Issue - Southern Medical Association

Original Article

Epiploic Appendagitis: The Great Mimicker

Abstract:Epiploic appendagitis is a benign, self-limited, clinicopathological, and radiological entity that has become more commonly recognized. The clinical presentation resembles a variety of other medical and surgical intra-abdominal conditions and may easily be confused with many of them. Computed tomography (CT) demonstrates characteristic features that help make the diagnosis in…

Original Article

High Levels of Autoantibodies Against Catalase and Superoxide Dismutase in Nasopharyngeal Carcinoma

Introduction:Autoantibodies against the antioxidant enzymes have been described in Epstein-Barr virus-associated diseases. Here, we hypothesize that Epstein-Barr virus (EBV), which is associated with nasopharyngeal carcinoma (NPC), induces anticatalase and/or antisuperoxide dismutase autoantibodies that inhibit catalase and/or superoxide dismutase activities and thereby contribute to the oxidative stress status described in this…

CME Topic

Bronchus-Associated Lymphoid Tissue Lymphomas

Background:Bronchus-associated Lymphoid Tissue (BALT) lymphomas are a rare type of extranodal marginal zone lymphomas. They comprise 1% of lymphomas and more than two-thirds of all primary non-Hodgkin lymphoma (NHL) of the lung. BALT lymphomas arise from the bronchus-associated lymphoid tissue.Methods:This report describes five cases of BALT lymphoma and discusses the…

CME Topic

Surgical Margins in Breast Conservation Therapy: How Much Should We Excise?

Background:Breast conservation therapy (BCT) has become the standard of treatment for early stage breast cancer, and the surgical margin was one of the important factors that affected risk of local recurrence. This review looks at the safe margin for BCT in early stage invasive breast cancer and ductal carcinoma in…

Review Article

Basic Invasive Mechanical Ventilation

Abstract:Invasive mechanical ventilation is a lifesaving intervention for patients with respiratory failure. The most commonly used modes of mechanical ventilation are assist-control, synchronized intermittent mandatory ventilation, and pressure support ventilation. When employed as a diagnostic tool, the ventilator provides data on the static compliance of the respiratory system and airway…

Review Article

Narcolepsy: Clinical Decision Making for the Primary Care Physician

Abstract:Narcolepsy is a serious neurological condition in which patients are overcome by persistent, excessive feelings of fatigue and drowsiness. In addition to chronic fatigue, patients with narcolepsy often succumb to intermittent, uncontrollable periods where they abruptly fall asleep during waking hours. In addition to episodic bouts of daytime sleeping, narcoleptics…

Review Article

Pancreatic Injury

Abstract:Injury to the pancreas, because of its retroperitoneal location, is a rare occurrence, most commonly seen with penetrating injuries (gun shot or stab wounds). Blunt trauma to the pancreas accounts for only 25% of the cases. Pancreatic injuries are associated with high morbidity and mortality due to accompanying vascular and…

Case Report

Palliation of Malignant Rectal Obstruction from Invasive Prostate Cancer with Multiple Overlapping Self-Expanding Metal Stents

Abstract:Self-expandable metal stents (SEMS) are used for colonic neoplastic and extracolonic metastatic obstruction relief. Limited data exists on their use for locally invasive prostate cancer. We describe a unique approach using overlapping SEMS to alleviate a rectosigmoid obstruction from locally invasive prostate cancer. A patient with locally advanced prostate cancer…

Case Report

Prolonged Respiratory Illness After Single Overnight Continuous Positive Airway Pressure Humidification: Endotoxin as the Suspect

Abstract:A patient developed a prolonged respiratory illness after a single overnight use of tap water to humidify air supplied by a constant positive airway pressure (CPAP) device, which she had previously used for six years without difficulty. During those years, she used only distilled water for this purpose, as instructed…

Case Report

Brugada Syndrome Unmasked by Lithium

Abstract:A 38-year-old man was brought by emergency medical service after resuscitation following cardiac arrest. The patient was found pulseless with a wide complex tachycardia. The patient had bipolar disorder and was on lithium, lamotrigine, and ziprasidone. His electrolytes and lithium levels were normal. An electrocardiogram (EKG) was performed the next…

