Issue - Southern Medical Association

Original Article

Community-Associated Methicillin-Resistant Staphylococcal Infection in an Inner City Hospital Pediatric Inpatient Population

Background:Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a serious problem in the community setting, primarily as a cause of skin and soft tissue infections.Methods:A retrospective study based on the review of pediatric inpatients admitted to Lincoln Medical and Mental Health Center from March 2006 to February 2007 was performed.Results:Eighteen (55%)…

Original Article

Pharmaceuticals Companies’ Medication Assistance Programs: Potentially Useful but Too Burdensome to Use?

Objectives:This study examined how physicians perceive pharmaceutical companies’ medication assistance programs (MAPs).Methods:The study was conducted using a survey of 373 primary care physicians from four southern states; they were surveyed within the formative evaluation phase of a larger study (MI-Plus). Respondents were queried about use and usefulness of MAPs for…

Original Article

A Comparative Study of Unscheduled Hospital Readmissions in a Resident-Staffed Teaching Service and a Hospitalist-Based Service

Background:The rate of unscheduled readmissions is an important quality indicator with financial implications for hospitals.Objective:To determine if resident-staffed services have more favorable outcomes compared to hospitalist services, predictors of readmissions were determined within an academic hospital.Methods:From November 1, 2006 to April 30, 2007, 5943 admissions were assigned to a resident-staffed…

Original Article

Use of Intrathecal Nicardipine for Aneurysmal Subarachnoid Hemorrhage-Induced Cerebral Vasospasm

Background:Cerebral vasospasm leading to delayed ischemia is a common and serious complication of aneurysmal subarachnoid hemorrhage that often results in increased morbidity and mortality. Treatments for cerebral vasospasm, including triple-H therapy (therapeutic hypervolemia, hypertension, and hemodilution), nimodipine, balloon angioplasty, and intra-arterial vasodilators have limitations in their efficacy and safety profiles….

Original Article

Comparison of Bronchoscopic Washing and Gastric Lavage in the Diagnosis of Smear-Negative Pulmonary Tuberculosis

Objective:To evaluate the diagnostic contribution and utility of bacteriologic surveys using bronchoscopic washing and gastric lavage in cases of radiologically suspected tuberculosis with no detectable acid-fast bacilli (AFB) in the sputum.Material and Methods:This prospective study performed bronchoscopic lavage following gastric washing in suspected pulmonary tuberculosis patients. The presence of AFB…

Original Article

Chinese Metabolic Syndrome Risk Score

Background:The metabolic syndrome (MetS) was first proposed to predict the occurrence of cardiovascular disease and type 2 diabetes. However, it is difficult to identify subjects with MetS early. No previous studies designed to develop a predictive model for MetS in the Chinese population exists; this study was designed to fill…

CME Topic

Tracheobronchial Foreign Body Aspiration in Adults

Abstract:Tracheobronchial foreign body (TFB) aspiration is rare in adults, although incidence rates increase with advancing age. Risk factors for TFB aspiration in adults are a depressed mental status or impairment in the swallowing reflex. Symptoms associated with TFB aspiration may range from acute asphyxiation with or without complete airway obstruction,…

Review Article

New Guidelines for the Prevention and Treatment of Osteoporosis

Abstract:The World Health Organization Fracture Risk Assessment Tool (FRAX™) and the National Osteoporosis Foundation’s (NOF) Clinician’s Guide to Prevention and Treatment of Osteoporosis are helpful clinical tools in the management of osteoporosis. Appropriate use of these tools requires a clear understanding of their limitations as well as their benefits. Good…

Review Article

Concurrent Smoking-Related Interstitial Lung Diseases in a Single Patient

Abstract:The three smoking-related interstitial lung diseases (ILD) include desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and pulmonary Langerhans cell histiocytosis (PLCH). They are considered discrete entities, yet it is not unusual to find a mixture of pathologic features rendering the histopathologic diagnosis difficult. It is uncommon to…

Case Report

Adult Segmental Hirschsprung Disease

Abstract:Hirschsprung disease (HD) is characterized by aganglionosis, which mainly occurs in the rectum and distal sigmoid colon. Typical HD is seldom diagnosed in adulthood, and segmental involvement is very rare. A 37-year-old man suffered from refractory constipation for 20 years. He could only defecate once a week and frequently needed…

