Issue - Southern Medical Association

Editorial

Diagnosis of Irritable Bowel Syndrome: What Are We Missing?

Over the past several decades, irritable bowel syndrome (IBS) has earned its place as a diagnosis among primary care providers and gastroenterologists due to its increasingly high prevalence, between 3–20%, and its debilitating symptoms. Aside from the health concerns to the patient, the societal and economic impacts of IBS are…

Original Article

Preferable Colonic Investigations for Isolated Abdominal Pain

Objectives: Isolated abdominal pain is seen as a poor indication for colonic investigations. The yield of serious pathology detected by optical colonoscopy (OC) has differed greatly in published series. This study aims to establish the yield of colonic investigations for isolated abdominal pain. Methods: A retrospective analysis of the endoscopy…

Review

Hydatid Cyst Disease: Optimal Management of Complex Liver Involvement

The most frequent location of hydatid cystic lesions is in the liver (up to 80% of cases), followed by the lung (about 20% of cases), and with lower reported incidence, virtually in any other organ or tissue in the body. Therefore, the case an American medical practitioner would most likely…

Review

Current Management of Salicylate-Induced Pulmonary Edema

Salicylate-induced pulmonary edema (SIPE) can occur in both acute and chronic users of aspirin or salicylate products. The medical history, especially when it reveals the use of salicylates, is critical when considering this diagnosis. Unfortunately, the neurologic and systemic effects of salicylate toxicity may hinder the ability to obtain a…

Letter to the Editor

Tuberous Sclerosis and Neurocysticercosis

To the Editor: I read the recent publication on tuberous sclerosis (TS) and neurocysticercosis with great interest.1 Nandhagopal concluded that “cerebral tubers could be mistaken for perilesional edema of cysticercal cysts, especially if the clinical features of TS were subtle and not carefully looked for.”1 This report is a very…

Editorial

Isolated Abdominal Pain: Should Colonic Investigation Be Performed?

For patients presenting to a gastroenterology clinic, abdominal complaints are quite common and can often be attributed to functional bowel disorders. These patients, even in the absence of significant signs such as blood in the stool, weight loss, or a family history of colorectal cancer, often ask for an examination…

Editorial

Editor's Note

The article entitled “Hepatitis B Vaccination Coverage Levels among Nurses in Greece: Need for Improvement,” which was posted in the February 5, 2011 Published Ahead of Print feature on the Journal Web site, has been removed from this issue for several reasons: (1) Two days after the PAP went online,…

Original Article

Polycystic Ovary Syndrome: Focus on Platelets and Prothrombotic Risk

Objectives: Subjects with polycystic ovary syndrome (PCOS) were shown to carry an increased long-term cardiovascular risk. Systemic inflammation and reactive leukocytosis have also been described in PCOS. Recent research suggests the presence of an increased thrombotic risk in these patients. Methods: We describe a cohort of PCOS patients presenting with…

Original Article

Clinical Characteristics and Evaluation of Patients with Large Hiatal Hernia and Cameron Lesions

Objectives: Cameron lesions are located at the neck of large hiatal hernias, and are associated with anemia or overt gastrointestinal (GI) bleeding. The aim of this study was to investigate the clinical and endoscopic properties of patients with Cameron lesions. Methods: Eighteen patients were diagnosed as having large hiatal hernia…

Original Article

Safety of Conscious Sedation in Patients with Sleep Apnea in a Veteran Population

Objectives: Due to the presumed higher risk of cardiopulmonary complications in patients with obstructive sleep apnea (OSA), many endoscopy centers consider OSA a contraindication to using conscious sedation. We evaluated the safety of conscious sedation during endoscopy for patients with OSA in a veteran population, and compared this to patients…

Original Article

Prophylaxis with Ertapenem in Patients with Obstructive Jaundice Undergoing Endoscopic Retrograde Cholangiopancreatography: Safety, Efficacy, and Biliary Penetration

Antibiotic prophylaxis before endoscopic retrograde cholangiopancreatography (ERCP) is primarily aimed at the prevention of cholangitis and secondary sepsis. Although these complications are uncommon, they are associated with considerable morbidity and, rarely, mortality. Despite the absence of strong level I evidence, the European Society of Gastrointestinal Endoscopy guidelines, published in 1999,…

Review

Diagnosing Irritable Bowel Syndrome: A Changing Clinical Paradigm

Rather than being a diagnosis of exclusion, irritable bowel syndrome (IBS) is a diagnosis that can be identified by symptom-based criteria. The collection of these criteria by a meticulous history can be enhanced by using various tools. Once a positive diagnosis is made, using clinical criteria for diagnosis, one should…

