Issue - Southern Medical Association

CME Topic

Medication Use for Diabetes, Hypertension, and Hypercholesterolemia from 1988–1994 to 2001–2006

Abstract:The objective of this study was to compare rates of use of medications for diabetes, hypertension, and hypercholesterolemia between 1988–1994 and 2001–2006 and determine whether increased medication use may be partly attributable to nonadherence to healthy lifestyle habits. This study analyzed and compared data from two different time periods in…

CME Topic

Adverse Cutaneous Reactions Induced by TNF-&agr; Antagonist Therapy

Objective:To review adverse cutaneous drug reactions induced by tumor necrosis factor alpha (TNF-&agr;) antagonist therapy.Methods:A literature search was performed using PubMed (1996–March 2009), EMBASE, and selected MEDLINE Ovid bibliography searches. All language clinical trial data, case reports, letters, and review articles identified from the data sources were used.Results:Since the introduction…

Review Article

Peripheral Arterial Disease: Current Perspectives and New Trends in Management

Abstract:Peripheral arterial disease (PAD) is defined as an arterial brachial index (ABI) of ≤0.90 in the lower extremities and results from a narrowing of the arteries as a result of progressive atherosclerosis. PAD affects 12–20% of Americans aged 65 years or older; however, most are asymptomatic and many do not…

Review Article

Acute Respiratory Distress Syndrome, Sepsis, and Cognitive Decline: A Review and Case Study

Abstract:The objective of this investigation is to review existing research pertaining to cognitive impairment and decline following critical illness and describe a case involving a 49-year-old female with sepsis and acute respiratory distress syndrome (ARDS) with no prior neurologic history who, compared to baseline neuropsychological test data, experienced dramatic cognitive…

Case Report

Successful Treatment of Severe Pneumocystis Pneumonia with Clindamycin-Primaquine in an HIV-Negative Patient

Abstract:Pneumocystis pneumonia is an increasingly recognized threat in non-HIV immunosuppressed patients and is associated with worse outcomes compared to HIV-infected patients. The preferred first line treatment is trimethoprim-sulfamethoxazole; however, second line treatments for those intolerant of this regimen have been primarily studied in patients with acquired immunodeficiency syndrome (AIDS). We…

Case Report

Diagnosis and Treatment of the Primary Malignant Meningioma in Mediastinum: A Case Report

Abstract:Primary ectopic meningioma is rare and usually limited to the head and neck region. Until now its occurrence in the mediastinum has not been reported in the literature searched on Medline using the keywords meningioma and mediastinum. We report here a case of primary mediastinal malignant meningioma which was treated…

Case Report

Mycobacterium chelonae Vertebral Osteomyelitis

Abstract:Mycobacterium chelonae is a rapidly growing mycobacterium (RGM) in Runyon group IV. This group includes all other nontuberculous mycobacterium (NTM) except the mycobacterium tuberculosis complex. The most commonly infected organ by RGM is the lung, usually in immunosuppressed patients or those with underlying lung disease. Vertebral infection is very rare….

Case Report

A Rare Cause of Complicated Hypertension: Urinary Bladder Paraganglioma

Abstract:After a subarachnoid hemorrhage, a 35-year-old patient developed paroxystic hypertension accompanied by typical symptoms. These symptoms occurred exclusively after urination. A urinary bladder paraganglioma was discovered using iodine-123 metaiodobenzylguanidine (I-123 MIBG) scintigraphy and magnetic resonance imaging (MRI) after the detection of an abnormally elevated plasma metanephrine measurement. A partial cystectomy…

Case Report

Uterine Arterial Pseudoaneurysm: Transcatheter Arterial Embolization as a Rare Complication of Caesarean Section

Abstract:We describe the case of a 22-year-old female who presented to the emergency department with vaginal bleeding after Caesarean section. A diagnosis of pseudoaneurysm of the uterine artery was established radiologically. Pseudoaneurysm of the uterine artery is an uncommon cause of delayed postpartum hemorrhage. This condition can be treated with…

Case Report

Collateral Meridian Acupressure Therapy Effectively Relieves Postregional Anesthesia/Analgesia Backache

Abstract:Epidural and spinal aesthesia may cause backache. In fact, the overall incidence of postneuraxial block backache is 9% to 50% and the incidence of back pain on the third postoperative day ranges from 5.91% to 22% after spinal anesthesia. Five patients suffering from postneuraxial block backache after regional anesthesia or…

Case Report

An Uncommon Case of Heart Failure

Abstract:A 55-year-old man evaluated for syncope had mild and gradually progressive left ventricular systolic dysfunction on initial workup. Although not identified initially, repeat cardiac magnetic resonance one year later demonstrated the presence of trabeculations in the left ventricle consistent with the diagnosis of isolated non-compaction of the left ventricular myocardium….

Special Sections: Letters to the Editor

Impetigo Herpetiformis: A Rare Dermatosis of Pregnancy

To the Editor:Impetigo herpetiformis is a rare pustular dermatosis of pregnancy. Recently, a 32-year-old lady presented with eruptive pustular skin lesions in the 26th gestational week of her third pregnancy. The lesions started from the axillae and spread centrifugally. Her two previous pregnancies were uncomplicated. There was no personal and…

Special Sections: Letters to the Editor

Intracranial Cryptococcal Infection in an Immunocompetent Patient

To the Editor:Cryptococcus neoformans is an opportunistic fungal infection that affects the central nervous system more frequently in immunocompromised hosts. It can infrequently be seen in immunocompetent patients as well.1 We report a case of an unusual presentation of cryptococcal infection in the brain in an immunocompetent patient.A 65-year old…

