Issue - Southern Medical Association

Editorial

Delirium as Proxy for Health Care Reform

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…

Letter to the Editor

Low-Dose Azathioprine Effectively Suppresses Clinical and Immunological Manifestations of Generalized Myasthenia

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…

Announcement

Southern Medical Association Announcement 2

MedEd On-Demand

Original Article

Efficacy of Multidisciplinary Outpatient Management (MOM) Program in Long Term Heart Failure Care

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…

Case Report

Inflammatory Bowel Disease-Related Thoracic Aortic Thrombosis

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…

Expired CME Credit Submission and Evaluation Form

February 2010 CME Questions

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…

Original Article

Inappropriate Psychiatric Admission of Elderly Patients with Unrecognized Delirium

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…

Case Report

Culture-Negative Bilateral Emphysematous Pyelonephritis Presented as Acute Renal Failure and Managed Medically Only

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…

Case Report

Predominant Cartilaginous Hamartoma: An Unusual Variant of Chondromatous Hamartoma

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…

Announcement

Southern Medical Association Announcement 3

Guiding the Path Toward your Financial Goals

Expired CME Article

The Heimlich Maneuver: Breaking Down the Complications

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…

Original Article

Effect of Physician Education and Patient Counseling on Inpatient Nonsurgical Percutaneous Feeding Tube Placement Rate, Indications, and Outcome

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…

Editorial

Neuroimaging for Children Presenting with Head Trauma

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…

Original Article

Occult Cranial Injuries Found with Neuroimaging in Clinically Asymptomatic Young Children Due to Abusive Compared to Accidental Head Trauma

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,…

Editorial

Imaging in Asymptomatic Children After Trauma?

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…

Case Report

Gastroduodenal Plasmacytoma Presenting with Jaundice

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…

Editorial

Guns and Safety

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…

Case Report

Guillain-Barré Syndrome as a Paraneoplastic Manifestation of Small-Cell Carcinoma of Lung

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…

Case Report

Pneumoretroperitoneum and Pneumoperitoneum Following Argon Plasma Coagulation for a Bleeding Duodenal Diverticulum: A Case Report

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…

Case Report

Dyspnea and Dysentery: A Case Report of Pleuropulmonary Amebiasis

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…

Editorial

Diuresis in the Setting of Right Heart Failure: A New Look at an Old Problem

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….

Letter to the Editor

Assessing Immunocompetence in Mycobacterium szulgai Infections

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…

Letter to the Editor

Upper Gastrointestinal Bleeding in a Patient with a History of Peptic Ulcer Disease: Don’t Presume the Diagnosis

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,…

Original Article

The Successful Use of Phosphodiesterase Type 5 Inhibitors to Treat the Syndrome of Cor Pulmonale and Prerenal Azotemia with Diuresis of Anasarca (CorPRADA)

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…

Case Report

Desmoid Tumor Arising in the Site of Previous Surgery in the Left Lower Quadrant of the Abdomen

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…

Expired CME Credit Submission and Evaluation Form

CME Submission Form

CME Submission Form

Expired CME Article

Chronic Kidney Disease: Whom to Screen and How to Treat, Part 1: Definition, Epidemiology, and Laboratory Testing

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…

Announcement

Southern Medical Association Announcement 1

2010 Calendar of Educational Events

Review Article

Do Guns Provide Safety? At What Cost?

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…

Editorial

Informed Decision-Making Surrounding the Use of Chronic Enteral Nutrition: Let’s Talk the Talk

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…