Issue - Southern Medical Association

Original Article

Knowledge, Attitudes, and Use of Emergency Contraception Among Hispanic Women of North Carolina

Introduction:This project was designed to determine the knowledge, attitudes and self-reported use of emergency contraception (EC) of Spanish-speaking women of western North Carolina.Materials and Methods:Using a cross-sectional survey, a convenience sample of patients completed the survey in exam or interview rooms of an obstetric and gynecology residency program in western…

Original Article

Warning Signs and Symptoms of Subarachnoid Hemorrhage

Objectives:The objective of this study was to assess the warning signs and symptoms in patients with spontaneous subarachnoid hemorrhage (SAH).Methods:Patients admitted with spontaneous SAH were enrolled in the study and were asked for their history of frequent warning signs and symptoms as cited in other studies.Results:Overall, 28 cases of spontaneous…

Original Article

Prevalence of Intra-abdominal Surgery: What Is an Individual’s Lifetime Risk?

Background:The lifetime risk of intra-abdominal surgery is unknown. The objectives of this study were to derive this information from our local population, and to consider the role of incidental surgery.Methods:Over an 8-year period, 2648 autopsy and clinical records from a public and private hospital were reviewed for evidence of intra-abdominal…

Original Article

The Effects of Body Fat Distribution on Pulmonary Function Tests in the Overweight and Obese

Objectives:To determine the predominant pulmonary function abnormality in overweight and moderately obese subjects and to evaluate the correlation between the severity of lung function impairment and the degree of obesity.Methods:Fifty-three volunteers underwent physical examination, skin fold measurements, and standardized pulmonary function tests. Thirty-one women and 22 men with a mean…

Original Article

Hantavirus Pulmonary Syndrome in Texas: 1993–2006

Background:Hantavirus pulmonary syndrome (HPS) is a rare cardiopulmonary disease that was first described after a 1993 epidemic in the southwestern United States. This study reviewed all cases reported in Texas to date.Methods:We reviewed case report forms submitted to the Texas Department of State Health Services and medical records (when available)…

Original Article

The Role of Observation in the Management of Atypical Nevi

Objective:The definition and management of the atypical nevus remains a controversial issue. Some believe that atypical nevi are common variants of benign melanocytic nevi while others believe they are lesions intermediate between benign melanocytic nevi and melanoma. Therefore, the question of whether or not partially removed atypical nevi should be…

CME Topic

Cardiovascular Effects of Thiazolidinediones: A Review of the Literature

Abstract:Type 2 diabetes is a common problem with serious complications. Optimal glycemic control is a major challenge in diabetes, and inadequate control can lead to acute complications as well as end-organ damage. Cardiovascular disease is the primary cause of death in diabetes. Thiazolidinediones (TZDs), one of the newer classes of…

Patient's Page

The Patient’s Page

Artificial Sweeteners&NA;Sugar: The American Darling1,2The United States consumes more sweeteners than any other country. We are one of the top sugar producers, and also one of the largest sugar importers. Ten years ago, the average American was recorded as consuming “the equivalent of 20 teaspoons of sugar a day”1 (while…

Case Report

Arrow Shaft Injury of the Wrist and Hand: Case Report, Management, and Surgical Technique

Abstract:A case of accidental, self-inflicted injury to the hand from a hollow carbon shaft arrow which broke in its midshaft while attempting to shoot the arrow from a compound bow is presented. Basic knowledge of low velocity gunshot wounds and arrow injuries was applied in the treatment of this injury…

Case Report

Forearm Muscle Metastasis as an Initial Clinical Manifestation of Lung Cancer

Abstract:Skeletal muscle metastasis from lung cancer is rare, and the optimal treatment strategy is unknown. A 37-year-old man presented with painful swelling in the left forearm. A biopsy of the swollen muscle disclosed the presence of pulmonary adenocarcinoma. The patient was treated with systemic chemotherapy and radiotherapy; radiographic examination revealed…

Case Report

Fulminant Hepatitis Induced by Lamotrigine

Abstract:Anticonvulsant hypersensitivity syndrome (AHS) is a potentially life-threatening adverse drug reaction presenting with fever, skin eruptions, and internal organ involvement. We describe a case of AHS with fulminant hepatitis that occurred two weeks after introduction of lamotrigine in a 40-year-old female patient with a recently diagnosed bipolar disorder, no pre-existent…

