SMJ // November 1981, Volume 74 - Issue 11
Editorial
ON RIGHTS AND WRONGS
Announcement
GENERAL ANNOUNCEMENTS
Primary Article
Trimethoprim-Sulfamethoxazole Therapy for Infective Endocarditis
A man with stenosis of the aortic valve acquired endocarditis after abdominal surgery. Klebsiella pneumoniae and Acinetobacter calcoaceticus were cultured from his blood. The blood cultures remained positive despite intravenous gentamicin and cephalothin to which the organisms were sensitive in vitro. Ultimately, the blood was sterilized by a combination of…
Primary Article
Atypical Mycobacterial Infections A Clinical Study of 92 Patients
Between July 1970 and December 1979, 92 patients with atypical mycobacterial infections of the lung were hospitalized 110 times at Blue Ridge Hospital (Charlottesville, Va). These patients comprised less than 3% of all patients hospitalized for active mycobacterial disease. Sixteen had Mycobacterium kansasii or group I disease, three had group…
Primary Article
Treatment of Small Cell Carcinoma of the Lung With Methotrexate, Doxorubicin, Cyclophosphamide, and Lomustine A Community-Based Study
Forty-four patients with undifferentiated small cell carcinoma of the lung (SCCL) were diagnosed and treated at community hospitals. Patients with limited disease were treated with surgical resection or primary radiation therapy (RT) followed by chemotherapy; those with extensive disease received chemotherapy followed by RT if there was not a complete…
Primary Article
Nervous System Metastasis From Carcinoma of the Lung Three Unusual Cases
Carcinoma of the lung, fairly common in middle aged men, may be silent and have its first manifestation as a metastatic lesion. In 25% to 35% of such cases the metastases are to the nervous system. Management is dependent upon many factors but satisfactory results can be obtained with proper…
Primary Article
Ventilation-Perfusion Imaging and Pulmonary Angiography Changing Pattern of Use
The hospital and departmental records of the University of Virginia Medical Center from 1976 to 1980 show an increasing frequency of ventilation studies relative to perfusion studies and a decrease in frequency of ventilation-perfusion diagnosis of pulmonary embolus. Pulmonary angiograms have increased from one per 68 nuclear studies to one…
Primary Article
Arthroscopy and Arthrography of the Knee A Comparative Study
Between 1975 and 1978, over 200 knee arthroscopies were performed at the Emory University Hospitals; the findings were totally correct in 91%. During the same period, arthrograms were performed on 79 different patients, 39 of whom had confirming arthrotomies. The arthrograms were totally correct in 38%. Fifteen totally incorrect arthrograms…
Primary Article
Use of Sugar and Povidone-Iodine to Enhance Wound Healing Five Years Experience
Over a 56-month period (January 1976 to August 1980), we treated 605 patients for wounds, burns, and ulcers with granulated sugar and povidone-iodine. Rapid healing ensued, due to a reduction in bacterial contamination, rapid debridement of eschar, probable nourishment of surface cells, filling of defects with granulation tissue, and covering…
Primary Article
Traumatic Meniscal Lesions in Children
Of 475 consecutive meniscectomies evaluated, only nine were in patients 14 years old or younger. These nine cases were studied as to the mechanism of injury to the knee, type of lesion of the meniscus, concomitant lesions of the knee, rehabilitation, and final result. Traumatic lesions of the meniscus in…
Primary Article
Massive Pulmonary Hemorrhage and Fulminant Renal Failure Associated With Immune Complex Glomerulonephritis
A 54-year-old man had massive pulmonary hemorrhage and fulminant renal failure. Although his clinical presentation was similar to that of Goodpastures syndrome, his renal disease was associated with deposition of immune complex rather than with production of antiglomerular basement membrane antibody. Serum cryoglobulins were present, presumptive evidence of circulating immune…
Primary Article
Measuring the Renal Function of Acutely III Patients
In acutely ill patients drug doses will often have to be modified depending on the level of renal function. The blood urea nitrogen, serum creatinine, and creatinine clearance are the laboratory tests most frequently used to estimate renal function. However, volume, age, injury to muscle, acute renal failure, and factors…
Primary Article
Hemodynamic Assessment and Surgical Correction of the Kinked Internal Carotid Artery
A fluid-filled oculoplethysmograph (OPG) was used to assess carotid artery flow in 50 patients with symptoms of cerebral ischemia. Based on positional OPG and angiographic studies, 20 patients had angioplastic procedures. At operation, positional electromagnetic flow measurements were obtained to confirm the preoperative noninvasive findings. Electromagnetic flow reductions were identified…
Primary Article
Pericardial Closure and Paradoxic Septal Motion After Surgery
We tested the role of the pericardium in the development of paradoxic septal motion in 29 patients by analyzing M-mode echocardiograms made before and after cardiac surgery. Surgical technic was the same for all patients, but the pericardium was closed by random selection in 12 (40%). Paradoxic septal motion developed…
Primary Article
Solitary Nonparasitic Hepatic Cysts
We reviewed eight cases of nonparasitic solitary hepatic cysts found in two community hospitals during a ten-year period ending in 1978. Diagnostic evaluation consisted primarily of ultrasonography, arteriography, liver scan, and upper gastrointestinal contrast studies. Six symptomatic patients were operated upon and two nonsymptomatic patients were observed. There have been…
Primary Article
Treatment of Local Skin Response to Imported Fire Ant Sting
The sting of the imported fire ant (IFA), Solenopsis invicta Buren and Solenopsis richteri Forel, produces characteristic sterile pustules. Substantial morbidity and occasional mortality from secondary infection of the IFA pustule(s) or anaphylaxis in hypersensitive persons has occurred. IF As are found in the southeastern and south central United States….
Primary Article
Treatment of Diabetic Ketoacidosis by Endocrinologists Versus Nonendocrinologists Patterns in Laboratory Usage and Length of Stay
We report a study contrasting the treatment of diabetic ketoacidosis in a teaching hospital by physicians trained in endocrinology as compared to those internists who have not been trained specifically in that specialty. Parameters studied included patterns of laboratory usage and length of hospital stay. The period of hospitalization was…
Primary Article
Arden Grating Test in Evaluating “Early” Posterior Subcapsular Cataracts
Patients with “early” posterior subcapsular (PSC) cataracts often complain of severe visual impairment, despite maintenance of relatively good Snellen acuity. The Arden grating test of contrast sensitivity provides a simple method of evaluating visual function in a manner more nearly approximating the real visual world. This test often reveals profound…
Review Article
Differential Diagnosis of Acute Weakness
Muscle weakness evolving rapidly over hours to days demands prompt diagnosis and proper treatment to prevent life-threatening respiratory insufficiency. Such weakness usually results from diseases affecting some portion of the motor unit, such as poliomyelitis, Guillain-Barré syndrome, botulism, and dyskalemic myopathy. The differential diagnosis of these processes is discussed.
Review Article
Psychosocial Aspects of Illness
Medical practice and research today are largely guided by a biomedical model of disease which assumes that disease can be fully accounted for by deviations from the norm of measurable biologic variables. It is suggested that this model has outlived its usefulness. Instead, the biopsychosocial model offers greater understanding of…
