Issue - Southern Medical Association

CME Topic

Antidepressant-Induced Suicidality: Implications for Clinical Practice

Abstract:The risk of suicidal behavior associated with antidepressant treatment is an issue of debate and concern. The US FDA has required that antidepressants carry a black box warning that there may be a risk of suicidal ideations in depressed pediatric patients treated with these medications, and recently extended the warning…

CME Topic

The Many Facets of Cardiovascular Magnetic Resonance Imaging: Review of Background, Clinical Utility, and Increasing Use in the Community Hospital

Abstract:Cardiovascular magnetic resonance imaging (CMR or cardiac MRI) has advanced dramatically in the last ten years and has been proven a reliable and flexible method for cardiac diagnosis. Stress perfusion MRI is a new technique that accurately detects coronary heart disease with high sensitivity and specificity. The role of CMR…

Review Article

Subphrenic Abscess Secondary to Actinomycosis meyeri and Klebsiella ozaenae Following Laparoscopic Cholecystectomy

Abstract:A case is reported of a subphrenic abscess 12 months post-laparoscopic cholecystectomy in a 72-year-old male with identification of Actinomyces meyeri and the oropharyngeal commensal Klebsiella ozaenae. The first organism is exceptionally rare following laparoscopic cholecystectomy and is presumed to be a result of inadvertent gallstone spillage. The second organism…

Review Article

Pancreatic Pseudocyst Rupture into the Portal Vein

Abstract:A patient with a pancreatic pseudocyst rupture into the portal vein with a resultant noninfectious systemic inflammatory response syndrome and subsequent portal vein thrombosis diagnosed by computed tomography and ultrasonography is reported. A review of the existing English literature on this rare complication is also provided.

Case Report

Metachronous Splenic Metastasis from Colonic Carcinoma Five Years After Surgery: A Case Report and Literature Review

Abstract:Metastatic lesions of the spleen are a rare finding and are generally associated with widespread disease. Moreover, solitary metastases of the spleen are exceptional. In this paper, we describe the case of a patient who developed an isolated splenic metastasis from colon carcinoma five years after surgery, and was successfully…

Case Report

The Development of Primary Cutaneous Adenoid Cystic Carcinoma in a Patient with Ankylosing Spondylitis Treated with Etanercept

Abstract:The tumor necrosis factor-alpha (TNF-&agr;) inhibitors are widely used in the treatment of some autoimmune disorders with promising results. However, their safety has been questioned with multiple postmarketing reports of increased risk for malignancies. The case of a patient with ankylosing spondylitis who developed cutaneous adenoid cystic carcinoma after three…

Case Report

Waxing and Waning Pulmonary Nodules and Myelodysplastic Syndrome

Abstract:A 53-year-old diabetic woman with the diagnosis of myelodysplastic syndrome was admitted to our hospital with symptoms of anorexia, malaise, fatigue, night sweats, and weight loss. The radiological evaluation revealed waxing and waning pulmonary nodules. A diagnosis of pulmonary tuberculosis was reached by pathologic examination of a wedge biopsy. We…

Case Report

Myelitis Complicating Systemic Lupus Erythematosus: Successfully Treated with Corticosteroids and Cyclophosphamide

Abstract:Systemic lupus erythematosus (SLE), a multisystem autoimmune disease with protean manifestations, occurs with neuropsychiatric manifestations in ≤60% of patients. Myelitis is a rare but serious complication of SLE. The diagnosis of myelitis may be difficult, but magnetic resonance imaging is generally very useful in assessing the extension and severity of…

Editorial

Evidence-Based Analysis of the Conclusion: What to do Without a Treatment Algorithm

The manuscript “Metachronous Splenic Metastasis from Colonic Carcinoma Five Years after Surgery: A Case Report and Review of the Literature”1 points out some salient features of carcinomas that are worth remembering. First, not all patients’ diseases follow the textbook descriptions. This patient underwent surgery for a T4, N0, M0 (stage…

Case Report

Metastatic Pancreatic Carcinoma Presenting as Colon Carcinoma

Abstract:Determining the origin of poorly differentiated adenocarcinomas remains a challenge for the pathologist. This manuscript reports the use of a panel of specific immunohistochemical stains to determine the primary site of a tumor in the colon. A 45-year-old man had a right hemicolectomy for adenocarcinoma. Immunohistochemical staining documented that the…

Case Report

Pericardial Involvement as a Rare Manifestation of Hypereosinophilic Syndrome

Abstract:A 56-year-old female with idiopathic hypereosinophilic syndrome who presented with chest tightness, dyspnea and new-onset atrial fibrillation is reported. Work up revealed significant peripheral eosinophilia, pericarditis, and a pericardial effusion with tamponade physiology. Pericardiocentesis revealed predominant eosinophils (88%) in the pericardial fluid. After initial stabilization, pericardial effusion reaccumulated with persistence…

