Issue - Southern Medical Association

Letter to the Editor

Secondary Aortoenteric Fistula Presenting with Recurrent Episodes of Sepsis

To the Editor: A 78-year-old female with an aortobifemoral bypass graft two years previously was seen in consultation for a 3-month history of recurrent episodes of sepsis with Enterobacter cloacae. Each episode was treated with antibiotics; however, following a brief regression, the symptoms recurred each time. Extensive workup, including computed…

Letter to the Editor

Lymphocytic Colitis in Satoyoshi Syndrome

To the Editor: Satoyoshi syndrome characterized by progressive, intermittent, and painful muscle spasms, alopecia, and severe watery diarrhea is a rare disease of unknown pathogenesis.1 It may include a malabsorption state that can cause abnormal childhood development, such as epiphysial destruction and growth retardation, and must be treated effectively.

Letter to the Editor

Implications of Occult Cranial Injuries for Perpetrator Identification in Cases of Alleged Abusive Head Trauma

To the Editor: After reading the recent article in the Southern Medical Journal, “Occult Cranial Injuries Found with Neuroimaging in Clinically Asymptomatic Young Children Due to Abusive Compared to Accidental Head Trauma” by Fickenscher et al1 and the accompanying editorial comments by Dr. Block2 and Drs. Waseem and Zipin,3 I…

Case Report

Refractory Diffuse Bony Pain 20 Years After Jejunoileal Bypass

Osteomalacia can be a late but unrecognized complication following jejunoileal bypass. We describe a 53-year-old man who underwent jejunoileal bypass for morbid obesity twenty years earlier who suffered from progressive diffuse bony pain refractory to nonsteroidal anti-inflammatory drugs. He was initially diagnosed with a malignancy with bone metastasis. However, pertinent…

Case Report

Incomplete Facial Nerve Palsyz: New Lessons from Activated Orbicularis Oculi Muscles

Motor nerve conduction studies (MNCS) and blink reflexes (BR) were done on a 42-year-old female patient who presented with peripheral facial nerve palsy (PFNP); these investigations were done while she had her facial muscles relaxed (“A”), and contracted (“B”). While in the “A” state, MNCS of the facial nerves had…

Editorial

Are We Providing Ethical Care for the Severely Obese?

The prevalence of obesity has increased dramatically worldwide in the past 25 years, but the United States is in the forefront with an estimated 72 million obese persons and over 65% of the population overweight or obese.1 Unfortunately, the proportion of those considered to be severely obese (BMI > 40…

Acknowledgment

Reports From the 2009 American Society of Nephrology meeting

Blood Pressure and Hypertension in Kidney Disease

Original Article

Association of Reduction in Waist Circumference with Normalization of Mood in Obese Women Initiating Exercise Supported by the Coach Approach Protocol

Background: Interrelations of exercise, mood, and weight reduction are unclear in the behavioral treatment of obesity. Methods: Obese women volunteers with high tension (anxiety) (T), depression (D), or total mood disturbance (TMD) scores, who were previously randomized into conditions of (1) exercise supported by The Coach Approach: a protocol based…

Case Report

Streptococcus sanguinis Brain Abscess as Complication of Subclinical Endocarditis: Emphasizing the Importance of Prompt Diagnosis

A 19-year-old male patient was diagnosed with S. sanguinis brain abscess of unknown etiopathology as a complication of subclinical endocarditis. While viridans streptococci are implicated in dental seeding to the heart, S. sanguinis brain abscesses are rare. Six previous cases of S. sanguinis brain abscess in the literature reported dental…

Announcement

Southern Medical Association Announcement 2

MedEd On-Demand

Review Article

Nonalcoholic Steatohepatitis: A Review of the Literature and Updates in Management

Nonalcoholic steatohepatitis is a common cause of liver inflammation and is associated with obesity, insulin resistance, and hyperlipidemia. There are concerns that it may turn out to be the most common cause of liver failure as prevalence of obesity increases. It leads to increased morbidity and mortality. Other causes of…

Editorial

Obesity—Who Is Responsible?

