Issue - Southern Medical Association

Original Article

Hepatitis C Infection and the Risk of Bacteremia in Hemodialysis Patients with Tunneled Vascular Access Catheters

Background:The major complication of tunneled vascular catheters in dialysis patients is infection. In preliminary work, an association was noted between hepatitis C virus (HCV) infection and bacteremia in these patients. On this basis, we theorized that HCV infection may be associated with bacteremia in dialysis patients with tunneled catheters.Methods:We conducted…

CME Topic

Diagnosis of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone

Background:Hyponatremia is a frequent condition in elderly patients. In diagnostic workup, a 24-hour urine sample is used to measure urinary osmolality and urinary sodium concentration necessary to confirm the diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This study was undertaken to test the hypothesis that a…

CME Topic

Cutaneous Metastasis of Breast Carcinoma Presenting as Alopecia Neoplastica

Abstract:Alopecia neoplastica is defined as hair loss secondary to a visceral malignancy that has metastasized to the scalp. We describe a woman with adenocarcinoma of the breast who developed alopecia neoplastica while receiving antineoplastic therapy. Alopecia neoplastica has been observed in 25 women. Breast cancer was the primary malignancy in…

Review Article

Addressing Lipid Treatment Targets Beyond Cholesterol: A Role for Prescription Omega-3 Fatty Acid Therapy

Abstract:Decreasing very high triglyceride (TG) levels (≥500 mg/dL) is recommended to prevent pancreatitis. Decreasing low-density lipoprotein cholesterol (LDL-C) is the primary lipid treatment target to reduce the risk of atherosclerotic coronary heart disease. A secondary lipid treatment target for patients at LDL-C goal, but with persistent TG elevations, includes achievement…

Case Report

An Unusual Case of Colonic Ischemia

Abstract:Sumatriptan is widely prescribed for the treatment of migraine headaches. Its actions are mediated via agonist action on the vascular 5-hydroxytryptamine 1 receptor which results in vasoconstriction. We report a case of a 46-year-old woman who developed ischemic colitis while taking increasing doses of sumatriptan for a migraine headache. Her…

Case Report

Postoperative Resolution of Abnormal Blood Vessels Related to a Nerve Root Hemangioblastoma

Abstract:To our knowledge, there are currently no published reports that describe the postoperative evolution of abnormal blood vessels associated with spinal nerve root hemangioblastomas. We present a patient with a hemangioblastoma that was completely resected. Follow-up imaging revealed complete resolution of the abnormal blood vessels. We hypothesize that complete resection…

Editorial

Syndrome of Inappropriate Secretion of Antidiuretic Hormone

In this issue of the Journal, Holm et al1 test the hypothesis that a spot urine sample is sufficient for urinalysis in patients with suspected hyponatremia. The first step in the approach to the patient with hyponatremia is to rule out acute, symptomatic hyponatremia and ‘acute on chronic’ hyponatremia, when…

Case Report

Rapunzel Syndrome—A Rare Cause of Multiple Jejunal Intussusception

Abstract:Trichobezoars are usually without symptoms until they reach a large size. The “Rapunzel” syndrome is a trichobezoar with a long tail extending from the stomach to small bowel. We report the case of a 6-year-old girl with a history of trichotillomania and hair ingestion for three years, who presented with…

Case Report

Ileocecal Intussusception Due to Isolated Metastasis from Primary Esophageal Adenocarcinoma

Abstract:Isolated metastases to the small intestine are rare, but are known to originate from malignant melanoma, or breast or lung cancer. To our knowledge, this is the first reported case of metastases from primary esophageal adenocarcinoma presenting as subacute small bowel obstruction due to ileocecal intussusception. Physicians should consider palliative…

Case Report

An Uncommon Etiology of Cholestatic Jaundice: Intraductal Mucinous Papillary Tumor of the Bile Duct

Abstract:Intraductal papillary mucinous tumors (IPMT) are known to occur in the pancreas but rarely can occur in the bile ducts. These tumors secrete mucin that may form mucous plugs resulting in biliary stasis, biliary duct obstruction and dilation. We report a case of IPMT of the biliary tract that presented…

Case Report

Increased Serum CA-125 Levels in Patients with Lung Cancer Post Thoracotomy

Abstract:Cancer antigen (CA)-125 is a useful tumor marker for the follow up of ovarian and lung cancer. It is a sensitive, but not specific, tumor marker. Increased serum CA-125 levels have already been described in a number of benign and malignant diseases. We report two cases of increased serum CA-125…

Case Report

Pseudoaneurysm Formation After Ultrasound-Guided Liver Biopsy in an Obese Child

Abstract:Pseudoaneurysm formation is a rare complication of percutaneous liver biopsy, the incidence of which can be reduced by using ultrasound (US) guidance. We describe an obese 11-year-old male who underwent US-guided liver biopsy for persistently elevated transaminases. He subsequently developed anemia, melena, and hemobilia as noted on esophagogastroduodenoscopy. He was…

