Issue - Southern Medical Association

Case Report

Missed Brown Tumors in a Young Adult with Decreased Bone Density

Brown tumors, a benign osteolytic process, are most commonly caused by hyperparathyroidism. Multiple bone involvement is relatively rare. There are many similarities in the radiologic and histological features of brown tumors and giant cell tumors (GCTs) of bone. Differentiation between the two lesions is dependent upon evaluation of serum biochemistry…

Review Article

Current Concerns for Blood Donor Well-Being and Health

In addition to assuring an adequate and safe blood supply, blood collection agencies are responsible for the well being of donors. Several aspects of the current blood donor experience may negatively impact donor health and require modification. Physicians need to be aware of health-related issues associated with blood donation in…


The Role of the Primary Care Physician in the Prevention, Diagnosis and Treatment of Breast Cancer: Contemporary Knowledge and Controversies

Dr. Mary Hooks reminds us that we have achieved the primary prevention of breast cancer (BC) without seeming to have noticed it.1 The specific estrogen receptor modulators tamoxifen and raloxifene have both been shown to significantly reduce the risk of BC in pre- and postmenopausal American women; the latter without…

Case Report

Whipple Disease

Whipple disease (WD) is a rare disease caused by Tropheryma whipplei. The classic profile of the patient is that of a middle-aged man presenting with fever, chronic diarrhea, and arthralgias. Extragastrointestinal manifestations are not rare. A high degree of clinical suspicion for the disease is needed in atypical cases. Trimethoprim-sulfamethoxazole…

Expired CME Credit Submission and Evaluation Form

April 2010 CME Questions

&NA;Breast Cancer Risk Assessment and Prevention1. Over the last twenty years the mortality from breast cancer has: A. Increased B. Decreased C. Remained the same 2. An increased risk of breast cancer is associated with: A. Late menarche B. Early menopause C. More than six term pregnancies D. Fibrocystic breast…

Original Article

Rising Incidence of Tumorectomies without Breast Radiation in Patients Treated for Invasive Breast Cancer in Caribbean Nations

Background: Tumorectomy for invasive breast cancer (BC) is followed by local recurrence in 30% of patients who do not receive radiotherapy. In the United States 88% of tumorectomy patients receive radiation therapy. Many Caribbean nations lack radiation facilities and access to existing facilities is limited. Methods: The charts of the…

Original Article

Disparities in Sleep Position Awareness and Compliance

Objectives: To identify demographic predictors of caregivers who are more likely to position their infants prone for sleep; to determine caregivers’ primary information sources regarding sleep position recommendations; and to determine the primary influence on choice of infant sleep position among caregivers who still place their infants in an at-risk…


CME Submission Form

Figure. CME Submission Form

Original Article

Predictors of Poor Neurologic Outcome in Patients Undergoing Therapeutic Hypothermia After Cardiac Arrest

Background: Therapeutic hypothermia (TH) has been shown to reduce the degree of anoxic brain injury, decrease mortality, and improve neurologic recovery in patients surviving cardiac arrest. However, there is a paucity of data on potential markers of neurologic outcome that physicians can use in this setting. Methods: A retrospective medical…

Case Report

Subcutaneous Emphysema, Muscular Necrosis, and Necrotizing Fasciitis: An Unusual Presentation of Perforated Sigmoid Diverticulitis

With advancing age and the affluent, low-fiber Western diet, the incidence of diverticular disease is increasing. Fortunately, most cases can be managed conservatively without resorting to surgical intervention. Life-threatening complications such as perforation, especially when it is associated with gross fecal contamination, requires urgent aggressive surgical intervention. A 75-year-old man…

Letter to the Editor

Elevated Alanine Aminotransferase in Football Players

To the Editor: I read the recent publication by Selden et al1 with great interest. The abnormalities of laboratory investigation among the football players, who are externally very healthy and correlation to cardiometabolic disorder is of interest. This report can imply the observation of the occult pre-clinical abnormalities among the…

Case Report

Resolution of Pulsatile Tinnitus Following an Upper Mediastinal Lymph Node Resection

External compression of extracranial/mediastinal vessels has not been reported as an etiology of pulsatile tinnitus. We present a case in which compression of extracranial vasculature led to long term pulsatile tinnitus which resolved completely with surgical resection of metastatic lymph nodes. This should be included in the list of differential…


Regarding the “Rising Incidence of Tumorectomies without Breast Radiation in Patients Treated for Invasive Breast Cancer in Caribbean Nations”

