SMJ // July 1979, Volume 72 - Issue 7
Editorial
THOUGHTS FOR INDEPENDENCE DAY
Editorial
Duration of Intubation and ICU Stay After Open Heart Surgery
One hundred four consecutive patients undergoing open heart surgery were studied to determine the duration of intubation and ICU stay associated with an anesthetic management protocol designed to avoid prolonged postoperative respiratory depression. The results document the feasibility and safety of early extubation and shortened ICU stay in patients having…
Editorial
Variant Angina in the Setting of Hypothyroidism and Beta Blockade A Proposed Mechanism
Coronary artery spasm can occur in the presence of excessive alpha-adrenergic tone. A decrease in protective coronary vasodilator substance and enhanced alpha-adrenergic responsiveness, which occurs in the setting of hypothyroidism and beta blockade, predisposes to coronary artery spasm. The case presented supports these concepts.
Editorial
Analysis of Factors Influencing the Renin‐Aldosterone System in a Patient With Bartter's Syndrome
The response to indomethacin of a patient with Bartter's syndrome and proximal tubular sodium wasting is described. The patient had evidence of excessive prostaglandin activity (elevated urinary prostaglandin E metabolite [PGE-M] excretion) which returned to normal with indomethacin therapy. Indomethacin administration corrected the defect in proximal tubular sodium resorption, but…
Editorial
Air Embolism From Mechanical Ventilation in Respiratory Distress Syndrome
Three cases of air embolism secondary to mechanical ventilation in premature infants with respiratory distress syndrome are presented, and its mechanism is discussed. A plausible mechanism for air in the hepatic veins occurring in most of these cases is also discussed. Many sudden unexplained deaths in premature infants on mechanical…
Editorial
Metabolic Alkalosis Complicating Weaning From Mechanical Ventilation
Metabolic alkalosis was identified and confirmed as a precipitator of acute hypercapnea. As a result, weaning from mechanical ventilator therapy was delayed. Correction of alkalosis followed by reduction of Pco2 confirmed the compensatory mechanism during alkalosis, and weaning from intermittent mandatory ventilation then proceeded at an appropriate rate.
Editorial
Pathologic Fractures of Long Bones
Sixty-two cases of pathologic fractures occurring in 53 patients treated at Scott and White Memorial Hospital from 1966 to 1976 are reviewed and analyzed with regard to type of neoplastic lesion, location, mode of therapy initiated, functional stability of therapy selected, and average length of survival after orthopedic procedure. Pertinent…
Editorial
Follow‐up Study on Hemiarthroplasty of the Hip
This follow-up study on hemiarthroplasty of the hip evaluates the effectiveness of the treatment in various hip conditions. A total of 169 hemiarthroplasties of the hip were performed at the Medical College of Georgia from 1966 to 1972. Fifty-two patients were available for follow-up study in 1975. Hips were evaluated…
Editorial
Double‐Blind Comparison of Hydrochlorothiazide Plus Triamterene Therapy Versus Chlorthalidone Therapy in Hypertension
Effects of two dosage strengths of hydrochlorothiazide and triamterene in combination and chlorthalidone on blood pressure and serum potassium were compared in 126 patients in a double-blind, placebo-controlled study. Each drug regimen was administered once a day. All three regimens had significantly reduced blood pressure at each of the eight…
Editorial
Vascular Access for Cancer Chemotherapy
A persistent problem in caring for patients receiving long-term intravenous chemotherapy for cancer is the maintenance of access to the vascular system. At Emory University Hospital between January 1975 and December 1977, 48 cancer chemotherapy patients had upper-arm bovine arteriovenous fistulas created for vascular access. The heterografts were inserted from…
Vignette on Medical Writing
Commas in a Series
Article
Secondary Renal Neoplasms An Autopsy Study
The records of 11,328 autopsies performed on patients who died of malignant disease between March 1944 and August 1974 were reviewed, and 816 cases (7.2%) demonstrated renal metastases. The most common primary tumors in decreasing order of frequency were lung, breast, skin (melanoma), and tumors of the genitourinary, gastrointestinal, and…
Article
Factors Influencing the Occurrence of Advanced Cervical Carcinoma
The continued occurrence of advanced cervical carcinoma (stage II, III, IV) was studied. Patients were evaluated with regard to age, racial origin, socioeconomic status, geographic distribution, and presenting symptoms. Particular emphasis was placed on the role of screening in disease detection. The disturbing finding was that of the 170 patients…
Article
Colposcopy in Gynecologic Practice
We review the role of colposcopy in the setting of a private gynecologic practice and present the data regarding 418 patients. The practicality and propriety of using colposcopy to evaluate patients with abnormal results of cytology, gross cervical lesions with or without postcoital bleeding, or a history of intrauterine exposure…
Article
Group III Atypical Mycobacterial Infections
We retrospectively and prospectively examined the clinical presentation, course of disease, and response to therapy in 63 patients whose mycobacterial isolates were identified as Runyon group III atypical mycobacteria. All of the patients except four had pulmonary disease similar to typical pulmonary tuberculosis. The others had scrofula or abscess. There…
Article
Classic Migraine With Cerebral Cortical Infarction Causing Permanent Hemianopia
A patient with typical classic migraine, including clear-cut visual auras, who had been followed up clinically for more than 15 years developed permanent right homonymous hemianopia. The underlying cause of this clinical syndrome was established by computerized axial tomography as vascular infarction or ischemia, involving the contralateral visual cortex.
