The American Journal of the Medical Sciences (AM J MED SCI)

Publications in this journal

• Article: Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelet Count Syndrome in Patients With Eisenmenger's Syndrome.

  Hong Wang, Tao Liu
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  ABSTRACT: : Eisenmenger's syndrome is characterized by a right-to-left or bidirectional shunt in congenital heart diseases. Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, commonly occurring during pregnancy, includes hemolysis, elevated liver enzymes and low platelet counts. HELLP syndrome and pregnancy are extremely rare in patients with Eisenmenger's syndrome. The authors report 4 cases of pregnancy complicated by the HELLP and Eisenmenger's syndrome and describe their initial intervention and the in-hospital outcomes of these cases. Special emphasis is given to elaborate about the hemodynamic monitoring, magnesium sulphate for convulsions, corticosteroid treatment, anticoagulation therapy, management of pulmonary hypertension, the timing of delivery, and blood product transfusion.
  The American Journal of the Medical Sciences 05/2013;
• Article: Cardiac Troponins: Bench to Bedside Interpretation in Cardiac Disease.

  Vasundhara Muthu, Hani Kozman, Kan Liu, Harold Smulyan, Daniel Villarreal
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  ABSTRACT: : Cardiac troponins are the preferred biomarkers for the determination of acute myocardial necrosis. The high sensitivity of the available assays has significantly increased the detection of microscopic amounts of myocardial damage. Although compelling evidence indicates that elevated cardiac troponins are markers of poor prognosis and increased mortality, irrespective of the clinical scenario, small elevations can be seen in protean conditions and may confound the diagnosis of acute coronary syndromes. Emerging evidence suggests multiple different cellular mechanisms leading to cardiac troponin release, which challenge long held paradigms such as equivalency between troponin release into the circulation and irreversible cell death. Hence, knowledge of the physiology and pathophysiology of these cardiac biomarkers is essential for their accurate interpretation and consequent correct clinical diagnosis. Herein, the current relevant information about cardiac troponins is discussed, with special emphasis on pathophysiology and clinical correlates.
  The American Journal of the Medical Sciences 05/2013;
• Article: Food Impaction Due to Nutcracker Esophagus.

  Antonio Mendoza Ladd, Alicia M Alvarez, Richard W McCallum, Marc J Zuckerman
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  ABSTRACT: : Nutcracker esophagus is an esophageal motility disorder characterized by the presence of hypertensive contraction waves. These waves can have very high amplitudes, but they maintain a peristaltic pattern and therefore, bolus passage is minimally affected. Esophageal food impactions are rare in nutcracker esophagus. Our patient was a previously asymptomatic man who presented with an esophageal meat impaction due to nutcracker esophagus in which high-resolution manometry played a key role in the diagnosis. Although a rare etiology, nutcracker esophagus can result in esophageal food impaction. High-resolution manometry plays a critical role in the diagnosis of specific motility disorders, even in the setting of minimal symptoms.
  The American Journal of the Medical Sciences 05/2013;
• Article: New and Emerging Risk Factors for Coronary Heart Disease.

  Ehimare Akhabue, Jeffrey Thiboutot, Jeh-Wei Cheng, Timothy J Vittorio, Georgios Christodoulidis, Kathleen M Grady, Stamatios Lerakis, Constantine E Kosmas
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  ABSTRACT: : Coronary heart disease (CHD) is one of the leading causes of death in the United States. Traditional risk factors such as family history, hypertension, hypercholesterolemia, diabetes mellitus and smoking cannot account for the entire risk for incident coronary events. Several other potential risk factors have been identified in an effort to improve risk assessment for CHD. This article reviews the current evidence on new and emerging risk factors for CHD and their current utility in screening, specifically focusing on coronary artery calcium score, C-reactive protein, lipoprotein (a), carotid intima-media thickness, homocysteine, lipoprotein-associated phospholipase A2, as well as high-density lipoprotein functionality.
  The American Journal of the Medical Sciences 05/2013;
• Article: Duplicated Renal Collecting System.