Case Report

Familial Fahr Disease in a Turkish Family

Abstract:Fahr syndrome refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcification. We present a 42-year-old woman with Fahr disease, but lacking extrapyramidal symptoms or a metabolic disorder. Her neurological examination was normal. Computed tomographic scans demonstrated symmetrical calcification over the basal ganglia, thalamus and cerebellum. No underlying…

Case Report

A Case of Emphysematous Cystitis in Cystic Fibrosis

Abstract:It is postulated that gas-forming organisms ferment glucose within the wall of the urinary bladder leading to air collection; emphysematous cystitis occurs due to the fermentation of glucose by these organisms. Emphysematous cystitis is a rare condition usually seen in patients who are either diabetic or have other immunosuppressive diseases,…

Case Report

Case Report of Mastocytosis in an Adult

Abstract:A case of adult-onset mastocytosis is presented to illustrate the classification, signs, symptoms, workup, treatment, and prognosis for this unusual condition. Although there is no cure for mastocytosis, symptoms of histamine release can be minimized with oral antihistamines. Ongoing surveillance of organ systems affected remains important. Our patient’s mast cell…

Editorial

Science, Ideology, and the Public Good: The Precarious State of Emergency Contraception in America

Indigent women are disproportionately affected by undesired pregnancy. Unintended births continue to rise among poor women, potentiating the cycle of poverty and taxing overburdened social welfare systems.1 While limited access to care or inability to pay for contraceptive measures bear some responsibility for the epidemic of unintended pregnancy, inconsistent use,…

Case Report

Ruptured Intracranial Dermoid Cyst Presenting With Neuropsychiatric Symptoms: A Case Report

Abstract:Psychiatric symptoms associated with frontal lobe unruptured or ruptured intracranial dermoid cysts are rarely described in the medical literature. The case of a 58-year-old man with a chronic history of anxiety, major depression, and obsessive compulsive disorder who presented with new onset auditory and visual phenomena is described. This case…

Case Report

Primary Plasma Cell Leukemia Presented as Progressive Paraplegia: A Case Report

Abstract:Plasma cell leukemia (PCL) is a rare plasma cell disorder. It is the leukemic variant of multiple myeloma. A 52-year-old man with an atypical presentation of primary plasma cell leukemia is reported. The patient presented with paraparesis which progressively worsened to paraplegia. MRI of the spine showed an extradural mass…

Special Sections: Letters to the Editor

The Pachuco Mark and Similar Tattoos

To the Editor:A 75-year-old Caucasian male with a history of hepatitis C virus (HCV) presented to the dermatology clinic with signs and symptoms of lichen planus. During the exam, we noted an unusual tattoo on the dorsum of his right hand. The amateur tattoo contained a cross with four lines…

Special Sections: Letters to the Editor

Invasive Streptococcus agalactiae Septic Arthritis Mimicking Polymyalgia Rheumatica

To the Editor:A 70-year-old man was admitted to our hospital with a two-month history of fever, polyarthralgia, and lumbago. At another hospital, he was diagnosed with polymyalgia rheumatica and administered 30 mg of prednisolone daily. Subsequently, acute onset polyarthralgia with deformities, swelling, and lumbago progressed rapidly and his temperature reached…

Editorial

Why Emergency Contraception Remains Controversial

The Ethical Distinction Between Prevention and TerminationWhy is the termination of pregnancy socially, politically and ethically so controversial? More specifically, why is termination of pregnancy controversial in a way that prevention of pregnancy is not? Clearly this is because termination of pregnancy ends the life of a human embryo or…

Special Sections: Letters to the Editor

Pneumomediastinum in a 21-year-old Female with Lupus

To the Editor:A 21-year-old female presented with shortness of breath persisting after ascending up a flight of stairs one week earlier. Exercise tolerance previously had been unlimited. She recalled coughing six days prior to presentation, with productive, nonbloody, yellow phlegm. Subjective fever and headache were also reported. Although she had…

Special Sections: Letters to the Editor

Penetrating Orbital Trauma with Internal Carotid Injury

To the Editor:Penetrating intraorbital injury is one of the most serious types of trauma. In the United States, from 1992 through 2001 the overall estimated rate of eye injury ranged from 8.2 to 13.0 per 1000 population.1 The most common settings in which eye injuries occur today are the home…

Editorial

Upper Extremity Arrow Shaft Injury and Management

With westward expansion in the 19th century, military confrontations forced US Army surgeons to deal with arrow wounds in detail.1 The most famous Army surgeon preoccupied with arrow wounds was Colonel Joseph Bill (?-1885). Bill strongly advocated aggressive treatment, including extensive incisions to remove arrows and re-exploration of wounds to…

