Issue - Southern Medical Association

Original Article

Exposure Risks and Tetanus Immunization Status in Farmers Ages 50 and Over

Background:Despite an effective tetanus vaccine, tetanus continues to claim lives worldwide. The very young and the elderly are at highest risk for the disease. Farmers are at high risk for injury, the leading factor associated with tetanus.Methods:As part of a larger study of older members of farm households in the…

Original Article

Measurement of Central Venous Pressure from a Peripheral Intravenous Catheter in the Prone Position During Spinal Surgery

Introduction:A central venous pressure (CVP) measurement is used to assess intravascular status. Although this is usually accomplished by the placement of a central venous catheter (CVC), there are circumstances when placement may be technically difficult or impossible. The current study evaluates the feasibility of measuring CVP from a peripheral intravenous…

Original Article

A Survey of Mothers’ Comfort Discussing Contraception with Infant Providers at Well-Child Visits

Objective:To determine whether mothers feel comfortable with their infants' providers discussing contraception with them at their infants' well-child checks.Methods:A cross-sectional survey was conducted using a convenience sample of 114 mothers presenting at a community family medicine residency program for well-child visits among infants up to 17 months old.Results:Almost all mothers…

Original Article

Maternal Characteristics and Outcomes Associated with Late Enrollment for Care in Teenage Pregnancies

Objective:To identify characteristics associated with late prenatal care in adolescent mothers.Methods:This retrospective cohort study reviews all nulliparous adolescent deliveries at the authors' institution during 2000–2004. Subjects were divided into three trimester groups using American College of Obstetricians and Gynecologists standard definitions. First trimester enrollees served as controls. Second and third…

Original Article

Characteristics of Second Primary Lung Malignancy in Patients with Known Breast Cancer

Background:As breast cancer survival improves, the incidence of additional malignancies will likely rise. Identification of a lung nodule in a patient with known breast cancer poses a challenging diagnostic problem. This study outlines the management of such patients and identifies factors that correlate with survival.Methods:From 1977 through 2002, 35 patients…

CME Topic

Clinical Definition of COPD Exacerbations and Classification of Their Severity

Abstract:A standardized definition of chronic obstructive pulmonary disease (COPD) exacerbation still represents an unmet need in respiratory medicine; definitions currently rely on clinical empiricism with little evidence-based scientific support. Exacerbations of COPD are certainly clear events in the mind of practicing physicians. However, when one tries to provide simple concepts…

CME Topic

Causes and Risk Factors for Postoperative Fever in Spine Surgery Patients

Abstract:Postoperative fever is a common dilemma faced by neurosurgeons. To study this problem, we prospectively collected patients who developed fever after spine surgery during the academic year 2007–2008 for whom the internist's consultation was requested. Eighty-five (85) patients were identified, of which 17 had an identifiable infectious cause for their…

Case Report

The Water Jet Deformation Sign: A Novel Provocative Colonoscopic Maneuver to Help Diagnose an Inverted Colonic Diverticulum

Abstract:Colonoscopic differentiation of an inverted colonic diverticulum from a true colonic polyp is important because a true colonic polyp usually requires colonoscopic snare polypectomy or at least biopsy, whereas these maneuvers are contraindicated for an inverted diverticulum due to the risk of colonic perforation. Previously described diagnostic maneuvers to evert…

Case Report

Acute Stress Cardiomyopathy Following Treatment of Status Asthmaticus

Abstract:Broken heart syndrome, otherwise known as takotsubo syndrome, is stress-induced cardiomyopathy. Clinical presentation mimics acute ST segment elevation myocardial infarction, but with characteristic left ventricular apical ballooning. The mechanism is linked to overstimulation of the sympathetic system from high circulating catecholamine levels. We report a 46-year-old Caucasian female whose treatment…

Case Report

When Childbirth Causes Reversed Hemodialysis and Renal Failure

Abstract:A 26-year-old woman with no prior illness presented with progressive weakness, nausea and vomiting. Evaluation revealed acute renal failure and a large amount of ascites in her abdomen. A cystogram demonstrated leakage of contrast into the peritoneal cavity, confirming bladder injury. This precipitated “reverse” autoperitoneal dialysis. She had likely sustained…

Case Report

Grapefruit Juice and Verapamil: A Toxic Cocktail

Abstract:The US public consumes grapefruit juice in large quantities, with 14% of the population drinking the juice at least weekly. Grapefruit juice is a well-documented inhibitor of the CYP3A4 isoenzyme, which is involved in the metabolism of over 50% of commonly prescribed drugs. Here we report an unusual case of…