  Mauricio Danckers, Vikramjit Mukherjee, Paru Patrawalla
  The American Journal of the Medical Sciences 05/2013;
• Article: Atypical Case of Trichinellosis.

  Sara Severini, Christian Bracco, Cristina Serraino, Fulvio Pomero, Elisabetta Castagna, Alessia Giraudo, Alberto Silvestri, Domenico Ferrigno, Attilio Allione, Liliana Vercelli, Luigi Maria Fenoglio
  The American Journal of the Medical Sciences 04/2013;
• Article: A Case of Apathetic Thyroid Storm With Resultant Hyperthyroidism-induced Hypercalcemia.

  Kristine I Parker, Aundrea Loftley, Carmina Charles, Kathie Hermayer
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  ABSTRACT: : Thyroid storm is a complication of thyrotoxicosis with a 20% to 30% mortality rate characterized by hyperthermia, tachycardia and altered mental status. Rarely, thyroid storm may have an apathetic presentation. The authors present a 63-year-old woman with apathetic thyrotoxicosis and hypercalcemia. The action of thyroid hormones stimulating bone resorption more than bone formation is thought to cause increased bone demineralization and, occasionally, hypercalcemia. This occurs in the absence of malignancy, prolonged immobility, hypervitaminosis D and primary hyperparathyroidism. Her thyroid storm was medically managed and her hypercalcemia was treated with intravenous fluids, calcitonin and a bisphosphonate. This case describes the presence of hypercalcemia in a patient with apathetic thyroid storm with no other factors contributing to the hypercalcemia. In addition, this patient had significant elevation in serum calcium, which possibly contributed to her symptomatology. The calcium remained normal after the thyrotoxicosis resolved, which is typical of the hypercalcemia of thyrotoxicosis.
  The American Journal of the Medical Sciences 04/2013;
• Article: Formerly Obese, Now Thin and Confused: The Utility of Mnemonics in the Approach to Altered Mental Status.

  Chad M Burski, Chad S Miller, Robert M Centor
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  ABSTRACT: : Altered mental status represents a common cause for admission to general medicine services. Often a significant workup ensues to define an underlying etiology. When a history of bariatric surgery with small bowel resection precedes the presentation, the differential diagnosis expands. We review a patient, having prior bariatric surgery and small bowel resection, who presents with altered mental status. After an extensive workup, she was diagnosed with a rare clinical problem, D-lactic acidosis. In presenting this case, we examine the use of mnemonics in medicine and how this can assist in solving clinical problems.
  The American Journal of the Medical Sciences 04/2013;
• Article: An Unusual Etiology of Post-traumatic Meningitis.

  Allen T Griffin, Forest W Arnold
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  ABSTRACT: : Clostridium perfringens and related species are well-known culprits of post-traumatic soft tissue and bone infection. However, central nervous system involvement with these organisms spontaneously or subsequent to trauma is unusual. The authors reported a case of post-traumatic meningitis in which both C perfringens and Enterococcus faecium were isolated.
  The American Journal of the Medical Sciences 04/2013;
• Article: Association of Brachial-Ankle Pulse Wave Velocity, Ankle-Brachial Index and Ratio of Brachial Pre-Ejection Period to Ejection Time With Left Ventricular Hypertrophy.