Case Report

Nonvenereal Sclerosing Lymphangitis of the Penis

Abstract:A 30-year-old man presented to the genitourinary medicine clinic with the sudden appearance of an asymptomatic, 2 mm wide, flesh-colored, firm, and cord-like lesion encircling the coronal sulcus circumferentially following vigorous sexual intercourse with his wife. An initial diagnosis of sexually transmitted disease-associated penile swelling was entertained. He was given…

Case Report

Primary Biliary Cirrhosis in an Elderly Man with Normal Liver Tests

Abstract:Primary biliary cirrhosis (PBC) is a cholestatic liver disease that usually presents in middle-aged women. Women are about ten times more commonly affected than men. The case of a 78-year-old man with PBC who presented with pruritus is discussed. Liver biopsy and antimitochondrial antibody serology were diagnostic of early-stage PBC.

Special Sections: Letters to the Editor

Pericarditis Revealing a Relapse of Sarcoidosis

To the Editor:Sarcoidosis is an immune-mediated condition affecting numerous organs, especially the lungs, lymph nodes, skin, and eyes.1–3 Cardiac manifestations are more uncommon complications in these patients. We recently observed a case of particular interest as the patient developed severe pericarditis revealing sarcoidosis relapse.A 43-year-old woman was diagnosed as having…

Special Sections: Letters to the Editor

Dilated Cardiomyopathy Associated with Bechterew Disease and Myopathy

To the Editor:Dilated cardiomyopathy (dCMP) is characterized by dilation of the cardiac cavities, systolic dysfunction and normal coronary arteries.1 dCMP may be idiopathic, genetic (20–30%), viral, or immunogenic.1 Although Bechterew disease (BD) has been reported together with dCMP, mitral valvulopathy with pericarditis, heart failure and conduction block, to our knowledge,…

Acknowledgment

Heyde Syndrome: A Common but Less Recognized Complex of Aortic Stenosis and Bleeding Intestinal Angiodysplasia

To the Editor:A 90-year-old woman presented with sudden onset massive hematochezia. Her medical history included severe aortic stenosis (AS) and atrial fibrillation with the treatment of warfarin for 10 years. Physical examination revealed hypotension, but no abdominal tenderness. Routine laboratory tests revealed a decreased hemoglobin of 6.7 g/dL. Emergent colonoscopy…

Editorial

New Direction for the Southern Medical Journal

As we celebrate the close of 2009, the editorial staff of the SMJ finds itself looking forward to 2010 with great anticipation. We are preparing to embark on a new venture with the Southern Medical Journal: beginning with the January issue, the SMJ will become an online-only publication—one of the…

Original Article

The Association Between Chlamydia pneumoniae and Metabolic Syndrome in Taiwanese Adults

Objective:Both Chlamydia pneumoniae (Cp) seropositivity and metabolic syndrome (MeS) have been identified as risk factors for atherosclerosis and cardiovascular disease (CVD), but the association between Cp seropositivity and MeS has not been extensively studied.Background:We recruited participants from Taiwanese adults who received an annual health examination at a medical facility. We…

Original Article

Mass Casualties from Acute Inhalation of Chlorine Gas

Objectives:Chlorine gas is a potent pulmonary irritant that affects the mucous membranes and induces severe disturbances of pulmonary gas exchange within minutes of inhalation. The present study evaluated an extraordinary type of mass inhalational exposure.Material and Methods:Clinical reports of 25 soldiers who were admitted to the emergency department of Maresal…

Acknowledgment

Metastases with Hypoadrenalism: Diagnostic Parallels and Diagnostic Traps

To the Editor:The association of primary hypoadrenalism and adrenal metastases as the sole presenting feature of bronchial carcinoma1 has, as its parallel, the association of secondary hypoadrenalism and pituitary metastasis as the sole presenting feature of hepatocellular carcinoma, and renal carcinoma, respectively.2,3 In my own experience, in the context of…

Editorial

Rectal Stents as an Alternative to Surgery

A case report in this issue of the Southern Medical Journal by Smith et al1 discusses the use of self-expanding metal stents (SEMS) to relieve colorectal obstruction due to prostate cancer. Heretofore, surgery was the accepted option for such a high-grade obstruction.Prostate cancer is the most common cancer in American…

Editorial

Comparative Role of Angiotensin Receptor Blockers Versus Other Agents in the Management of Hypertension, Cardiovascular Disease and Nephropathy