Case Report

Sebaceous Gland Carcinoma of the Right Flank

Abstract:Extraocular sebaceous gland carcinoma is a rare cutaneous malignancy which sometimes can grow rapidly. There is no proven effective treatment for metastatic disease, but the tumor can be successfully treated by surgery if diagnosed early. We report an 83-year-old gentleman with a rapidly growing sebaceous gland carcinoma of the right…

Editorial

Mobile Discharge Instruction Videos (MDIV) in Primary Care Settings: An Innovative Audiovisual Tool

The study by Choi et al1 presents a novel approach to bolstering patient care. It is pertinent to the medical community since patient education is a growing area of research. The issue of following discharge instructions is especially important for clinicians since patients' failure to follow such instructions can adversely…

Case Report

Spontaneous Coronary Artery Dissection: Case Report and Review of Literature

Abstract:Spontaneous coronary artery dissection (SCAD) is a deadly cause of myocardial infarction (MI) that mainly affects otherwise healthy, young females. We examine the case of a young female who presented with chest pain. She developed ST elevations in anterolateral leads mimicking ST elevation MI. Cardiac catheterization was done and showed…

Case Report

Calciphylaxis in Primary Hyperparathyroidism: A Case Report and Brief Review

Abstract:A 52-year-old woman was admitted with complaints of nonhealing skin ulcers. The laboratory assessment showed a calcium level of 13.2 mg/dL (normal 8.4–10.2 mg/dL), albumin 2 g/dL (normal 3.5–4.8 g/dL), corrected calcium 14.8 mg/dL, phosphorus 1.4 mg/dL (normal 2.4–4.7 mg/dL), creatinine 0.7 mg/dL (normal 0.5–1.2 mg/dL), parathyroid hormone 893.3 pg/mL…

Case Report

A Case of Bone Metaplasia of the Gallbladder Epithelium

Abstract:The case of a 53-year-old female with abdominal pain is presented. Abdominal ultrasound was unremarkable, a HIDA scan demonstrated biliary dyskinesia, and a computed tomography scan of the abdomen and pelvis revealed an intraluminal gallbladder hyperdensity suspicious for a gallstone. A laparoscopic cholecystectomy was performed and, on pathologic examination, no…

Case Report

Uterine Leiomyosarcoma Metastatic to Soft Tissue of the Flank Following a Ten-Year Disease-Free Interval

Abstract:A 52-year-old female presented with a metastatic uterine leiomyosarcoma to the left flank ten years following total abdominal hysterectomy for a left adnexal primary. Due to the location of the metastasis in the subcutaneous tissue, it was initially felt to be a lipoma. Following excision, pathology revealed leiomyosarcoma. Rarely do…

Special Sections: Letters to the Editor

Acute Hepatitis in a Patient Given Propofol During Colonoscopy

To the Editor:Colonoscopy is an effective colon cancer screening procedure and is becoming increasingly common with our aging population. It is important for physicians to be aware of any potential complications of the procedure. We present a case of acute hepatitis in a patient given propofol during colonoscopy.A 62-year-old female…

Editorial

Jewish Law and End-of-Life Decisions

There are few things more painful to witness than a close relative suffering from a chronic debilitating illness slowly stealing away his or her life. Having lived through that experience with a family member who had amyotrophic lateral sclerosis for two years prior to her death, I can testify that…

Special Sections: Letters to the Editor

Ingestion and Endoscopic Retrieval of Tweezers in a 23-Year-Old Patient

To the Editor:A 23-year-old male of Puerto Rican descent presented to our institution requesting the surgical removal of a pair of tweezers, which he reportedly swallowed by mistake the evening prior. He denied having suicidal ideation, but psychiatric history included lacerating his arms and abdomen at the age of 8…

Editorial

Missed Opportunities

Tetanus toxoid has been available since 1924. Its use became widespread during World War II when mortality from tetanus-infected battle wounds became exceedingly rare with high immunization rates among the soldiers. Tetanus toxoid use spread to the general population and the number of tetanus cases dropped to a low of…

Editorial

Toward a Standardized Definition and Severity Classification of COPD Exacerbations

In this issue of the Southern Medical Journal, Caramori et al1 review the clinical definitions and classifications of the severity of chronic obstructive pulmonary disease (COPD) exacerbations. Ideally, the definition should be unambiguous; the criteria for severity classification must be rigorous and validated clinically.Because the incidence and severity assessment of…

