SMJ // November 1978, Volume 71 - Issue 11
Editorial
ON OBSOLESCENCE
Commentary
METAMORPHOSIS OF BREAST CANCER
Primary Article
The Surgeon as Oncologist
Primary Article
Southern Regional Trophoblastic Disease Center, 1972–1977
ABSTRACT:The experience of the Southern Regional Trophoblastic Disease Center includes 222 patients who were referred from January 1972 to October 1977. The initial tissue diagnosis was hydatidiform mole in 212 patients and choriocarcinoma in ten. There was spontaneous remission of 142 (69%) of the moles and one of the choriocarcinomas,…
Primary Article
Massive Skin Necrosis In Rocky Mountain Spotted Fever
ABSTRACT:The occurrence of massive skin necrosis of approximately 50% of the body surface area in an 8-year-old girl with Rocky Mountain spotted fever is reported. Although the surgeon will not often be confronted with the management of Rocky Mountain spotted fever or its complications, certain therapeutic corollaries can be outlined,…
Primary Article
Asymptomatic Bartter's Syndrome
ABSTRACT:A 63-year-old man had asymptomatic Bartter's syndrome, discovered during evaluation for hypokalemia. Elevated plasma renin and aldosterone levels, angiotensin resistance, and elevated urinary prostaglandin excretion were noted. Tubular function studies implicated the proximal tubule as the site of a mild sodium reabsorption defect, and renal wasting of potassium and magnesium…
Primary Article
Treatment of Psoriasis With 8‐Methoxypsoralen and Sunlight
ABSTRACT:Photochemotherapy with 8-methoxypsoraleh and sunlight (PUVA-SOL), administered three times weekly, proved effective in the treatment of psoriasis. Weekend photochemotherapy (modified PUVA-SOL) also appeared useful as an adjunct to standard topical corticosteroid therapy. Careful measurement of ambient long-wave ultraviolet light (UVA) in the treatment locale and respect for the phototoxic potential…
Primary Article
Acute Febrile Neutrophilic Dermatosis Sweet's Syndrome
ABSTRACT:A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) is described in a patient with chronic myelogenous leukemia, with a review of all published reports in the English literature. The disease is characterized by an acute febrile illness with painful plaques involving the extremities, face, and neck, and responds dramatically…
Primary Article
Methicillin‐Resistant Staphylococcus epidermidis
ABSTRACT:Staphylococcus epidermidis is frequently associated with infection of prosthetic heart valves, prosthetic orthopedic devices, and neurosurgical shunts. Penicillinase-resistant semisynthetic penicillins, such as methicillin, have been the therapeutic and prophylactic agents of choice for S epidermidis infection. However, more S epidermidis isolates are now resistant to methicillin and other penicillins. In…
Primary Article
Nafcillin‐Associated Granulocytopenia
ABSTRACT:Three patients treated with nafcillin developed granulocytopenia. Only three other such cases have been reported. This complication is most likely due to a direct toxic effect on the bone marrow; markers for an immunologically mediated mechanism have not been found. Nafcillin-associated granulocytopenia usually occurs during the third week of therapy…
Primary Article
Acetaminophen Overdoses at a County Hospital A Year's Experience
ABSTRACT:During a recent one-year period nine cases of hepatotoxicity caused by overdoses of acetaminophen were recognized at Parkland Memorial Hospital. This contrasted with the previous year in which no cases were seen. These cases and an additional case seen after the one-year period are presented and discussed. Hepatic injury ranged…
Primary Article
Vincristine‐Induced Dysphagia
ABSTRACT:Dysphagia was observed in two patients receiving combination chemotherapy for metastatic carcinoma of the breast. Results of esophagogram and esophagoscopy were unremarkable. Vincristine, an anticancer drug, was incriminated as the causative agent. Cessation of vincristine therapy resulted in definite improvement. In one patient, inadvertent administration of vincristine caused prompt recurrence…
Primary Article
Operative Correction of Obstructed Subclavian or Innominate Arteries
ABSTRACT:We have performed 82 operations on 79 individuals with occlusive disease of the subclavian or innominate arteries during the past 16 years. The left subclavian was occluded in 63, the right in nine, and the innominate in seven. Presenting symptomatology was neurologic in 29, arm ischemia in 24, and combined…
Primary Article
Clinical Trial of Surgery for Morbid Obesity
ABSTRACT:A clinical trial of jejunoileal and gastric bypass in 38 morbidly obese patients is described. The results which led to the decision to discontinue the clinical trial are discussed. Gastric bypass is recommended as the surgical procedure of choice in properly selected patients with morbid obesity.