Cardiovascular disease (CVD) represents a pathological continuum that begins with a predisposing, progressive pathological process such as hypertension (HTN) and diabetes.1 Untreated, these processes perpetuate the progression of end-organ disease and present as new onset myocardial infarction, heart failure, end stage renal disease, stroke and/or death.The renin–angiotensin–aldosterone system (RAS) acts…

Acknowledgment

Multiple Faces of Sarcoidosis Mimicking an Underlying Disease: Don’t Forget Immunoglobulin G

To the Editor:I read with keen interest the case reported by Patel et al1 in the last issue of the Journal. I agree that nearly one third of sarcoidosis patients develop more progressive pulmonary disease that may lead to life threatening respiratory failure, bronchiectasis, and even severe pulmonary hypertension.I would…

Special Sections: Letters to the Editor

Cervical Spinal Epidural Abscess Complicated with Cerebral Salt Wasting

To the Editor:Cerebral salt wasting (CSW) is a mysterious clinical entity characterized by inappropriate natriuresis and volume contraction in response to intracranial pathology or neurosurgical intervention. Diagnosis can be difficult and therapy is challenging. CSW frequently occurs in patients with brain injury and neurosurgical intervention, but it is extremely rare…

Editorial

Mechanical Ventilation Simplified

Mechanical ventilation (MV) is an intervention used to artificially supplement, or substitute breathing. The first account of mechanical breathing was by the second century Roman physician Galen, where he describes blowing air through a reed into the larynx of a dead animal.1 In 1908 professor George Poe (a cousin of…

Acknowledgment

Regarding “The Third Wave: Medical Tourism in the 21st Century”

To the Editor:While medical tourism involving American patients traveling abroad increases, academic medical centers in the United States have actively recruited wealthy foreigners for treatment in luxury (“concierge”) practices.1,2 Despite such centers’ historical tradition of being the providers of last resort for the underserved, their concierge practices have burgeoned, while…

Editorial

The Metabolic Syndrome: Underdiagnosed and Undertreated

The metabolic syndrome (MSy) has become an important public health problem worldwide, yet it remains underdiagnosed and undertreated. Timely identification, diagnostic tools that provide accurate assessment of the burden of risk, and continued research to identify causal and contributory factors are all crucial to effectively address this growing health threat.Rates…

Scientific Paper Abstracts

Poster Presentation Abstracts

Editorial

Alternative Approaches to Pancreatic Duct Injury

Ahmed and Vernick1 provided an excellent overview on the diagnosis and management of pancreatic injury. We agree that patients presenting with significant concern for blunt abdominal injury require additional evaluation beyond physical exam, and abdominal computed tomography (CT) scans have quickly become the standard. In regards to pancreatic trauma from…

CME Topic

December 2009 CME Questions

Bronchus-Associated Lymphoid Tissue Lymphomas1. Which of the following statements is true of bronchus-associated lymphoid tissue (BALT) lymphoma?A. It is a common type of lymphoma.B. It is a rare low-grade lymphoma, and its prognosis is usually good.C. It is associated with Mycoplasma pneumoniae infection.D. It is a form of Hodgkin lymphoma.E….

CME Topic

CME Submission Form

Special Section: In Appreciation

In Appreciation

The editor and staff of the Southern Medical Journal would like to extend their appreciation to those who served as reviewers during 2009. The editorial staff apologizes for any omissions or errors.John Abide, MDV. Aboyans, MD, PhDS Abramson, MDSouvik Adhikari, MSSusan Adkins, RN, MSN, CCRN, ACNP-CEmmanuel Agaba, MD, FRCSEnoch Agunanne,…

Original Article

Prayers in the Clinic: How Pediatric Physicians Respond

Background:Physicians and researchers have recently paid increased attention to prayer in physician-patient interactions. Research focuses more on attitudinal questions about whether physicians and/or patients think prayer is relevant than on actual data about when and how prayer comes up in the clinic and how physicians respond. We focus on pediatric…

Case Report

Priapism and Risperidone

Abstract:A patient taking oral risperidone while using cocaine and alcohol presented with priapism shortly after long-acting, injectable risperidone was prescribed. Another case of priapism was diagnosed in a sickle cell disease patient who was on oral risperidone. A penectomy due to necrosis was required in the first case, while the…