Article
Postoperative Beta Irradiation in the Treatment of Pterygium
High recurrence rates are reported after surgical treatment of pterygia. With the use of beta irradiation, the recurrence rate drops dramatically. This paper describes technic and dosage used in a group of patients receiving postoperative beta irradiation. Two thirds of these patients, however, had at least two surgical procedures. A…
Article
Tendon Rupture After Local Steroid Injection
Thirteen patients who developed 15 ruptured tendons subsequent to injection of a depository steroid in or about the tendons are described. Eight were treated surgically. Ruptures were encountered in three Achilles tendons, two supraspinati, one lateral epicondylar attachment at the elbow, eight tendons of the long head of the biceps…
Article
Inguinal Herniorrhaphy Reduced Morbidity, Recurrences, and Costs
Costs, morbidity, and recurrences have been reduced in the repair of inguinal hernias. In 18 months 135 repairs were done using local anesthetics, prompt ambulation, and minor variations in the Shouldice technic. Men and women aged 22 to 84 years were operated upon. No recurrences have been reported, and urinary…
Article
Serum Gamma‐Glutamyl Transpeptidase Its Specificity and Clinical Value
The clinical import of the serum gamma-glutamyl transpeptidase (GGTP) level was evaluated in 162 prospectively studied patients. GGTP is helpful in determining the origin of alkaline phosphatase (AP); it clearly separates increased AP of bone and placental origin from that of liver origin. The GGTP level closely parallels the AP…
Acknowledgment
BOOKS RECEIVED
Acknowledgment
Combined Oral L-Dopa and Propranolol for Growth Hormone Provocation
A convenient test of growth hormone (GH) provocation using oral doses of L-dopa and propranolol (L+P) is compared with insulin-induced hypoglycemia (IIH) in 28 children and adolescents with short stature. In eight of these children, growth hormone deficiency was diagnosed when GH failed to rise above 7 ng/ml. The GH…
Acknowledgment
Pain Clinics Their Value to the General Practitioner
Physicians in general practice frequently encounter patients with chronic pain; such patients pose a difficult management problem. A new approach to treatment is offered by the Pain Center at the University of Tennessee Center for the Health Sciences. The Pain Center, with a staff drawn from a number of medical…
Acknowledgment
Physician Attitudes Toward Relicensure The Simulated Patient Option
Primary care physicians in one Southern city were asked to return a mail questionnaire stating their attitudes toward relicensure issues. Respondents overwhelmingly preferred continuing education as the method of creditation for relicensure, but as a second choice preferred the simulated patient procedure to formal examinations. Nearly one half of the…
Acknowledgment
Practice Monitoring as a Means to Direct Individual Continuing Medical Education
Methods of practice monitoring currently available and requiring little of the physician's time are discussed. The application of these tools to direct individual continuing medical education efforts and to examine and improve patient care are illustrated from my experience and that of the Department of Family Practice of the Medical…
Review Article
Cytomegalovirus Infections
Current Concepts
Computers in the ICU
Article
The Complete Health Checkup Fad, Fiction, or Fact
The ritual of the annual physical examination is scrutinized with respect to its clinical value. The periodic physical examination is not usually a health examination, because it does not include all components that affect a person's total health. The annual physical examination is usually not of importance to the physician…
Article
Adolescent Pregnancy
This paper reviews the literature of the past seven years concerning adolescent pregnancy. Social and motivational factors leading to pregnancy are discussed and weighed. Obstetric aspects of adolescent pregnancy are reviewed as well as the repercussions of this event. Goals and objectives are proposed, including: (1) assurance of health education,…