Editorial

Skeletal Muscle Metastasis Secondary to Lung Cancer

Lung cancer is frequently metastatic at the time of diagnosis and metastases have been reported in every organ. Autopsy series correlating the frequency of metastasis with histologic type show the highest incidence with small cell lung cancer, anaplastic carcinoma, adenocarcinoma, and squamous cell carcinoma.1 Metastasis usually precludes a cure for…

Case Report

Donovanosis Presenting as a Pelvic Mass Mimicking Ovarian Cancer

Abstract:A 29-year-old female presented with chronic postpartum abdominal pain. Computerized tomography scan was consistent with ovarian carcinoma, and biopsy yielded macrophages laden with eosinophilic bodies. Cultures, histoplasma serologies, and taxoplasma serologies were negative. A diagnosis of pelvic donovanosis was reached; the patient was treated with azithromycin resulting in clinical and…

CME Topic

Peritoneal Tuberculosis: Modern Peril for an Ancient Disease

Abstract:Extrapulmonary manifestations of Mycobacterium tuberculosis (MTB) in general, and tuberculous peritonitis (TBP) in particular, have posed complex diagnostic challenges for centuries. Peritoneal tuberculosis is a very rare manifestation of MTB with subtle clinical findings that may result in a significant diagnostic delay, often of more than four months. As the…

Case Report

Tuberculous Peritonitis: A Surgical Dilemma

Abstract:This is a case report of tuberculous peritonitis (TB), an entity which is difficult to diagnose. When TB is found in extrapulmonary organs it is usually associated with an immunocompromised state, such as that caused by the human immunodeficiency virus (HIV). Medical therapy continues to be the treatment of choice…

Case Report

Anaphylactic-like Reaction to Lugol Solution During Colposcopy

Abstract:There are a lack of reports about the adverse effects of Lugol iodine solution staining of the genital epithelia, known as a Schiller test, during colposcopy. We report that during the Schiller test, a patient complained of an anaphylactic-like reaction to the Lugol solution with vaginal and generalized pruritus, vaginal…

Case Report

Cocaine Abuse Complicating Acute Painful Episodes in Sickle Cell Disease

Abstract:We report three sickle cell patients with recent cocaine abuse who presented with typical symptoms of vaso-occlusion rapidly progressing to major organ dysfunction. Our experience suggests cocaine abuse is a risk factor for major complications of a sickle cell painful episode. Enhanced clinical and laboratory surveillance for organ dysfunction is…

Review Article

Importance of Postprandial Glucose Levels as a Target for Glycemic Control in Type 2 Diabetes

Abstract:Increasing evidence supports the importance of postprandial glucose (PPG) in glycemic control with regard to the development of complications in patients with diabetes. PPG plays a critical role in determining overall glycemic control, particularly in patients who are close to their glycemic goals. Data also indicate that postprandial hyperglycemia may…

Original Article

Gamma Knife® Stereotactic Radiosurgery for Intracranial Metastases from Conventionally Radioresistant Primary Cancers: Outcome Analysis of Survival and Control of Brain Disease

Objective:The aim of this study was to analyze our experience with stereotactic radiosurgery in the management of patients with brain metastases from radioresistant primary cancers.Methods:We retrospectively reviewed the clinical record of those patients for the outcome measures. All data were coded and entered into multivariate regression analysis for studying the…

Review Article

Consequences of Delaying Progression to Optimal Therapy in Patients with Type 2 Diabetes Not Achieving Glycemic Goals

Key PointsInsulin is the most efficacious therapy for diabetes.Patients with diabetes are not initiated on insulin therapy soon enough.A range of modern insulin formulations and delivery devices are available to help improve tolerability and patient compliance.The State of DiabetesDiabetes is a major and rapidly growing world health problem. In the…

Special Section

Medical Webwatch

The “Care and Education” section http://www.idf.org/home/index.cfm?node=7 of the International Diabetes Federation is a rich and multifaceted resource. The Diabetes Education tab leads to a download of their “International Curriculum,” and also to their “Diabetes Education Modules” which is a series of audio-visual presentations. Also on the side menu are “Guidelines”…

Editorial

The Race to Insure Surgery

We all know that race plays a role in healthcare. Certain diseases have inherent ethnic differences; cystic fibrosis, sickle cell disease, inflammatory bowel disease, etc. But, what we don’t expect is that race might have an effect on service, access, quality, and outcomes in medicine. In this issue’s article, “Prevalence…

