SMJ // November 1979, Volume 72 - Issue 11
Editorial
ON BEING THANKFUL
Editorial
ALLOPURINOL TOXICITY
Primary Article
Severe Hypersensitivity Reactions to Allopurinol
ABSTRACTThe frequency of severe reactions to allopurinol has probably been underestimated. A retrospective study encompassing a five-year period has yielded 20 patients with severe hypersensitivity reactions to allopurinol. Patients with preexisting renal impairment or who were receiving concomitant thiazide diuretics appeared to be especially predisposed. Cutaneous reaction patterns included maculopapular…
Announcement
GENERAL ANNOUNCEMENTS
Primary Article
Subclavian Steal Review of the Clinical Manifestations
ABSTRACTThis study reviews the spectrum of clinical presentations and methods of treatment used in 35 patients with subclavian or innominate occlusions over the past 16 years. Symptoms included vertigo or dizziness, visual disturbances, and lateralizing hemispheric symptoms. Twenty-two patients had arm claudication or weakness, and 88% had a difference in…
Primary Article
Subclavian Steal Syndrome An Update
ABSTRACTThe clinical findings in this series of 22 cases of subclavian steal syndrome showed a predominance of men (13:9), a mean age of 51 years, and a predominance of left subclavian artery obstruction. There was a blood pressure differential of more than 20 mm Hg and diminished pulses ipsilaterally in…
Primary Article
Knee Pain in Runners
ABSTRACTOf 149 runners seen with knee pain, 60 had common orthopedic problems as the cause. Eighty-nine had recurring pain but few or no classic findings. These runners were divided into four groups depending on localization of the pain. Gait mechanical problems were identified and treatment regimens developed. Questionnaires were returned…
Primary Article
Effects of Epinephrine, Benzalkonium Chloride, and Intraocular Miotics on Corneal Endothelium
ABSTRACTDrugs formulated for use both inside and outside of the eye were tested for their potential toxic effects on the corneal endothelium. Commercially available epinephrine 1:1000 was toxic to the corneal endothelium, but solutions diluted fivefold caused no endothelial damage. The toxic agent was the sodium bisulfite 0.1% preservative. Benzalkonium…
Primary Article
Clinical and Experimental Correlations in Temporal Bone Fracture The Facial Nerve
ABSTRACTIn this review of 50 patients with fracture of the temporal bone, 11 patients had ipsilateral facial paralysis, three of immediate and eight of delayed onset. Eight patients with complete paralysis of the facial nerve had facial nerve decompression; six of these had incomplete return of function. Only one patient…
Primary Article
Carbon Dioxide Laser in Otolaryngology
ABSTRACTLaser therapy has been an addition to our therapeutic armamentarium. Although in certain conditions (ie, webs, granulomas, and to a lesser degree papillomas) it has been serviceable, conventional methods of treatment are used in the majority of our patients.
Primary Article
Acute Sarcoidosis Occurring During the Course of Systemic Lupus Erythematosus
ABSTRACTA diagnosis of systemic lupus erythematosus (SLE) was established in a 54-year-old woman with a compatible history, as well as patchy alopecia, anemia, arthralgias, and a positive LE cell preparation. Sixteen months later bilateral hilar and mediastinal lymph nodes appeared on chest roentgenogram. Sarcoidosis was diagnosed when hypercalcemia and noninfectious,…
Primary Article
Obstruction of the Inferior Vena Cava Complicating Hemodialysis in Polycystic Kidney Disease
ABSTRACTTwo patients with polycystic kidney disease and renal failure developed profound hypotension within 30 minutes after starting hemodialysis. After ruling out all recognized causes of hypotension during early dialysis, we found that their vena cavas were obstructed by compression of the vessels against the spinal column by the greatly enlarged…
Primary Article
Modern Chemotherapy in the Management of Testicular Tumors
Primary Article
Nephrotic Syndrome in Anti‐GBM Antibody Mediated Glomerulonephritis
ABSTRACTGlomerulonephritis induced by antibodies to the glomerular basement membrane is a well recognized cause of renal disease and is responsible for 5% to 15% of all glomerular disease. The patients usually present with an acute nephritic syndrome followed by rapidly progressive renal failure. We report two patients who presented with…
Primary Article
Radiologic Appearance of Pulmonary South American Blastomycosis
ABSTRACTSouth American blastomycosis is an uncommon type of systemic fungal disease endemic in the subtropical moist and wet areas of Latin America. Two illustrative cases are presented, with a review of the main pulmonary features of this infection.
