Issue - Southern Medical Association

Original Article

Plasma Viscosity Changes in Patients with Liver Cirrhosis

Objectives:Plasma viscosity (PV) is a major determinant of capillary blood flow through the microcirculation, which, if impaired, can result in potentially important clinical sequelae. The objectives of this study were to investigate the alterations of PV values in different stages of cirrhosis, and to determine if any change in PV…

Original Article

Analysis of Young and Elderly Advanced Stage Nonsmall-Cell Lung Carcinoma Cases

Objective:Even though there have been considerable improvements in the diagnosis and treatment of lung cancer, the prognostic factors for elderly patients with advanced nonsmall-cell lung cancer (NSCLC) remain insufficient. Therefore, our aim is to compare the prognostic factors for elderly and young cases with advanced stage NSCLC.Methods:The data of 370…

CME Topic

Vitamin Deficiency After Gastric Bypass Surgery: A Review

Abstract:More than 60% of the adult US population now meets the criteria for being overweight or obese. Gastric bypass surgery has become a popular and effective way to combat this medical problem. Despite the success of these procedures, they are associated with many complications, including malnutrition, neurological compromise, and vitamin…

CME Topic

Carcinoid Tumors of the Gastrointestinal Tract

Abstract:The gastrointestinal tract is the largest neuroendocrine system in the body. Carcinoid tumors are amine precursor uptake decarboxylase (APUD) omas that arise from enterochromaffin cells throughout the gut. These tumors secrete discrete bioactive substances producing characteristic immunohistochemical patterns. Most tumors are asymptomatic and detected at late stages. Hepatic metastases are…

Case Report

Platypnea-Orthodeoxia Syndrome: A Diagnostic Challenge

Abstract:Platypnea-orthodeoxia (P-O) syndrome is an underdiagnosed condition characterized by dyspnea and deoxygenation accompanying a change from a recumbent to an upright position. It is caused by increased right-to-left shunting of blood on assuming an upright position. The diagnosis of this shunt is often challenging. A case where a diagnosis was…

Case Report

Rheologic Reflection in Hypertriglyceridemia-Induced Pancreatitis

Abstract:Triglyceride levels greater than 1,000 mg/dL may cause severe pancreatitis, and there is mounting evidence for the use of plasmapheresis to remove triglycerides for the treatment of triglyceride-induced pancreatitis. The failure of continuous venovenous hemodialysis (CVVHD) due to severe lipemia, necessitating plasmapheresis in the early phase of severe acute hypertriglyceridemia-induced…

Case Report

Celiac Disease Associated with Dilated Cardiomyopathy

Abstract:Celiac disease is an intestinal disorder caused by an immunologic response to gluten, which results in diffuse damage to the proximal small intestinal mucosa with malabsorption of nutrients. An association between celiac disease and nonischemic dilated cardiomyopathy has been noted. Cardiomyopathy has been shown to improve in some patients on…

Case Report

Bilateral Simultaneous Ectopic Pregnancy

Abstract:Spontaneous bilateral ectopic pregnancy is the rarest form of ectopic pregnancy. A 31-year-old patient with spontaneous bilateral tubal pregnancy was admitted after light vaginal bleeding, 42 days after her last menstruation. Ultrasonography showed a bilateral tubal ectopic pregnancy. A bilateral laparoscopic salpingectomy was performed without complication and the pathology report…

Case Report

Giant Ulcerated Lipoma of the Colon Causing Iron Deficiency Anemia Successfully Treated with Endoscopic Ultrasound-Assisted Resection

Abstract:Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of…

Case Report

Diffuse Malignant Peritoneal Mesothelioma Presenting as Intestinal Obstruction

Abstract:Diffuse malignant peritoneal mesothelioma (DMPM) represents 90% of all peritoneal forms of mesothelioma. It affects mainly patients 50–69 years old. In 50% of cases there is a history of asbestos exposure. The clinical presentation of the disease is not characteristic: nonspecific abdominal pain, weight loss, and abdominal distension are common….

Case Report

Retroperitoneal Ganglioneuroma in an Adult Patient: A Case Report and Literature Review of the Last Decade

Abstract:Ganglioneuromas arise from the neural crest and are highly differentiated and benign. The case of a 43-year-old female who presented with a 6.5 cm primary extra-adrenal retroperitoneal ganglioneuroma (RGN) is presented, and the relevant English literature from the last decade is reviewed. Histology showed mature ganglion cells and nerve fibers…

Case Report

Unusual Presentation of Pheochromocytoma with Ischemic Sigmoid Colitis and Stenosis

Abstract:A 45-year-old woman with poorly controlled hypertension and diabetes mellitus presented with left iliac fossa pain, constipation alternating with diarrhea, and weight loss. She had been diagnosed with idiopathic cardiomyopathy five years previously. Echocardiogram had shown a left ventricular ejection fraction (LVEF) of 35%; coronary angiogram was normal. Colonoscopy revealed…

Case Report

Acute Methotrexate Neurotoxicity with Choreiform Movements and Focal Neurological Deficits: A Case Report