It is astounding that in one of our premiere teaching hospitals, obesity in hospitalized patients is noted less than one fifth of the time and a management plan is made in less than 10% of the patients.1 The study conducted by Howe et al published in this issue of the…

Acknowledgment

Southern Medical Association Announcement 1

2010 Calendar of Educational Events

Letter to the Editor

Acute Profound Thrombocytopenia Following Eptifibatide Administration

To the Editor: An 84-year-old female with a history of diabetes mellitus, hypertension, ulcerative colitis, and dyslipidemia presented to the emergency room with acutely worsening shortness of breath (SOB). Home medications included aspirin, glimepiride, insulin, furosemide, metoprolol, mesalamine, irbesartan, simvastatin, and vitamins. Examination showed bibasilar fine crackles with 1+ pitting…

Case Report

Chronic Cough as the Presenting Symptom of Hydrocephalus

Chronic cough is defined as a daily cough lasting for more than eight weeks. We report an unusual case of chronic cough as the primary manifestation of obstructive hydrocephalus. Chronic cough in our case was determined to be of neurogenic origin only after exhaustive investigations failed to reveal a systemic…

Letter to the Editor

Splatter-Free Compression Cryotherapy for Skin Lesions

To the Editor: Cryotherapy using liquid nitrogen spray is a mainstay of office skin care. It is used by both dermatologists and primary care physicians to eradicate select skin lesions with minimal to no scarring. The spray is trigger released from a pressurized canister. Since the spray is released from…

Letter to the Editor

Thirteen Years’ Survival After Glioblastoma

To the Editor: In a previous letter to the editor, my colleagues and I presented a long-term glioblastoma survivor.1 The patient lived more than 13 and a half years after initial glioblastoma diagnosis and died shortly after the publication of that letter. A year before that, the patient presented with…

Original Article

Chronic Calcific Pancreatitis: Combination ERCP and Extracorporeal Shock Wave Lithotripsy for Pancreatic Duct Stones

Background: Chronic pancreatitis is commonly associated with debilitating abdominal pain, in part due to pancreatic duct obstruction. Pancreatic stones are often impossible to extract from the duct with endoscopic retrograde cholangiopancreatography alone. Extracorporeal shock wave lithotripsy (ESWL) is commonly used for fragmentation of obstructing nephrolithiasis and has demonstrated effectiveness in…

Original Article

Addressing Obesity in the Hospitalized Patient: A Needs Assessment

Objective: To perform a needs assessment to determine the extent to which hospitalist providers recognize and intervene upon obese patients in the hospital setting. Methods: A chart review was performed for patients admitted to the hospitalist service at Johns Hopkins Bayview Medical Center between September 1 and October 1, 2008….

Expired CME Article

Challenges of Abdominal Organ Transplant in Obesity

Obesity is a worldwide epidemic and public health crisis associated with severe comorbidity leading to end organ dysfunction and poorer transplant outcome. Large population studies show decreased patient and graft survival in obese kidney transplant patients. Despite the poorer outcomes, kidney transplant is considered because of the survival benefit as…

Original Article

Access to Medical Care, Dental Care, and Prescription Drugs: The Roles of Race/Ethnicity, Health Insurance, and Income

Background: After accounting for socioeconomic factors and other demographic characteristics, racial/ethnic disparities in access to care were examined. Methods: Using nationally representative data on 34,403 individuals from the 2004 Medical Expenditure Panel Survey (MEPS), multiple logistic regression analyses for five outcome measures were conducted: self-reports of being unable to get…

Case Report

Pathologic Cervical Burst Fracture Presenting with Airway Compromise

Mechanical airway compromise following cervical spine injury or fracture is a rare but known entity. It most commonly is the result of the development of a retropharyngeal hematoma or prevertebral soft tissue edema that obstructs the airway, leading to respiratory distress and emergent need for airway management and possible surgical…

Announcement

Southern Medical Association Announcement 3

The Standard Insurance Group

Letter to the Editor

Ankle-Brachial Index Measurement in the Primary Care Setting

To the Editor: In their articles, Pearson et al,1 Salameh and Federman2 and Aslam et al3 (November 2009 issue) emphasize the important role of the ankle-brachial index (ABI) as a consistent and significant predictor of cardiovascular events. However, ABI is rarely performed in primary care office settings due to time…

Letter to the Editor

Standing at the Crossroads-Will the Increments in Resident Clinic Sessions Help?

To the Editor: Recent years have witnessed an increasing trend towards reforming and redesigning the configuration of internal medicine residency training to prepare the residents for future clinical practice.1,2 This has meant a step-by-step increase in the number of resident clinic sessions and the percentage of time spent in outpatient…

Editorial

Access to Unused Health Care

In this issue of the Southern Medical Journal, Shi and coworkers1 use data from the Medical Expenditures Panel Survey (MEPS)—a nationally representative survey of US households—to assess racial and ethnic disparities in care.

