Issue - Southern Medical Association

Original Article

Increased All-Terrain Vehicle Crash Accidents in Older Riders

Objective:Recent reports on all-terrain vehicle (ATV) accidents cite high injury and death rates, disproportionately affecting younger riders. We sought to determine whether serious injuries at a level 1 trauma center have increased among older riders.Materials and Methods:Using the trauma registry, 300 ATV accidents from March 1, 1997 through March 30,…

Original Article

ATV Deaths Among Older Adults in West Virginia: Evidence Suggesting that “60 is the New 40!”

Objectives:Describe the epidemiology of all-terrain vehicle (ATV) deaths among persons ≥65 years of age in West Virginia from 1999–2007.Material and Methods:We conducted a review of death certificates identifying ATV fatalities from ICD-10 diagnostic codes V86.0, V86.1, V86.3, V86.5, V86.6, and V86.9.Results:ATV deaths increased 155% from 11% during 1985–1998 to 28%…

Original Article

Heroin Body Packing: Clearly Discerning Drug Packets Using CT

Background:To determine if heroin body packing has occurred using computed tomography (CT), and to evaluate the role of CT in screening such cases.Methods:We collected 158 cases of suspected drug packers' imaging materials (all underwent CT, 42 cases were imaged using plain x-ray film) from September 5, 2005 to April 23,…

Original Article

Impact of Preinjury Anticoagulation in Patients with Traumatic Brain Injury

Introduction:This study was undertaken to examine the impact of various anticoagulation agents in head injury patients.Methods:The medical records and trauma registry were used to analyze the data. All adult trauma patients using aspirin, clopidogrel bisulfate (Plavix®), warfarin (Coumadin®), or heparin and admitted to the hospital with computed tomography (CT) scan…

Original Article

Improved GI Tolerability with Monthly Ibandronate in Women Previously Using Weekly Bisphosphonates

Objective:This subanalysis of CURRENT, an open-label, 6-month, multicenter study, assesses changes in gastrointestinal (GI) tolerability with once-monthly oral ibandronate in women who switched from once-weekly bisphosphonates and had reported GI symptoms with their previous weekly bisphosphonate regimen.Methods:Postmenopausal women currently taking a weekly bisphosphonate switched to 150 mg monthly ibandronate. At…

Original Article

Intestinal Necrosis due to Sodium Polystyrene Sulfonate (Kayexalate) in Sorbitol

Background:Sodium polystyrene sulfonate (SPS, Kayexalate) has been implicated in the development of intestinal necrosis. Sorbitol, added as a cathartic agent, may be primarily responsible. Previous studies have documented bowel necrosis primarily in postoperative, dialysis, and transplant patients. We sought to identify additional clinical characteristics among patients with probable SPS-induced intestinal…

Original Article

Fine-Needle Aspiration Cytology of Thyroid Nodule: Does the Needle Matter?

Objectives:Ultrasound-guided fine needle aspiration cytology (US-FNAC) represents the most effective test available to distinguish between benign and malignant thyroid nodules. The major limit is the rate of inadequate specimens which generates a much higher cost. The aim of the present study was to evaluate whether the adoption of stylet needles…

CME Topic

Thrombotic Thrombocytopenic Purpura: The Masquerader

Abstract:Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder with a mortality rate of up to 90% if left untreated, and is characterized by microvascular thrombi, mainly in small arteries and capillaries, thrombocytopenia, hemolysis, and neurological abnormalities. Malignant hypertension (HTN) is a clinical syndrome characterized by severe hypertension associated with end-organ…

CME Topic

Inadequate Documentation of Asthma Management in Hospitalized Adult Patients

Abstract:Undocumented patient information in the medical record (MR) is a barrier to providing high quality care. Inadequate documentation has recently been reported for two cardiovascular diseases. This study was designed to evaluate the documentation of asthma management in the MR to determine if it is consistent with the NIH asthma…

Review Article

Tricuspid Valve and Pacemaker Endocarditis Due to Pseudallescheria boydii (Scedosporium apiospermum)