Abstract:Methotrexate (MTX) is an effective antimetabolite treatment for various oncological disorders including the central nervous system involvement (CNS) in widespread leukemia and CNS lymphoma. This form of treatment has a notable toxic effect on the nervous system, and the pediatric population seems to be more vulnerable to the neurologic toxicity…

Case Report

Anomalous Origin of Right Coronary Artery Originating from the Proximal Part of the Left Anterior Descending Artery Via a Collateral

Abstract:The incidence of anomalous coronary artery is approximatly 1% in patients who undergo coronary angiography. These anomalies, together with congenital heart disease, may cause myocardial ischemia, decreased life expectancy and sudden death. The case of a patient with a rare anomalous right coronary artery (RCA) from the very proximal part…

Case Report

Endobronchial Tuberculosis with Lobar Obstruction Successfully Treated by Argon Plasma Coagulation

Abstract:Endobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree. A 17-year-old male patient with tuberculosis who developed middle lobe syndrome on antituberculous treatment is presented. The patient was admitted with complaints of fever, cough and weight loss. Right paracardiac and perihilar heterogeneous infiltrations were present. During fiberoptic bronchoscopy, the…

Case Report

Fusobacterium nucleatum Endocarditis Mimicking Polymyalgia Rheumatica

Abstract:A case of Fusobacterium nucleatum endocarditis in an 80-year-old man is reported. The patient presented with a headache and nonspecific musculoskeletal symptoms and was misdiagnosed as having polymyalgia rheumatica. The diagnosis of bacterial endocarditis was delayed because of an insidious presentation, typical in infections with low virulence micro-organisms. The musculoskeletal…

Case Report

Successful Treatment of Idiopathic Orbital Inflammatory Disease with Leflunomide: A Case Report

Abstract:Orbital pseudotumor, also known as idiopathic orbital inflammatory disease (IOID), is an idiopathic inflammatory process within the orbit. The potential for permanent visual impairment makes this disease important to diagnose and treat. While oral corticosteroids are the mainstay of therapy, they can have significant toxicity when used for long periods…

Special Sections: Letters to the Editor

A Unique Case of Hypereosinophilic Syndrome Presenting with Dysphagia

To the Editor:Hypereosinophilic syndrome (HES) is a spectrum of disorders marked by the sustained overproduction of eosinophils in which eosinophilic infiltration and mediator release cause damage to multiple organs.1 We report a unique case of HES which presented with dysphagia.A 46-year-old African-American male without a significant medical history presented with…

Special Sections: Letters to the Editor

Lenalidomide Therapy in a Rare Case of POEMS Syndrome with Kappa Restriction

To the Editor:POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes), is a rare multisystem disease. The majority of POEMS syndrome patients have osteosclerotic myeloma which is almost always (95%) monoclonal lambda type, which carries a better prognosis than multiple myeloma.1 We describe a rare case of POEMS syndrome…

Editorial

A Challenging Case of Severe Acute Hypertriglyceridemia-Induced Pancreatitis

Hypertriglyceridemia is the most common cause of acute pancreatitis other than gallstones and alcohol and is responsible for 1–4% of all cases of pancreatitis.1 In a case report in this month’s issue of the SMJ, Martin et al2 emphasized the importance of early diagnosis of hypertriglyceridemia-induced pancreatitis and suggested the…

Editorial

Celiac Disease and the Heart

Celiac disease (CD), an immune disorder primarily affecting the gut, occurs in nearly 1% of the general US population.1 Extraintestinal manifestations of CD include dermatitis herpetiformis, osteoporosis, hyposplenism and a susceptibility to streptococcal sepsis, thyroid disorders and connective tissue disorders. Iodha et al2 report a case of dilated cardiomyopathy which…

In Memoriam

In Memoriam Andrew F. Giesen, Jr., MD 1925–2009

Figure. No caption available.On June 11, 2009, the Southern Medical Association lost a Past President and friend, Andrew F. Giesen, Jr., MD. Dr. Giesen joined the SMA in April 1959, became a Life Member in 1964 and joined the Society of 1906 in 1992. He also served many offices in…

Original Article

Elevated Alanine Aminotransferase in Current National Football League Players: Correlation with Cardiometabolic Syndrome Markers, Obesity, and Insulin Resistance

Objectives:Media reports suggest increased cardiovascular mortality in former National Football League (NFL) players. We previously demonstrated that current heavier players already have cardiometabolic syndrome markers: blood pressure (BP) ≥130/85 mm Hg, fasting glucose ≥100 mg/dL, triglycerides ≥150 mg/dL, waist circumference ≥100 cm, and high-density lipoprotein (HDL) ≤40 mg/dL.Methods:A prospective study…

Original Article

The Utility of Repeated Stool Toxin Testing for Diagnosing Clostridium difficile Colitis

Abstract:Clostridium difficile is diagnosed using the enzyme-linked immunoassay (EIA) with the specificity and sensitivity ranging from 50–90% and 70–95%, respectively. Due to the wide ranges, there is considerable confusion regarding the value of the EIA toxin test. We undertook this study to evaluate the benefit of repeat stool toxin testing.