The paper by Braverman et al1 reports on the rapid increase in tumorectomies (breast conserving surgery) without adequate supply of radiation therapy facilities in the Caribbean nations and the resulting high rate of local recurrence in breast cancer. Whereas in the United States 88% of patients receive radiation therapy after…

Expired CME Article

Breast Cancer: Risk Assessment and Prevention

Breast cancer is the most common cancer and the second most common cause of cancer death in women. In 2008 there were 182,460 women diagnosed with breast cancer, and 40,480 women died of this disease.1 Breast cancer can be prevented by medical (tamoxifen or raloxifene) or surgical approaches (bilateral mastectomy…

Case Report

A Report of Iliac Muscle Abscess Due to Mycobacterium bovis After Bacillus Calmette-Guerin Therapy for Bladder Cancer

Bacillus Calmette-Guerin (BCG) vaccine is traditionally used for vaccination against tuberculosis. BCG vaccine contains live attenuated strain of Mycobacterium bovis. Intravesical BCG is also effective in treatment of transitional cell carcinoma of the urinary bladder. Complications after intravesical BCG immunotherapy are extremely rare. We report an iliac muscle abscess due…


Southern Medical Association Announcement 1

2010 Calendar of Educational Events

Case Report

Not Your Typical Chronic Obstructive Pulmonary Disease Exacerbation: Aspergillus Tracheobronchitis in a Nonclassical Immunocompromised Host

he present study reports on a 72-year-old female initially treated as a presumed chronic obstructive pulmonary disease (COPD) exacerbation, but she was ultimately discovered to have Aspergillus tracheobronchitis. Bronchoscopic findings were characteristic, revealing diffuse plaque-like inflammatory lesions extending from midtrachea into the mainstem bronchi. Evidence suggests that the rise in…

Letter to the Editor

Partial Cranial Nerve III Palsy as a Manifestation of Undiagnosed Diabetes

To the Editor: Diabetic mononeuropathy is one of the rare forms of neuropathy, which is a serious problem from a diagnostic and therapeutic point of view. Cranial neuropathies in diabetic patients are extremely rare and occur in older individuals with a long duration of diabetes.1 Patients with diabetes mellitus may…

Original Article

Obesity and Mortality in Persons with Obstructive Lung Disease Using Data from the NHANES III

Objectives: The objective of this study was to determine the relationship between obesity and all-cause mortality among participants with obstructive lung disease in the National Health and Nutrition Examination Survey (NHANES III). Methods: Public data from a retrospective cohort of the 33,994 participants in NHANES III was analyzed to determine…

Case Report

Respiratory Failure in a 70-Year-Old Veteran

In Western countries the incidence of amyotrophic lateral sclerosis (ALS) is 1.89 per 100,000 per year and the prevalence is 5.2 per 100,000. The incidence of ALS is lower among African, Asian, and Hispanic ethnicities when compared to Caucasians. The mean age of onset for sporadic ALS is about 60…


Breast Cancer Screening Recommendations: Who Will Advocate for the Patient?

In November 2009, the U.S. Preventive Services Task Force issued breast cancer screening recommendations. These recommendations were based on a case-based analysis,1 and were “intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services.” It quickly became apparent that these recommendations and…

Case Report

Biliary Fascioliasis Mimicking Sphincter of Oddi Dysfunction

Fasciola hepatica, a liver fluke of livestock, rarely presents as chronic biliary tract infection in humans. We report a 38-year-old woman from Ethiopia who presented with right upper quadrant pain and a dilated common bile duct on ultrasound and magnetic resonance cholangiopancreatography (MRCP) without other abnormalities. She was suspected to…

Letter to the Editor

Necrotic Gastric Ulcer in an Elderly Patient: A Rare Case of Gastric Zygomycosis

To the Editor: An 85-year-old woman presented with bright red blood per rectum for one day. A month prior to her presentation, she was diagnosed with acute interstitial nephritis for which prednisone was started and tapered over 2 weeks. She appeared malnourished; abdomen was soft with mild epigastric tenderness. Pertinent…

Original Article

Community-Based Application of Mild Therapeutic Hypothermia for Survivors of Cardiac Arrest

Objective: To demonstrate that the application of therapeutic hypothermia is technically feasible in a community-based setting. Background: Implementation of therapeutic hypothermia for survivors of cardiac arrest in the United States has been slow, at least partially because of the perception that this therapy is technically difficult, especially at the community…


Southern Medical Association Announcement 3

SMA Insurance, Retirement


Therapeutic Hypothermia for Survivors of Cardiac Arrest in a Community-Based Setting