Case Report

A Strange Case of Acute Abdomen

Abstract:A 30-year-old male suffered from acute abdomen following duodenal biopsy taken at esophagogastroduodenoscopy (EGD). Exploratory laparotomy showed a large retroperitoneal hematoma arising from the second part of the duodenum that was then treated conservatively. To the authors’ knowledge, this is the first case of extensive retroperitoneal hematoma following EGD. The…

Case Report

Acute Acalculous Cholecystitis Simulating Mirizzi Syndrome: A Very Rare Condition

Abstract:Mirizzi syndrome, a rare complication of chronic cholelithiasis, is caused by an impacted stone in the cystic duct or the neck of the gallbladder. Patients present with abdominal pain, fever, and obstructive jaundice. The cholangiographic finding is a smooth stricture caused by lateral compression of the common hepatic duct. A…

Case Report

Disseminated Intravascular Coagulation Precipitated by Thyroid Storm

Abstract:Thyroid storm is a rare disorder. Early recognition and treatment are essential in reducing morbidity and mortality from this disease. Described here is a case of atypical thyroid storm (normothermic, normotensive), accompanied by multiple organ dysfunction syndrome, including disseminated intravascular coagulopathy. This case highlights the importance of recognizing atypical presentations…

Case Report

Xanthogranulomatous Inflammation of the Colon: A Rare Cause of Cecal Mass With Bleeding

Abstract:Xanthogranulomatous inflammation is a well-defined disease most frequently reported in the kidney and gallbladder. The occurrence of this disease in the colon is extremely rare, with only five cases of appendix vermiformis involvement in the literature. Its clinical importance is that it can be misinterpreted as a malignant process clinically…

Editorial

The Rising Tide: Skin and Soft Tissue Infections Due to Community-Associated Methicillin-Resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of skin and soft tissue infections (SSTIs) in persons without typical healthcare-associated MRSA (HA-MRSA) risk factors, such as hospitalization or residence in a long-term care facility, surgery or dialysis in the prior year, the presence of an indwelling device, or…

Case Report

Community-Acquired Methicillin-Resistant Staphylococcus aureus: An Emerging Cause of Acute Bacterial Parotitis

Abstract:Staphylococcus aureus has long been recognized as a cause of acute bacterial parotitis. A case of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) parotitis is presented, highlighting the emergence of this increasingly important pathogen to cause a wide variety of infections. Also reviewed are the salient clinical and microbiologic features of this…

Case Report

An Interesting Case of Positional Hypoxia: The Effect of Multiple Synergistic Pathological Conditions

Abstract:This report describes an elderly patient evaluated for generalized fatigue, dyspnea, presyncopal episodes, and positional hypoxemia. Workup revealed posturally related oxygen desaturation, a patent foramen ovale (PFO), an atrial septal aneurysm, and primary adrenal insufficiency. Normal intracardiac pressures and a right-to-left PFO shunt were present only while the patient was…

Case Report

Bilateral Leser-Trélat Sign Mirroring Lung Adenocarcinoma with Early Metastases to the Contralateral Lung

Abstract:We present a case featuring a unique overlap between the body areas involved by lung adenocarcinoma and the cutaneous paraneoplastic sign of Leser-Trélat. In our patient, the Leser-Trélat sign consisted of explosive multiple seborrheic keratoses in combination with acanthosis nigricans, representing a remarkable geometric skin projection of lung cancer which…

Editorial

Physician Customer Satisfaction and Medication Assistance Programs from Pharmaceutical Companies

According to the US Census Bureau, in 2006 approximately 15.8% (47 million) of Americans did not have health insurance1—many because of financial constraints. Consequently, these people also cannot afford the cost of the medications necessary to treat their illnesses.Pharmaceutical medication assistance programs (MAPs) constitute one method of help for individuals…

Special Sections: Letters to the Editor

Unusual Metastasis of Carcinoma Gallbladder

To the Editor:A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall, anterior chest wall, back, and in both breasts for the previous two months. These nodules presented simultaneously, were painless and increased progressively in size. She complained of a significant, associated weight loss. She was cachectic and…

Special Sections: Letters to the Editor

Synchronous Occurrence of Colorectal Adenocarcinoma and Colonic Gastrointestinal Stromal Tumor

To the Editor:Gastrointestinal stromal tumors (GISTs) have only recently become recognized as a distinct pathologic entity.1 The vast majority of these tumors are positive for CD117 and vimentin in immunohistochemical staining.2GISTs typically present in older individuals and are most common in the stomach, followed by the small intestine, colon/rectum, and…

