April 2008, Volume 101 - Issue 4

New Opportunities and Old Responsibilities

G. Richard Holt, MD, MSE, MPH, MABE

Abstract: 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...

(pp 249)

Hydatid Cyst Disease Revisited: Optimal Management of Complex Liver Disease

Emmanuel Atta Agaba, MD, FRCSEd, FACS, Diego R. Camacho, MD, FACS, Prathiba Vemulapalli, MD, FACS

Abstract: 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...

(pp 254-255)

Overweight and Psychiatric Illness in Children

Julie C. Lumeng, MD

Abstract: 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...

(pp 347-348)

Obesity: Where’s the Beef?

Scott W. Yates, MD, MBA, MS, FACP

Abstract: 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,...

(pp 349-350)

Polyarteritis Nodosa: The Great Mimicker, Mimicked

Philip Seo, MD, MHS

Abstract: “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,...

(pp 351-352)

Informed Society—Fact or Fiction? The Jelly Case

Uwe Wollina, MD

Abstract: 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...

(pp 353)

The Many Guises of Pheochromocytoma: Insights from a Case Report

Alejandro L. Rosas, MD

Abstract: 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...

(pp 354-355)

Hepatobiliary Tuberculosis: A Review of Presentations and Outcomes

Vui Heng Chong, MRCP, FAMS

Abstract: 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...

(pp 356-361)

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

Jose Barriga, MD, Mankanwal S. Sachdev, MD, Lee Royall, MD, Garrick Brown, MD, Claudio R. Tombazzi, MD

Abstract: 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...

(pp 362-366)

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

Mehrul Hasnain, MD, W Victor R. Vieweg, MD, John M. Hettema, MD, PhD, David Colton, PhD, Antony Fernandez, MD, Anand K. Pandurangi, MD

Abstract: 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...

(pp 367-372)

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

Reza Shariat Moharari, MD, Mohammad Reza Khajavi, MD, Peyman Khademhosseini, MD, Seyed Reza Hosseini, MD, Atabak Najafi, MD

Abstract: 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...

(pp 373-375)

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

William T. Brown, MD, Xiaodong Wu, PhD, John F. Fowler, DSc, PhD, Silvio García, MD, Fahed Fayad, MD, Beatriz E. Amendola, MD, Alberto de la Zerda, PhD, James G. Schwade, MD

Abstract: 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...

(pp 376-382)

Urologic Injuries Sustained After Free Falls From Hunting Tree Stands

Tyler L. Christensen, MD, Steven B. Brandes, MD

Abstract: 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...

(pp 383-387)

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

George A. Hurst, MD, FACP, FCCP, Marion G. Williams, BS, Judith E. King, LMSW, ACSW, Richard Viken, MD

Abstract: 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...

(pp 388-392)

The Prevalence and Etiology of Nongenetic Obesity and Associated Disorders

Richard N. Redinger, MD

Abstract: 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...

(pp 395-399)

Status Epilepticus

Eliahu S. Feen, MD, Eric M. Bershad, MD, Jose I. Suarez, MD

Abstract: 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...

(pp 400-406)

Capsule Endoscopy: A Review

Mankanwal S. Sachdev, MD, Mohammad K. Ismail, MD

Abstract: 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...

(pp 407-414)

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

Suzanne M. Shultz, MA

Abstract: 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...

(pp 415-418)

Polyarteritis Nodosa Complicated by Antiphospholipid Syndrome

Jorge L. Musuruana, MD, Javier A. Cavallasca, MD

Abstract: 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...

(pp 419-421)

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

Ming Chen, MD, PhD, Chandana Yalamanchili, MD, James Hamous, MD, Mary A. Piskun, MD, Brian Weis, MD, PhD

Abstract: 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...

(pp 422-424)

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

Inan Anaforoglu, MD, M Eda Ertorer, MD, Filiz E. Haydardedeoglu, MD, Tamer Colakoglu, MD, Naime Tokmak, MD, Nilgun G. Demirag, MD

Abstract: 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...