Abstract:We report a case of native valve and pacemaker endocarditis in a 78-year-old male with diabetes mellitus who died after cardiac surgery. At autopsy, tricuspid valve vegetations and lung abscesses containing thick, hyaline, septate, and branching hyphae were present. The culture identified Scedosporium apiospermum, an infrequent cause of opportunistic infections…

Review Article

The Distribution of Brown Recluse Spiders in the Southeastern Quadrant of the United States in Relation to Loxoscelism Diagnoses

Abstract:The southern and eastern margins of the range of the brown recluse spider run through the southeastern quadrant of the United States. Populations vary from abundant in states such as Arkansas and west and central Kentucky and Tennessee to absent in the Atlantic seaboard states. The diagnosis of loxoscelism should…

Case Report

ST Elevation Myocardial Infarction in a Teenager: Case Report and Review of the Literature

Abstract:In the presence or absence of atherosclerosis, young adults can experience a myocardial infarction. Notably, young patients are at increased risk to be misdiagnosed since they do not frequently have traditional coronary risk factors. We describe a 19-year-old woman with chest pain and ST elevation on electrocardiogram who was initially…

Case Report

Significant Cardiomyopathy Secondary to West Nile Virus Infection

Abstract:West Nile virus (WNV) myocarditis has been documented pathologically in birds and mammals, but has rarely been reported in human clinical syndromes. Severe cardiomyopathy as a consequence of WNV has not yet been reported.

Case Report

Primary Hydatid Disease of Pancreas Mimicking Cystic Neoplasm

Abstract:Primary hydatid disease of the pancreas is very rare. We report a 33-year-old female who was admitted to the hospital with abdominal discomfort due to the pancreatic mass. A diagnosis of a pancreatic cystic mass was established through abdominal ultrasonography and computed tomography scan. Hydatid disease as well as a…

Case Report

Urticarial Vasculitis: A Unique Presentation

Abstract:Urticarial vasculitis is a relatively rare diagnosis in a patient presenting with urticaria. The process is classically described as a generalized eruption, painful more so than pruritic, lasting longer than 24 hours. Two forms of urticarial vasculitis have been described: ahypocomplementemic form more commonly associated with systemic disease, and a…

Case Report

A Case of Cerebellopontine Angle Epidermoid Cyst Presenting as Trigeminal Neuropathy

Abstract:We present the case of a 35-year-old female who had paraesthesia and numbness on the left side of her face. Initially the ophthalmic division and maxillary divisions on the trigeminal nerve were involved, but later involved the mandibular division as well. On MRI, a cerebellopontine angle (CPA) epidermoid cyst was…

Case Report

Simultaneous Adrenal Pheochromocytoma and Sarcoidosis

Abstract:A 48-year-old man presented for evaluation of general weakness. Because he had a history of excessive alcohol use, an abdominal computed tomography scan was obtained, which revealed a left adrenal mass. Hormonal evaluation showed elevated levels of urinary catecholamines. Bilateral hilar lymphadenopathy was detected on a chest radiograph. The suspected…

Editorial

Diagnosis of Heroin Body Packing Using Computed Tomography

With the increase of intra-abdominal concealment of drugs throughout the world, radiologists are more often confronted with diagnostic imaging of body packers. In their article in this month's issue of the SMJ, Yang et al1 evaluate the role of CT in suspected heroin body packing. The relevance of identifying heroin…

Case Report

Dural Venous Thrombosis Following Splenectomy in a Patient with Hereditary Spherocytosis

Abstract:Hereditary spherocytosis is a common form of hemolytic anemia sometimes requiring splenectomy in recalcitrant cases. The complications of splenectomy include an increased risk of thrombosis, usually presenting with deep vein thrombosis or pulmonary embolism. However, common complaints such as headache should warn clinicians of involvement in less common sites, primarily…

Case Report

Gemcitabine Plus Vinorelbine as an Effective Salvage Chemotherapeutic Regimen in Cisplatin-Refractory Germ Cell Tumor