Editorial

Big Bleed After Endoscopic Mucosal Biopsy

The case report by Galea et al1 concerns a life-threatening retroperitoneal bleed after duodenal biopsies during a routine esophagogastroduodenoscopy (EGD) to screen for celiac disease. It is likely that the artery inadvertently was clasped or punctured by the forceps. Clinical significant bleeding with “cold biopsy” forceps during EGD occurs in…

Editorial

Thyroid Dysfunction and the Coagulation System: The Often Ignored Link

The relationship between thyroid dysfunction and coagulation abnormalities has been known for a very long time.1 These coagulation abnormalities have been in the form of thrombotic disorders as well as bleeding diatheses. Most of the abnormalities of the coagulation system might stem from the direct action of thyroid hormones on…

Case Report

Tick Paralysis as a Cause of Autonomic Dysfunction in a 57-Year-Old Female

Abstract:Both Guillain-Barré and tick paralysis can present with ataxia and acute, ascending, flaccid motor paralysis. While autonomic dysfunction has been identified in Guillain-Barré, it has never been reported in association with tick paralysis—possibly due to the rapid recovery of tick paralysis patients after removal of the tick. We present a…

Case Report

Childhood Hepatitis A Virus Infection Complicated by Pseudotumor Cerebri

Abstract:A 4-year-old male child with hepatitis A virus (HAV) infection is presented. His disease course was complicated by the development of pseudotumor cerebri (PC), as evidenced by symptoms and signs of increased intracranial pressure in the presence of normal cerebrospinal fluid examination and cranial magnetic resonance scan. The neurological examination…

Case Report

Peritoneal Dialysis Masking Symptoms of an Insulinoma Uncovered During the Perioperative Period: A Case Report

Abstract:A 61-year-old male with a chronic history of renal insufficiency treated with peritoneal dialysis (PD) was discovered to be asymptomatic for an occult insulinoma after peripheral revascularization. The patient's near continuous provision of glucose in the PD fluid acted to conceal symptoms of an insulinoma which was revealed when PD…

Case Report

Paralysis in an Adolescent

Abstract:An 18-year-old male with a history of diabetes presented with hemiparesis. His serum glucose was low, but did not fit the numerical criteria for hypoglycemia. His symptoms rapidly reversed after glucose infusion. This case illustrates crucial features of hypoglycemia. Symptoms may be atypical in the young adult population and may…

Case Report

Inguinal Endometriosis: Three Cases and Literature Review

Abstract:Three cases of endometriosis infiltrating the round ligament are presented. The initial diagnosis was irreducible hernia, since this rare nosologic entity often causes unusual preoperative symptoms and diagnostic problems. Diagnosis is frequently made by histologic examination. The rarity of inguinal endometriosis should not exclude it from a possible diagnosis in…

CME Topic

Artifactual Laboratory Abnormalities in Patients with Paraproteinemia

Abstract:Paraproteinemia, most often as a result of monoclonal gammopathy of unknown significance (MGUS), is very common and its prevalence is expected to increase with the aging of the population. Paraproteins can be associated with a variety of laboratory abnormalities. These may occur as a result of the underlying disease process…

Case Report

Boerhaave Syndrome Presenting as Massive Hemothorax

Abstract:Boerhaave syndrome is a rare entity which classically presents with perforation and mediastinal sepsis. The patients' outcome is directly related to the length of time required to diagnose and surgically address the syndrome. Atypical presentations can contribute to a delay in recognizing the phenomenon, which portends poorly. The case of…

Editorial

Hirschsprung Disease in Adults

Congenital aganglionic megacolon was first described in 1886 by Harald Hirschsprung, who described the autopsies of infants who died with swollen abdomens and hypertrophied colonic walls. The pathophysiology has been hypothesized to be a failure of the neural crest cells to migrate to colonic segments during embryonic development. This leads…

Editorial

Cholecystectomy in Patients with Mirizzi Syndrome: A Formidable Challenge

In this issue of the Journal, Ahlawat1 describes a case of acute acalculous cholecystitis which simulated Mirizzi syndrome (MS). MS, a rare complication of prolonged cholelithiasis, has a spectrum that varies from extrinsic compression of the common hepatic duct to the presence of a cholecystobiliary fistula. MS represents a dangerous…

Special Sections: Letters to the Editor

Guidelines to Improve Maternity Practices and Support Breast-Feeding Are Readily Available

