SMJ // April 1979, Volume 72 - Issue 4
Editorial
ON MANDATORY CME
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Perspectives on Mandatory Continuing Medical Education
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Patient Education The New Dimension
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Clinical Study of 81 Gastrointestinal Carcinoid Tumors
The behavior and treatment of gastrointestinal carcinoid tumors have been the subject of much discussion. Size, location, and histologic invasiveness have been shown to correlate with regional and remote metastasis in previous series. We reviewed 81 patients with gastrointestinal carcinoids seen at the Medical University of South Carolina Teaching Hospitals…
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Treatment of Cholelithiasis in Patients With Sickle Cell Anemia
The incidence of cholelithiasis and surgical risk of cholecystectomy in patients with sickle cell anemia is reviewed. Records of all patients with sickle cell disease currently attending the Medical University of South Carolina Hematology Clinic were reviewed. An oral cholecystogram has been part of the initial evaluation for the past…
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Late Results of Myocardial Revascularization
Data are presented on 1,400 consecutive patients who had myocardial revascularization at our institution. The patients ranged in age from 33 to 80 years. Coronary bypass was done with an associated noncardiac procedure in 70 patients and with an associated cardiac procedure in 73 patients. The hospital mortality was 2.0%….
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Surgical Treatment of Hyperparathyroidism*
Hyperparathyroidism, as seen by a single group of surgeons in a community of 320,000, is reviewed in a retrospective fashion. It was shown that symptomatic hypocalcemia could occur up to 110 hours postoperatively and was most likely to occur in individuals showing skeletal demineralization preoperatively. Though large doses of calcium…
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Serum Concentrations of 25‐Hydroxyvitamin D in Florida Children Effect of Anticonvulsant Drugs
The mean serum concentration of 25-hydroxyvitamin D (25OHD), determined by nonchromatographic radioassay, was significantly lower (P < .02) in Florida children with epilepsy treated with anticonvulsant drugs (34.4 ± 11.3 [SD] ng/ml) than in normal subjects (40.9 ± 14.3), despite exposure of both groups to sunlight throughout the year. In…
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Gastric, Intestinal, and Gallbladder Varices Hemodynamic and Therapeutic Considerations
Atypically located varices are frequently overlooked in the differential diagnosis of gastrointestinal bleeding in patients with portal hypertension. The circulatory changes associated with these lesions are described and their relation to diagnosis and treatment emphasized.
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Medical Education and the Dying Patient
Several recent cases illustrate the medical-ethical-legal consequences associated with lack of awareness in caring for and treating the dying patient. We question whether solutions advanced by others are feasible or desirable for use in medical education, and suggest looking to the familiar principles of clinical medicine. These principles can be…
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Cushing's Disease Megadose Dexamethasone Suppression in a Case Refractory to Medical Therapy
A patient with Cushing's disease failed to show complete suppressibility of adrenal function with conventional “high” doses of dexamethasone (8 mg per day). Higher doses were required to achieve suppression. Pituitary irradiation and medical therapy (cyproheptadine, metyrapone, and aminoglutethimide) failed to control the disease, necessitating bilateral adrenalectomy. The diagnostic and…
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Simple Screening Technic to Estimate Postoperative Narcotic Use
The General Health Questionnaire, a 30-item, self-response inventory, identified individuals who required significantly more pain medication after elective cholecystectomy. The questionnaire is well tolerated by surgical patients and is easy to score. It can identify those individuals prone to request excessive narcotic medication postoperatively.
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Death Caused by Brain Herniation During Hemodialysis
Brain edema with brain herniation during or after dialysis has been reported previously. However, coexisting lesions of the central nervous system (CNS) which might play a facilitating role were present in these case reports. Described here is an 18-year-old white man with renal failure who developed clinical signs consistent with…
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Traumatic Hemobilia Coordination of Roentgenographic, Scintigraphic, and Angiographic Findings
This report proffers a diagram of radiologic procedures to aid in the diagnosis of traumatic hemobilia and updates the most important radiologic findings of hemobilia to demonstrate the value of the coordinated use of liver scintigraphy and angiography. According to the diagnostic schema, evaluation of biliary tract hemorrhage progresses from…
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Primary Dysmenorrhea Treated With Indomethacin
Primary dysmenorrhea is a difficult entity to treat, and therapy is usually directed at relieving symptoms. There is some indication that this disorder is caused by an increase in prostaglandin F2α Therefore, logically the treatment may include antiprostaglandin agents. We have studied 32 women with the diagnosis of primary dysmenorrhea…
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Myopathy Limited to the Quadriceps and Gastrocnemius Muscles Occurring in Three Brothers
This is a report of three cases of myopathy limited to the quadriceps and gastrocnemius muscles, occurring in the male offspring of the same mother but two different fathers. They have many similarities to a previously described clinical syndrome called quadriceps-confined myopathy. The pedigree demonstrates an apparent sex-linked recessive condition…
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Renin Aldosterone System and Potassium Levels in Chronic Lead Intoxication
Renin activity and aldosterone were evaluated relative to potassium levels and lead intoxication in 33 patients with a history of “moonshine” ingestion. Patients were divided into three groups: I, lead intoxicated with hyperkalemia; II, lead intoxicated without hyperkalemia; and III, not lead intoxicated without hyperkalemia. Those in group I demonstrated…
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Respiratory Failure Secondary to Mycoplasma pneumoniae Infection
Three previously healthy patients presented with bilateral pulmonary infiltrates, hypoxemia, and respiratory failure associated with Mycoplasma pneumoniae infection. None had underlying pulmonary or immune deficiency diseases. One died with dense fibrotic reorganization of the lungs, and another survived after prolonged mechanical ventilatory assistance. Two developed pulmonary superinfections with Pseudomonas aeruginosa….
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Surgical Management of Nasal Valvular Obstruction of Dorsal Origin
Nasal obstruction from valvular dysfunction may take many forms besides alar collapse. Some valvular stenoses result from scarring and tissue loss from the dorsum of the nose. Any surgical correction should take into consideration replacement of lost tissue. Several surgical means of handling this type of obstruction are described.
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Pneumococcal Endocarditis in Infants
A case of pneumococcal endocarditis in an infant is reported together with a review of seven cases previously described in the literature. The prominent presenting symptoms of this usually fatal disease consisted of tachycardia, tachypnea, and cardiomegaly. A new murmur was heard in six of the eight patients. Fever was…
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Simplified Endometrial Testing by the Milan‐Markley Technic
Recent articles have urged physicians to give increased attention to the use of cytologic and histopathologic technics in the detection of precancerous and cancerous endometrial lesions, since there is an increasing incidence of malignant disease at that site. A routine cervicovaginal smear is inadequate to diagnose cancer of the endometrium….
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Cost Containment Medical System Rehabilitation or Reform*
Cost containment is considered the premier goal for improvement of the medical care system. Before any other steps can be taken to improve availability, accessibility, or quality, or before introduction of any governmental programs for the removal of economic obstacles to obtaining medical care,—in other words, before any effort to…
