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…
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.
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…
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…
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…
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…
Blood Pressure and Hypertension in Kidney Disease
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…
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…
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…
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…
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…
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…
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…
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…
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…
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….
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…
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…
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…
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…
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…
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.
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,…
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…
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…
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…
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…
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…
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…
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.
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…
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…
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…
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…
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