Survival rates and neurologic outcomes from sudden out-of-hospital cardiac arrest are poor.1,2 Although recent advances in cardiopulmonary resuscitation (CPR) techniques and advanced cardiac life support (ACLS) have resulted in somewhat improved survival rates over the past decade, ensuring good neurologic outcome in cardiac arrest survivors continues to be problematic. Even…

Letter to the Editor

Pelvic Splenosis Presenting as Posterior Cervical Mass

To the Editor: Splenosis refers to acquired autotransplantation of viable splenic tissue usually occurring after traumatic rupture of the spleen or splenectomy and can be found in any intraperitoneal or extraperitoneal site including the thoracic cavity. The most common locations are the peritoneum, omentum, and mesentery. We report a case…

Original Article

Medical Decision Making: Guide to Improved CPT Coding

Background: The Current Procedural Terminology (CPT) coding system for office visits, which has been in use since 1995, has not been well studied, but it is generally agreed that the system contains much room for error. In fact, the available literature suggests that only slightly more than half of physicians…

Case Report

Efalizumab-Induced Inflammatory Polyarthritis: What are the Implications?

A 49-year-old female was started on efalizumab for severe psoriasis. Three weeks later, she developed rapidly progressive inflammatory polyarthritis associated with high titers of both rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP) antibody. To our knowledge, this is the first reported case of efalizumab-induced anti-CCP-positive rheumatoid arthritis (RA). The…

Case Report

Concomitant Graves Hyperthyroidism with Thyrotrophin-Secreting Pituitary Adenoma

The relationship of autoimmune thyroid disease and TSH-producing pituitary tumor is rarely found. We report two patients with hyperthyroidism, a 27-year-old man and a 28-year-old woman, who were diagnosed with Graves hyperthyroidism with elevated free thyroxine (FT4), suppressed TSH and positive thyrotropin receptor autoantibodies. After treatment with antithyroid drugs, FT4…

Case Report

Scombroid Fish Poisoning After Eating Seared Tuna

Food safety is an increasing concern to Americans. Recent recalls of peanuts and pistachios, and Food and Drug Administration (FDA) warnings to pregnant women to avoid eating fish have increased government oversight of food processing and handling. Consumers can play an important role in alerting their healthcare providers to food-related…

Expired CME Article

Transition Medicine: A Review of Current Theory and Practice

Every year more than 500,000 children with special health care needs (CSHCN), patients who need more consistent medical care or face significant consequences and complications, transition to adult-oriented providers. Yet these patients may encounter even greater difficulty in transitions of care than healthy adolescents and young adults, whether it is…


Southern Medical Association Announcement 2

MedEd On-Demand

Letter to the Editor

Isolation of Abiotrophia/Granulicatella Species from a Brain Abscess in an Adult Patient Without Prior History of Neurosurgical Instrumentation

To the Editor: Organisms in the genera Abiotrophia and Granulicatella are fastidious Gram-positive nutritionally variant streptococci. Although part of normal human oral, genital, and intestinal flora, these organisms have been implicated in the development of endocarditis, vertebral osteomyelitis, endovascular infections, and central nervous system (CNS) infections after instrumentation. We report…

Letter to the Editor

Screening Veterans Affairs Patients with Iron Deficiency for Celiac Disease

To the Editor: Upper gastrointestinal tract (GI) endoscopy and colonoscopy are the cornerstones for investigating iron deficiency anemia (IDA).1 If the endoscopic evaluation of the GI tract is equivocal, small bowel (SB) biopsies are routinely obtained to rule out celiac disease (CD). Diagnostic yield of this practice differs in different…

Original Article

Association of Thrombotic and Fibrinolytic Factors with Severity of Culprit Lesion in Patients with Acute Coronary Syndromes Without ST Elevation

Background: Increased procoagulant activity and/or impaired fibrinolysis contribute to the development and organization of thrombus, subsequently resulting in complete or incomplete obstruction in acute coronary syndromes (ACS). We investigated the relationship between culprit lesion severity and thrombotic and fibrinolytic parameters in patients who had non-ST elevation ACS (NSTE-ACS). Methods: This…


Thrombotic and Fibrinolytic Factors in Acute Coronary Syndrome

It is now generally accepted that intracoronary thrombosis after plaque disruption is a major cause of the acute coronary syndromes (ACS) of unstable angina, myocardial infarction, and sudden cardiac death. Thrombus arises from procoagulant changes in complex plaques, which trigger both platelet activation and coagulation pathways.1 The magnitude of the…