SMJ // November 1977, Volume 70 - Issue 11
Editorial
ABUSE OF THE DATAGATHERING PROCESS
Commentary
HOSPITAL‐ACQUIRED INFECTIONS
Primary Article
Morbidity/Mortality and Economics of Hospital‐Acquired Blood Stream Infections A Controlled Study
A controlled study of mortality, length of hospital stay, and cost of hospitalization in 40 patients with hospital-acquired blood stream infections and 40 similarly ill patients without blood stream infections was done. Patients with septicemia were identified by ongoing routine surveillance, while controls were selected from computer surveys of similarly…
Primary Article
Role of Antibody‐Coated Bacteria in the Management of Urinary Tract Infections
The antibody-coated bacteria (ACB) test was used to localize the site of urinary tract infection in a group of pediatric and adult patients. Duration of treatment of ACB-positive (upper tract) and ACB-negative (lower tract) infections was correlated with rates of recurrence during follow-up for six or more months. Two relapses…
Primary Article
Postpartum Surveillance for Urinary Tract Infection Patients at Risk of Developing Pyelonephritis After Catheterization
Asymptomatic postpartum bacteriuria occurred in ten of 354 patients not catheterized (2.8%) and in 19 of 313 patients who were catheterized (6.1%). Obstetric lacerations were commonly associated with bacteriuric patients who were not catheterized. Primigravidas as a total group were more likely to have significant bacteriuria. Nine of 23 patients…
Primary Article
Primary Epstein‐Barr Virus Infection in a Renal Transplant Recipient
A young girl with familial nephronophthisis and chronic renal failure contracted a primary Epstein-Barr virus infection after renal transplantation. During the illness she developed a clinical picture of fever and pneumonitis which closely resembled the posttransplantation syndrome usually associated with cytomegalovirus, although she had no evidence of cytomegalovirus infection. A…
Primary Article
Salvage Cystectomy After Radiation Failure in Patients With Bladder Carcinoma*
Thirty-two patients with cancer of the bladder definitively treated with irradiation had radical cystectomy without lymphadenectomy for treatment of recurrent or persistent tumor. Preoperative clinical staging was accurate in distinguishing between superficial and deeply invasive disease in 94% of patients, while in 44% clinical and pathologic stage were identical. There…
Primary Article
The Thoracic Outlet Syndrome as a Cause of Aneurysm Formation, Thrombosis, and Embolization
The thoracic outlet syndrome may have a serious vascular component consisting of subclavian artery aneurysm with possible thrombosis and embolization which can result in severe ischemic symptoms in the upper extremity, gangrene, amputation, and even hemiplegia. Four cases of subclavian artery aneurysm in association with thoracic outlet syndrome are presented….
Primary Article
Vascular Changes in Leg Trauma
Fifteen patients with closed fractures of the distal tibia and fibula had marked elevations of initial compartment pressures. The pressures remained elevated for five days in the ten patients treated by cast and elevation. The pressures returned to normal within 24 hours in the five patients placed in a prototype…
Primary Article
Extra‐Anatomic Bypass Grafting in Aortoiliac Occlusive Disease A Seven‐Year Experience
In recent years, axillofemoral and femorofemoral bypass grafting have emerged as alternate methods of managing severely ill patients with aortoiliac occlusive disease. Additionally, axillofemoral grafting is indicated when intra-abdominal graft infection necessitates closure of the aorta. Femorofemoral bypass grafting has been advocated in similar high-risk patients who have unilateral occlusive…
Primary Article
Disarticulation for Failed Surgical Procedures About the Hip
Complications following treatment of disease about the hip may render a limb so nonfunctional that the patient is confined to bed or a wheelchair. Admitting therapeutic defeat and knowing “how and when to quit” may be wise-Four chronically disabled patients released from their confinement and rehabilitated by disarticulation of the…
Primary Article
Coxa Magna
Coxa magna is probably due to a period of relative hyperemia of the capital femoral epiphysis between 2 and 8 years of age. The peripheral cartilage of the metaphysis and epiphysis proliferate as a response to reactive hyperemia secondary to synovitis. We have observed 11 patients with coxa magna and…
Vignette on Medical Writing
Student's t‐test
Primary Article
Aspiration and Irrigation of Congenital and Traumatic Cataracts
Aspiration and irrigation of congenital and traumatic cataracts has proven to be a successful procedure over many years. The purpose of this paper is to reemphasize the importance of this procedure and, more particularly, to point out the comparative advantages of two-needle aspiration and irrigation to phacoemulsification, roto-extraction, double-bore cannula,…
Primary Article
Evaluation of Postexcisional Strontium 90 Beta Ray Therapy for Pterygium
During a ten-year period, 211 patients with a diagnosis of pterygium were treated in the University of Texas Medical Branch by a combined effort using a strontium 90 beta ray applicator immediately after surgical excision. Only one patient developed recurrence. No complications were observed during the first year of follow-up.