Case Report

A Case of Tubulocystic Carcinoma Simultaneously Occurring with Clear Cell Type Renal Cell Carcinoma and Micropapillary Urothelial Carcinoma of Bladder

Abstract:The coexistence of multiple and synchronous primary neoplasms in the genitourinary system has rarely been described in the literature. To our knowledge, this is the first report of a very rare tumor, a “tubulocystic carcinoma,” simultaneously occurring with micropapillary urothelial carcinoma in the bladder and clear cell type renal cell…

Case Report

Bilateral Anterior Inferior Iliac Spine Avulsion in an Adolescent Soccer Player: A Typical Imitator of Malignant Bone Lesions

Abstract:Avulsion fractures are usually diagnosed easily in acutely presented cases. The diagnosis becomes definite if clinical and radiological follow up reflect the fracture’s healing phase. A 13-year-old soccer player with bilateral anterior inferior iliac spine (AIIS) avulsion, who had been examined in other institutions with a prediagnosis of malignancy, is…

Case Report

Hypokalemic Rhabdomyolysis Due to Watery Diarrhea, Hypokalemia, Achlorhydria (WDHA) Syndrome Caused by Vipoma

Abstract:Mild hypokalemia is common and encountered in a multitude of diseases, but severe hypokalemia leading to rhabdomyolysis is relatively rare. The watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP)-producing tumors, is an extremely rare cause of hypokalemic rhabdomyolysis and the literature is limited to one case…

Case Report

The Lack of Vitamin D Toxicity with Megadose of Daily Ergocalciferol (D2) Therapy: A Case Report and Literature Review

Abstract:The maximum daily dose of vitamin D currently recommended is 2000 IU. Ergocalciferol (D2) 50,000 IU orally weekly for 8–12 weeks is often used to treat vitamin D deficient patients (25(OH) vitamin D <20 ng/mL). The lack of vitamin D toxicity after massive doses of ergocalciferol has yet to be…

Case Report

Cardiac Myxoma Showing Extramedullary Hematopoiesis in a Patient with Beta Thalassemia

Abstract:A 52-year-old woman presented with recurrent episodes of chest pain, shortness of breath, palpitations, and fatigue for three months. Her past medical history was significant for chronic anemia. Physical examination revealed a pansystolic murmur radiating to the left axilla. Her admission workup showed microcytic anemia. Her serum creatinine and iron…

Special Sections: Letters to the Editor

Prevalence of Gout and Hyperuricemia in Taiwan&colon; A Hospital-Based, Cross-Sectional Study

To the Editor:We retrospectively analyzed the medical records of all patients undergoing health examination at a medical center located at Taichung City in Taiwan from 2000 to 2002. A total of 3397 people were enrolled in this study. They were divided into three age groups, 20–39, 40–64 and ≥65. There…

Special Sections: Letters to the Editor

To Pick a ‘Bone’ with the Gallbladder

To the Editor:The case report by Nelson and Khan1 of bone metaplasia in the gallbladder was very insightful on this uncommon histologic finding of unknown clinical significance. We would like to contribute a similar case from our surgical pathology archive.A 52-year-old, obese female (body mass index of 37.6 kg/m2), with…

Editorial

Awareness Is the Key to Conquering Male Breast Cancer

While it might sound obvious, breast cancer can also occur in males, and, while the rarity of the disease does not represent a social issue, as in females, it can be a private and personal drama for some patients and their families.Male breast cancer (MBC) is a rare disease in…

Special Sections: Letters to the Editor

Early Diagnosis of Parastomal Hernia

To the Editor:Parastomal hernia is not uncommon following the formation of an ileostomy or colostomy. Although most patients are asymptomatic, life-threatening complications such as strangulation, perforation, and obstruction may occur.1 Early diagnosis is essential for preservation of herniated contents. We report a case of parastomal hernia after colostomy, presenting with…

Special Sections: Letters to the Editor

Cytomegalovirus Clostridium Colitis Disease in an Immunocompetent Patient

To the Editor:Resistant Clostridium difficile infection is an emerging clinical problem with significant clinical consequences. It usually raises the suspicion of drug–resistant C difficile colitis infection.1 To our knowledge, this is the first case of cytomegalovirus (CMV) colitis on top of resistant C difficile in an immunocompetent patient. We propose…

Editorial

The Ongoing Debate&colon; Is There Actually a Causal Connection Between Anti-TNF&agr; Drugs and Skin Cancer?