Case Report

A Rare Case of Malignant Triton Tumor with Pluridirectional Differentiation

Abstract:An enlarging soft tissue mass was resected from the leg of a young man with neurofibromatosis type 1. Rhabdomyosarcomatous elements admixed with islands of osteoid and chondroid matrix was seen on microscopy. Based on immunohistochemistry, a malignant triton tumor, an uncommon subtype of peripheral nerve sheath tumor with rhabdomyosarcomatous elements,…

Editorial

Cutaneous Metastases from Breast Cancer

In this issue of the SMJ, Conner and Cohen1 provide an excellent review of the rare alopecia neoplastica syndrome of hair loss from scalp metastasis, which is sometimes a diagnostic problem. All 25 patients were women, and 21 had breast cancer. As such scalp lesions may remain flat for some…

Case Report

Overdose in Infant Caused by Over-the-Counter Cough Medicine

Abstract:Each year consumers purchase about 95 million units of over-the-counter medications for pediatric use, an unsafe application that can cause life-threatening effects. Despite a warning from the Food and Drug Administration, many parents or caregivers continue to administer these remedies to children. This report describes the case of a 4-month-old…

Special Sections: Letters to the Editor

Esophageal Intramural Pseudodiverticulosis

To the Editor:A 63-year-old man presented for upper gastrointestinal tract screening. He was asymptomatic. Physical examination revealed no abnormalities, and routine laboratory studies were normal. Barium contrast esophagogram disclosed multiple, small, flask-shaped outpouchings in the midesophagus; the characteristic hallmarks of esophageal intramural pseudodiverticulosis (Fig.).Fig. Barium contrast esophagogram.Esophageal intramural pseudodiverticulosis, first…

Special Sections: Letters to the Editor

Cecoanal Intussusception in an Adult Caused by Cecal Polyp

To the Editor:Intussusception of the colon is a rare occurrence in the adult population. It occurs when the proximal segment of bowel telescopes into the lumen of the adjacent distal segment. In contrast to the pediatric population, a definitive etiology is found in up to 90% of cases in adults.1,2We…

Editorial

Reporting Adverse Drug Reactions

Reported in this month’s edition of the Southern Medical Journal is a case of ischemic colitis potentially caused by sumatriptan.1 The authors do an excellent job of describing the patient history and linking the adverse event to the potential causative drug. Although these adverse drug reports are somewhat commonplace, reporting…

Editorial

Hemangioblastomas of Spinal Nerve Roots and Spinal Medullary Venous Congestion

The paper by Riesenburger et al1 in this issue of the Journal is both interesting and somewhat controversial. Hemangioblastomas are benign tumors that occur sporadically (two-thirds of cases) or in association with von Hippel-Lindau (VHL) disease (one-third of cases).2 They can be found throughout the entire central nervous system, but…

Original Article

Obesity and Complicated Diverticular Disease: Is There an Association?

Objective:Obesity is becoming a growing health concern in the general population. Multiple studies have linked diverticular disease to obesity. Furthermore, recent research has shown fat to be a critical element in the regulation of immunity and the inflammatory response. In this study, we sought to determine if body mass index…

Original Article

Weight Perception and Weight Control Practice in a Multiethnic Sample of US Adolescents

Objectives:Obesity is disproportionately prevalent among many racial/ethnic minority groups. The main objectives of this study are (1) to examine the extent of body weight misperception for a representative sample of US adolescents; (2) to explore the gender and racial/ethnic differences associated with an adolescents’ weight goals and weight loss attempts…

Original Article

Effects of Rosuvastatin and Colestimide on Metabolic Parameters and Urinary Monocyte Chemoattractant Protein-1 in Type 2 Diabetic Patients with Hyperlipidemia

Background:Rosuvastatin, a strong statin, and colestimide, a new anion exchange resin, are both clinically beneficial drugs for treatment of hypercholesterolemia. The main purpose of the study was to compare the effects of rosuvastatin and colestimide on metabolic parameters, adipokines, and markers of oxidative stress and diabetic nephropathy in patients with…

Original Article

Instances of Mantle Cell Lymphoma Morphologically Mimicking Other Subtypes of B-Cell Lymphoid Proliferation

Abstract:Mantle cell lymphoma is a well-characterized category of mature B-cell lymphoma with aberrant coexpression of CD5 antigen. This subtype of lymphoma is genetically defined by t(11;14) resulting in upregulation of cyclin D1 protein. In clinical practice, mantle cell lymphoma is typically diagnosed based on combination of morphology, CD20/CD5 coexpression, and…

Case Report

Duodenal Mantle Cell Lymphoma in a Patient with Advanced Sigmoid Adenocarcinoma

Abstract:While colorectal cancer is one of the most commonly encountered gastrointestinal malignancies, primary lymphoma is an uncommon neoplasm of the gastrointestinal tract. The duodenum is not a common location for the recurrence of colon cancer or of primary gastrointestinal lymphoma. Studies regarding mantle cell lymphoma (MCL) as a secondary synchronous…

