Issue - Southern Medical Association

Original Article

Burnout in Medical Students: Examining the Prevalence and Associated Factors

Objective: Burnout has been described as a syndrome of emotional exhaustion, depersonalization, and decreased personal accomplishment, and may originate during medical school. The objective of this study is to determine the prevalence of burnout and contributing factors in medical students. Methods: A survey was administered to 249 medical students using…

Editorial

A Role for Extracorporeal Treatment in Severe Influenza?

Influenza occurs worldwide as a seasonal infection. The influenza virus is enclosed in an envelope containing the glycoproteins hemagglutinin and neuraminidase. It has been known for many decades that the virus mutates to form new subtypes and strains, which are named according to the antigenic types of hemagglutinin and neuraminidase,…

Case Report

Renal Urothelial Carcinoma with Extended Venous Thrombus

Vascular invasion is not uncommon histologically in patients with urothelial carcinoma (UC) arising from the renal pelvis or ureter, while tumor thrombus affecting the main renal vein or the inferior vena cava (IVC) is rare. Herein, we report a unique case of renal pelvic UC with extended IVC thrombus manifested…

Case Report

A Unique Case of Recurrent Takotsubo Cardiomyopathy

Takotsubo (stress induced) cardiomyopathy is also known as broken heart syndrome or transient left ventricular apical ballooning syndrome. The clinical presentation, which mimics acute myocardial infarction, is preceded by intense emotional or physical stress. Recurrence of apical ballooning syndrome seems to be rare. We present a case of recurrent takotsubo…

Original Article

Obstructive Sleep Apnea and Immunity: Relationship of Lymphocyte Count and Apnea Hypopnea Index

Objectives: The impact of chronic poor quality sleep on immunity as seen in obstructive sleep apnea (OSA) has not been evaluated. We aim to explore the relationship between lymphocytes, neutrophil, and total leukocyte counts with severity stratified apnea hypopnea index (AHI) in patients with OSA. Methods: A retrospective review of…

Original Article

Racial Differences in General Health, Suicidal Thoughts, Physical and Sexual Abuse in African-Americans and Caucasians with Irritable Bowel Syndrome

Objectives: Knowledge of the contribution of race to irritable bowel syndrome (IBS) -associated morbidity helps not only with health care policy decisions but also may provide important clues to the pathophysiologic interactions involved. Methods: We conducted a survey at 9 different sites in our metro area. Subjects filled a questionnaire…

Editorial

Bariatric Surgery

The number of Americans who are overweight, grossly overweight, and morbidly obese has been increasing rapidly. Of greatest concern is the growing incidence of childhood obesity. Multiple reasons are given for these increases: overeating, high caloric fast food, inactivity, and lack of exercise. It is, though, a matter of numbers—…

General Information

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Case Report

A Solitary Pelvic Extramedullary Plasmacytoma

A case of an extramedullary plasmacytoma (EMP), which presented with a solitary pelvic tumor, is reported. Complete tumor resection was performed, followed by radiation therapy. Our experience demonstrates a satisfactory short-term oncological outcome.

Letter to the Editor

Livedoid Vasculopathy in a Woman with Multiple Myeloma

To the Editor: A 62-year-old Caucasian woman with a history of multiple myeloma diagnosed one year ago presented with chief complaints of lower extremity rash of two weeks’ duration and severe burning pain in the same area for the past four days. The patient had no known drug allergies and…

Case Report

Unsuspected Polymicrobial Brain Abscess Arising from an Intra-Abdominal Source in a Patient with Hereditary Hemorrhagic Telangiectasia

The unusual and unprecedented occurrence of a patient with hereditary hemorrhagic telangiectasia (HHT) and a polymicrobial abscess with three different organisms, including fungi, is reported. The patient was a 48-year-old woman with human immunodeficiency virus (HIV) infection and HHT who was brought to the hospital after a motor vehicle accident…

Editorial

Hypovitaminosis D in Hypertension

Rickets, characterized by the failure of growing bones to mineralize, is now known to be caused by vitamin D deficiency. During the Industrial Revolution, rickets was noted to be rampant among underprivileged infants in the northern United States and several large cities in Europe. An autopsy study done in 1909…

Case Report

Community-Acquired Methicillin-Resistant Staphylococcus aureus Pericarditis Presenting as Cardiac Tamponade