Primary Article
Subtrochanteric Fractures of the Femur Treatment With ASIF Blade Plate Fixation
ABSTRACT:Management of the severely comminuted subtrochanteric fracture of the femur has been extremely difficult due to problems in stabilization, failure of fixation, and/or failure of the device, as well as associated high morbidity and mortality. Twenty-three such fractures treated with the Association for the Study of Internal Fixation (ASIF) blade…
Primary Article
Respirator Paradox
ABSTRACT:Massumi, in 1973, presented three distinct clinical conditions in which he described a reversal of the expected variations of blood pressure relative to respiratory activity. He termed this phenomenon reverse pulsus paradoxus. One of his cases was a patient with congestive heart failure receiving intermittent positive pressure ventilation (IPPV). The…
Primary Article
Pott's Paraplegia
ABSTRACT:Tuberculosis of the spine associated with neurologic deficit has fortunately become an uncommon disease. Of 48 patients with Pott's paraplegia seen over a 20-year period, 28 were adequately followed up. Ten patients in this series died, most of causes not directly related to the tuberculosis, and ten patients were lost…
Primary Article
Evaluation of the Shake Test to Predict Respiratory Distress Syndrome
ABSTRACT:An analysis of the relationship of amniotic fluid shake test titers and the subsequent fetal lung maturity as evinced by the development of the respiratory distress syndrome (RDS) has been conducted. Over a four-year period, 131 amniotic fluid samples were tested within 48 hours of delivery. RDS was diagnosed in…
Primary Article
Pharmacologic Management of Asthma in Childhood
ABSTRACT:New drugs such as inhalable cbrticosteriods, disodium chromoglycate, and selective β2 sympathomimetic agents, as well as new understanding of pathophysiologic mechanisms of older drugs, enable better pharmacologic management of the child with asthma. Emphasis is on educating patient and parents and on using doses calculated for weight of anhydrous theophylline…
Primary Article
Echocardiographic Findings in Amyloid Cardiomyopathy
ABSTRACT:Echocardiographic manifestations of two patients with cardiac amyloidosis are presented. The findings consisted of increased thickness of the left ventricular posterior wall and interventricular septal wall, a normal to small left ventricular cavity, and pericardial effusion. The echocardiograph is useful in the evaluation of patients with cardiomyopathy and congestive heart…
Primary Article
Distal Renal Tubular Acidosis in Selective Hypoaldosteronism
ABSTRACT:Renal mechanisms for metabolic acidosis in selective hypoaldosteronism were investigated in a patient with marked renal insufficiency. Studies demonstrated a distal hydrogen ion secretory defect. Control of elevated serum potassium levels did not normalize urinary acid excretion, but systemic acidosis was improved. Mineralocorticoid therapy normalized serum potassium without increasing urinary…
Primary Article
Characteristics of Hospitalized Tuberculous Patients Today
ABSTRACT:The characteristics of 149 patients with tuberculosis consecutively discharged from the Tuberculosis Service of the University of Tennessee Hospital in 1975 and 1976 were evaluated. The results of this study indicate the presence in this group of advanced age, alcohol abuse, debility from multiple chronic diseases, drug resistance, and recalcitrance….
Primary Article
Diverticular Disease of the Colon Surgical Management at a Military Hospital
ABSTRACT:A recent review of the surgical management of diverticular disease of the colon included 73 patients. One-stage resections were accomplished in 67%, primarily in patients operated on electively for recurrent diverticulitis or fistula, and in the group of patients with cecal diverticulitis operated on for presumed appendicitis. Single-stage resection with…
Review Article
“e” Antigen what is it?
Review Article
Tumor Immunology and Interferon
ABSTRACT:Host defense mechanisms against cancer depend on an intact cellular immunity system. Immunosurveillance depends on thymus lymphocytes which, when sensitized, form lymphokines. One of the important lymphokines produced by T-lymphocytes is called interferon, well known for its antiviral effects. Recent experimental evidence points also to the potential effectiveness of interferon…
Current Concepts
Adult Respiratory Distress Syndrome
ABSTRACT:Treatment of the adult respiratory distress syndrome requires an understanding of the current concepts of the pathogenesis of this syndrome. The clinical features and pathophysiology are briefly discussed. Differential diagnosis requires the exclusion of pulmonary infection and left heart failure. Therapy is aimed at correction of the associated initiating disease…