  Ho-Ming Su, Tsung-Hsien Lin, Po-Chao Hsu, Chee-Siong Lee, Wen-Hsien Lee, Szu-Chia Chen, Wen-Chol Voon, Wen-Ter Lai, Sheng-Hsiung Sheu
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  ABSTRACT: BACKGROUND:: Arterial stiffness, peripheral artery disease and left ventricular systolic dysfunction contributed to left ventricular hypertrophy (LVH). Using an ABI-form device, we can obtain brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and the ratio of brachial pre-ejection period to ejection time (bPEP/bET), which are markers for arterial stiffness, peripheral artery disease and left ventricular systolic function, respectively. The aim of this study was to assess whether "BAP score" calculated from the 3 measures of baPWV, ABI and bPEP/bET is associated with LVH. METHODS:: A total of 1,146 patients were included in the study. BAP score was calculated based on a point system in which 1 point was assigned for baPWV above the median value of 1670 cm/s, ABI < 0.9 or ≥ 1.3 in either leg and bPEP/bET > 0.38. RESULTS:: There was a significant trend for a stepwise increase in the left atrial diameter, left ventricular mass index (LVMI) and the prevalence of LVH and a stepwise decrease in the left ventricular ejection fraction corresponding to advancement in BAP score from 0 to 3. In addition, increased BAP score is significantly associated with increased LVMI and LVH. CONCLUSIONS:: Our results demonstrated increased BAP score was related to increased LVMI and LVH independent of traditional risk factors such as old age, diabetes, hypertension, obesity, anemia, hyperlipidemia and chronic kidney disease. Therefore, the BAP score obtained from the same examination might be useful and convenient in identifying patients with increased LVMI and LVH.
  The American Journal of the Medical Sciences 04/2013;
• Article: Different β-Blockers and Initiation Time in Patients Undergoing Noncardiac Surgery: A Meta-analysis.

  Neng Dai, Dachun Xu, Ji Zhang, Yidong Wei, Weiming Li, Bing Fan, Yawei Xu
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  ABSTRACT: : The effects of differences among β-blockers and initiation times in patients undergoing noncardiac surgery (NCS) remain unknown. On June 1, 2012, the authors searched PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to identify all trials of perioperative β-blockers in patients undergoing NCS published between January 1960 and June 2012. The authors included only randomized, double-blind and placebo-controlled trials of perioperatively administered β-blockers (ie, during the pre-, intra- and/or postoperative period) in patients with at least 1 risk factor for coronary artery disease undergoing NCS. The endpoints of these trials had to include all-cause mortality, myocardial infarction (MI) and/or stroke. The authors identified 8 English-language publications, involving 11,180 patients, which fulfilled our inclusion criteria. Perioperative β-blocker therapy was associated with a significant decrease in patient risk of developing MI (relative risk [RR] = 0.73; 95% confidence interval [CI], 0.61-0.86) but a significant increase in risk of developing stroke (RR = 2.17; 95% CI, 1.35-3.50) versus placebo, resulting in a nonsignificant decrease in overall mortality (RR = 0.91; 95% CI, 0.60-1.36). Indirect comparisons demonstrated that perioperative atenolol therapy was associated with lower mortality and incidence of MI. β-blocker therapy initiated >1 week before surgery was associated with improved postoperative mortality. Perioperative β-blocker treatment of patients undergoing NCS increases the incidence of stroke but decreases the incidence of MI, leading to a nonsignificant decrease in mortality. The authors also observed that atenolol treatment or β-blocker therapy initiated >1 week before NCS was associated with improved outcomes.
  The American Journal of the Medical Sciences 04/2013;
• Article: Widening the Differential for Brain Masses in Human Immunodeficiency Virus-Positive Patients: Syphilitic Cerebral Gummata.

  Andrew M Land, George A Nelson, Stephen G Bell, Kara J Denby, Carlos A Estrada, Lisa L Willett
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  ABSTRACT: : A 39-year-old man with newly diagnosed human immunodeficiency virus (HIV) infection was admitted with right-sided weakness, right-sided vision loss and slurred speech, which worsened over several weeks. Brain imaging revealed bilateral intraparenchymal ring-enhancing lesions and enhancement of the right optic nerve. Serological findings were positive for venereal disease research laboratory test, whereas the cerebrospinal fluid venereal disease research laboratory test was nonreactive. Brain biopsy suggested a diagnosis of syphilitic cerebral gummata, and the patient's improvement with penicillin and dexamethasone further supported this etiology. Syphilitic cerebral gummata have rarely been reported in patients with HIV infection. This patient demonstrates that cerebral gummata should be considered in the differential diagnosis in immunocompromised patients with characteristic brain masses, that HIV and syphilis often coexist with early neurosyphilis appearing more frequently in this patient population and that normal cerebrospinal fluid studies may not represent a true lack of syphilitic activity in HIV patients.
  The American Journal of the Medical Sciences 04/2013;
• Article: A Young Man With Multiple Erythematous Nodules.