Editorial

Broken Heart Syndrome: An Under-recognized Phenomenon

In this issue, Osuorji et al1 report a unique case of a 46-year-old female whose treatment of status asthmaticus with ketamine and epinephrine induced Takotsubo cardiomyopathy. This likely under-recognized phenomenon, also known as “broken heart syndrome,” is a transient, acute left ventricular apical ballooning in the absence of significant coronary…

Original Article

The Effectiveness of Mobile Discharge Instruction Videos (MDIVs) in Communicating Discharge Instructions to Patients with Lacerations or Sprains

Objective:This study evaluates the effectiveness of mobile discharge instruction videos (MDIVs) in communicating discharge instructions to patients with lacerations or sprains.Method:A prospective controlled study was performed on patients with lacerations or sprains in a quaternary emergency center from April 1, 2008 to May 31, 2008. Upon discharge, patients were systematically…

Case Report

Urticaria Due to Etanercept in a Patient with Psoriatic Arthritis

Abstract:A 50-year-old woman was referred to our emergency room because of urticaria. Eleven days after etanercept therapy was started, the patient developed an urticarial rash of the trunk and face. A diagnosis of generalized urticaria was made. Etanercept treatment was suspended. Treatment was started with methylprednisolone and dexchlorpheniramine. The patient’s…

Case Report

Diabetic Neuropathic Cachexia: A Rare Manifestation of Diabetic Neuropathy

Abstract:Diabetic neuropathic cachexia is characterized by bilateral, painful neuropathy usually involving the anterior thighs, with dramatic weight loss. The cause is unknown. Most patients to date have been middle-aged type 2 diabetics on oral agents, and it has rarely been reported in patients with type 1 diabetes. Most patients recover…

Case Report

Doxycycline-Induced Pseudotumor Cerebri

Abstract:Tetracyclines are a commonly prescribed medication for the treatment of acne vulgaris that are associated with pseudotumor cerebri (PTC). With doxycycline specifically, however, the incidence of PTC is very rare. A patient was using oral doxycycline and topical retinoids for acne, and within two months she developed PTC. This case…

Review Article

Iatrogenic Meningitis in an Obstetric Patient After Combined Spinal-Epidural Analgesia: Case Report and Review of the Literature

Abstract:Iatrogenic meningitis is a rare but potentially fatal condition. We report a case of meningitis after combined spinal-epidural anesthesia and review previous reports of meningitis subsequent to spinal, combined spinal-epidural and epidural analgesia or anesthesia. Streptococci remain the most commonly identified agent, although cultures are frequently negative. Droplet contamination or…

Original Article

Fluids and Nutrition: Perspectives from Jewish Law (Halachah)

Purpose:The use of nutrition and hydration in the terminally ill had been considered normal supportive measures until recently. Currently, many institutions, health care personnel and family members hold that nutrition and hydration are extraordinary measures that may be terminated.Methods:A case is offered to discuss the ruling by traditional Jewish law…

Review Article

The General Surgeon Shortage: Causes, Consequences, and Solutions

Abstract:In recent years, there has been great interest in the looming shortage of general surgeons. The media has begun to take notice, and politicians are now being forced to answer difficult questions regarding access to emergent surgical care. There are a number of issues which have impacted upon the shortage:…

Case Report

A Re-emerging Infection?

Abstract:A 38-year-old female with a two-week history of amoxicillin use for fever, cough, and coryza presented with two days of erythematous chest macules. Despite discontinuation of the antibiotic, her rash continued; measles was diagnosed with IgM titers. Three weeks previously she had returned from China. She had received only one…

Case Report

Trichomonal Sinusitis in an Adolescent Patient with Multiple Trauma

Abstract:Trichomonal disease typically involves the genital and occasionally respiratory tracts. Although exposure of the upper respiratory tract to infected genital secretions is not uncommon with contemporary sexual practices, trichomonal sinus disease has been rarely described. The present report describes the case of a healthy 17-year-old male admitted to an intensive…

Special Sections: Letters to the Editor

Erythroderma as the First Manifestation of Colon Cancer

To the Editor:Skin disorders are common and associations with systemic illnesses, such as end stage renal failure, diabetes mellitus, and thyroid diseases are well recognized. Associations with underlying nondermatological malignancies have been reported, but are extremely rare.1,2A previously healthy 76-year-old man presented to the dermatologist with a 1-month history of…