The article in this month’s issue of the SMJ, entitled “The Development of Cutaneous Adenoid Cystic Carcinoma in a Patient with Ankylosing Spondylitis Treated with Etanercept”1 raises some interesting questions regarding the use of tumor necrosis factor &agr; (TNF&agr;) in the pathogenesis of inflammatory diseases. Hence, anti-TNF&agr; drugs are commonly…

Original Article

Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae, Northeast Florida

Background:Since 2001 there have been several reported outbreaks due to carbapenem-resistant Klebsiella pneumoniae (Kp), particularly in the northeastern states.Methods:Carbapenemase-producing Enterobacteriaceae from healthcare facilities in Northeast Florida were phenotypically identified and confirmed using PCR amplification and sequencing of the blaKPC gene.Results:Results from PFGE analysis of these isolates demonstrated possible horizontal spread…

Original Article

The Effects of Deep Breathing Training on Pain Management in the Emergency Department

Purpose:The purpose of this study was to measure the impact of deep breathing exercises on the pain levels in patients who presented to the emergency department (ED) with pain as their chief complaint. A secondary purpose was to measure the impact of deep breathing teaching on indicators of patient satisfaction.Methods:This…

Original Article

Nocturnal Hypoxia and Arterial Lactate Levels in Sleep-Related Breathing Disorders

Background:Lactate may be useful in pointing out the higher risk subgroups in sleep-related breathing disorders (SRBD) with various patterns of hypoxemia. We aimed to search whether morning and night lactate levels are related to apnea-hypopnea, hypoventilation, and hypoxemia in patients with SRBD and to compare it with patients without SRBD…

Original Article

Factors Contributing to Elevated Indoor Radon in the Paso Del Norte Region of the Texas-Mexico Border&colon; Information for Physicians

Background:We collected sample data on radon concentrations concurrently in the air, water, and soil in the northern part of the Texas-Mexico border (both sides) popularly known as Paso Del Norte.Methods:These field data were used to statistically correlate relative contributions of yard soil, tap water, location, and house features to concentrations…

Original Article

Postage Stamps Fading as Medical Education Tool

Abstract:Postage stamps have often been used around the world to educate the general public and to promote programs and policies. Stamps with medical themes have also been used to educate the general public about different aspects of medicine. As a result of the newer methods of communication, however, fewer and…

Case Report

Nitazoxanide and Probiotics for the Treatment of Recurrent Clostridium difficile Infection in a Peritoneal Dialysis Patient

Abstract:Nitazoxanide has been proven to be efficacious for the treatment of Clostridium difficile infection (CDI), but data is limited in peritoneal dialysis (PD) patients. This report details the successful utilization of nitazoxanide and probiotics to treat multirecurrent CDI in a PD patient. A 58-year-old woman was admitted with hypotension, nausea…

Case Report

Male Breast Cancer Presenting as an Axillary Mass&colon; A Case Report and Literature Review

Abstract:The presentation of breast cancer in a male as a solitary axillary mass is very unusual. In general, though the disease presents later in men than in women, the presentation is essentially the same in either gender group. Late and/or atypical presentation, however, delays diagnosis and treatment and carries a…

Special Sections: Letters to the Editor

Extrapulmonary Tuberculosis

To the Editor:I read with interest the article by Khan et al.1 The authors state that gastrointestinal and peritoneal forms are the most prevalent types of extrapulmonary tuberculosis; however, I disagree. Gastrointestinal involvement is uncommon. The cervical lymph node is the most commonly infected site in extrapulmonary tuberculosis, particularly in…

Special Sections: Letters to the Editor

Punch Biopsy in Wells Syndrome

To the Editor:In 1971, Wells1 first described a syndrome of recurrent granulomatous dermatitis with eosinophilia. Wells and Smith renamed it eosinophilic cellulitis. Eosinophilic cellulitis (Wells syndrome) is a rare condition of unknown etiology. Wells syndrome is listed as a “rare disease” by the Office of Rare Diseases (ORD) of the…

Special Section

Medical Webwatch

Finding the Path http://brighamrad.harvard.edu/education/online/ftp/FTP.html is authored by Leyla Azmoun, MD, Piran Aliabadi, MD, and B. Leonard Holman, MD and is an index of cases from the Department of Radiology, Brigham and Women’s Hospital Harvard Medical School. This problem-based guide to diagnostic imaging strategies in the emergency room presents both “Cases”…

CME Topics

July 2009 CME Questions

“Antidepressant-Induced Suicidality: Implications for Clinical Practice”1. Potential mechanisms by which antidepressants may induce suicidality may include:A. Paradoxical worsening of depressed moodB. Energizing psychomotor retarded patients before improving moodC. Causing akathisiaD. Disturbance of sleep architectureE. All of the above2. Which of the following types of patients would likely be most vulnerable…

CME Topics

CME Submission Form

Special Sections: Book Review

Christian Bioethics&colon; A Guide for the Perplexed, A Book Review Agneta Sutton. T & T Clark. A Continuum in Print. The Tower Building 11 York Road, London SE1 7NX, England and 80 Maiden Lane, Suite 704, New York, NY 10038; 2008

Recent scientific discoveries and their applications are transforming our society. Issues that were only recently considered science fiction are now affecting everyday life. Secrets of the very fabric of life are being unveiled, and the possibility of modifying and altering various life forms is now emerging. These developments raise a…