Issue - Southern Medical Association

Original Article

Is N-Cadherin Expression Important in Ductal Carcinoma?

Objectives: Neural (N)-cadherin is a calcium-dependent cell adhesion molecule that is associated with invasive tumors in breast cancer, but no association with grade or nodal status has been shown in previous studies. The present study examined the expression of N-cadherin in human breast cancer and assessed its prognostic value in…

Original Article

Comparison of Neopterin Levels in Patients with Coronary Artery Ectasia Versus Patients with Obstructive Coronary Artery Disease

Objectives: Inflammation has been reported as an important component of vascular aneurysm formation, as found in obstructive vascular disorder. Neopterin is produced by activated macrophages and is thought to represent a marker of immune activation and macrophage activity. The plasma neopterin levels were investigated in coronary artery ectasia (CAE) patients…

Original Article

A 30-Month Experience of Thoracic Empyema in a Tertiary Hospital: Emphasis on Differing Bacteriology and Outcome Between the Medical Intensive Care Unit (MICU) and Medical Ward

Objectives: To analyze the causative pathogens and outcomes of patients with thoracic empyema admitted to the medical intensive care unit (MICU) and medical ward. Methods: We prospectively studied the empyemic patients in the MICU and retrospectively analyzed the medical records of empyemic patients in the medical ward treated in a…

Original Article

Poor Outcomes Associated with Drainage of Pericardial Effusions in Patients with Pulmonary Arterial Hypertension

Objectives: Pulmonary arterial hypertension (PAH) in its advanced stages is complicated by right heart failure and often pericardial effusion. The optimal treatment of large or hemodynamically significant pericardial effusions in this group has not been defined. Methods: All patients followed at the Johns Hopkins Hospital for PAH during a 1-year…

Original Article

Change in Residents’ Perceptions of Teaching: Following a One Day “Residents as Teachers” (RasT) Workshop

Objectives: The objective of this study was to assess the perceptions and attitudes of resident physicians toward teaching before and after participation in a mandatory “Residents as Teachers” (RasT) workshop in four domains: (1) setting goals and expectations, (2) use of clinical microskills in teaching, (3) evaluation and feedback, and…

Original Article

The Kentucky SimSmoke Tobacco Policy Simulation Model: Reaching Healthy People 2010 Goals Through Policy Change

Objectives: Healthy People (HP) 2010 has a goal of reducing adult smoking prevalence to 12% by 2010. Kentucky, with the highest adult smoking rates (28.7% versus a US average of 20.9%) and weak tobacco control policies, has the potential to reduce smoking by implementing stricter policies. Methods: The SimSmoke tobacco…

Original Article

Vascular Access Infection Among Hemodialysis Patients in Northern Jordan: Incidence and Risk Factors

Objectives: Vascular access infection (VAI) causes significant mortality and morbidity in hemodialysis patients. The aim of this prospective, descriptive, exploratory survey of end-stage renal disease patients was to explore the incidence and risk factors of VAI. Methods: A total of 188 patients were included in the study from five different…

Original Article

Patient Gender Affects Skin Cancer Screening Practices and Attitudes Among Veterans

Background: Skin cancer screening (SCS) with a full body skin examination (FBSE) has the potential to reduce morbidity and mortality. Little is known about gender differences with respect to SCS practices and attitudes between men and women. Methods: Data from two previously published studies based on questionnaires administered to veterans…

Expired CME Article

Endobronchial Ultrasound in the Evaluation of Lung Cancer: A Practical Review and Cost Analysis for the Practicing Pulmonologist

Flexible bronchoscopy remains an important tool in the staging, diagnosis, and treatment of primary and metastatic lung malignancies. Endobronchial ultrasound is a new technology utilized with bronchoscopy that has been shown to identify bronchial wall invasion by malignant tumors, aid in the fine needle aspiration of peripheral lung lesions and…

Case Report

A Case of Flavor-Induced Lung Disease

Bronchiolitis obliterans, a rare inflammatory disorder of the small airways, has been associated with various infections, aspiration, toxic fume inhalation, drugs, transplants, and collagen vascular disorders. In May 2000, this condition was described in eight workers in a microwave popcorn plant in Missouri. Subsequent studies reported its association with exposure…

