Original Article

Public Perceptions of Substance Abuse and How Problems Are Resolved: Implications for Medical and Public Health Services

Background: Increasing utilization and appeal of substance abuse services requires understanding public perceptions of substance abuse and problem resolution. Method: A statewide survey (N = 439) assessed public views of the prevalence of problems, service utilization, and outcomes using random digit dialing sampling. Results: Compared with population data, the sample…

Original Article

Orthopaedic In-Training Examination Performance: A Nine-Year Review of a Residency Program Database

Background: The Orthopaedic In-Training Examination (OITE) provides an objective way for both the residency program and the resident to monitor progress. Methods: This longitudinal descriptive study tracks the OITE performance of 16 residents from one orthopaedic surgery residency program over nine years (1997–2005). Domain comparisons are made to national averages…

Original Article

Characteristics of Patients Who Present to the Emergency Department with Molar Pregnancy

Objective: The purpose of this study was to determine presenting signs/symptoms and risk factors in emergency department (ED) patients ultimately diagnosed with molar pregnancy. Methods: A retrospective review of ED medical records using a standardized abstraction sheet was conducted over a 10-year period (1995–2005) from three EDs. Results: Records were…

Expired CME Article

Improper Renal Dosing in Long-Term Care Facilities

Objectives: With advancing age, physiologic changes occur that affect drug metabolism. Possibly the most predictable function decline in geriatric population is renal function. Methods: The prescribing habits of physicians and the attention given to patient renal function was investigated. Data was collected from two nursing facilities in southeastern Georgia. Results:…

Expired CME Article

Stress Test: A Primer for Primary Care Physicians

Although stress testing is generally a safe procedure, complications may occur. Types of stress tests include electrocardiographic exercise stress test, myocardial imaging exercise stress test, and myocardial imaging pharmacological stress tests. Nuclear imaging stress test is a preferable modality in women. Exercise-based stress tests provide evaluations of functional capacity, as…

Expired CME Article

The Effects of Outpatient Management on Hospitalization for Ambulatory Care Sensitive Conditions Associated with Diabetes Mellitus

Background: Ambulatory care sensitive conditions (ACSC) related to diabetes mellitus can potentially be prevented by good quality outpatient care. The purpose of this study was to evaluate which characteristics of ambulatory patients with diabetes were associated with ACSC hospitalizations. Methods: Retrospective chart review of 65 adults with an ACSC diabetes-related…

Review Article

The Pleiotropic Effects of Antihypertensive Agents: Do They Account for Additional Cardiovascular Benefit Beyond BP Reduction?

Hypertension commonly clusters with other cardiovascular risk factors, giving rise to the concept that hypertension is a multifaceted disease that potentially shares common pathogenic pathways with other risk factors. The renin-angiotensin-aldosterone system has a central role in the shared mechanisms of hypertension and cardiovascular disease, primarily through angiotensin II. Increased…

Review Article

Maximizing Effectiveness of Bisphosphonate Therapy for Osteoporosis

While highly prevalent, osteoporosis is greatly underdiagnosed and undertreated in clinical practice. Even when appropriate treatments are prescribed, patient adherence to bisphosphonate therapy is low. As osteoporosis is a silent disease, and therapy is required for many months before benefit is realized, strategies to increase bone mineral density (BMD) and…

Case Report

CT Angiogram and Endovascular Stent Graft for an Axillary Artery Gunshot Wound

A patient with an axillary artery gunshot wound pseudoaneurysm was evaluated and managed with computed tomographic angiogram and endovascular stent graft. Vascular injuries resulting from penetrating trauma or interventional vascular procedures are relatively uncommon. Subclavian and axillary arterial injuries may be associated with substantial morbidity and mortality if not managed…

Case Report

Primary Malignant Melanoma of the Duodenum: Aggressive Management and Long-Term Survival of an Unusual Oncologic Entity

Primary malignant melanoma originating in the small bowel is extremely rare. We report the case of a 55-year-old man who presented with a preoperative bleeding duodenal tumor. A standard pancreaticoduodenectomy was performed. Histopathological examination ascertained the diagnosis of a duodenal malignant melanoma with locoregional lymphatic spread. A thorough postoperative investigation…

Case Report

Aortic Dissection Presenting as Uniocular Blindness

A patient presented with uniocular blindness and headache, which was initially suspected to be subarachnoid hemorrhage. The patient had a seven-year history of diabetes mellitus, hypertension and hypothyroidism, as well as a two-year history of congestive cardiac failure with aortic regurgitation. Upon autopsy, the patient was diagnosed with aortic dissection….