Primary Article
Dysphoria and Impaired Mentation in Young Physicians
A syndrome of dysphoria and impaired mentation afflicting young physicians is described. Complaints involve a perceived inability to remember recently read medical literature and a perceived lack of ability and “memory lapses” in the clinical care of patients. This syndrome occurs at a time when the young physician's professional role…
Primary Article
Posttraumatic Pulmonary Insufficiency A Treatable Disease
Posttraumatic pulmonary insufficiency was treated using positive end-expiratory pressure (PEEP), intermittent mandatory ventilation, and cardiovascular monitoring and support. These were begun when intrapulmonary shunt exceeded 15% and before development of hypoxemia despite high inspired oxygen fractions; or retention of CO2; or infiltrative changes on roentgenogram. Of 39 patients treated, 28…
Primary Article
Vibrometry and Uremic Peripheral Neuropathy
The vibratory sensation threshold (VST) was measured with a vibrometer to assess the progression of neuropathy in patients with end-stage renal disease. Normal patients and patients receiving chronic hemodialysis were studied. We found that the longer the patients were dialyzed, the lower their VST (P < 0.01). Regression equations were…
Primary Article
Foibles and Fallacies in the Diagnosis of Arthritis
The diagnosis of arthritis is usually made on a clinical basis, and laboratory and x-ray aids are only secondary and sometimes misleading tools. Set forth are 11 common fallacies which often mislead the physician in his interpretation of laboratory and x-ray findings in the study of a patient with arthritis….
Primary Article
Repeat Myocardial Revascularization for Uncontrollable Angina After Occlusion of Prior Aortocoronary Bypass
Twelve patients at Emory University Hospital have had repeat myocardial revascularization for recurrent, uncontrollable, disabling angina pectoris after previous coronary artery bypass grafts. The interval between initial bypass procedure and reoperation ranged from six weeks to six years. The native coronary circulation remained unchanged in six, had developed additional proximal…
Primary Article
Postoperative Deaths Due to Unsuspected Pheochromocytoma
Two cases of postoperative death due to unsuspected pheochromocytoma are presented. Both patients exhibited signs and symptoms preoperatively which might have been attributable to a pheochromocytoma. These reports serve as a reminder of the potentially fatal consequences of inadequate evaluation of hypertensive patients before surgery.
Primary Article
Review of 18 Years' Experience With Pituitary Tumors
The presenting signs, symptoms, roentgenographic findings, endocrine evaluations, treatment, and results in 68 cases of presumed pituitary adenomas treated over an 18-year period are discussed. The most common symptoms were headache, acromegalic changes, visual symptoms, and amenorrhea. Most common physical findings were obesity, acromegaly, and visual field defects, usually bitemporal…
Primary Article
Fatal Amniotic Fluid Embolism During Induced Abortion, 1972–1975
From 1972 to 1975, four women have died in the United States from documented amniotic fluid embolism during legal induced abortion. These women, whose pregnancies ranged from 14 to 35 menstrual weeks, had intra-amniotic saline instillation (three cases) and hysterotomy (one case). Performance of abortion in the first trimester and…
Primary Article
Appearance of a Gastric Ulcer During Diphosphonate Therapy in a Woman With CRST Syndrome
A 46-year-old woman with the CRST variant of scleroderma (calcinosis, Raynaud's phenomenon, sclerodactyly, and telangiectasis) was treated with a diphosphonate (disodium etidronate) in an effort to reduce her dystrophic calcifications or retard their progression. After 18 months of therapy, no improvement in her calcinosis was noted. In addition, she developed…
