I read with interest Reeves et al’s1 article in this issue of the SMJ, entitled “Psychiatric Admission of Elderly Patients with Unrecognized Delirium.” This noteworthy study analyzes the success rate of distinguishing dementia from delirium, and factors contributing to errors in that process. While I appreciate the practical information they…
To the Editor: Azathioprine (AZT) is the treatment of choice for long-term immunosuppression in patients with myasthenia gravis (MG).1,2 There is some evidence that reduction of the standard dosage is ineffective, but some studies even report ineffectivity of the standard AZT dosage for generalized MG.3 We show that low-dose AZT…
Background: Heart failure (HF) management programs worldwide have reported conflicting outcomes in the past. Objectives: We sought to determine retrospectively whether the multidisciplinary outpatient management (MOM) program [heart failure clinic (HFC)], decreased readmission rates (RR), duration of hospital stay, and/or mortality in HF patients. Methods: Records of 138 HF patients…
Arterial and venous thromboembolisms have long been associated with inflammatory bowel disease (IBD) and can cause significant morbidity and mortality. We present a patient with aortic arch thrombosis embolizing to the left lower extremity during hospitalization for active ulcerative colitis (UC). The limb was preserved following emergent embolectomy. Thrombophilia was…
Chronic Kidney Disease: Whom to Screen and How to Treat Part 1: Definition, Epidemiology and Laboratory Testing1. Which of the following are the 2 screening tests for chronic kidney disease (CKD) recommended by the KDOQI guidelines?A. Creatinine clearance and 24-hour urine collection for proteinB. Serum creatinine and 24-hour urine collection…
Objectives: To explore factors that might contribute to misattribution of mental status changes to psychiatric illness when an elderly patient actually has a delirium (mental status changes due to a medical condition). Methods: Records of 900 elderly patients referred to a Veterans Affairs psychiatric inpatient unit and 413 to an…
Emphysematous pyelonephritis is a life-threatening infection especially seen in patients with poorly-controlled diabetes mellitus. Imaging modalities (preferably computed tomography) are required to establish the diagnosis. Treatment modalities include volume resuscitation, broad-spectrum antibiotics, percutaneous drainage, and, as a last resort, nephrectomy. We present a case of a 46-year-old female who had…
Chondromatous hamartomas are the most common benign lung tumors and the third most common pulmonary nodule. Histologically, they are characteristically composed of hyaline cartilage mixed with fibromyxoid stroma and adipose tissue surrounded by epithelial cells. We report the case of a healthy, 60-year-old woman with an incidentally discovered chondromatous hamartoma…
Guiding the Path Toward your Financial Goals
The very young and the very old are vulnerable to choking, and there are over 4000 choking-related deaths annually in the United States. Complications from the Heimlich maneuver (HM), as reported in infrequent case reports, predominantly relate to the elderly. It is doubtful that the denominator, numerator, appropriateness, expertise, and…
Background: The decision to place a percutaneous feeding tube (PFT) in patients who are at the end of life is multidimensional and often complicated. We assessed the effect of physician education and counseling for patients and their surrogates on inpatient nonsurgical (endoscopic and radiologic) PFT placement rates, indications, complications, and…
This issue of the Southern Medical Journal contains an important article by Fickenscher et al,1 describing neuroimaging findings in a group of 58 children younger than 20 months, evaluated for either abusive head trauma (AHT)2 or accidental head injury. The paper concludes with three interesting findings: 1) children in both…
Objective: To compare occult brain injuries on neuroimaging in clinically asymptomatic children under 20 months due to abusive versus accidental head trauma. Subjects and Methods: A retrospective review of 58 children under 20 months who underwent neuroimaging for possible abusive trauma was performed. The data collected were demographics, neurological signs/symptoms,…
This issue of the Southern Medical Journal introduces an important pediatric research article concerning the presence of occult brain injuries in clinically asymptomatic young children of less than twenty months.1 The article examines the presence of brain injuries of both abusive and accidental victims as seen with neuroimaging and notes…