(pp 425-427)

A Lady with Rapid Onset of Swollen Parotid Glands

Kai Ming Chow, MRCP, Ka Tak Wong, FRCR, Cheuk Chun Szeto, MRCP, MD

Abstract: 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...

(pp 428-431)

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

Cheng-Jui Lin, MD, Chyou-Shen Lee, MD, Hsiang-Kuang Tseng, MD, Yuan-ching Chang, MD

Abstract: 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...

(pp 436-438)

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

Michio Naoe, MD, Yoshio Ogawa, MD, Kumiko Takeshita, PhD, Sanju Iwamoto, MD, Akira Miyazaki, MD

Abstract: 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...

(pp 439-441)

Spontaneous Coronary Artery Dissection

Gustavo A. Cardenas, MD, Cindy L. Grines, MD, Mark Sheldon, MD, James A. Goldstein, MD

Abstract: 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....

(pp 442-446)

An Unrecognized Cause of Acute Abdomen in Peripartum Cardiomyopathy

Uzoma N. Ibebuogu, MD, John W. Thornton, MD, FACC, Guy L. Reed, MD

Abstract: 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...

(pp 447-448)

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

Mamatha Gautam, MD, Anurag Gandhi, MD, Fredrick Rose, MD

Abstract: 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...

(pp 449)

Benign Esophageal Schwannoma

Weiguo Zhang, MD, Xingyang Xue, MD, Qinghua Zhou, MD

Abstract: 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...

(pp 450-451)

A Diagnostic Surprise

Lee B. Reichman, MD, MPH

Abstract: 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...

(pp 344)

Choosing Sedation for Upper Endoscopy

Marc D. Basson, MD, PhD, MBA

Abstract: 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...

(pp 345-346)

Rumination Syndrome: An Emerging Case Scenario

Navneet Attri, MD, M Ravipati, MD, Preeti Agrawal, MD, Christine Healy, A Feller, MD

Abstract: 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...

(pp 432-435)

April 2008 CME Questions


Abstract: April 2008 CME...

(pp 393)

CME Submission Form


Abstract: CME Submission...

(pp 394)

Patient’s Page

Lindy Russell, BA, Betsy Allen, MA

Abstract: 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....

(pp 337)

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

Christopher K. Finch, PharmD, BCPS, Bob L. Lobo, PharmD, BCPS

Abstract: “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...

(pp 340-341)

Antioxidant Vitamins—No Benefit for CVD Prevention

Vera Bittner, MD, MSPH

Abstract: 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...

(pp 339-340)

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

Marc Smaldone, MD, Danielle Sweeney, MD, Benjamin J. Davies, MD

Abstract: 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...

(pp 338)

Thiazides and Osteoporosis: An Addition to the Armamentarium?

Ronald C. Hamdy, MD

Abstract: 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...

(pp 342-343)

Motor Vehicle Occupant Restraints and Alcohol Use While Driving

Juan March, MD

Abstract: 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...

(pp 341-342)

Iron Supplementation in Pregnancy: More Harm than Good?

Howard A. Shaw, MD, Julia A. Shaw, MD

Abstract: 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...

(pp 339)

Medical Webwatch

Jim Young

Abstract: 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...

(pp 453)



Abstract: 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...

(pp 452)

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

Enver Erbilen, MD, Erim Gulcan, MD, Sinan Albayrak, MD, Olcay Ozveren, MD

Abstract: 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;...

(pp 448)

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

Pankaj Kumar Garg, MBBS, Nikhil Gupta, MS, MRCS, Vivek Gautam, MS, Niladhar Shankarrao Hadke, MS

Abstract: 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...

(pp 449-450)

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

Oscar M. P. Jolobe, MRCP (UK)

Abstract: 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...

(pp 451-452)

Response to Dr. Jolobe

George N. Iaonnou, MD, Don C. Rockey, MD

Abstract: 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...

(pp 452)