Special Sections: Letters to the Editor

Lansoprazole-Induced Acute Interstitial Nephritis

To the Editor:A 70-year-old Caucasian male presented to his primary care provider with a history of fatigue and nausea of two weeks’ duration. The patient denied fever, vomiting, or other constitutional symptoms. Three weeks prior to presentation, the patient took lansoprazole for his worsening reflux symptoms. Four days after taking…

Special Sections: Letters to the Editor

Dieulafoy Lesion: A Rare Cause of Gastrointestinal Bleeding

To the Editor:Dieulafoy lesion is an uncommon cause of major gastrointestinal bleeding and may be difficult to recognize. It consists of a large caliber artery that protrudes through a mucosal defect in the stomach causing significant and often recurrent hemorrhaging from a pinpoint nonulcerated arterial lesion. It has been identified…

Special Section

Medical Webwatch

This is the “Education & Resources” section of the Nephrology Gateway, http://www.nature.com/isn/education/index.html, a publication of the International Society of Nephrology, based in Brussels. Under the “Education Articles” on the left menu can be found “Multimedia,” which lists some interesting material. Another good starting page is “Browse all articles,” http://www.nature.com/isn/education/subject/subject.html, which…

Patient's Page

Patient’s Page

Rest EasyRecent studies show that sleep is more than just “shut-eye.” And, with 40 million Americans suffering from chronic, long-term sleep disorders each year, the dangers and costs warrant a full examination of sleep and its contributions to health.1What Does Sleep Do?1Sleep and the BrainSleep provides restoration to parts of…

Editorial

Beware the Inverted Diverticulum!

The accompanying article by Cappell1 describes differentiation of a colon polyp from an inverted diverticulum by application of a water perfusion technique. Specifically, water jet liquid pressure can be used to partially or entirely evert a diverticulum that is protruding into the colon lumen and mimicking a polyp. This differentiation…

Editorial

The Importance of Measles Vaccinations

Measles is an integral component of the measles, mumps, and rubella (MMR) vaccine, which consists of the three live attenuated viruses. Vaccination is usually performed in childhood, and is completed with a series of two inoculations. A single dose is typically adequate; antibodies develop in approximately 95% of children vaccinated…

Special Sections: Letters to the Editor

The Effect of Severe Iron Deficiency Anemia on Primary Photophobia

To the Editor:A 73-year-old physician presented with an exacerbation of eye pain. Past history included mild hypothyroidism and mild diabetes, both easily treated with oral medications. Past surgeries included fusion of lumbar disk and fractured femur. The patient’s symptoms began after six weeks of at least sixteen hour days on…

Special Sections: Letters to the Editor

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of a Mediastinum Mass with Severe Central Airway Obstruction After Stenting

To the Editor:Severe central airway obstruction (CAO) is sometimes complicated by various benign and malignant mediastinum lesions.1 Clinical signs of airway obstruction, the extent of the disease, or comorbidities sometimes make these patients poor candidates for surgery, especially for elderly patients. We report a case of an 80-year-old male patient…

CME Topic

March 2009 CME Questions

“Clinical Definition of COPD Exacerbations and Classification of Their Severity”1. The presence of pneumonia in a chest radiograph of a patient with known COPD:A. Confirms the diagnosis of COPD exacerbation.B. Excludes the diagnosis of COPD exacerbation.C. Is mandatory for the diagnosis of COPD exacerbation.2. COPD exacerbations can be defined according…

CME Topic

CME Submission Form

Special Section

In Appreciation

The Southern Medical Association greatly appreciates the 2008 contributors to the Research & Education FoundationMrs. Stephanie AdamsDr. Katherine S. AldridgeDr. Luis M. AlvardadoDr. Michael N. AmsdenDr. Ignacio G. AnduezaDr. Mark E. AtrusioDr. Abdallah O. AskarDr. Jeanne F. AttrepDr. Janos T. BacsanyiDr. James E. BakerMrs. Ann BallardDr. Willie J. BanksDr. &…

Erratum

Erratum

In the article “Dark Chocolate Effect on Platelet Activity, C-Reactive Protein and Lipid Profile: A Pilot Study,” which appeared in volume 101 of The Southern Medical Journal on pages 1203–1208, an author’s name was listed incorrectly. The author’s name should have appeared as Anand Singla, MD.Hamed MS, Gambert S, Bliden…