We report a case of neutropenia and gram-negative septicemia in a 73-year-old male with ulcerative colitis. During the hospital course, medications were adjusted according to rare accounts of drug-induced neutropenia. While the substitution of propafenone for another antiarrhythmic brought about no change in the patient’s absolute neutrophil count, the cessation…
Background: Vancomycin treatment failures and increased mortality have been reported in methicillin-resistant Staphylococcus aureus (MRSA) isolates with minimum inhibitory concentrations (MICs) >1 μg/mL. Most of this data utilized manual testing to determine the MIC. Recent vancomycin treatment guidelines do not specify the optimal testing method to define the MIC. Methods:…
With the passage of The American Reinvestment and Recovery Act of 2009 that includes the Health Care Information Technology for Economic & Clinical Health Act, the opportunity for states to develop a Health Information Technology Center (THITC) has emerged. The Center provides the intellectual, financial, and technical leadership along with…
In this issue of the Southern Medical Journal, Cakir and Gammon1 assess patient readmission rates for the same diagnosis within one month of initial discharge at a community hospital. Escalating health care costs and financial deficits have compelled policy makers and hospital administrators to identify measures for expense reduction. A…
Background: Although exercise is related to weight loss, minimal energy expenditures typical in deconditioned persons explain only small portions of this reduction. Thus, it has been suggested that exercise-induced changes in psychological variables associated with appropriate eating may be mediators. Methods: Adults with obesity (N = 106; Mean BMI =…
Pseudoaneurysm of the thoracic aorta is an extremely rare and potentially fatal condition that can mimic acute coronary syndrome, aortic dissection, or pulmonary embolism. Chest trauma and aortic surgery are the usual predisposing factors. Rarely, noncardiovascular thoracic surgeries can result in aortic pseudoaneurysm secondary to unrecognized perioperative injury. Clinical presentation…
To the Editor: A 46-year-old man presented with a two-day history of pain on the right chest wall, caused by stretching movement of the thorax and palpation. Physical examination revealed a 10 cm x 3 mm firm, cord-like, tender induration on the right anterolateral thoracoabdominal wall (Fig. 1). Ultrasonography showed…
Background: Little is known about why physicians prescribe inappropriate stress ulcer prophylaxis (SUP) among nonintensive care unit (ICU) hospitalized patients without supporting evidence. This study seeks to understand which factors influence physician prescribing behavior regarding SUP. Design: We designed a cross sectional web-based survey to assess physicians′ knowledge, beliefs, and…
Thick melanomas are relatively common; however, melanomas greater than 10 cm in size are rarely encountered. Though the size may seem daunting, the work up and principles of wide surgical excision remain the same. Sentinel lymph node biopsy should also be considered in patients with no clinical evidence of metastatic…
Background: The electronic exchange of health records has been a notable topic in recent years in the effort to improve the quality of healthcare delivery and reduce administrative burden. Interviews and documents from stakeholders in human immunodeficiency virus (HIV) care, and HIV information technology were collected between November 2004 through…
Objectives: The need for colonoscopy is common among diabetic patients. However, there are no standards per se for bowel preparation in patients with type 2 diabetes. In this study, we evaluated the efficacy, safety, and tolerability of sodium phosphate (NaP), and the quality of bowel cleansing in relation to glycemic…
Primary hyperparathyroidism (PHPT) is characterized by inappropriate secretion of parathyroid hormone (PTH). The proportion of PHPT with asymptomatic or nontypical symptoms is continuously increasing. PHPT typically affects elderly women, and it is characterized by few symptoms or complications. We explored a case of a 77-year-old woman with previously undiagnosed PHPT…
Colonoscopy is a routine procedure done tens of thousands of times per year for screening purposes. The vast majority of these procedures are uneventful. There are, however, complications that can arise from this procedure, including hollow viscus perforation and hemorrhage. We present a case in which a lesser known complication…
The association between acute coronary events and acute allergic reactions has been recognized for several years. The first reported case occurred in 1950, during an allergic reaction to penicillin. In 1991, Kounis and Zavras described the syndrome of allergic angina and allergic myocardial infarction, currently known as Kounis syndrome. Two…
The use of tourniquets for upper and lower extremity operative procedures is controversial in patients with sickle cell hemoglobinopathies. The authors used Ovid and MEDLINE®, PubMed, and CINAHL® to detect English-language reports of any surgical procedure where a tourniquet was used on a patient with sickle cell disease or trait….