Chest computed tomography showed pericardial effusion and bilateral small pleural effusion in a 19-year-old patient. Nine hundred mL of yellow purulent fluid was drained by pericardiocentesis. Culture of the fluid grew methicillin resistant Staphylococcus aureus (MRSA). Our patient denied history of previous hospitalization, surgical procedures, or illicit drug use and…

Review Article

Acute Adult Supraglottitis: Current Management and Treatment

Acute adult supraglottitis can be a serious, life-threatening disease because of its potential for sudden upper airway obstruction. Symptoms and signs of this disease may be nonspecific and may resemble those of upper respiratory tract infection. Unexplained sore throat with tenderness of the anterior neck over the hyoid bone warrant…

Original Article

Effects of Vitamin D Supplementation on Blood Pressure

Objective: Inconsistent findings from epidemiological studies have continued the controversy over the role of oral vitamin D supplementation in reducing blood pressure in normotensive or hypertensive populations. Methods: We performed a literature search up to December 2009, with no restrictions. Only double-blind randomized controlled trials (RCTs) of oral vitamin D…

Case Report

Complete Currarino Triad Presenting with Diarrhea in a 7-Month-Old Girl

The Currarino triad is a complex genetic disorder characterized by multiple caudal anomalies. Currarino et al first described this syndrome in 1981 as a sacral bony defect, presacral mass, and an anorectal malformation. Patients with this disorder usually present with constipation and characteristic radiological findings. Early diagnosis is vital for…

Review Article

Cisplatin-Induced Renal Salt Wasting Syndrome

Cisplatin was the first platinum compound to be introduced as a chemotherapeutic agent with antineoplastic activity against a wide variety of solid tumors. Renal impairment with a decline in glomerular filtration has been the classical nephrotoxicity of cisplatin. Renal salt wasting syndrome is yet another, though it is not common….

General Information

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Letter to the Editor

How Long Does It Take for a Trichobezoar to Form?

To the Editor: A thirteen-year-old female was admitted to Children’s Hospital of Michigan with abdominal pain, vomiting, and a diagnosis of acute pancreatitis. Laboratory studies were remarkable for hypochromic microcytic anemia, elevated amylase, and lipase levels. Past medical history included iron deficiency anemia, depression, obsessive compulsive disorder, pica, and trichotillomania….

Expired CME Article

Metabolic, Renal, and Nutritional Consequences of Bariatric Surgery: Implications for the Clinician

Management of obesity-associated comorbidities costs about $60 billion/year, about 5% of total US healthcare expenditure. Bariatric surgery is the only proven effective weight loss therapy for severely obese patients with a BMI ≥35 kg/m2. Bariatric surgery produces long-term weight loss, improves quality of life, and reduces the number of sick…

Case Report

Myositis as an Unusual Presentation of Secondary Syphilis

Myositis is a complication of many infectious and noninfectious processes. Secondary syphilis is an uncommon cause of myositis, and, therefore, the diagnosis may be delayed. We describe a man with human immunodeficiency virus infection presenting with diffuse muscle injury secondary to syphilis. He had complete resolution of all signs and…

Announcement

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2010 Calendar of Educational Events

Original Article

Should Increased Levels of Urinary 8-Hydroxydeoxyguanosine in Chronic Gastritis Imply Intestinal Metaplasia or Gastric Atrophy?

Objectives: Helicobacter pylori (H pylori) infection induces chronic inflammation that can progress to gastric atrophy, intestinal metaplasia, and gastric adenocarcinoma. We have examined oxidative damage caused by Helicobacter pylori, metaplasia, and atrophy of gastric mucosal cells in patients with chronic gastritis by measuring their urinary 8-hydroxydeoxyguanosine (8-OHdG) levels. Methods: We…

Case Report

Nine-Year Progression of Untreated Pulmonary Mycobacterium szulgai Infection

A 58-year-old man was seen with complaints of fevers, night sweats, weight loss, and multiple bilateral cavitary lung lesions. Mycobacterium szulgai with nearly identical antibiograms grew from separate sputum specimens 9 years apart. He was treated with a combination of clarithromycin and ethambutol with clinical, microbiologic, and radiographic resolution of…

Letter to the Editor

Recurrent Cerebral Embolism Associated with Indwelling Catheter in the Presence of Anomalous Neck Venous Structures

To the Editor: A 52-year-old white female was diagnosed with clinical stage IIIB invasive ductal carcinoma of the right breast and was started on neo-adjuvant chemotherapy with doxorubicin and cyclophosphamide every 3 weeks. The first cycle was administered through peripheral veins before indwelling catheter placement.

