Issue - Southern Medical Association

Case Report

Asacol®-induced Neutropenia Resolution Without the Use of Granulocyte Colony-stimulating Factor

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…

Original Article

Vancomycin MIC Susceptibility Testing of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Isolates: A Comparison Between Etest® and an Automated Testing Method

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:…

General Information

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Original Article

Toward a Statewide Health Information Technology Center (Abbreviated Version)

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…

Editorial

Curbing Readmission Rates: An Uphill Task

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…

Original Article

Relationship of Exercise Program Participation with Weight Loss in Adults with Severe Obesity: Assessing Psychologically Based Mediators

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 =…

Case Report

Thoracic Aortic Pseudoaneurysm Following Noncardiovascular Surgery: A Rare Complication that Can Mimic Common Chest Emergencies

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…

Letter to the Editor

Mondor Disease: An Unusual Cause of Chest Pain

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…

Original Article

Why Do Physicians Prescribe Stress Ulcer Prophylaxis to General Medicine Patients?

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…

Case Report

Giant Melanoma: Novel Problem, Same Approach

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…

Original Article

A Comparison of the Adoption of Electronic Health Records in North Carolina and South Carolina HIV Systems

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…

Announcement

Southern Medical Association Announcement 1

2010 Calendar of Educational Events

Original Article

Efficacy and Safety of Sodium Phosphate for Colon Cleansing in Type 2 Diabetes Mellitus

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…

Case Report

Primary Hyperparathyroidism Presenting as Intractable Nausea and Vomiting

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…

Case Report

Splenic Laceration Following Routine Colonoscopy

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…

Review Article

Kounis Syndrome

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…

Review Article

Tourniquet Use and Sickle Cell Hemoglobinopathy: How Should We Proceed?

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….

Letter to the Editor

Ventricular Tachycardia and Cardiac Arrest During Nasogastric Tube Insertion

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…

Letter to the Editor

Periampullary Leiomyosarcoma Presenting with Cutaneous Metastases: A Rare Entity

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…

Case Report

Hypereosinophilia Associated with Echinacea Use

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…

Expired CME Article

Evaluation and Management of Shoulder Pain in Primary Care Clinics

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…

Case Report

Acute Bilateral Ischemia of Fingers: An Unusual Complication of Temporal Arteritis

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.

Original Article

Relationship of the Intensity of Helicobacter pylori and Severity of Inflammation with Beta-2 Microglobulin Levels in Serum According to the Updated Sydney System

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…

Letter to the Editor

Lemierre Syndrome: A Rare Disease Affecting Previously Healthy, Young Individuals

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…

Case Report

Hiccups as a Sign of Chronic Myocardial Ischemia

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…

Letter to the Editor

Intrahepatic Expansion of Amebic Liver Abscess Can Also Generate Life-Threatening Complications

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…

Original Article

Evaluating Readmission Rates: How Can We Improve?

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…

General Information

Southern Medical Association Announcement 3

SMA Insurance Announcement

Original Article

Universal MRSA Nasal Surveillance: Characterization of Outcomes at a Tertiary Care Center and Implications for Infection Control

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…

Case Report

Bullous Pemphigoid After Boiling Water Burn

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.

Expired CME Article

Adverse Drug Reactions: Part II

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…

Letter to the Editor

Refractory Metastatic Thyroid Cancer: Is Doxorubicin Still a Valid Treatment Option?

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…

Case Report

MEFV Gene Mutations in a Patient with Eosinophilic Gastroenteritis

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…

Editorial

Silica Exposure and Silicosis: Action is Needed Now

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…