Case Report

Thrombotic Microangiopathy as a Complication of Medicinal Leech Therapy

Medicinal leeches (hirudo medicinalis) are increasingly used as a useful therapeutic option in various medical and surgical settings. The potential complications associated with this therapy include infections with Aeromonas species, bleeding, anemia, and allergic reactions. We describe a patient who developed thrombotic microangiopathy and acute renal failure following leech therapy….

Case Report

Isolated Medial Cuneiform Fracture: A Special Forces Soldier with a Rare Injury

Isolated cuneiform fractures rarely occur, but must be considered in the differential diagnosis for midfoot injuries. Along with other nondisplaced, nondislocated midfoot injuries, these fractures are commonly missed or delayed in diagnosis. A review of the literature reveals only three other reported cases of isolated medial cuneiform fractures. Because of…

Letter to the Editor

Unusual Metastatic Soft Tissue Calcification in a Hemodialysis Patient

To the Editor: Metastatic calcification is a serious complication of end-stage renal disease (ESRD) occurring throughout the body, including the interstitial tissue of the blood vessels,1 kidneys, lungs,2 and gastric mucosa. To our knowledge, calcification of the bilateral vas deferens in hemodialysis patients is extremely rare and has not been…

Editorial

Unadjusted Medication Dose in Patients with Chronic Kidney Disease

According to National Health and Nutrition Examination Survey (NHANES) III, as many as 6.6 million United States residents older than 60 have an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2.1 Patients with chronic kidney disease (CKD) are at high risk for adverse drug reactions and drug-drug interactions….

Editorial

The Use of Dopamine Agonist in the Treatment of Restless Legs Syndrome: Caution for Practitioners and Bipolar Patients

Restless legs syndrome (RLS) is a commonly “undiagnosed and untreated” pathology seen in the primary care physicians’ (PCP) office.1 One particular area of concern is in treating patients with comorbid psychiatric issues. Of primary concern is the bipolar patient who is often unrecognized and treated by the PCP.2

Case Report

Fetal and Neonatal Graves Disease: A Case Report and Review of the Literature

Fetal and neonatal thyrotoxicosis from maternal Graves disease is a very rare entity. Fetal symptoms result from the transplacental passage of thyroid-stimulating immunoglobulins, which persist in the neonate resulting in neonatal symptoms. We present a case of fetal and neonatal thyrotoxicosis from maternal Graves disease. Fetal symptoms were controlled with…

Case Report

Placenta Increta and Cocaine Abuse in a Grand Multipara Leading to a Second Trimester Rupture of an Unscarred Uterus: A Case Report

A case of a uterine rupture in a grand multiparous patient with an unscarred uterus at 19 weeks’ gestation secondary to placenta increta and cocaine abuse is presented. This was a diagnostically difficult case where abnormal implantation of the placenta, grand multiparity, and cocaine abuse were all contributors to the…

Expired CME Credit Submission and Evaluation Form

CME Submission Form

Expired CME Article

August 2008 CME Questions

Improper Renal Dosing in Long-Term Care Facilities1. Adverse drug reactions in elderly patients can: A. Increase mortality B. Increase hospitalization C. Increase risk of fall D. All of the above 2. According to the Beers report, what percentage of nursing home facilities receive at least one inappropriate medication? A. 25%…

Editorial

Antihypertensive Agents: Are All of Them Equal?

Hypertension is one of the main cardiovascular risk factors. Different guidelines have reported that the presence of hypertension significantly increases cardiovascular morbidity and mortality. The Seventh Report of the Joint National Committee (JNC-7)1 and the European guidelines for the management of arterial hypertension2 show that even small elevations above optimal…

Editorial

Endovascular Grafting as a Complement to Open Surgery Treatment for Axillary and Subclavian Vascular Injuries

The most important step in evaluating a patient with upper extremity vascular trauma is the physical examination. Physical signs may be hard or soft. Hard signs include severe hemorrhage, expanding hematoma, arterial bruit, palpable thrill, or findings of acute ischemia. Soft signs include small nonexpanding hematoma, ipsilateral neurologic deficit or…

Editorial

Cocaine Abuse in Pregnancy: An Evolution from Panacea to Pandemonium

Cocaine is an alkaloid derived from the leaves of the Erythroxylon coca plant, and is available as either a hydrochloride or as freebase crack cocaine. While cocaine has an unfavorable public image as an addictive substance, this drug has also had an illustrious history as a medicinal panacea. Coca utilization…

Rapid Response

Is There a Silver Lining to Rising Gasoline Prices?