  Yen-Chung Lin, Yuarn-Jang Lee
  The American Journal of the Medical Sciences 04/2013;
• Article: Effective Use of Loop Diuretics in Heart Failure Exacerbation: A Nephrologist's View.

  Kamalanathan K Sambandam
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  ABSTRACT: : Unfortunately, patients with congestive heart failure suffer frequent admissions for the management of fluid overload. Loop diuretics are pivotal in the management of this common clinical problem. Although loop diuretics have been in clinical use since the 1960s, we still do not understand how to optimally administer these drugs. It is unknown why some decompensated heart failure patients exhibit improvements in renal function with diuresis, whereas others display renal function deterioration, limiting attainment of euvolemia. Here the physiologic interactions between the failing heart and kidneys are reviewed. A conceptual framework is presented that emphasizes the balance between tubuloglomerular feedback and venous congestion in determining renal function during loop diuretic use in heart failure. Within this framework, guidelines are derived that seek to maximize the chance for achieving adequate volume removal while maintaining stable or improved renal function during the treatment of acute decompensated heart failure.
  The American Journal of the Medical Sciences 04/2013;
• Article: Efficacy and Safety of Ibutilide for Chemical Cardioversion of Atrial Fibrillation and Atrial Flutter in Cancer Patients.

  Courtney L Bickford, Rajiv Agarwal, Diana L Urbauer, Jean-Bernard Durand, Daniel J Lenihan
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  ABSTRACT: BACKGROUND:: Atrial fibrillation and atrial flutter (AF/AFL) are the most common arrhythmias encountered in clinical practice. Rate versus rhythm control remains a difficult decision, especially in the acute setting. Ibutilide is a class III antiarrhythmic indicated for pharmacological cardioversion of recent-onset AF/AFL. At the University of Texas MD Anderson Cancer Center, restoration of sinus rhythm is desirable because many patients have contraindications to anticoagulation. In addition, most are on multiple medications that prolong the QT interval; therefore, the objective of this study was to establish the safety and efficacy of ibutilide. METHODS:: This was a retrospective chart review of 81 patients who were identified via the pharmacy database as receiving ibutilide for AF/AFL from January 2002 to May 2006. Outcomes including cardioversion rates and effects on the QT interval were recorded. RESULTS:: Ibutilide use was associated with successful cardioversion in 75% of patients. Out of 81 patients, 68 patients (84%) were on at least 1 medication that prolonged the QT interval at the time of ibutilide administration. However, no significant changes in the corrected QT interval pre and post ibutilide cardioversion were noted in any group of patients. CONCLUSIONS:: Overall, ibutilide is safe and effective in cancer patients when used for acute cardioversion of AF/AFL. Despite the use of multiple medications that can potentially prolong the QT interval, no patient experienced serious life-threatening rhythm disturbances or significant QT prolongation during ibutilide administration.
  The American Journal of the Medical Sciences 04/2013;
• Article: Hepatosplenic Schistosomiasis Presenting as Spontaneous Hemoperitoneum in a Filipino Immigrant.

  Koh Okamoto, Joel D Brown
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  ABSTRACT: : Hepatosplenic schistosomiasis is due to chronic parasitic trematode infections with various Schistosoma sp. The Schistosoma life cycle requires contamination of surface water by infected human or animal excreta, specific freshwater snail intermediate hosts and human skin contact with water. The disease is prevalent in many developing tropical areas, particularly in sub-Saharan Africa as well as in Southeast Asia. Deposition of Schistosoma eggs in the hepatic portal system leads to periportal fibrosis, cirrhosis and portal hypertension but little hepatocellular damage. Portal hypertension of any etiology may cause gastrointestinal varices. Rarely, ectopic varices may rupture into the peritoneal cavity and result in a hemoperitoneum. The authors describe a case of a Filipino immigrant who presented with a hemoperitoneum associated with previously unrecognized hepatosplenic schistosomiasis due to Schistosoma japonicum.
  The American Journal of the Medical Sciences 04/2013;
• Article: Polycythemia Vera and the Jak2(V617F) Mutation in a Case of Hereditary Spherocytosis.

