Issue - Southern Medical Association

Case Report

Urinothorax: Presentation of a New Case as Pleural Exudate

Urinothorax or urothorax (UT) is a rare condition which often goes undiagnosed. In published cases of UT, the pleural fluid is usually transudative and is very rarely exudative. We present a case of UT after right nephroureterectomy for urothelial carcinoma, in which the pleural fluid presented characteristics of exudate. The…

Review Article

Types of Hair Loss and Treatment Options, Including the Novel Low-Level Light Therapy and Its Proposed Mechanism

Androgenetic alopecia (AGA) is the most common form of hair loss in men, and female pattern hair loss (FPHL) is the most common form of hair loss in women. Traditional methods of treating hair loss have included minoxidil, finasteride, and surgical transplantation. Currently there is a myriad of new and…

Original Article

Change in Bilirubin Level Following Acute Myocardial Infarction Is an Index for Heme Oxygenase Activation

Objectives: Heme oxygenase 1 (HO-1) is rapidly induced by stress, degrading pro-oxidant heme into carbon monoxide, bilirubin, and free iron (Fe). Induction of HO-1 is an important defense mechanism against tissue injury. Here, we tested the hypothesis that HO-1 is activated in the myocardium after acute myocardial infarction (AMI) in…

Letter to the Editor

A Case of an Unusual Foreign Body of the Tongue

To the Editor: We describe the management of a very unusual case of a 13-year-old girl presenting to the emergency department (ED) for removal of a large metallic globe (approximately 3 inches in diameter) entrapping the tongue (Fig.). The access to the oropharynx was completely blocked by the globe. The…

Original Article

Clinical Manifestations, Radiographic Findings, Treatment Options, and Outcome in Sarcoidosis Patients with Upper Respiratory Tract Involvement

Background: Sarcoidosis of the upper respiratory tract (SURT) is an underappreciated manifestation of sarcoidosis. We described the clinicoradiological findings, methods of treatment, and outcomes of 68 patients with SURT seen in our clinic over a 7-year period. Methods: This was a retrospective study. A Case Control Etiology of Sarcoidosis Study…

Letter to the Editor

Successful Endoscopic Clip Closure of Postoperative Esophageal Leak

To the Editor: Esophageal leaks can occur secondary to instrumental or pathologic perforation, postsurgical anastomotic leak, or formation of benign or malignant esophageal fistulae. Repair of the leak and diversion of the luminal contents along with nutritional support and antibiotics is the cornerstone of managing esophageal leaks. An anastomotic leak…

Case Report

Scedosporium apiospermum Infection Presenting as a Pneumothorax and Cavitary Lung Lesions in a Patient with Acquired Immune Deficiency Syndrome

The Scedosporium genus consists of filamentous fungi that inhabit soil, sewage, manure, and polluted waters, and contains two medically important species: Scedosporium apiospermum and Scedosporium prolificans. Scedosporiosis is caused by inhalation or traumatic subcutaneous implantation of the organism, and may have varied clinical presentations. A variety of pulmonary manifestations can…

Case Reports

Coexistence of Cerebral Tubers with Neurocysticercosis

A case of tuberous sclerosis with seizure disorder and coexisting neurocysticercosis is reported. The diagnostic and therapeutic implications of establishing the proximate cause of clinical seizure type are described and emphasized.

General Information

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Case Report

Panniculitis Ossificans in a Patient with Excessive Push-ups: Imaging Findings with Histological Correlation

Panniculitis ossificans arising symmetrically in the subcutaneous layer of both shoulders is rare. A case of a 27-year-old man with recent history of doing excessive push-ups is reported. According to the patient’s statement, there is no notable history of alcoholism, major trauma, or injection of nonsteroidal anti-inflammatory drugs. Computed tomography…

Expired CME Article

Clostridium difficile: An Update for the Primary Care Clinician

Clostridium difficile infection (CDI) is an important cause of intestinal disease, primarily affecting hospitalized patients exposed to antibiotics. Infection has been associated with prolonged hospital stays and excess healthcare expenditures. Recent changes in the epidemiology, pathogenesis, and treatment of CDI have occurred, leading to renewed scrutiny of this pathogen. Increases…

Letter to the Editor

Subcutaneous Hydatid Cyst of the Thigh

To the Editor: A 26-year-old woman presented with a swelling in the anteromedial part of her left thigh for the previous 14 months. The swelling had been gradually increasing. There was no history of trauma or fever. On examination, a well-defined, nontender swelling in the subcutaneous area of the left…