A newly published study suggests that an increase in gasoline prices, sustained over time, will reduce traffic fatalities and deaths due to air pollution. However, gasoline prices are relatively volatile and there is little indication that a large price increase will be sustained such that individuals will dramatically alter their…

Rapid Response

To Dig or Not to Dig: A Lethal Question in Atrial Fibrillation?

Despite digoxin being considered a class I indication for rate control in many patients with persistent and permanent atrial fibrillation, with or without heart failure, its long-term efficacy and safety remains uncertain. Well-designed, multicenter, randomized clinical trials are necessary to clarify the safety profile of a drug daily used in…

Rapid Response

Preventive Performance of Pneumococcal Vaccination in Adults: Insights into Theory and Practice of the Vaccination

The practical benefit of pneumococcal vaccination may still be the focus of controversy. There is no evidence that current vaccination reduces illness or mortality from bacteriemia, though many observational studies have shown a significant protective effect against it. As long as the protective effectiveness is well demonstrated, even if the…

Rapid Response

Understanding the Health Impact of the September 11th Attacks

In a cross-sectional study of companies in the area surrounding the World Trade Center, a defensive organizational culture was associated with worker reports of high-strain jobs and a 34% higher likelihood of reporting a cough 2-years post 9/11. The authors do not offer a plausible explanation for how cultural processes…

Special Section

Medical Webwatch

Pediatric Grand Rounds http://www.cincinnatichildrens.org/ed/cme/streaming-media/library/pgr/2008.htm is an educational media program that provides streaming media for physicians and is produced by the Cincinnati Children’s Hospital Medical Center. The presentations are archived to 2001 and are linked to online CME post-tests. To the left of the audio-visual presentation screen are tabs for slides,…

Special Section

Erratum

Erratum In the article “Atypical Antipsychotics, Elderly Patients, and Mortality Risk,” which appeared in volume 100 of the Southern Medical Journal on pages 964–965, a line of text was left out due to a production error. The last three sentences of the article should read “Thus, when faced with an…

Letter to the Editor

Rapid Rise in Bed Bug Populations: The Need to Include Them in the Differential Diagnosis of Mysterious Skin Rashes

To the Editor: Bed bugs, Cimex lectularius, had nearly disappeared in developed countries for almost half a century until a recent dramatic increase in bed bug numbers, geographic distribution, and biting incidence.1–3 The bugs are increasingly common inside hotel rooms, dormitories, and apartments in the United States and elsewhere. International…

Letter to the Editor

Poverty or Big Government: Which is the Real Disease?

To the Editor: In an editorial, Dr. Hamdy waxes passionate about the alleged vices of this great nation – poverty and the uninsured. I do not doubt his passion, but he doubts ours. He says we clinicians do not have the time, or perhaps the temperament, to comprehend that “poverty…

Letter to the Editor

Physician Signatures

To the Editor: In a dermatology practice, the amount of daily documentation necessary to fulfill governmental, insurance, and institutional requirements has continued to increase. A physician’s signature is one aspect of this documentation. We recorded and analyzed the number of times a dermatology resident signed his name during 16 three-hour…

Letter to the Editor

The Sociocultural Dimensions of Pain in the Mid-South

To the Editor: Pain is a potentially important but poorly understood subject, affecting roughly 50 million people in the United States per year.1,2 Though an emerging body of literature is defining the presence, origins, and impacts of pain, as well as its treatment and management, little has been explored regarding…

Letter to the Editor

The PC Mouse as a Learning Tool for the Development of Eye-Hand Coordination for Trainees in Laparoscopic Surgery

To the Editor: The introduction of laparoscopic surgery brought with it psychomotor challenges to the surgeon; notably, eye-hand coordination.1 This phenomenon is caused by a combination of field-video displacement, instrument movement distortion, depth misperception and tactile stimulus deprivation.2 Skill acquisition in laparoscopic surgery is time-dependent, as it is an adaptive…

Letter to the Editor

Appropriateness of the Use of Serum Ferritin or Serum Transferrin Saturation as a Diagnostic Tool for the Evaluation of Anemia

To the Editor: We read with great interest the paper by Ioannou et al which was recently published in the Southern Medical Journal1. In this article, the authors tried to identify the clinical predictors that led to laboratory evaluation of iron deficiency anemia in 637 consecutive anemic patients admitted to…

Letter to the Editor

A Man With Sicca Symptoms and Bilateral Parotid Enlargement

To the Editor: A 50-year-old otherwise healthy man presented with a three month history of dry mouth, dry eyes, and a recent bilateral painless enlargement of his parotid gland. He denied fatigue, fever, cough, wheeze, or night sweats. Physical examination was normal except for bilateral parotid swelling and severe dryness…

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