Issue - Southern Medical Association

Case Report

Acute In-Stent Coronary Thrombosis Without ST Change on Electrocardiography: A Case Report and Literature Review

Coronary stent thrombosis is a major complication which occurs in 0.5-1.9% of patients undergoing stent implantation. The case of a 65-year-old male who was admitted to the hospital due to chest pain is presented. A 12-lead electrocardiography showed complete AV block, acute inferior wall, and right ventricle myocardial infarction. Coronary…

Case Report

Endoscopic Removal of a Brunneroma with EUS Guidance

Brunner glands are compound tubular submucosal glands typically found in the duodenal bulb. The most common benign tumors of the small intestine are adenoma, and 25% of these occur in the duodenum. Among the benign tumors of the duodenum, 30–50% arise from the Brunner glands. Most of the literature describes…

Case Report

Multiple Myeloma Presenting as Recurrent Sinopulmonary Infections

Multiple myeloma is a plasma cell malignancy that classically presents with bone pain secondary to osteolytic lesions, anemia, and renal insufficiency. A 49-year-old man presented for workup of possible primary immunodeficiency due to a history of recurrent sinopulmonary infection and abnormal immunoglobulin levels. He was subsequently diagnosed with multiple myeloma,…

Case Report

Familial Isolated Primary Hyperparathyroidism with Double Adenoma

Familial hyperparathyroidism includes the diagnoses of multiple endocrine neoplasia type 1, type 2A, and familial isolated primary hyperparathyroidism. Familial isolated primary hyperparathyroidism is a rare, distinct form of familial primary hyperparathyroidism, mainly due to four-gland hyperplasia or single-gland adenoma. We describe our success in treating a 24-year-old woman with familial…

Case Report

Candida glabrata Liver Abscess and Fungemia Complicating Severe Calculus Cholecystitis in an Immunocompetent Nondiabetic Host

We report a rare case of Candida glabrata liver abscess and fungemia complicating severe calculus cholecystitis in a 64-year-old female patient who had no history of immunosuppression or diabetes mellitus. The patient underwent cholecystectomy, resection of liver abscess, and systemic antifungal therapy using micafungin.

Original Article

Intrathecal Sufentanil for Intraoperative and Postesophagectomy Pain Relief

Objectives: The present study compares the analgesic properties of intrathecal (IT group) and intravenous (IV group) sufentanil in postoperative pain relief. Methods: This randomized, single blinded study was performed on patients awaiting transhiatal esophagectomy. The patients were randomly allocated to receive sufentanil intrathecally or intravenously. Sufentanil consumption during the operation,…

Case Report

Radius Fracture from an Electrical Injury Involving an Electric Guitar

Electrical injury ranges widely from simple shock and mild burns to more extensive superficial injury, internal injury, and mortality. Bony fracture from electrically-induced tetanic muscle contraction is a rare but recognized injury. We report the case of a 14-year-old boy who suffered a minor burn and radius fracture related to…

Original Article

Effect of Helicobacter pylori Eradication on Insulin Resistance, Serum Lipids and Low-Grade Inflammation

Background/Aim: Many studies have revealed a close relationship between Helicobacter pylori (HP) infection and insulin resistance. The aim of this study was to investigate the effects of HP eradication on insulin resistance, serum lipids and low-grade inflammation. Materials and Methods: This was a prospective, open-label, single-center study which consisted of…

Expired CME Article

Antineoplastic Agent-Associated Serpentine Supravenous Hyperpigmentation: Superficial Venous System Hyperpigmentation Following Intravenous Chemotherapy

Purpose: To review the clinical characteristics and associated antineoplastic agents in patients who developed hyperpigmentation of the superficial venous system after chemotherapy. Background: Serpentine supravenous hyperpigmentation was the term coined by Hrushesky to describe increased pigmentation of the skin immediately overlying the venous network used for intravenous infusion of 5-fluorouracil….

Original Article

Overuse of Acid Suppression Therapy in Hospitalized Patients

Background: Acid suppression therapy (AST) is one of the most commonly prescribed classes of medications in hospitalized patients. Multiple studies have shown that AST is overused during inpatient admissions. However, minimal data is available regarding the frequency and patient characteristics of those discharged on unnecessary AST. The aims of the…

Case Report

Reparative Change with Extensive Squamous Metaplasia: A Potential Diagnostic Pitfall on Thyroid Aspiration

Squamous metaplasia and cystic change can appear in the thyroid and mimic a variety of lesions. In this report, a patient with two dominant left thyroid nodules underwent fine needle aspiration (FNA) biopsy for each nodule. One of the nodules was diagnosed as consistent with papillary carcinoma and the other…

Expired CME Credit Submission and Evaluation Form

March 2010 CME Questions

Management of Chronic Kidney Disease: What is the Evidence?1. The blood pressure goal for chronic kidney disease (CKD) patients with more than 1 g proteinuria/day is: A. <140/90 mm Hg B. <130/80 mm Hg C. <125/75 mm Hg D. <120/70 mm Hg 2. Which of the following statements regarding treatment…

Expired CME Article

Management of Chronic Kidney Disease: What is the Evidence?