Case Report

Postchemotherapy Hyperammonemic Encephalopathy Emulating Ornithine Transcarbamoylase (OTC) Deficiency

A young patient with hepatocellular carcinoma receiving chemotherapy presented with encephalopathy. Evaluation of the patient revealed a metabolic profile consistent with ornithine transcarbamoylase (OTC) deficiency, an inherited disorder of the urea cycle. The evaluation yielded a plasma amino acid analysis consistent with OTC deficiency. However, genetic analysis did not reveal…

Case Report

A Primary Tracheal Carcinoid Tumor Masquerading as Chronic Obstructive Pulmonary Disease

Primary tumors of the trachea are rare and can be missed because of the paucity of symptoms and findings and the difficulty in detecting them with chest radiographs. A 31-year-old male patient was admitted with complaints of shortness of breath, coughing, phlegm, and blood in the sputum. He stated that…

Case Report

A Case of Black Magic

The authors present the case of a 64-year-old woman who presented with massive subcutaneous emphysema 2 weeks after unknowingly inhaling a Brazil nut. Foreign body inhalation should be a differential diagnosis in all such patients, with computed tomography scanning of the chest being the most appropriate investigation. Key Points *…

Case Report

Necrotizing Panniculitis: A Skin Condition Associated with Acinar Cell Carcinoma of the Pancreas

Pancreatic panniculitis (PP) is a rare cutaneous eruption that is associated with severe pancreatic disease. A patient presented with a fever, joint pains, and an erythematous rash with draining pustules that had spread from his legs to his arms over 4 months. Thorough investigation revealed stage IV acinar cell carcinoma…

Case Report

A Case of Paraneoplastic Cerebellar Ataxia Secondary to Renal Cell Carcinoma

A 64-year-old female patient presented with acute cerebellar ataxia. After ruling out vascular, infectious, metastatic, demyelinating, and medication etiologies, a paraneoplastic origin for her illness was determined. A renal mass was discovered and found to be renal cell carcinoma. Her symptoms resolved after a radical nephrectomy. Physicians should consider the…

Case Report

Cardiac Tamponade: An Unusual Complication of Simultaneous Treatment of Tuberculosis and HIV

Human immunodeficiency virus (HIV) has caused resurgence in tuberculosis (TB) worldwide. HIV-TB coinfected individuals are at increased risk for complications of TB and HIV treatment, such as adverse drug reactions and immune reconstitution syndrome. A 17-year-old male with HIV-TB coinfection, who developed cardiac tamponade from immune reconstitution during treatment for…

Case Report

Diagnosis of Marginal Cell Lymphoma of Small Intestine by Double Balloon Enteroscopy

A 65-year-old woman with a medical history of diabetes mellitus type 2, hypertension, an old cerebrovascular accident, and seizure disorder presented to the emergency room with lower abdominal pain of 4 weeks duration. Upon physical examination, her abdomen was soft and bowel sounds were present, but there was diffuse tenderness…

Letter to the Editor

Psoas Muscle Abscess as a Complication of Femoral Vein Catheterization in a Hemodialysis Patient

To the Editor: Percutaneous femoral vein catheterization is useful for immediate, temporary vascular access for hemodialysis, but it is not without complications. The local complications include hematoma, pseudoaneurysm, arteriovenous fistulas, abscess, arterial obstruction, and lymphoceles.1 Psoas muscle abscess is an extremely rare disorder presenting with an insidious onset, and it…

Editorial

The Significance of N-Cadherin Expression in Breast Cancers: An Evolving Story

The mortality associated with human epithelial malignancies can be attributed primarily to their uncontrolled local growth and their destructive properties at metastatic sites.1 In addition to a wide variety of other attributes, carcinomas are characterized by perturbations in cell-cell adhesions, cell-matrix adhesions, and cell adhesion-mediated signaling.2 Cell-cell adherens junctions are…