Abstract:Germ cell tumors (GCT) are the most common malignancies among male adolescents. Approximately 5% of GCTs are of extragonadal origin. Cisplatin-based chemotherapy is the standard first-line treatment for GCT. Patients who fail to respond to first-line treatment usually have poor outcomes. High-dose chemotherapy with stem cell support, paclitaxel, gemcitabine, and…

Case Report

Neuroleptospirosis with Hydrocephalus and Very Elevated Cerebrospinal Fluid Protein

Abstract:To our knowledge, this is the first known case of a patient with leptospirosis and very elevated CSF, which caused hydrocephalus.

Special Sections: Letters to the Editor

Enterovascular Fistula in a Patient with Squamous Cell Carcinoma Arising in a Cystic Teratoma

To the Editor:Enterovascular fistulas are defined as a communication between the vessel and adjacent bowel and are a rare cause of acute gastrointestinal bleeding1; this usually occurs in patients with vascular grafts.2 To our knowledge, this is the first case presented in the English literature in which an ovarian malignancy…

Editorial

Medical Ethics: Promise vs. Practice

I remember back in the 1960s and early ‘70s when mechanical ventilators, or “breathing machines” as we called them, started coming into common use in American hospitals. I also remember when, in 1975, we were first introduced to the name of Karen Ann Quinlan and her parents’ subsequent struggle to…

Editorial

Thrombotic Thrombocytopenic Purpura and Its Imitators

Because thrombotic thrombocytopenic purpura (TTP) calls for immediate and aggressive therapy, Patel et al’s1 reminder that the now uncommon malignant hypertension may mimic this disease is important. Their patient had the classic TTP syndrome of renal insufficiency, central nervous system (CNS) symptoms of angiopathic hemolysis, and thrombocytopenia, but his severe…

Editorial

Infective Endocarditis: A Changing Demographic

Infective endocarditis is an uncommon disorder that was almost universally fatal in the preantibiotic era. Outcomes improved with the advent of antibiotics and surgical intervention, but the in-hospital mortality remains around 20%. While the annual incidence of 25–50 cases per 1 million persons per year has been stable for the…

Editorial

ST Elevation Myocardial Infarction in Young Adult Females

Myocardial infarction (MI) in young adult females less than 35 years of age is uncommon and its exact incidence is not currently known. Anecdotally, more and more emergency department (ED) physicians and cardiologists are seeing these cases. As many of these patients may not have traditional risk factors associated with…

Original Article

Ethics Committees in Small, Rural Hospitals in East Tennessee

Background:Little research has been conducted to observe the impact that rural settings have on the structure and function of hospital ethics committees. Additionally, studies need to focus on ethics committees, as it is often the body which protects the values of the community as globalization increases. The purpose of this…

Editorial

Preinjury Anticoagulation Levels in Traumatic Brain Injury

Surgeons and other physicians dealing with accident victims are often faced with patients whose injuries are complicated, either actually or potentially, by pre-existent disease and its treatment. The various severity scores do not adequately predicate the course of these patients. Prognostic information is, therefore, of value in evaluating outcomes. The…

Special Sections: Letters to the Editor

Editorial Fair Play and Emergency Contraception

To the Editor:With pleasure and a sense of academic responsibility, I accepted an invitation to submit an editorial addressing a paper by Galvin and Fagan1 in the January 2009 issue (Vol 102, Number 1) of Southern Medical Journal. Subsequently, I read with interest a thoughtful second editorial2 which addressed not…

Editorial

Changes in the Epidemiology of All-Terrain Vehicle Accidents

In this issue of the Southern Medical Journal, Testerman1 examined several years of data at a Level 1 trauma center in order to detect trends in the epidemiology of all terrain vehicle (ATV)-related injuries.In 1970, the Honda Motor Company introduced the first recreational ATV in the United States. In 1988,…

Editorial

The Importance of Specific Education for Asthma Patients Discharged from the Emergency Department and Hospital

Discharge education from the hospital or emergency department (ED) is a challenging affair for everyone, including the asthma patient. An article in this issue of the Journal1 identifies a lack of documentation of asthma education for patients discharged from the hospital. This properly suggests the likelihood of problems with education…

Special Sections: Letters to the Editor

Paclitaxel: Friend or Foe for Systemic Lupus Erythematosus?