Case Report

Anti-Immunoglobulin E in the Treatment of Refractory Atopic Dermatitis

Atopic dermatitis (AD) is a common diagnosis seen in both children and adults, and it is often the first manifestation of atopic disease. Research has shown a strong correlation between serum IgE levels, the severity of atopic dermatitis, and co-existing asthma and/or allergic rhinitis.18 Omalizumab (Xolair®, East Hanover, NJ; Genentech,…

Case Report

Spigelian Hernia as a Cause of Small Bowel Obstruction

Spigelian hernia is a rare abdominal wall defect usually appearing between the abdominal muscle lateral to the rectus abdominis and through a debilitated spigelian aponeurosis. Spigelian hernias account for 0.12% to 2.4% of all abdominal wall hernias with a 17–24% risk of strangulation. We report the case of a 77-year-old…

Original Article

Faith and Religious Beliefs in an Outpatient Military Population

Background: This study of outpatients at a military medical center seeks to evaluate the extent that this population relies on religion and spirituality to cope with health-related stress. This study also assesses outpatients’ desire for spiritual intervention in the context of their medical appointments. Methods: A cross-sectional survey was conducted…

Editorial

Chronic Calcific Pancreatitis: Good News, Bad News

Chronic pancreatitis is a common condition with limited treatment options. Pain is the predominant symptom requiring treatment and remains a major clinical challenge. The etiology of pain in chronic pancreatitis is varied and complex. The two most frequently implicated factors are increased ductal and intraparenchymal pressure (obstructive pancreatitis), and alterations…

Original Article

Usefulness of CRP and ESR in Predicting Septic Joints

Objective: To determine whether erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or a combination of both was better in diagnosing a septic joint. Methods: A retrospective chart review was done in all patients who had serum assays for ESR or CRP as well as joint fluid analysis over a two-year…

Case Report

Interferon Alpha-Induced Hashimoto Thyroiditis Followed by Transient Graves Disease in a Patient with Chronic HCV Infection

The case of a 37-year-old man with chronic hepatitis C virus (HCV) infection is presented. The patient had received a 6-month course of antiviral therapy with peg interferon alpha-2a and ribavirin, with concomitant clearance of hepatitis C virus ribonucleic acid (HCV-RNA) from serum at the end of treatment. Three months…

Case Report

Diagnostic Puzzle of Inflammatory Pseudotumor of the Urinary Bladder: A Case Report with Brief Literature Review

Inflammatory pseudotumor of the urinary bladder is a rare reactive proliferation with a clinical presentation similar to malignant neoplasms. We present the case of a 35-year-old woman who presented with left lower quadrant pain and gross hematuria. A diagnosis of cystitis glandularis was initially considered; however, the symptoms did not…

Editorial

Re: Pathologic Cervical Burst Fracture Presenting with Airway Compromise

The advent of spiral computed tomography (CT) and magnetic resonance imaging (MRI) has revolutionized the way physicians diagnose and treat patients who present with spinal injuries. These medical advances have improved our understanding of spine biomechanics and present a modern approach to the management of the spinal-injured patient.

Expired CME Article

Acute Radiation Syndrome: Assessment and Management

Primary care physicians may be unprepared to diagnose and treat rare, yet potentially fatal, illnesses such as acute radiation syndrome (ARS). ARS, also known as radiation sickness, is caused by exposure to a high dose of penetrating, ionizing radiation over a short period of time. The time to onset of…

Letter to the Editor

Swallowed Dental Bridge Perforating the Terminal Ileum

To the Editor: A 53-year-old male presented to the emergency department complaining of right iliac fossa pain 24 hours after swallowing his dental plate. On examination his abdomen displayed signs of right iliac fossa peritonism. He was taken to the theatre and, during the operation, a tooth was seen protruding…

Letter to the Editor

Can a Normal Colonic Mucosa Harbor an Aggressive Underlying Lymphoma?

To the Editor: Chronic diarrhea is a common gastrointestinal (GI) complaint with an overall prevalence of 3–5% in the United States. Common causes include irritable bowel syndrome, inflammatory bowel disease, microscopic colitis, malabsorption syndromes, chronic infections, and medications. The laboratory tools available for evaluation are often expensive and invasive. As…

Case Report

Scimitar Syndrome: A Rare Cause of Dyspnea in Adults

Scimitar syndrome is a rare congenital malformation resulting in anomalous pulmonary venous return and lung malformations. Symptoms commonly develop in the first year of life, leading to diagnosis and surgical correction. In this case, the atypical presentation of scimitar syndrome in an adult woman with complaints of dyspnea on exertion…