The duodenum and gastrointestinal tract are rarely involved by multiple myeloma, either diffusely or as a focal mass. A 59-year-old man was diagnosed with multiple myeloma and given chemotherapy. Four months later, he developed jaundice. Gastroduodenal plasmacytoma causing extrahepatic biliary obstruction was diagnosed. To the best of our knowledge, this…
In this issue of the SMJ, we are pleased to publish the article “Do Guns Provide Safety? At What Cost?,” written by Drs. Narang, Paladugu, Manda, Smock, Lippman and Ms. Cosnay, RN. This article evaluates the statistics regarding the easy accessibility of guns in the United States and its relationship…
Guillain-Barré syndrome (GBS) encompasses the variants of acute immune-mediated polyneuropathies usually preceded by an infection. A few case reports have associated GBS to neoplastic diseases. It remains unclear whether these are merely coincidental or represent paraneoplastic phenomena. The clinical features of GBS associated with oncological cases do not appear to…
Duodenal diverticula are usually asymptomatic, with an incidence of 0.16% to 22%. Symptomatic bleeding from a duodenal diverticulum is an even rarer event. The management of such a hemorrhage is almost entirely surgically based. Since the first reported case of endoscopic therapy for duodenal diverticular bleeding (DDB) by Sim et…
Pleuropulmonary amebiasis is an uncommon complication of Entamoeba histolytica infection. It typically occurs in endemic regions including Central and South America, Africa and the Indian subcontinent. The case of a previously healthy US Army male stationed in Liberia with an acute onset of fevers, abdominal pain and bloody diarrhea is…
Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure greater than 25 mm Hg at rest or 30 mm Hg with exercise, as measured by right heart catheterization.1 Pulmonary hypertension can be classified as either primary pulmonary hypertension or idiopathic pulmonary arterial hypertension (IPAH) and secondary pulmonary hypertension….
To the Editor: I am grateful to Lin et al1 for their contribution to the knowledge of nontuberculous mycobacterial infections. However, I would like to make one comment. When assessing immunocompetence, we need to ask ourselves what are we looking for. It is well known that patients with deficiency of…
To the Editor: Pemphigus vulgaris (PV) is a rare chronic autoimmune disorder characterized by the development of flaccid bullae on the skin and mucous membranes. IgG autoantibodies are produced against desmogleins (Dsg) 1 and 3, which are the desmosomal units of the skin. Symptomatic involvement of stratified squamous epithelial mucosa,…
Background: The occurrence of deteriorating renal function test results along with the attempts at diuresis of anasarca has been described but not named, and no solution other than the standard treatment of related medical conditions such as congestive heart failure (CHF) and reducing or stopping diuretics has been offered. Phosphodiesterase…
A desmoid tumor is a fibroblastic proliferation arising in musculoaponeurotic structures. The pathogenesis is still not clear. A 79-year-old woman who developed a desmoid tumor in the left lower abdomen after surgical resection of an abdominal lipoma seven years previously is presented. Preoperative computed tomography showed a large left lower…
Chronic kidney disease has become a major public health problem due to its high prevalence, its exorbitant cost, and large reductions in life expectancy and quality of life of affected people. Seventy percent of cases of end-stage renal disease are due to diabetes and hypertension, conditions which are usually managed…
Many people feel that having a gun provides greater safety for them and their family. Actually, having a firearm in the home escalates the risk for death or injury, while using it to shoot someone who endangers the household is much less common. The resultant injuries, deaths, emotional turmoil, and/or…
Artificial nutrition through tube feeding is not unusual among persons with end stage dementia. It is estimated that about one-third of nursing home residents with advanced dementia are tube fed.1 This occurs even though the cited benefits of use; prolonging life, preventing aspiration, healing pressure ulcers, and providing comfort, do…
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