To the Editor:Recently, I read an interesting case report titled “Systemic Lupus Erythematosus Associated with Paclitaxel Use in the Treatment of Ovarian Cancer” published in the SMJ. In this article, Dasanu and Alexandrescu1 reported the first known case of a patient with serologically confirmed systemic lupus erythematosus (SLE) secondary to…

Special Sections: Letters to the Editor

Morphine as an Analgesic That Causes Vomiting

To the Editor:I read with interest the article by Salem et al.1 The authors prescribed morphine to relieve epigastric pain in acute pancreatitis. While morphine increases the pressure in the sphincter of Oddi, no firm evidence supports its disadvantage in acute pancreatitis.2 I agree with the initial usage of morphine…

Special Sections: Letters to the Editor

Intraductal Administration of a Mucolytic Agent with Gland Massages: A Suitable Conservative Treatment of Acute Obstructive Parotitis

To the Editor:Sialolithiasis accounts for the majority of the diseases of the salivary glands, occurring in more than 80% of the cases in the submandibular gland and less commonly in the parotid gland (6%). The complete obstruction causes prolonged symptoms and in some cases, because of salivary stasis, a secondary…

Special Sections: Letters to the Editor

Challenges with Extrapulmonary Tuberculosis

To the Editor:I read with interest the January issue of the Southern Medical Journal which reported on the challenges of extrapulmonary tuberculosis (EPTB).1–3 The significant morbidity and mortality associated with EPTB remain significant issues.In my experience, diagnosing EPTB can be made early as long as the diagnosis is considered. Therefore,…

Special Sections: Letters to the Editor

Importance of Postprandial Glucose Levels in Type 2 Diabetes

To the Editor:In his review of the importance of postprandial glucose control, Tibaldi1 states that thiazolidinediones (TZDs) are not known for their effects on postprandial glucose control. This is not factual, since multiple studies have shown that both rosiglitazone and pioglitazone lower postprandial glucose.2–4 In addition, unlike other diabetic therapies,…

Editorial

The Ethical Benefits of Small Community Hospitals

Many physicians are skeptical of the relevance of ethics at this time. The article by Jackson and Olive1 in this issue of the Southern Medical Journal provides a simple, convincing approach. Small homogeneous Christian community hospital ethics committees can bring a simpler evaluation of small ethical issues, particularly through good…

Special Section

Medical Webwatch

This is the tumors page of the Atlas of Genetics and Cytogenetics in Oncology and Haematology http://atlasgeneticsoncology.org/Tumors/Tumorliste.html a peer reviewed online journal and database. They say that it “is made for and by: clinicians and researchers in cytogenetics, molecular biology, oncology, haematology, and pathology.” Contributions are reviewed before acceptance. The…

CME Topic

May 2009 CME Questions

Thrombotic Thrombocytopenic Purpura: The Masquerader1. Thrombotic microangiopathy (TMA) or microangiopathic hemolytic anemia (MAHA) is:A. Complement-mediated lysis of RBCsB. IgG-mediated lysis of RBCsC. Excess fragmentation of RBCs passing through a narrowed vessel2. Though no clearly defined ADAMTS-13 level has been established, what level of ADAMTS-13 is highly suggestive of TTP in…

CME Topic

CME Submission Form

Special Sections: Erratum

Erratum

Orthopaedic In-Training Examination Performance: A Nine-Year Review of a Residency Program Database: ERRATUMIn the article which appeared on pages 791–796 of volume 101, number 8, an author's name was listed incorrectly. The author's name should have appeared as Charles H. Crawford III. This error has been noted on the online…