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…
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…
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…
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…
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…
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…
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…
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.
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…
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…
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…
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…
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…
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…
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…
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,…
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…
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…
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…
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)…
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…
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…
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,…
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…
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?
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…
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…
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…
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…
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…
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…
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…
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