To the Editor: Cardiac arrest during surgery is uncommon, but one cause of asystole is vagal stimulation.1,2 We present a case of a 64-year-old, 153 lb male patient with cecum tumor, who was scheduled for right hemicolectomy. The patient had arterial hypertension and diabetes mellitus type 2, receiving losartan and…
To the Editor: Leiomyosarcoma (LMS) is a rare malignancy, which arises from smooth muscle cells and comprises less than 10% of all soft tissue sarcomas.1 More than 50% of LMS are uterine in origin, followed by gastrointestinal and retroperitoneal. Though the metastatic potential of visceral LMS is well recognized, its…
Echinacea, believed by herbal practitioners to enhance the immune system, is one of the most widely used herbal supplements in the United States. Like most herbal products, it lacks strict FDA regulation and more information is needed about its potential adverse reactions. Here, we report the case of a patient…
Shoulder pain is a frequent clinical problem facing primary care physicians. Despite its common occurrence, many clinicians are unfamiliar with the diagnosis and treatment of many common shoulder ailments. Because therapy for most shoulder disorders can be made at the initial consultation, a good history and physical remain paramount. The…
We describe the case of a patient with documented temporal arteritis, who presented two years into her course with acute digital ischemia, presumed secondary to small vessel vasculitis. To our knowledge, this complication of temporal arteritis has not been previously reported.
Objective: Helicobacter pylori (HP) is a cause of chronic gastritis. Beta-2 microglobulin has been used as a simple inflammatory indicator in some diseases. We investigate the usability of beta-2 microglobulin as a simple marker that may reflect the severity of inflammation and intensity of HP in gastric mucosa. Materials and…
To the Editor: Lemierre syndrome, also known as “postanginal sepsis,” is characterized by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, most commonly Fusobacterium necrophorum. Lemierre syndrome is mainly a disease of previously healthy young adults, although it…
Chronic myocardial ischemia often presents with a fairly typical history, but patients can present with atypical chest pain or pain referred to a less-typical location like the jaw, stomach, or back. Sometimes patients describe symptoms usually not attributed to heart disease, like indigestion or feeling cold and clammy, in the…
To the Editor: Although extrahepatic manifestations of amebic liver abscess (such as the ones listed by Shrestha et al) are the most memorable life-threatening complications of this disorder, it is also worth remembering that even when an abscess is confined to the liver substance, intrahepatic extension can cause damage to…
Objectives: To detect the readmission rates of a hospitalist group at a community hospital, to identify probable causes of rehospitalizations, and to propose solutions to decrease the rate of readmissions. Methods: We conducted a retrospective medical chart review on patients who were rehospitalized with the same diagnosis within 30 days…
Background: Recognition of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage by active surveillance cultures has been widely debated. Our institution implemented universal nasal screening by polymerase chain reaction (PCR) for MRSA and isolation of screen positive patients in December 2007. Here we present data about the correlation between screen positivity and…
Bullous pemphigoid is the most frequent autoimmune blistering disease, usually affecting elderly patients. Most cases are idiopathic. We report a case of bullous pemphigoid developing four weeks after a boiling water burn, initially at the site of the burn, then elsewhere.
Pharmacovigilance is the process of identifying, monitoring, and effectively reducing adverse drug reactions. Adverse drug reactions (ADRs) are an important consideration when assessing a patient’s health. The proliferation of new pharmaceuticals means that the incidence of ADRs is increasing. The goal for all health care providers must be to minimize…
To the Editor: Although widely metastatic disease is rarely seen with papillary thyroid carcinoma, it represents the main cause of death in affected patients. Furthermore, the mortality rate increases dramatically after the age of 60. The most common metastatic sites are lung (∼50%), bone (∼25%), or both (∼15%). With distant…
Eosinophilic gastroenteritis (EG) is an uncommon gastrointestinal disease affecting both children and adults. The underlying molecular mechanism predisposing to the clinical manifestation of eosinophilic gastroenteritis is unknown. A 39-year-old man who was followed up with the diagnosis of familial Mediterranean fever (FMF) was admitted to our clinic with diarrhea, abdominal…
Exposure to silica and subsequent silicosis continues to be a problem in developed countries,1 with more than 3.2 million workers exposed in the European Union in 2000, and is particularly prevalent in developing countries, where new clusters of cases have occurred (eg, denim sandblasters in Turkey2 and stone grinders in…
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