxis Justifiable in Prepubescent Children With Recurrent Urinary Tract Infections? The natural course of urinary tract infections (UTI) in children is unpredictable, and management is controversial. Of the 3% and 1% of prepubescent girls and boys diagnosed with a UTI, up to 17% have infection-related renal scarring.1…

Rapid Response

Thiazides and Osteoporosis: An Addition to the Armamentarium?

Thiazides and Osteoporosis: An Addition to the Armamentarium? The use of thiazides in the management of osteoporosis should receive renewed interest. Thiazides inhibit the Na+-Cl− cotransporter system in the distal convoluted renal tubules, thereby increasing renal sodium excretion and decreasing renal calcium loss.1 They also increase the alkalinity of the…

Rapid Response

Motor Vehicle Occupant Restraints and Alcohol Use While Driving

Motor Vehicle Occupant Restraints and Alcohol Use While Driving As healthcare professionals, we are all well aware of the overwhelming evidence that car restraints reduce injury and death rates during motor vehicle crashes. The current prevalence of restraint use for certain age groups is approaching the goal set by Healthy…

Rapid Response

Iron Supplementation in Pregnancy: More Harm than Good?

Iron Supplementation in Pregnancy: More Harm than Good? Daily iron supplementation is extensively used as an intervention to prevent and correct iron deficiency anemia during pregnancy. The Institute of Medicine recommends a daily dietary allowance of 27 mg/day of ferrous iron for women during pregnancy.1 However, some authors have found…

Special Section

Medical Webwatch

Patient UK http://www.patient.co.uk/ has a series of informational sections including “Health and Diseases,” an A to Z listing of conditions holding 728 leaflets. Most general practitioners in the United Kingdom have these leaflets on their computer to print out for patients during consultations. The website is currently developing audio versions…

Special Section

Erratum

In the article “Sternal Tuberculosis: Presenting as Multiple Cutaneous Sinuses”, which appeared in volume 101 of the Southern Medical Journal on pages 303-304, an author’s degree was incorrect. The author’s name and degree should have appeared as Niladhar Shankarrao Hadke, MS. Garg P, Teckchandani N, Hadke N. Sternal Tuberculosis Presenting…

Letter to the Editor

Acute Myocardial Infarction Due to a Bee Sting Manifested with ST Wave Elevation after Hospital Admission

To the Editor: Bee venom can promote acute coronary artery thrombosis via platelet aggregation and hypotension. Acute myocardial infarction (AMI) after a bee sting has been rarely reported in the literature.1 A 44-year-old male farmer had been stung by a bee on his tongue; he experienced tongue paresthesia and a…

Letter to the Editor

Gastric Zygomycosis: Unusual Cause of Gastric Perforation in an Immunocompetent Patient

To the Editor: A 35-year-old woman presented to our surgical emergency ward with symptoms of peritonitis. Her routine laboratory investigations were in normal range. There was no history of organ transplantation or prescribed immunosuppressant drugs or steroids. An emergency exploratory laparotomy was performed, which revealed a 4-cm perforation in the…

Letter to the Editor

Response to “Predictors of Endoscopic and Laboratory Evaluation of Iron Deficiency Anemia in Hospitalized Patients”

To the Editor: The original article by Ioannou, Spector, and Rockey published in October’s issue of this Journal could have been improved slightly. The prediction of iron deficiency could have been potentially enhanced by incorporating, in the screening protocol, not only the mean cell volume (MCV),1 but also the mean…

Letter to the Editor

Response to Dr. Jolobe

To the Editor: We appreciate the comments by Dr. Jolobe. We would point out that the aim of our study was not to identify the optimal peripheral blood test for the diagnosis of iron deficiency anemia; rather, our aim was to determine what diagnostic tests were done to further evaluate…