SMJ // June 1977, Volume 70 - Issue 6
Commentary
EVALUATIONS IN AMBULATORY MEDICINE
Commentary
Planning for Ambulatory Care Simple Methods for Improving Patient Flow
A combined patient flow and work sampling study was done at the Ambulatory Pediatric Service of the Medical University of South Carolina. The biggest problem was that almost two thirds of the patient's time was spent waiting to see the doctor. Reasons for delay included too few examining rooms, the…
Commentary
GENERAL ANNOUNCEMENTS
Commentary
Pilot Evaluation of Teaching Strategies in Ambulatory Pediatrics
Creating an effective learning experience for medical students in ambulatory pediatrics can be a problem. In a pilot study several strategies to improve learning were tested on 51 students during their eight-week basic pediatric clerkship. Each student spent half of this clerkship in the outpatient area. Thirty-six received a detailed…
Commentary
Acetaminophen and Hepatic Dysfunction in Infectious Mononucleosis
Two family members developed severe hepatitic dysfunction in association with infectious mononucleosis and acetaminophen administration. Since severe hepatitis is an extremely rare complication of infectious mononucleosis, we postulate that the hepatic dysfunction was induced by acetaminophen.
Commentary
Management of Open Fractures of the Tibial Shaft
In a retrospective study of 98 open fractures of the tibial shaft, the end result was found to be most closely correlated with the severity of the initial injury. Comparison of six different forms of treatment (external immobilization, external immobilization with early weight bearing, pins and plaster immobilization, intramedullary fixation,…
Commentary
Unusual Cutaneous Manifestations of Sarcoidosis
The diagnosis of sarcoidosis is best established when there is evidence of granulomatous involvement in two or more organs. Three patients with unusual cutaneous manifestations of sarcoidosis, including palmar and follicular lesions, nonscarring alopecia, and widespread plaque or erythrodermic sarcoidosis, are reported. In all three patients the skin biopsy was…
Commentary
Spinal Epidural Abscess
This paper describes problems in the diagnosis and management of six patients with spinal epidural abscess. Since the clinical findings in this disease process are frequently misinterpreted, one must be careful to exclude this diagnosis in any patient with fever, leukocytosis, back pain and recent infection or back trauma. Alcoholic…
Commentary
Childhood Poisoning A Community Hospital Experience
We reviewed medical records of 53 children who ingested poison and were treated as inpatients and 107 who were treated as outpatients in a Southeastern community hospital. Findings included a much higher incidence of petroleum distillate poisoning than is found nationally, and a low frequency of aspirin ingestions. Data on…
Commentary
Local Tissue Flaps in Reconstructive Facial Plastic Surgery
When a lesion is excised from the facial area and the defect cannot feasibly be closed primarily or by secondary healing, skin grafting or adjacent tissue transfer is usually used to close the defect. In the facial area, adjacent tissue transfer gives a better color and texture match and is…
Case Report
Experience With Deep Hypothermia and Elective Circulatory Arrest for Cardiac Surgery in Infants
During hypothermic circulatory arrest (19 C nasal) averaging 55 minutes in 25 infants, the mean increase in base deficit was only −3.95 mEq/liter, when arterial gases before circulatory arrest were compared with samples ten minutes after perfusion had been resumed. Few significant arrhythmias occurred, and all survivors appeared neurologically normal…
Case Report
Current Status of Total Knee Replacement
Correction of deformity and relief of pain in advanced arthritis of the knee joint can be obtained by implantation of a total knee prosthesis. For the painful, mildly damaged knee, the Charnley prosthesis may be used, while in the more moderately damaged knee, the geometric prosthesis may be indicated. For…
Case Report
Frequency of HLA Antigens in Chronic Myelocytic Leukemia
Histocompatibility antigen (HLA) phenotypes of 34 patients with Ph1+ chronic myelogenous leukemia (CML) were evaluated for association with HLA antigens. Two control populations were compared to the CML patients: 142 normal volunteer platelet donors, and 160 normal donors of granulocyte transfusions. HLA typing was done by lymphocyte microcytotoxicity tests for…
Case Report
The Efficacy of Percutaneous Liver Biopsy in the Initial Staging of Patients With Lymphoma
To evaluate the usefulness of percutaneous needle liver biopsy in the initial staging of lymphoma patients, 115 patients presenting to M. D. Anderson Hospital between Sept 1, 1972, and Aug 31, 1975, and having either percutaneous (45) or celiotomy (70) liver biopsy were identified. Sixty-six patients had Hodgkin's disease, 49…
Case Report
Recurrence Patterns and Survival After Combined Radical Mastectomy and Postoperative Irradiation A Retrospective Analysis
Recurrence patterns were analyzed in 323 patients treated by radical mastectomy, 219 of whom received postoperative irradiation. Thirty-five patients with inner quadrant lesions and negative axillary nodes received postoperative regional node irradiation; 33 of these 35 patients are alive without recurrence from 2 to 22 years later. Six of 219…
Case Report
Removal of Foreign Bodies The Flexible Fiberoptic Endoscope
Three foreign bodies were successfully removed from the upper gastrointestinal tract with a fiberoptic endoscope. They included a food bolus lodged above an esophageal stricture, a metallic nebulizer tip impacted in the mid-esophagus, and a spoon lodged in the stomach. A razor blade could not be removed from the duodenum….
