SMJ // May 1978, Volume 71 - Issue 5
Editorial
ALCOHOLIC HELPATITIS
Editorial
ACKONOWLEDGMENT
Original Article
Iatrogenic Supralevator Fistula
ABSTRACT:This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses…
Vignette on Medical Writing
“ology” Words
Original Article
Hypertension After Clonidine Withdrawal
ABSTRACT:Rebound hypertension occurred in two patients upon clonidine withdrawal. Treatment of the hypertensive crisis consists of both alpha- and beta-adrenergic receptor blockade, reserpine, or the reintroduction of clonidine. With effective control of pressure during the crisis, long-term antihypertensive therapy must be resumed.
Original Article
Grey Scale Ultrasonography Evaluating the Jaundiced Patient
ABSTRACT:Over a period of one year, 75 patients with jaundice were evaluated by grey scale ultrasonography. Intravenous cholangiography was attempted in 26 instances (bilirubin value greater than 4.3 mg/100 ml) and was diagnostic in only four. Ultrasound, on the other hand, was diagnostic for surgical jaundice in 62 of the…
Original Article
Multiple Pneumococcal Pyarthrosis Complicating Rheumatoid Arthritis
ABSTRACT:Pneumococcal pyarthrosis was documented in seven and ten joints, respectively, in two patients with rheumatoid arthritis. The recognition of multiple pyarthrosis superimposed upon rheumatoid arthritis can be difficult. The present cases are compared with eight previously reported cases of pneumococcal arthritis in patients with rheumatoid arthritis.
Original Article
Late Benign Syphilis of the Skin
ABSTRACT:Two cases of late cutaneous syphilis are presented. After treatment for secondary syphilis in 1957 and retreatment for rising VDRL titers ten years later, one patient had developed a nodular syphilid. The other patient had several gummas. He had two quantitative nonreactive VDRL tests and a negative Treponema pallidum immobilization…
Original Article
How to Handle the Rape Victim
ABSTRACT:All physicians should know the basics of care for the alleged rape victim. In a systematized approach, the procedure is presented for treating the patient and for collecting testimonial evidence in the event the assailant is apprehended and the crime becomes a legal case.
Original Article
Treatment of Nocardia asteroides Infection With Trimethoprim‐Sulfamethoxazole
ABSTRACT:Although sulfonamide therapy has reduced the case fatality rate in infection due to Nocardia asteroides from nearly 100% to 25% to 45% there remains a need for a still more effective chemotherapeutic regimen. We describe three cases of serious infection due to N asteroides treated successfully with trimethoprim-sulfamethoxazole (TMP-SMX) and…
Original Article
Continuous Monitoring of Skin Temperature Using a Liquid‐Crystal Thermometer During Anesthesia
ABSTRACT:Forehead skin temperature measured by a strip of liquid-crystal material was compared to esophageal, rectal, and axillary temperatures measured by thermistor probes in patients having general anesthesia for coronary artery bypass grafting. Before extracorporeal circulation, forehead skin temperature was lower than axillary, rectal, and esophageal temperatures by approximately 2.2 C…
Original Article
Combination Chemotherapy and Radiation Therapy of Undifferentiated Small Cell Bronchogenic Carcinoma
ABSTRACT:We reviewed 76 cases of small cell bronchogenic carcinoma seen at the University of South Florida Medical Center. One third of the 55 patients who have subsequently died did so within one month of diagnosis. Thirty-five patients were treated with cyclophosphamide, adriamycin, vincristine, and radiation therapy including prophylactic cranial irradiation….
Original Article
Subcutaneous Mastectomy With Delayed Subpectoral Augmentation
ABSTRACT:National survival statistics for breast cancer victims are basically the same today as they have been for the last 50 years. Less than 60% survive five years after diagnosis, and they frequently must accept mutilating results of treatment. To improve this bleak picture, our efforts should be directed toward prevention….
Original Article
Mesenchymal Hamartoma of the Liver
ABSTRACT:A surgically treated case of a mesenchymal hamartoma, a rare, benign liver tumor of infants and occasionally children, is reported. The clinical picture is characterized by marked, usually rapid abdominal enlargement. If untreated, the tumor may compromise other organ systems, resulting in death. The treatment is surgical removal. The tumor…
Original Article
Clindamycin and Gentamicin in Surgical Infections
ABSTRACT:The combination of clindamycin phosphate and gentamicin sulfate in treating 53 patients with a variety of serious infections was studied. Initial cultures of specimens from 31 patients yielded both anaerobic and aerobic pathogens. Eleven cultures showed only anaerobic organisms and 11 showed only aerobes. Of patients treated with clindamycin and…
Original Article
Extracardiac Rhabdomyoma A Rare Entity
ABSTRACT:Extracardiac rhabdomyomas are rare benign lesions of striated muscle origin. A review of the world literature revealed about 27 acceptable cases of benign, adult-type rhabdomyoma with a distinct male predominance. In most of the reported cases, the tumor was located in the head and neck region, usually submucosal or deeper….