Editorial

Neopterin: Its Role in Inflammation and Coronary Heart Disease

Neopterin (d-erythro-1′, 2′, 3′-trihydroxypropylpterin) (Fig.), a byproduct of the guanosine triphosphate-biopterin pathway, is a pyrazolopyridine derivative that plays a ubiquitous role as a biochemical marker of cellular immunity.1 In vitro neopterin promotes proliferation and differentiation of progenitor cells. It is activated upon cellular stimulation by interferon and can be measured…

Editorial

A New Stigmata

It is a reasonable assumption that most of us at some time have fantasized about being invisible. We’ve imagined the freedom it would give us, or the fun that we could have being invisible to others. Yet there’s another sort of invisibility—when a person is made to disappear, by force…

Editorial

Osteomyelitis of the Mandible

Osteomyelitis may manifest itself in acute, subacute, or chronic forms. Chronic osteomyelitis will result in variable sclerosis and deformity of the affected bone. After the age of 50, the majority of the blood supply to the mandible comes from the overlying periosteum and attached musculature, due to age and atherosclerosis-related…

Case Report

Psychotic Mania Associated with Mefloquine in a Bipolar Patient

A 63-year-old male patient with a history of bipolar I disorder presented to the emergency department in an acutely psychotic state. The patient had just returned from vacation in a malarial high-risk area and, as a result, had taken five weekly doses of mefloquine for prophylaxis. The patient’s bipolar disorder…

Case Report

Multidrug-Resistant Viridans Streptococcus (MDRVS) Osteomyelitis of the Mandible Successfully Treated with Moxifloxacin

Multidrug-resistant viridans group streptococcus (MDRVS) strains have emerged as important pathogens. Treatment of MDRVS infections is problematic. The use of fluoroquinolones for treatment of MDRVS osteomyelitis has not been established. We present the first case of MDRVS osteomyelitis of the mandible successfully treated with sequential intravenous then oral moxifloxacin, and…

Expired CME Article

C-Reactive Protein: The Harbinger of Cardiovascular Diseases

Coronary heart disease remains the major cause of mortality and morbidity in the United States and other western countries despite major advances in its treatment. During the last decades, many markers of coronary artery disease have been found which help predict future risk of cardiovascular events. High-sensitivity C-reactive protein has…

Expired CME Article

Human Trafficking and the Healthcare Professional

Despite the legislation passed in the 19th century outlawing human slavery, it is more widespread today than at the conclusion of the civil war. Modern human slavery, termed human trafficking, comes in several forms. The most common type of human trafficking is sex trafficking, the sale of women and children…

Expired CME Article

May 2008 CME Questions

Human Trafficking and the Healthcare Professional1. Severe forms of human trafficking include all of the following except:A. Commercial sex act induced by force, fraud or coercion.B. Commercial sex act willingly performed by someone under age 18.C. Using force fraud or coercion to harbor a person for the purpose of involuntary…

Expired CME Credit Submission and Evaluation Form

CME Submission Form

Editorial

Hyperammonemic Coma: Beyond Hepatic Encephalopathy

Hyperammonemic coma (HAC) in adults is still perceived by many as synonymous with hepatic encephalopathy. Although this may be true in most cases, awareness of the differential diagnosis of the combination of impaired consciousness and hyperammonemia may disclose other potentially reversible states. In this issue of the Southern Medical Journal,…

Editorial

Can Medicine be Compared with Art?

The practice of medicine is often described as an art, albeit a difficult one. I believe the report by Uskul et al1 published in this issue has two points of interest: a scientific one and an educational one. The report first emphasizes the difficulty of diagnosing proximal airway tumors. This…

Editorial

Respiratory CSI: Diagnosing Occupationally Related Lung Disease

In this issue of the Southern Medical Journal, Modi et al1 describe how working in a popcorn factory led to a devastating, irreversible lung disease: bronchiolitis obliterans. Environmental and occupational insults causing respiratory disorders are often difficult to diagnose, because recognition requires a certain amount of detective work by the…

Original Article

Colchicine Exposures: The Texas Experience

Objectives: Colchicine is a relatively uncommon toxin, but is known to precipitate severe multiorgan failure in overdose. Little is known about exposure patterns and outcomes in cases of colchicine ingestion. Our goal was to add to toxicologic knowledge through a database review and descriptive study of colchicine exposures. Methods: Texas…