Review Article

Nissen Fundoplication and Gastrointestinal-Related Complications: A Guide for the Primary Care Physician

Abstract:Gastroesophageal reflux disease is a common condition affecting many individuals in the Western world. Most patients are managed successfully with acid suppression, while others may require more invasive interventions. The majority of patients undergoing antireflux surgery will have favorable outcomes. A small percentage, however, will be considered surgical failures and…

Original Article

Clinical Impact of Identifying Lactose Maldigestion or Fructose Malabsorption in Irritable Bowel Syndrome or Other Conditions

Background:The role of carbohydrate maldigestion or malabsorption remains unclear in patients with irritable bowel syndrome (IBS). The purpose of this study was to examine the impact of identifying lactose maldigestion (LM) and fructose malabsorption (FM) on patients with and without IBS.Methods:Patients who received lactose and fructose challenge testing formed the…

Editorial

Never Forget the “Priceless” Diagnosis!

Some diagnoses can be “priceless” for our patients. A lot of these diagnoses are illustrated in case reports and in some chapters named “clinical pearls.” According to us, a “priceless diagnosis” is an etiology of a symptomatic disease with a specific, effective therapy.Platypnea-orthodeoxia syndrome (POS) secondary to right-to-left shunt seems…

Special Sections: Letters to the Editor

IDSA Lyme Guidelines: Response to Dr. Gershon’s Letter

To the Editor:Anne Gershon, MD, the current president of the Infectious Diseases Society of America (IDSA), attempts to defend her organization’s beleaguered Lyme disease treatment guidelines.1 Although her arguments sound plausible, closer examination reveals that, like the IDSA Lyme guidelines themselves, her views are flawed.Dr. Gershon contends that a “small…

Special Sections: Letters to the Editor

Unproven Therapies Don’t Belong in Lyme Disease Guidelines

To the Editor:We take issue with a recent article and accompanying editorial in the Southern Medical Journal criticizing the Infectious Diseases Society of America (IDSA) and its Lyme disease guidelines.1,2 Filled with inaccuracies and wrong assumptions, the article reflects the views of a small group of doctors who have repeatedly…

Special Sections: Letters to the Editor

Rethinking Lyme Guidelines Within the Spirit of the Law

To the Editor:Anne Gershon1, MD, President of the Infectious Diseases Society of America (IDSA), has written a letter to the editor sweeping me into her broad criticism of the International Lyme and Associated Diseases Society’s (ILADS) competing scientific opinions on the existence and treatment of chronic Lyme disease.Dr. Gershon groups…

Editorial

Repeated Stool Toxin Testing for Diagnosing Difficile Colitis Is Still Valid

We would like to thank the authors for this interesting and practical article,1 especially regarding the assertion that Clostridium difficile is becoming a major health concern in many institutions; however, we would like to comment on several points mentioned in this article.Firstly, C. difficile causes about 15 to 25% of…

Special Sections: Letters to the Editor

Myocardial Infarction in Takayasu Arteritis

To the Editor:It was with great interest that I read the article by Vivo and Krim1 in the May issue of the SMJ. However, there was a notable omission in the article—the authors do not mention Takayasu arteritis as an important differential diagnosis in a teenage girl presenting with myocardial…

Editorial

The Association of Obesity, Metabolic Syndrome, Diabetes, and Cardiovascular Disease with Nonalcoholic Fatty Liver Disease

In this issue, Helzberg et al1 report that in a group of National Football League (NFL) players, elevation of the liver enzyme alanine aminotransferase (ALT) was associated with obesity and markers of the metabolic (insulin resistance) syndrome and speculate that these elevations signify the presence of nonalcoholic fatty liver disease…

Special Sections: Letters to the Editor

End-of-Life Issues from a Catholic Perspective

To the Editor:A friend shared with me the March 2009 issue of the Southern Medical Journal, which contained Barrow’s editorial,1 “Jewish Law and End-of-Life Decisions” and “Fluids and Nutrition Perspectives from Jewish Law (Halachah)” by Rosner and Abramson.2 I found both enlightening as the exact same issue is being discussed…

Editorial

Gastroesophageal Reflux Disease and Obesity

Gastroesophageal reflux—the retrograde movement of gastric contents through the lower esophageal sphincter (LES)—is a common, normal phenomenon that may or may not produce symptoms. Causes of this reflux include “an incompetent LES, transient relaxation of the LES and inadequate clearance of acid from the distal esophagus.”1 With increasing frequency, practicing…

CME Topics

October 2009 CME Questions

Vitamin Deficiency after Gastric Bypass Surgery1. Glucose infusion should always be given prior to thiamine supplementation in order to prevent Wernicke encephalopathy.A. TrueB. False2. A 38-year-old female who underwent gastric bypass surgery is found on routine laboratory examination to have macrocytic anemia. She has been taking her multivitamins daily. Her…

CME Topics

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