Special Sections: Letters to the Editor

Half and Half Nail Secondary to Chronic Renal Failure

To the Editor:A 54-year-old woman had type 2 diabetes more than 5 years without regularly taking an oral hypoglycemic agent. She took a Chinese herb to control blood sugar for several years and presented with one week of progressive nausea and malaise. On physical examination, the cardiac and pulmonary examinations…

Editorial

Postcholecystectomy Colon Cancer: An Unanswered Question

For more than thirty years, there has been debate over the potential role of cholecystectomy in colonic adenoma formation. Multiple mechanisms that may lead to adenomas and eventual colorectal cancer have been postulated (Fig.). One suggested mechanism is increased exposure of the colon to secondary bile acids following cholecystectomy. These…

Editorial

Pharmacotherapy Use Versus a Healthy Lifestyle

This issue of the Southern Medical Journal contains an intriguing study which examines specific health care-related trends from one time period to another. The authors analyzed specific data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1988–1994 and compared the information to similar NHANES data collected from…

Editorial

Measuring Our Outcomes

In carpentry it is often said that one should measure twice and cut once. This bit of wisdom applies to many areas of life including the critical care unit. The last two decades have seen an improvement in the outcomes from critical illness which has led to an increased interest…

Editorial

Helicobacter pylori and Gastric Cancer: A Marital Risk?

Since its discovery in 1982, Helicobacter pylori has had a major impact on the diagnosis and treatment of upper gastrointestinal disease.1 Numerous epidemiological studies link H. pylori infection to an increased risk of developing gastric cancer.2–5 These epidemiological studies led the International Agency for Research of Cancer to declare H….

Original Article

Ankle Brachial Index Measurement in Primary Care Setting: How Long Does It Take?

Background:Peripheral arterial disease (PAD) affects over 8 million people in the United States and has been found to be associated with an increased incidence of coronary and carotid artery disease. The ankle brachial index (ABI) measurement is a highly specific noninvasive screening and diagnostic test for PAD, but is rarely…

Original Article

A Previous Cholecystectomy Increases the Risk of Developing Advanced Adenomas of the Colon

Background:There is limited data assessing the relationship between cholecystectomy and colorectal adenomatous polyps (AP). Our aim was to determine if cholecystectomy was associated with an increased prevalence of advanced AP in male veterans.Methods:The relationship of whether prior cholecystectomy modified the natural history of AP was investigated in a retrospective study….

Original Article

Clarithromycin Resistance and Efficacy of Clarithromycin-Containing Triple Eradication Therapy for Helicobacter pylori Infection in Type 2 Diabetes Mellitus Patients

Background:Antimicrobial resistance in Helicobacter pylori infection is an important factor leading to failure of therapy. The aim of this study was to determine the eradication rate of H pylori in type 2 diabetes mellitus and to assess the effect of clarithromycin resistance on H pylori eradication.Method:Fifty-six consecutive patients with type…

Original Article

Remifentanil to Facilitate High-Resolution Computed Tomography Imaging of the Chest or Magnetic Resonance Imaging in Infants

Introduction:High-resolution computed tomography (CT) imaging or magnetic resonance (MR) imaging may require brief periods of apnea for image acquisition. In adults, this may be done by voluntary breath holding. In infants and children, such studies are generally performed under general anesthesia using a laryngeal mask airway with maintenance of spontaneous…

Case Report

Electroconvulsive Therapy for Malignant Catatonia in Adolescence

Abstract:Malignant catatonia is a severe form of catatonia which is acute in onset, and is systemically devastating, as it is associated with fever and autonomic instability. Although rarely described in children and adolescents, malignant catatonia should feature prominently in the differential diagnosis of acute pediatric encephalopathies, as it is a…

Case Report

H. pylori-Associated Gastric Cancer in a Husband-Wife Pair: A Veritable Family Affair

Abstract:Family environment probably represents a high route of transmission for H. pylori, a bacterium associated with gastric cancer (GC). We report two cases of GC in a husband-wife pair of immigrants from Romania. The disease was first diagnosed in the wife, and three years later in her husband of 55…

Editorial

Peripheral Arterial Disease: Increasing Awareness—A Major Step Forward

Peripheral arterial disease (PAD), an atherosclerotic syndrome of the aorta and lower extremity arteries, is highly prevalent, affecting 11 to 16% of the population aged 55 or older.1,2 Given the systemic nature of atherosclerosis, patients with PAD are at high risk for developing cardiovascular events such as myocardial infarction, stroke,…

Special Sections: Letters to the Editor

Meningitis from an Uncommon Serotype of Streptococcus Pneumoniae in a Young Child

To the Editor:Streptococcus pneumoniae (S. pneumoniae) is a leading cause of meningitis in young children.1 While the heptavalent pneumococcal conjugate vaccine (PCV7) has decreased the incidence of meningitis due to PCV7-serotypes and PCV7-related serotypes, the rate of non-PCV7 serotype disease has increased, with serotypes 19A, 22F, and 35B becoming increasingly…

Special Sections: Letters to the Editor

Polymyalgia Rheumatica Associated with Neck Surgery

To the Editor:Polymyalgia rheumatica (PR) is an immune-mediated clinical syndrome of unknown etiology. A causative relationship with genetic factors, infections, and malignancies has been postulated.1 We report the first case of PR occuring after surgery for parathyroid adenoma.Asymptomatic hyperparathyroidism was diagnosed in a 72-year-old woman. Diagnostic work-up disclosed a parathyroid…

CME Topic

November 2009 CME Questions

Medication Use for Diabetes, Hypertension and Hypercholesterolemia from 1988–1994 and 2001–20061. Medication use for which of the following conditions has increased more than 100% over the last 18 years?A. DiabetesB. HypertensionC. HypercholesterolemiaD. All of the aboveE. None of the above2. Which of the following medications currently used to control hypertension…

CME Topic

CME Submission Form