Chronic kidney disease (CKD) is a strong risk factor for cardiovascular events and death. Hypertension, dyslipidemia, anemia, vascular calcification, and secondary hyperparathyroidism have all been implicated in the pathogenesis of cardiovascular disease associated with CKD. Numerous trials have been performed assessing the effects of modifying these risk factors on cardiovascular…

Original Article

The Value of Neopterin and Procalcitonin in Patients with Sepsis

Objective: Neopterin (NT) is a compound of low molecule-based pteridine. It is secreted by macrophages as a response to the stimulation of cytokines such as interferon-γ, interferon-1β, tumor necrosis factor α or bacteria compounds such as lipopolysaccharides. Procalcitonin (PCT) levels may increase in the course of bacterial, parasitic, and fungal…

Case Report

Macrodactylia Fibrolipomatosis Presenting as a Small Bowel Obstruction

A patient presented with progressive abdominal distention, discomfort, nausea, vomiting, and constipation. The patient also had congenital macrodactyly of the third, fourth, and fifth digits of the left hand. She was diagnosed with macrodactylia fibrolipomatosis with multiple small bowel lipomas and complete small bowel obstruction. Macrodactylia fibrolipomatosis is a rare…

Announcement

Southern Medical Association Announcement 1

2010 Calendar of Educational Events

Case Report

Large Pedunculated Eccrine Hidrocystoma: A Case Report

Eccrine hidrocystomas are benign, small, cystic growths that characteristically occur on the eyelids, but away from the lid margin. The size of these growths are generally reported as being between 1and 5 mm. The case of a patient with a very large hidrocystoma of the eyelid with a previously undescribed…

Case Report

Cinacalcet in the Treatment of Intractable Hypercalcemia Following Two Neck Exploration Surgeries for Primary Hyperparathyroidism

Primary hyperparathyroidism is commonly due to a single, sporadic parathyroid adenoma, and surgery is considered the treatment of choice based on guidelines established by the National Institutes of Health consensus panel. While there is no established medical therapy for this condition, pharmacotherapy with agents such as cinacalcet could be a…

Letter to the Editor

The Activity of Carotidynia Syndrome is Correlated with the Soluble Intracellular Adhesion Molecule-1 (sICAM-1) Level

To the Editor: Carotidynia is a syndrome characterized by unilateral neck pain, and was initially described by Fay in 1927.1 Clinical findings include tenderness over the carotid bifurcation and pain aggravated by movement of the neck without structural abnormalities.2 The symptoms normally have a short duration of about 2 to…

Announcement

Southern Medical Association Announcement 3

Guiding the Path Toward Your Financial Goals

Letter to the Editor

Diagnosing of Clostridium difficile Colitis

To the Editor: I read the recent publication by Gade and Turett1 with great interest. Gade and Turett1 emphasized the utility of repeated stool toxin testing for the diagnosing of Clostridium difficile colitis. Indeed, the repeated testing for stool toxin is an accepted method to overcome the problem of an…

Case Report

Metformin-Induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy

Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and…

Expired CME Credit Submission and Evaluation Form

CME Submission Form

Figure. CME Submission Form

Original Article

Intraoperative Fetal Heart Rate Monitoring During Nonobstetric Surgery in Pregnancy: A Practice Survey

Objective: To assess practice patterns concerning intraoperative fetal heart rate monitoring during nonobstetric surgery in pregnancy among members of the Association of Professors of Gynecology and Obstetrics (APGO). Study Design: A 16-question survey regarding intraoperative fetal heart rate monitoring during nonobstetric surgery was delivered to the 1300 APGO members via…

Editorial

Considering Global Vaccination against Helicobacter pylori

Although Helicobacter pylori has co-existed with the human race for over 50,000 years, its complexity as a bacteria is only starting to materialize. Marshall and Warren identified the bacteria in association with peptic ulcer disease in 1984,1 and, since then, its link in the pathogenesis of ulcer disease, gastric adenocarcinoma,…

Case Report

Bilateral Carotid Stenting After a Motor Vehicle Crash

Extracranial carotid artery dissection after blunt trauma may manifest as arterial stenosis or occlusion or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but, because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. A small…

Announcement

Southern Medical Association Announcement 2

MedEd On-Demand

Original Article

The Amount of Comorbidities as a Single Parameter Has No Effect in Predicting the Outcome in Appendicitis Patients Older than 60 Years

Background: Retrospective analysis of acute appendicitis patients older than 60 and statistical evaluation of the association between the accompanying illnesses, severity of peritonitis, morbidity, and mortality rates. Introduction: Although acute appendicitis is not frequent among aged populations, accompanying comorbidities of the geriatric patients are always fear factors before an emergency…

Letter to the Editor

Fantasy-Land, Reality-Land, and Guns

To the Editor: In the article Do Guns Provide Safety? At What Cost?, Narang et al1 attempt to answer the question as to whether guns are protective. The sad truth, confirmed yet again by this article, is that they do not. The sadder truth is that this is not a…

Editorial

Divinum est Opus Sedare Dolorem: Pretending the Divine in Postoperative Pain Management

The article by Bameshki1 in this issue of the Southern Medical Journal presents a prospective, randomized study comparing the postoperative analgesic effect of preemptive administration of intrathecal and intravenous sufentanil before transhiatal esophagectomy. The opioid requirement during and after the operation and the visual analog scale for pain and hemodynamic…

Editorial

Acute Stent Thrombosis: Rare but Still There

Since the first intracoronary stent implantation, the design and ease of use of coronary stents have continued to improve, and the indications for their use have continued to expand from bailout procedures to now-routine implantation in patients with myocardial infarction. Coronary stenting reduces the risk of restenosis and the number…

Case Report

Squamous Cell Carcinoma in an African American with Discoid Lupus Erythematosus: A Case Report and Review of the Literature

Discoid lupus is an autoimmune disorder with primarily cutaneous manifestations. Carcinomatous changes in discoid lupus can lead to the development of squamous cell carcinoma. While this most often occurs in Caucasians, the presented patient is an African American. She developed numerous squamous cell carcinomas in areas of scarring from discoid…