Original Article
Defense of the Radical Perineal Prostatectomy
ABSTRACT:There is sharp disagreement as to what constitutes the proper surgical approach to localized carcinoma of the prostate. We have performed 31 radical perineal prostatectomies in a six-year period with no mortality and minimal morbidity. Thirteen of these patients were understaged preoperatively and had extraprostatic cancer; however, only one has…
Original Article
Tumors of the Parapharyngeal Space
ABSTRACT:A variety of tumors of the parapharyngeal space were operated upon during one training year at the Pack Medical Foundation, New York. These tumors characteristically present as a mass of the upper neck, behind the angle of the mandible and/or as a lateral pharyngeal mass bulging medially. Surgeons who operate…
Original Article
Primary Urethral Malignancy Review of 22 Cases
ABSTRACT:Twenty-two cases of primary urethral malignancy have been diagnosed at the Medical University Hospital from 1955 to 1976. These lesions are uncommon and prognosis is poor except when disease is diagnosed in the early stages and treated aggressively. Anterior lesions are more often diagnosed at an early stage but may…
Original Article
Treatment of Intracranial Aneurysms Associated With Other Entities
ABSTRACT:Considering the current state of surgery for intracranial aneurysm, a philosophy for treating intracranial aneurysms associated with other entities is presented. The premise is based on a comprehensive review of the literature relative to the risk factors applied to intracranial aneurysms and personal experience in dealing with the combination of…
Original Article
Value of Fiberoptic Gastrointestinal Endoscopy in Infants and Children
ABSTRACT:Fiberoptic gastrointestinal endoscopy was performed on 52 patients between the ages of 2 months and 16 years. The procedures were safely and easily done with premedications consisting of meperidine, promethazine, and chlorpromazine, and atropine, with diazepam given at the time of the procedure. Fiberoptic endoscopy was particularly helpful in localizing…
Original Article
Common Alcohol‐Related Disorders Recognition and Management
ABSTRACT:Appropriate medical treatment of alcoholics often falls between the clinical specialties of psychiatry, internal medicine, toxicology, and neurology. All physicians need to have a high index of suspicion for alcoholism, since the diagnosis of alcohol dependence is frequently overlooked. Especially when alcoholics are self-referred to nonmedical agencies, their medical complications…
Original Article
Erythema Multiforme and the Stevens‐Johnson Syndrome
ABSTRACT:Erythema multiforme (EM) is clinically characterized by a “minor” form and a “major” form. The latter is known as the Stevens-Johnson syndrome. Infections (particularly herpes simplex and Mycoplasma pneumoniae) and drugs seem to predispose toward the development of EM. The pathogenesis is poorly understood. The treatment is supportive. Prognosis varies…
Original Article
Are Current Rates of Cesarean Justified?
ABSTRACT:Cesarean section is associated with increased maternal and fetal risks. It should not be done except for direct and positive indications. Current emphasis on early conduction anesthesia, the use of the fetal monitor in low-risk patients, section approach to breech delivery, and overemphasis on tests and roentgenograms contribute to excessive…
Original Article
Management of Decubitus Ulcers in Paraplegic Patients
Original Article
Pattern of Combined Collapse of Right Upper and Right Middle Lobes
ABSTRACT:Three cases of combined collapse of the right upper and middle lobes are presented. The appearance is the mirror image of collapse of the left upper lobe. The radiographic appearance is described, and possible causes and mechanisms of collapse are discussed.
Original Article
Colposcopy or Cervical Conization? An Economic Comparison
ABSTRACT:Costs of colposcopic evaluation of patients with abnormal Papanicolaou smears versus evaluation by conization are compared. The average colposcopic evaluation costs $106, and the average conization costs $923.70. Additional savings ensue if a colposcopic diagnosis, rather than conization of the cervix, precedes a definitive hysterectomy. All criteria for an adequate…
Current Concepts
Propranolol in the Treatment of Cardiovascular Disease
Case Report
Fragmentation Hemolysis in Idiopathic Hypertrophic Subaortic Stenosis
A 69-year-old woman with previously asymptomatic IHSS developed fragmentation hemolytic anemia in association with bacterial endocarditis when the calculated pressure gradient across the left ventricular outflow tract was 82 mm Hg. Partial correction of the anemia by transfusion resulted in a prompt reduction in fragmentation. The interplay of anemia and…
Case Report
Tuberculous Otitis Media With Complications
Tuberculous otitis media, although uncommon today, is still a differential diagnosis of suppurative otitis media. Our patient's otitis progressed from a draining ear with hearing loss to include facial nerve paralysis and meningitis. Several surgical procedures including radical mastoidectomy were insufficient to halt progression of the disease. After culture of…
Original Article
Multiple Intrahepatic and Extrahepatic Biliary Cysts
In most cases of congenital cyst of the extrahepatic biliary system, a single choledochal cyst is described. We have reported a patient with multiple intrahepatic and extrahepatic biliary cysts. Intraoperative cholangiograms demonstrated free reflux among the multiple choledochal cysts, with reflux into the intrahepatic biliary ductal system. After a side-to-side…
Original Article
Management of Chlorpropamide‐Induced Hypoglycemia With Diazoxide
Diazoxide, as demonstrated by the case we present, may be of substantial value in abolishing hypoglycemia and in preventing its recurrence. The mainstay of treatment for the patient with chlorpropamide toxicity is the constant close monitoring of clinical and laboratory parameters and the correction of hypoglycemia by administration of exogenous…
Original Article
Recurrent Hemolytic Anemia Secondary to Accessory Spleens
A Patient with recurrent hereditary spherocytosis due to a hypertrophied accessory spleen is presented. In patients in whom splenectomy is performed for hematologic disease, accessory spleens must be sought and removed. Recurrence of the initial disease should prompt a search for accessory spleens.
Original Article
Calcific Constrictive Pericarditis in Degos' Disease
A 31-year-old woman presented with symptoms and signs of constrictive pericarditis. She had a history of Degos' disease, a rare disorder characterized by skin and bowel lesions thought to be secondary to vasculitis. A chest roentgenogram showed extensive calcification of the pericardium. Although pleural and pericardial involvement has been reported…