Patient's Page

Patient’s Page

Currently, men are thought to have a 1 in 49 lifetime chance and women a 1 in 73 lifetime chance of developing melanoma. In the past 30 years, the percentage of people who develop melanoma has more than doubled in the United States. Early diagnosis and treatment is key when…

Rapid Response

Depression Treatment in Primary Care: Recent Improvements Leave Room to Grow

Depression Treatment in Primary Care: Recent Improvements Leave Room to Grow The research literature over the past two decades documents multiple difficulties with primary care-based depression management. Commonly cited studies from the 1980s and 1990s,1,2 for example, estimated that nearly half of depressed primary care patients and many with suicidal…

Rapid Response

Cardiovascular Risk in Women with High Normal Blood Pressure

“Doc, I know you said my blood pressure was normal at 132/86 but it has always been a lot lower. What does this mean?” How often have we heard this from a middle-aged female patient? On one hand we might reassure her that normal is normal, but on the other…

Rapid Response

Hip Protectors and Hip Fractures

Hip fractures can result from trauma or from a mechanically weakened bone that is unable to sustain mechanical stress. In most older people, trauma is due to a fall after tripping over an object or just losing one’s balance. In older patients, both conditions (trauma and osteoporosis) often coexist, work…

Special Section

Medical Webwatch

The Australian Virtual Medical Website http://www.virtualmedicalcentre.com/ was founded by Dr. Dean, a Perth palliative care specialist, and his businessman friend Wayne Hughes. Although it is a website that aims to help patients understand their conditions it also has a physicians-only section that offers access to medically sensitive and industry-sensitive information….

Letter to the Editor

Response to Self-Poisoning with Pet Medications

To the Editor: We welcome Ashawesh et al’s1 contribution to the growing body of published literature on human overdoses with pet prescription medications,1–4 although their single case is not the first as they claim. As we reported earlier in our case series in 2002, the recent exponential increase in prescribed…

Letter to the Editor

A Clinical Observation: Loxoscelism Pain Managed with Lidocaine Patch

To the Editor: In my 35 years of practice in a highly endemic area, I have had extensive experience treating brown recluse (Loxosceles reclusa) spider bites1–4 and I want to report an recent observation. Although anecdotal, I believe it is highly significant.

Letter to the Editor

Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications

To the Editor: We read with great interest the article by Leon-Sanchez et al,1 in which they reported a case of fatal posterior circulation cerebrovascular accident after cervical spine manipulation therapy.

Letter to the Editor

Synchronous Male Carcinoma of the Breast, Exocrine Pancreas, and Prostate

To the Editor: An association between carcinoma of the breast, pancreas, and prostate has been reported.1–3 Epidemiologic studies showed a higher risk of breast, prostate, and pancreatic cancer in families of breast cancer patients4; an increased risk of early onset of pancreatic and prostatic cancer in families with two cases…

Letter to the Editor

Vancomycin-resistant Enterococcus faecium Meningitis Successfully Treated with Linezolid

To the Editor: Over the last two decades, vancomycin resistance in enterococci has become increasingly prevalent since first described by Leclercq et al in 1988.1 In the United States, the resistance is due to the widespread use of vancomycin with resultant colonization and infection, predominantly in ill and debilitated patients…

Letter to the Editor

Burkitt Lymphoma Presenting with Hypercalcemic Emergency

To the Editor: Burkitt lymphoma is an aggressive type of non-Hodgkin lymphoma occurring in endemic, sporadic, and immunodeficient forms.1 Hypercalcemia is a rare complication of Burkitt lymphoma, and its underlying mechanisms are ill defined. A 40-year-old human immunodeficiency virus-positive woman presented with a progressive abdominal painful swelling, nausea, vomiting, and…

Letter to the Editor

Response to Drs. Bryant and Mycyk Regarding Pet Medication Poisoning

To the Editor: We thank Bryant and Mycyk for their comments on our letter which was published in the August 2007 issue of the SMJ.1 We would like to clarify that the aim of our letter was to describe the first case report in which a pet’s antiepileptic drug (phenobarbitone)…