To the Editor:Breast-feeding, as the species-specific food for infants, offers optimal nutrition and provides economic benefits to the family, health system, and society.1–5 There is convincing evidence for the adequacy of human milk as the only nutritional intake for normal infants for the first 6 months.6 The American Academy of…

Special Sections: Letters to the Editor

Bilateral Vocal Cord Paralysis in Systemic Lupus Erythematosus

To the Editor:Laryngeal involvement in systemic lupus erythematosus (SLE) is rare. It can range from mild ulcerations to vocal cord paralysis. Most are responsive to steroid therapy. We present a rare case of SLE with rapidly progressing pulmonary hypertension and bilateral vocal cord paralysis not responding to corticosteroid therapy.A 24-year-old…

Special Sections: Letters to the Editor

Simple Disease, Complex Work-up

To the Editor:Hypercalcemia is a fairly common metabolic emergency. Rapid diagnosis of hypercalcemia may be complicated because symptoms associated with hypercalcemia are characteristically nonspecific.A 50-year-old white male with no significant past medical history was brought to the emergency room by paramedics. He was complaining from a severe headache, had slurred…

Special Sections: Letters to the Editor

Klebsiella pneumoniae Deep Neck Infection with Acute Necrotizing Esophagitis

To the Editor:Deep neck space infections are potentially life-threatening conditions which may cause significant complications, such as mediastinitis, pleural empyema, pericarditis, and disseminated intravascular coagulopathy. However, to our knowledge, acute necrotizing esophagitis as a complication caused by deep neck infections has never been reported before.A 48-year-old male with a history…

Editorial

Smoking-Associated Interstitial Lung Diseases

Smoking is the number one preventable cause of untimely death and mortality in the Unites States and worldwide.1,2 Cigarette smoking is the main cause of lung cancer and the leading cause of death due to cancer in both sexes.1,2 Every year, research reveals more harmful effects of smoking. Although the…

Special Sections: Letters to the Editor

Unilateral Clubbing Without Shunts

To the Editor:I read with interest the article by Cerny et al.1 The authors conclude that arteriovenous shunts are a “condition sine qua non” to develop hypertrophic pulmonary osteoarthropathy. I disagree. Arterial graft sepsis and hemiplegic stroke, which are well-known causes of unilateral clubbing, might not require such shunts to…

Editorial

Lecturing for Industry—Death by Powerpoint®

In a cramped antechamber with noisy, sliding glass doors just off the main dining room of a trendy Italian restaurant, a few physicians, a few more hospital pharmacists, two nurse clinicians, and a medical technologist mill about in several uncomfortable groups waiting for the “educational program” to begin. The representative…

Editorial

Tick Paralysis: An Uncommon Dimension of Tick-Borne Diseases

Ticks are arachnids, related to spiders and scorpions. During the late Paleozoic or early Mesozoic era they became parasites,1 and are second only to mosquitoes in transmitting vector-borne diseases to humans. Ticks of medical importance are divided into two families: Argasidae (soft ticks) and Ixodidae (hard ticks).Cases of tick paralysis…

Special Section

Medical Webwatch

From Indiana University comes Human Embryology Animations http://www.indiana.edu/∼anat550/embryo_main/index.html produced by “Dr. Valerie O'Loughlin, Assistant Professor of Anatomy and Director of Undergraduate Human Anatomy.” Their animations were “… developed so students could better understand the complex processes that must occur in embryologic development.” These delightfully smooth animations are annotated with stand-alone…

Patient's Page

Patient’s Page

Preventing Heart Failure: Protecting Your Heart, Saving Your LifeThe heart is the body’s most important organ. The fetal heart develops as early as three weeks, and, from there, works nonstop for an entire lifetime. The human heart beats around 100,000 times a day, and 35 million times over a year.1…

CME Topics

February 2009 CME Questions

Artifactual Laboratory Abnormalities in Patients with Paraproteinemia1. The following is true about monoclonal gammopathy:A. The most common cause in unselected individuals is monoclonal gammopathy of undetermined significance (MGUS)B. The prevalence of monoclonal gammopathy increases with ageC. Higher prevalence has been reported in the African-American populationD. All of the above2. An…

CME Topic

CME Submission Form

Erratum

Erratum

In the article “Gastric Carcinoid Tumor in Association with Hepatocellular Carcinoma: A Case Report,” which appeared in volume 101 of the Southern Medical Journal on pages 1170–1172, the last names of several of the authors were inadvertently listed as the first names. The corrected author names are as follows: Athanasios…