Special Sections: Letters to the Editor

Secondhand Smoke: A Health Hazard Around Hospital Premises

To the Editor:The successful implementation of a clean indoor air policy in the state of New York is a major move towards a healthy workplace.1 It reduces the amount of smoke exposure for smokers and most importantly, protects nonsmokers and susceptible individuals, such as patients, children, and the elderly, from…

Special Sections: Letters to the Editor

Spontaneous Recovery from Long-term Phrenic Nerve Palsy

To the Editor:A 45-year-old man was referred to our hospital with a four-day history of dyspnea and intense orthopnea. He could not lie flat in bed and slept upright in a chair. Diabetes mellitus and systemic arterial hypertension had been diagnosed 15 years earlier and he had been treated without…

Special Sections: Letters to the Editor

Phytoestrogens and Their Role in the Management of Postmenopausal Osteoporosis

To the Editor:Isoflavones, lignans, and coumestans are three classes of phytoestrogens—plant constituents with a chemical structure similar to 17&bgr;-estradiol. Phytoestrogens exert weak estrogenic and antiestrogenic effects that vary according to the target tissue, and are mediated through binding to estrogen receptors &agr; (ER&agr;) and &bgr; (ER&bgr;). The phytoestrogens therefore fall…

Special Sections: Letters to the Editor

Coincidence of Tuberculosis and Malignancy: A Diagnostic Dilemma

To the Editor:A 34-year-old male smoker who was a farmer by occupation presented to the primary health center with fever and cough with expectoration of 6 weeks’ duration. His sputum for acid fast bacilli was positive in three samples. His chest x-ray showed a cavitating lesion in the left upper…

Special Sections: Letters to the Editor

Armadillos as a Source of Leprosy Infection in the Southeast

To the Editor:We read with interest the article entitled “Armadillos as a Source of Infection for Leprosy.”1 In the United States, there are at least several hundred new cases of leprosy diagnosed annually, most in immigrants from leprosy-endemic countries.2 However, in nonimmigrants who have lived in the United States all…

Editorial

Anticonvulsant Hypersensitivity Syndrome and Drug-Induced Hepatic Injury

In this issue of the Journal, Ouellet et al1 detail a case of fulminant hepatitis induced by lamotrigine, in which a 40-year-old female patient presented with features characteristic of anticonvulsant hypersensitivity syndrome (AHS). Causality is appropriately linked to lamotrigine, given that the signs appeared shortly after a dosage escalation, and…

Special Sections: Letters to the Editor

Early Repolarization and Sudden Cardiac Death

To the Editor:Early repolarization is an electrocardiographic (ECG) pattern characterized by a prominent J-point and ST-segment elevation with upward concavity ending in a positive high amplitude T-wave in most ECG leads, especially the midchest leads.1 It is a common ECG finding present in 1 to 5% of the general population…

Editorial

Postprandial Glucose in Diabetes: Time for Action

The number of patients with type 2 diabetes is increasing at alarming rates in developed and developing countries.1 Many patients with diabetes are not aware of the disease and several years often elapse before the diagnosis is made. The development of type 2 diabetes is characterized by insulin resistance and…

Editorial

The Warnings of Subarachnoid Hemorrhage

The study in this issue of the SMJ by Togha et al1 is small and descriptive in character, but yields very important information. The authors sought to estimate the prevalence of sentinel symptoms associated with subarachnoid hemorrhage (SAH). They did this by prospective analysis of 28 SAH cases, obtaining history…

Special Sections: Letters to the Editor

Adherence to Urate-Lowering Therapy

To the Editor:Gout first manifests as recurrent acute attacks, most commonly in the base of the big toe. We now know that this is also an important signal to attend to blood pressure, diet, alcohol intake, exercise, weight, abdominal girth, plasma lipids, and smoking. Not only will plasma urate fall,…

CME Topic

January 2009 CME Questions

Peritoneal Tuberculosis: Modern Peril for an Ancient Disease1. The delay in the diagnosis of tuberculous peritonitis (TBP) has been estimated to be between:A. 1–2 weeksB. 1–2 monthsC. 4–12 monthsD. None of the aboveE. All of the above2. Which one of the following is correct regarding peritoneal fluid consistency in patients…

CME Topic

CME Submission Form

Case Report

Rapunzel and Pregnancy

Abstract:Rapunzel, the girl with long golden tresses in the fairy tale, inspired Vaughan et al to describe, in 1968, cases of trichobezoar with a long tail causing bowel obstruction as “Rapunzel syndrome.” A 22-year-old Egyptian woman had been suffering from episodes of epigastric pain and vomiting throughout her pregnancy and…