Review

Ischemic Heart Disease in Women: A Review for Primary Care Physicians

Ischemic heart disease (IHD) is the leading cause of death among women in the Western world, and its prevalence is growing. The pathophysiology of heart disease in women differs from that in men. Women with chest pain and abnormal stress tests are less likely than men to have critical stenosis…

Review

Bloodstream Infection with Anaerobiospirillum succiniciproducens: A Potentially Lethal Infection

Anaerobiospirillum succiniciproducens (A succiniciproducens), a spiral, Gram-negative anaerobic rod which is part of the normal intestinal flora of cats and dogs, has rarely been reported as a cause of bacteremia and diarrhea in humans, particularly in immunocompromised hosts. Although it can be associated with significant mortality, the full extent of…

Review

Platypnea-Orthodeoxia: Bilateral Lower-Lobe Pulmonary Emboli and Review of Associated Pathophysiology and Management

Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea and arterial deoxygenation, which is exacerbated in an upright position and relieved with recumbency. We report a case of platypnea-orthodeoxia in a 56-year-old male who was found to have bilateral lower-lobe pulmonary emboli. He did not have any evidence of an intracardiac…

Case Report

Cutaneous Metastatic Rectal Carcinoma Masquerading as Herpes Zoster

A 78-year-old female with locally recurrent rectal carcinoma and hepatic metastases presented with new skin lesions. She had multiple painful skin lesions over her groin area initially treated as contact dermatitis. The lesions continued to spread to include the lower abdomen and developed a zosteriform appearance. She was referred to…

Case Report

Systemic Mastocytosis-Associated Leonine Facies and Eyebrow Loss

Leonine facies or loss of eyebrows, or both, occurring concurrently or in succession, can be associated with numerous etiologies. A 62-year-old woman with systemic mastocytosis who developed both leonine facies and eyebrow loss is described. The differential diagnosis of neoplasms that may present with leonine facies is summarized and conditions…

Case Report

Prolonged Sinus Pauses with Hydromorphone in the Absence of Cardiac Conduction Disease

A 49-year-old male had open sigmoid colectomy with colorectal anastomosis for sigmoid diverticulitis. The patient was given patient-controlled analgesia (PCA) hydromorphone and subsequently developed bradycardia with prolonged sinus pauses up to 7.1 seconds. The pauses resolved shortly after the hydromorphone was discontinued. This is the first case report to our…

Case Report

Low-Grade Fibromyxoid Sarcoma Arising in the Big Toe

Low-grade fibromyxoid sarcoma (LGFMS) is a rare neoplasm commonly affecting young adults and typically arising in the somatic soft tissue of the proximal extremities. Its occurrence within the big toe is exceedingly rare. A 43-year-old man had surgery on a mass located in the big toe, which was first noted…

Letter to the Editor

Proximal Intercessory Prayer

To the Editor: I read with interest the article titled “Study of the Therapeutic Effects of Proximal Intercessory Prayer (STEPP) on Auditory and Visual Impairments in Rural Mozambique,” by Brown et al.1 As a person of the Christian faith who also practices internal medicine, I often have to navigate the…

Letter to the Editor

Lemierre Syndrome Caused by Group C Streptococci and Associated with Red Cell Aplasia and Immune Thrombocytopenia

To the Editor: We read with great interest the article by Tran et al1 on Lemierre syndrome, a rare condition first described in 1936 by the French bacteriologist André Alfred Lemierre, which has perpetually intrigued and perplexed many generations of clinicians worldwide ever since. The authors make a valid point…

Letter to the Editor

Helicobacter pylori and Beta-2 Microglobulin Levels

To the Editor: Beta-2 microglobulin is present in all nucleated cells and it can be used as a nonspecific but sensitive marker of various neoplastic, inflammatory, and infectious conditions. Levels of beta-2 microglobulin can be elevated in lymphoid malignancies, for instance in multiple myeloma and chronic lymphocytic leukemia.1 It is…

Letter to the Editor

Bariatric Surgery for Diabetic Nephropathy

To the Editor: The excellent review article by Chauhan et al on the metabolic, renal, and nutritional consequences of bariatric surgery focuses on the severely obese patient.1 The authors comment about the occurrence of hyperoxaluria, which may lead to kidney stone formation and renal failure. Several recent articles should assuage…

Letter to the Editor

Algorithm for the Management of Osteoporosis

To the Editor: In their recent article, Hamdy et al1 propose an algorithm for the management of osteoporosis and recommend that patients at risk for osteoporosis should be tested with dual-energy X-ray absorptiometry (DXA) measurement of at least two skeletal sites. We agree with this recommendation, and we think that…