General Information

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Case Report

Bordetella bronchiseptica Bacteremia in a Patient with AIDS

Bordetella bronchiseptica bacteremia is often associated with various infection in animals. The majority of B bronchiseptica infections reported in humans are cases of pneumonia. Very few cases have been reported in patients with a history of acquired immune deficiency syndrome (AIDS). The patient described herein, who had a history of…

Review Article

Type 2 Diabetes Mellitus: Managing Hemoglobin A1c and Beyond

Comprehensive glycemic control, as demonstrated by desirable glycated hemoglobin A1c (HbA1c), postprandial glucose (PPG), and fasting plasma glucose (FPG) levels, is imperative for managing patients with type 2 diabetes mellitus (T2DM). It is important to minimize fluctuations in blood glucose levels, as they are thought to contribute to both the…

Case Report

Acute Pylephlebitis Following Gastrointestinal Infection: An Unrecognized Cause of Septic Shock

Pylephlebitis is the septic thrombosis of the portal vein. Hypercoagulability and intra-abdominal sepsis are the main predisposing factors. A 25-year-old man presented to a primary health care center complaining of fever, epigastric pain, and jaundice. He was initially diagnosed with a gastrointestinal infection and alcoholic hepatitis and, due to his…

Letter to the Editor

Alanine Aminotransferase Concentrations in Elite Athletes

To the Editor: I read the interesting paper published by Selden et al1,2 and the related correspondence. High values of alanine aminotransferase (ALT) in football players are linked with hypertension and metabolic syndrome, denying the expected healthy status of elite athletes. The topic is of particular interest because athletes are…

Editorial

Consideration of Subcutaneous Immunoglobulin Replacement Therapy in Humoral Immunodeficiency Patients

Antibody-related defects or humoral primary immunodeficiencies account for 65–70% of all primary immunodeficiencies.1–3 Common variable immunodeficiency (CVID) is the clinically relevant primary immunodeficiency most commonly encountered. CVID is a heterogeneous group of disorders characterized by hypogammaglobulinemia, increased susceptibility to recurrent pyogenic infections,4 autoimmunity,5–7 noncaseating sarcoid like granulomas,8 gastrointestinal disease (diarrhea,…

Case Report

Invasive Cancer in a Diminutive Rectal Polyp Amidst Internal Hemorrhoids Detected by Rectal Retroflexion

A diminutive rectal polyp amidst internal hemorrhoids, detected by rectal retroflexion during colonoscopy, was shown to harbor invasive rectal adenocarcinoma by colonoscopic biopsy. Initially this lesion had appeared to be a relatively innocuous prominent anorectal mucosal fold and was recognized as a diminutive polyp only after careful rectal retroflexion during…

Original Article

Hemoptysis Requiring Bronchial Artery Embolization in Pulmonary Arterial Hypertension

Objectives: Hemoptysis is an uncommon complication in patients with pulmonary arterial hypertension (PAH). Although the mechanism of hemoptysis is unknown, treatment with bronchial artery embolization (BAE) is proposed to be a safe and reliable method of treatment. We report our experience in treating PAH patients presenting with acute hemoptysis that…

Expired CME Article

Adenosquamous Carcinoma of the Pancreas: A Distinct Clinicopathologic Entity

Among exocrine pancreatic tumors, adenosquamous carcinoma (ASC) is a rare, aggressive subtype with a worse prognosis and a higher potential for metastases compared to its more conventional glandular counterpart, adenocarcinoma. The disease distribution shows an approximately 1:1 male/female ratio and a median survival of circa five months. Although such features…

Case Report

Mucosa-Associated Lymphoma Tissue of the Dura Presenting as Meningioma

Mucosa-associated lymphoma tissue (MALT) of the dura is extremely rare, with only a few reported cases worldwide. We present a unique case of a 61-year-old female who presented with neurologic symptoms of unsteady gait, dizziness, and sharp pain on her scalp for 3 weeks. A subsequent magnetic resonance imaging (MRI)…

Announcement

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2010 Calendar of Educational Events

Review Article

Amiodarone and Thyroid Dysfunction

Amiodarone is a potent antiarrhythmic drug associated with thyroid dysfunction. Its high iodine content causes inhibition of 5′-deiodinase activity. Most patients remain euthyroid. Amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH) may occur depending on the iodine status of individuals and prior thyroid disease. AIT is caused by excess iodine-induced thyroid…