Case Report

Successful Utilization of Aliskiren, a Direct Renin Inhibitor in Bartter Syndrome

Abstract:Bartter syndrome is traditionally treated with large doses of oral potassium with or without suppression of the renin-angiotensin system. Since plasma renin activity is invariably elevated in Bartter syndrome, the availability of the direct renin inhibitor aliskiren should lead to the ability to maintain potassium levels without utilizing large doses…

Case Report

Aliskiren-Induced QT Interval Prolongation

Abstract:Aliskiren gained FDA approval for the treatment of hypertension in 2007. It is the first approved pharmaceutical to manage hypertension by direct renin inhibition. With the introduction of novel drugs and mechanisms of action comes the challenge of monitoring for new unreported adverse events. The side effect profile for aliskiren…

Review Article

Management of Osteoporosis Among Home Health and Long-Term Care Patients with a Prior Fracture

Key PointsDiagnosis and treatment of osteoporosis and fractures among nursing home and home health care patients is commonly overlooked.Treatment with calcium and vitamin D has been associated with decreased fall and fracture risk. However, those with a history of fracture or osteoporosis should also be treated with prescription osteoporosis therapy.Among…

Case Report

Photobacterium damsela Wound Infection in a 14-Year-Old Surfer

Abstract:Photobacterium damsela (P damsela) is a common marine bacterium. Rare reports of P damsela causing septicemia and wound infection have been described in children. We report a case of Photobacterium damsela isolated from a wound culture taken from a 14-year-old male injured after a minor trauma while surfing. We alert…

Case Report

Primary Meningococcal Arthritis as Initial Presentation in a Previously Undiagnosed HIV-Infected Patient

Abstract:A 38-year-old African-American male complaining of pain in multiple joints was initially diagnosed with gouty arthritis concurrent with gonococcal septic arthritis. The diagnosis was made based on arthrocentesis results showing Gram-variable cocci and monosodium urate crystals in the synovial fluid. Final blood and synovial fluid cultures confirmed a diagnosis of…

Special Sections: Letters to the Editor

Brugada Syndrome, More Than Meets the Eye?

To the Editor:I read with interest the article by Caproni et al.1 The authors cite that Brugada syndrome occurs in patients with structurally normal hearts; however, I disagree. Such a conclusion might be congruent with noninvasive testing. Frustaci and colleagues performed endomyocardial biopsy in patients with Brugada syndrome and subsequently…

Special Sections: Letters to the Editor

Oculomotor Palsy Following Varicella in an Immunocompetent Adult

To the Editor:A 45-year-old Asian Indian male presented with fever, and a generalized maculopapular and vesicular rash two weeks following exposure to a child with varicella. The rash appeared in crops on the face and trunk and then spread centrifugally. Lesions included maculopapules and vesicles, and by the 7th day…

Editorial

Adverse Event in Response to Aliskiren

The article by Pietz et al suggests QT prolongation as a possible adverse event in response to aliskiren. Aliskiren was introduced in the US market in the year 2007 as an antihypertensive agent. Postmarketing data thus far have not suggested QT prolongation as a possible adverse event.1 This could be…

Special Section

Medical Webwatch

John Partridge’s Cardiac Imaging Site http://www.cardiacradiology.co.uk/ is produced by John Partridge FRCR, FRCP, FRANZCR, who returned to the UK in 1993 to work at Harefield Hospital near London. Dr. Partridge retired in 2006. All his consultant posts had been supraregional centers of cardiac medicine, in an era that had seen…

Special Sections: Letters to the Editor

Surgeon Signatures

To the Editor:I read with great interest the letter by Corey et al1 entitled “Physician Signatures” published in the August 2008 issue of the Southern Medical Journal. General surgery residents at the Medical College of Georgia (MCG) must complete similar paperwork as detailed by Corey et al1 to render daily…

Special Sections: Letters to the Editor

A Fortune Unfortunate

To the Editor:Orthopedic fixation wires are regularly utilized for the management of bone fracture and dislocation especially in clavicle and hand bone fracture.1 It has the advantage of being a semiclosed procedure, which is simple to perform. However, in a study of wire migration from the shoulder region, Lyons and…

Special Sections: Letters to the Editor

Unusual Metastases to Soft Tissue of Chest and Abdominal Wall from Head and Neck Squamous Cell Carcinoma

To the Editor:A 32-year-old man presented initially to our hospital in September 2006 with a mass over the tongue that had existed for more than one year. He was a heavy smoker with alcohol and areca betel nut consumption. A 7 × 6 cm ulcerative mass over the tongue with…

CME Topic

April 2009 CME Questions

“Diagnosis of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone”1. Hyponatremia in patients with no signs of overhydration (no edema, ascites or congestion) is in most cases due to: (check one item only)A. Adrenal insufficiencyB. MyxedemaC. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)D. Psychosis with compulsory water intake2. In…

CME Topic

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