Primary Article
Value of Cultures in Patients With Acute Cellulitis
ABSTRACTA retrospective review of blood and wound cultures obtained from adult patients admitted for acute cellulitis revealed positive culture rates of 0.77% and 86% respectively. Organisms from wound cultures were predominantly Staphylococcus aureus and Streptococcus pyogenes. The majority of our patients were otherwise healthy. Our study suggests that blood cultures…
Primary Article
Pneumocystis carinii Pneumonia in Children
ABSTRACTPrevious descriptions of Pneumocystis carinii pneumonia have emphasized a variety of radiographic patterns which most often apply to advanced disease. We reviewed the chest roentgenograms of children taken at or just after the onset of clinical symptoms. Subtle but definite abnormalities of pulmonary vessels, hila, parenchyma, and aeration were observed….
Primary Article
Relationship of Neonatal Pneumonia to Maternal Urinary and Neonatal Isolates of Group B Streptococci
ABSTRACTOf 1,500 consecutive deliveries, there were 41 term infants with suspected sepsis in association with a positive culture for group B streptococci (GBS) from either the infant soon after birth, or the mother's urine routinely collected three days postpartum, A statistically higher incidence of pneumonia was found in these infants…
Primary Article
Cardiac‐Pulmonary Edema and Low Pulmonary Capillary Wedge Pressure
ABSTRACTWe describe a patient who presented with acute massive pulmonary edema, clinically and on chest roentgenogram. Two hours later the patient became hypotensive and was found to have a low pulmonary capillary wedge pressure (PCWP). The blood pressure returned to normal after administration of fluids. Acute pulmonary edema develops if…
Primary Article
Echocardiographically Determined Mitral Valve Prolapse in Male Patients
ABSTRACTMitral valve prolapse syndrome is a common clinical entity that may occur as an isolated condition or in association with other cardiovascular diseases. In this retrospective study, 41% (23/56) of the male patients with echocardiographically diagnosed mitral valve prolapse had an additional form of cardiovascular disease.
Primary Article
Recurrent Atraumatic Subungual Splinter Hemorrhages in Healthy Individuals
ABSTRACTFour individuals with severe, chronic, recurrent splinter hemorrhages are reported. The duration of splinter hemorrhages ranged between six and 30 years. The fresh lesions were associated with burning sharp pain and tenderness which lasted for a few days. Although commonly located in the distal one third of nails, they were…
Primary Article
Fever in Megaloblastic Anemia
ABSTRACTCharts of 122 patients with megaloblastic anemia due to either B12 or folic acid deficiency were reviewed for the presence of fever. Fever, defined as a temperature of 100 F (37.8 C) or more, was present in approximately 40% of the patients with both. The elevation was usually minimal but…
Primary Article
Doppler Ultrasound in Evaluating the Localization and Severity of Peripheral Vascular Occlusive Disease
ABSTRACTWe studied 150 arterial Doppler examinations on 150 patients by obtaining segmental pressures and the analogue wave tracings, and comparing the ankle/arm index to the arteriograms. Each limb was divided into iliofemoral, femoral, popliteal, and trifurcation segments. Of the 793 segments interpreted as normal by arterial Doppler, 758 were confirmed,…
Primary Article
Minoxidil Therapy for Refractory Hypertension and Chronic Renal Failure
ABSTRACTMinoxidil, a potent vasodilator antihypertensive agent, was given to 14 patients with severe hypertension uncontrolled by conventional agents. Thirteen patients had elevated serum creatinine levels. Over a period of 20 months (mean duration of administration) minoxidil lowered blood pressure from 194/124 to 147/90 mm Hg (mean values), in combination with…
Primary Article
Postpartum Examination A Reevaluation
ABSTRACTFour hundred patients were polled to determine their attitudes and experiences regarding birth control measures, length of postpartum bleeding, and compliance with the advice to avoid sexual intercourse until the postpartum examination. As postpartum bleeding decreases and/or stops, there is a marked tendency for patients to resume full activity. Many…
Article
Control of Orthopedic Nosocomial Wound Infections
ABSTRACTThe catastrophic effects of deep sepsis as a complication of total joint replacements, especially the hip and the knee, are well documented. This review identifies risk factors predisposing to surgical wound infection. Proven, investigational, and theoretic methods of reducing nosocomial wound infection rates, particularly pertaining to orthopedic procedures, are given.
Medical Education
Why Is Medical School Difficult? Or, If It Isn't Difficult, Why It Should Be
ABSTRACTGiven the intellect and motivation of the idealized contemporary medical student and the structure of contemporary medical education, one might not expect medical school to be difficult; experience dictates otherwise. Since medical school prepares one to become a physician, the inherent difficulty of medical school is expected to lie in…