Expired CME Article

Clinical Pathological Characteristics and Management of Acute Respiratory Distress Syndrome Resulting from Influenza A (H1N1) Virus

Young adults, especially pregnant woman and patients with pre-existing medical conditions, appear to be at risk for the development of severe acute respiratory distress syndrome (ARDS) from influenza A (H1N1) infection, leading to critical hypoxemia. This may require high ventilator settings, the use of nonconventional modes, and extracorporeal membrane oxygenation…

Case Report

Elvis Is Back: Musical Hallucinations in a Parkinson Disease Patient

Hallucinations are common among patients with Parkinson disease (PD). Hallucinations, typically transitory and occurring at night, are classically visual and occur in 30% of treated patients; auditory hallucinations are rare. A musical hallucination (MH) is a rare type of complex auditory hallucination reported in only six PD patients so far….

Case Report

Small Cell Lung Cancer with Paraneoplastic Lipase Production

Kulchitsky cells represent the cells of origin of small cell lung cancer (SCLC). They display an antigenic makeup characteristic of both the neural crest and epithelium and have been shown to secrete both polypeptide hormones and enzymes. The coexistence of two or more (concomitant or sequential) paraneoplastic endocrine syndromes is…

Case Report

Chronic Lymphocytic Leukemia Associated with Myelodysplastic Syndrome with Ring Sideroblasts

Diagnosis of myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) and chronic lymphocytic leukemia (CLL) in the same patient is extremely rare. We describe a 69-year-old CLL patient who developed MDS with ring sideroblasts 1 year after diagnosis of CLL and without any previous treatment. Diagnosis was based on flow cytometry, bone marrow…

Letter to the Editor

Cimetidine-Induced Lactic Acidosis and Acute Pancreatitis

To the Editor: A 59-year-old Hispanic female with a medical history of diabetes mellitus type 2 and coronary artery disease was nine days’ postcardiac catheterization when she presented to the emergency department (ED). The patient had a two-day history of nausea and vomiting, with diarrhea starting on the day of…

Letter to the Editor

Cardiac Angiosarcoma and Recurrent Pericardial Effusion

To the Editor: Malignant pericardial effusions are not uncommon and are usually secondary to metastatic pericardial disease. There is, however, a relative lack of emphasis on primary cardiac malignancies as a cause of pericardial effusion due to extreme rarity of these tumors. These malignancies need to be considered in the…

Original Article

A Retrospective Review of Clinical Experience with Daptomycin for a Variety of Wound Types in a Burn and Wound Care Facility

Objective: Daptomycin is a novel antibiotic with activity against many Gram-positive organisms that has demonstrated efficacy in the management of skin and soft tissue infections (SSTIs). However, data regarding the use of daptomycin for the management of burn wound infections are lacking. We assessed the efficacy and safety of daptomycin…

Original Article

Pain Management by Primary Care Physicians, Pain Physicians, Chiropractors, and Acupuncturists: A National Survey

Objectives: Chronic pain is a serious public health problem and is treated by diverse health care providers. In order to enhance policies and programs to improve pain care, we collected information about the distribution of pain patients among four major groups of pain management providers: primary care physicians (PCPs), pain…

Case Report

Carcinomatous Meningitis Secondary to Transitional Cell Bladder Cancer

We report a patient with carcinomatous meningitis secondary to known transitional cell carcinoma of the bladder. The patient presented with multiple focal neurological signs and symptoms. Diagnosis was suggested by magnetic resonance imaging and confirmed by analysis of the cerebrospinal fluid. He received whole brain radiotherapy despite a poor prognosis….

Letter to the Editor

Continuous Venovenous Hemodiafiltration in Severe Metabolic Acidosis Secondary to Ethylene Glycol Ingestion

To the Editor: Ethylene glycol (EG) poisoning is uncommon, yet if unrecognized, potentially fatal. Treatment options for EG toxicity include correction of metabolic acidosis, fomepizole, hemodialysis, and supportive care.1 We present a unique case of severe metabolic acidosis secondary to EG and use of continuous venovenous hemodiafiltration (CVVHDF) over traditional…