  Roger A Fleischman
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  ABSTRACT: : The identification of Jak2(V617F) mutations in more than 90% of patients with polycythemia vera (PV) has greatly improved the diagnostic accuracy for this uncommon myeloproliferative disorder. Although previous cases of presumptive PV in patients with hereditary spherocytosis (HS) have been described, these earlier reports either preceded the establishment of widely accepted criteria for the diagnosis of PV or lacked definitive studies to rule out secondary causes of polycythemia. In contrast, the author describes here a novel case of PV confirmed at the molecular level in a patient with hereditary spherocytosis by the finding of a Jak2(V617F) mutation. Based on recent advances in understanding the role of Jak2 signaling in the pathogenesis of PV, the author proposes 2 independent biological mechanisms that could account for more than a chance association of these 2 disorders.
  The American Journal of the Medical Sciences 04/2013;
• Article: Do Amblyopic Eye First, Wait and Do Second Eye Cataract Surgery for Isoametropia, Accomodative Esotropic Amblyopia and Congenital Cataract Case

  Goktug Demirci, Gokhan Gulkilik, Mustafa Özsütçü, Banu Arslan, Mustafa Eliaçık
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  ABSTRACT: AbstractTo review a case with isoametropic, accomodative esotropic amblyopia and congenital posterior polar cataract. A 12 years old child with visual acuities 2/10 - 7/10, refractive error +9,00/ +7,00 and congenital cataract was observed previously for 5 years until the visual acuity of the right eye dropped 2 lines due to cataract in the more amblyopic eye. At first more amblyopic eye was operated and then we waited for 1 month to see how the amblyopic eye gains visual acuity. As the visual acuities become the same as 0,7/0,7 other eye was operated. Do amblyopic eye first, wait and do second eye surgery was very successful in our patient. Vısual acuities are 0,7/0,7 and there is no accomodative esotropia. Conclusion: If there is a challenging case with congenital cataract, isoametropic amblyopia and accomodative esotropia together, performing cataract surgery to the amblyopic eye first and postponing the surgery of second eye for the regression of amblyopia could be a choice in this kind of patients.
  The American Journal of the Medical Sciences 04/2013; 2013-1(2):21-23.
• Article: Lymphocyte-Platelet Crosstalk in Graves' Disease.

  Boris I Kuznik, Yuri A Vitkovsky, Olga V Gvozdeva, Alexey V Solpov, Eli Magen
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  ABSTRACT: OBJECTIVE:: Platelets can modulate lymphocytes' role in the pathophysiology of thyroid autoimmune diseases. The present study was performed to clarify the status of platelet-lymphocyte subpopulations aggregation in circulating blood in patients with Graves' disease (GD). METHODS:: One hundred and fifty patients with GD (GD group) and 45 hyperthyroid patients with toxic multinodular goiter (TMG group) were recruited in the study. Control group consisted 150 healthy subjects. Immunophenotyping of lymphocytes was performed by flow cytometry. Detection of lymphocyte-platelet aggregates (LPAs) was done using light microscope after Ficoll-gradient centrifugation. RESULTS:: The group of GD patients exhibited reduced CD8 lymphocyte and higher CD19 cell counts compared with TMG group and healthy controls. A greater number of activated CD3, HLA-DR+ lymphocytes were observed in GD than in TMG group and control group. GD group was characterized by lower blood platelet count (232 ± 89 × 10 cells/µL) than TMG group (251 ± 97 × 10 cells/µL; P < 0.05) and control group (262 ± 95 × 10 cells/µL; P < 0.05). In GD group, more platelet-bound lymphocytes (332 ± 91 /µL) were found than that in TMG group (116 ± 67/µL, P < 0.005) and control group (104 ± 58 /µL; P < 0.001). CONCLUSIONS:: GD is associated with higher levels of activated lymphocytes and lymphocyte-platelet aggregates.
  The American Journal of the Medical Sciences 04/2013;