Case Report
Diabetes Mellitus in Adolescents A Comprehensive Approach to Outpatient Care
A comprehensive approach to care of adolescents with diabetes mellitus requires knowledge of the unique characteristics of juvenile diabetes during this developmental period, appropriate medical goals, and awareness of the numerous psychologic and social problems encountered. Involvement of other health professionals is frequently needed. Successful adjustment of the adolescent to…
Case Report
Traumatic Spinal Cord Injuries Due to Automobile Accidents
Of the 1,164 patients with traumatic spinal cord injury admitted to the Texas Institute for Rehabilitation and Research from February 1959 through December 1975, 389 were injured in automobile accidents. The patients with spinal cord injury were predominantly male, and the average age was in the late 20s. Two thirds…
Case Report
Squamous Carcinoma of the Lower Lip in Patients Under 40 Years of Age
In a series of 1,308 squamous carcinomas of the lower lip, 97 (7%) occurred in patients under 40. Among the 56 followed up for at least five years, there were 12 deaths due to disease for a determinate mortality of 21%. In five of these patients (41 %) the tumor…
Case Report
Rare Occurrence of Addison's Disease and Diabetes Mellitus in Children
We report on two children with both Addison's disease and diabetes mellitus, a rare occurrence in children. One of the children first developed Addison's disease and later developed diabetes mellitus, while the other had the onset of diabetes mellitus first and later Addison's disease. In the latter patient a direct…
Case Report
Emotional Factors in Inflammatory Bowel Disease
Inflammatory bowel diseases are not caused by emotional conflicts, but emotional factors influence both the pathogenesis and the course of the illness. Establishing a trusting physician-patient relationship is important in helping the patient to (1) avoid denial of illness or chronic illness behavior, (2) understand symptoms and diagnostic and treatment…
Case Report
Use of Brom‐Ergocryptine in Treating Amenorrhea/Galactorrhea
Seven women with amenorrhea and galactorrhea, and no evidence of pituitary adenoma, were treated with brom-ergocryptine for two to 24 weeks. All seven patients had the resumption of regular menses within eight weeks, but six patients required 24 weeks of therapy to completely cease lactating. Two of the five women…
Case Report
Prognostic Value of Carcinoembryonic Antigen in Patients With Breast Cancer
Carcinoembryonic antigen (CEA) levels were followed in 18 patients with a history of breast cancer to determine the prognostic value of serial determinations in predicting either the development of clinically evident metastatic disease or the progression of previously stable metastatic disease. In patients with local disease, values were in the…
Case Report
Median Nerve Injuries and Their Management
Injuries of the median nerve cause two major syndromes. Interosseous nerve injury as it branches from the median just below the elbow produces a characteristic deformity. Treatment involves neurolysis, or primary or secondary repair. Various tendon transfers can be used to compensate for lost function. The other syndrome is produced…
Case Report
Intracranial Epidermoid Tumor Discussion of Four Cases
Four cases of intracranial epidermoid tumor are presented. These are uncommon tumors with no specific signs or symptoms, and their diagnosis depends upon a high index of suspicion. Computerized axial tomography (CAT scan) was helpful in diagnosing one of the cases described and undoubtedly will be instrumental in identifying future…
Review Article
Preventive Aspects of Heart Disease in Infants and Children
Case Report
Transient Megacolon After Gastroscopy
Case Report
Small Cell Carcinoma of the Lung Presenting as Bilateral Hilar Adenopathy
A case of perforation and bleeding from a cliver-ticulum of the second portion of the duodenum in a patient with recurrent pancreatitis is presented. Upper gastrointestinal roentgenogram revealed an abnormal tract and retroperiloneal air arising from the diverticulum. The fistulous tract communicated with pancreas. Bleeding was due to erosion of…