Case Report

Myocarditis Masquerading as a ST Elevation Myocardial Infarction (STEMI)

Myocarditis is an inflammatory disease of the myocardium with a wide range of clinical presentations, from vague flu-like symptoms to rapidly progressive heart failure. The diagnosis is made histopathologically, with the help of immunohistochemical stains. Myocarditis is classified by specific criteria, and the myocardial biopsy reveals an inflammatory infiltrate with…

Case Report

Cervical Myelopathy from Spinal Sarcoidosis as the Unexpected Initial Presentation for Systemic Sarcoidosis

This is a case which highlights unique diagnostic challenges in the evaluation of a previously healthy patient presenting with a myelopathy initially most concerning for malignancy. However, timely recognition and nonoperative therapy of unexpected spinal sarcoidosis with corticosteroidal therapy was crucial in averting the sequelae of undiagnosed or misdiagnosed neurosarcoidosis,…

Letter to the Editor

Carotid Artery Puncture, Myocardial Injury, and Ventricular Arrhythmia

To the Editor: A 51-year-old woman with a history of obesity (body mass index [BMI] of 40), alcohol abuse, and cirrhosis of the liver, came to our emergency room; she had lower left-sided chest pain, back pain, and hematuria resulting from an assault more than one week before. Initially, her…

Editorial

Proximal Intercessory Prayer

Studies of coping and of integrative therapies underline the importance of prayer to many patients and family. But what is the evidence that prayer influences medical outcomes?

Original Article

Cerebrospinal Fluid Viscosity: A Novel Diagnostic Measure for Acute Meningitis

Introduction: Early diagnosis of acute meningitis has paramount importance in clinical practice because of mortality and morbidity of the disease. Examination of cerebrospinal fluid (CSF) has critical value for the diagnosis of acute meningitis and discrimination of bacterial and aseptic meningitis. It has been previously reported that plasma viscosity can…

Original Article

Study of the Therapeutic Effects of Proximal Intercessory Prayer (STEPP) on Auditory and Visual Impairments in Rural Mozambique

Background: Proximal intercessory prayer (PIP) is a common complementary and alternative medicine (CAM) therapy, but clinical effects are poorly understood, partly because studies have focused on distant intercessory prayer (DIP). Methods: This prospective study used an audiometer (Earscan® 3) and vision charts (40 cm, 6 m “Illiterate E”) to evaluate…

Letter to the Editor

Case of Reverse Takotsubo Cardiomyopathy in Status Asthmaticus

To the Editor: We read with interest the paper on stress cardiomyopathy (SC) following use of ketamine and epinephrine by Osuorji et al1 in the March 2009 issue of the Southern Medical Journal. In this context, we would like to bring to the readers’ attention a somewhat similar observation we…

Editorial

Goals for HbA1c Need To Be Individualized Based on Clinical Judgment, Instead of Third Party Recommendations

Fowler et al1 in this issue of the SMJ recommend a comprehensive approach to achieving a desirable HbA1c by controlling both postprandial and fasting glucose levels and are careful to emphasize that, in achieving a desirable HbA1c, hypoglycemia should be avoided. Very often, in patients utilizing insulin and sulfonlyureas, even…

Original Article

Public Health Response to a Multidrug-Resistant Tuberculosis Outbreak Among Guatemalans in Tennessee, 2007

Background: In June 2007, the Tennessee Department of Health notified the Centers for Disease Control and Prevention of four multidrug-resistant tuberculosis (MDR TB) cases in individuals of Guatemalan descent, and requested onsite epidemiologic assistance to investigate this outbreak. Methods: A case was defined as either culture-confirmed MDR TB with a…

Original Article

Improved Quality of Life, Immunoglobulin G Levels, and Infection Rates in Patients with Primary Immunodeficiency Diseases during Self-Treatment with Subcutaneous Immunoglobulin G

Objectives: Primary immunodeficiency diseases (PIDDs) include a large class of genetically heterogeneous disorders which predispose patients to significant risk of serious and chronic/recurrent infections, as well as reduced quality of life (QoL). Intravenous immunoglobulin (IVIG) therapy improves the well being of PIDD patients; however, the need for venous access and…

Letter to the Editor

A Rare Cause of Wheezing

To the Editor: Wheezing is a common presentation in the emergency department (ED). Although common causes of wheezing are routine, certain etiologies may not be considered and can be overlooked. Scimitar syndrome is a rare cause of wheezing in infants. The usual presentation is congestive heart failure and respiratory distress…