SMJ // October 1980, Volume 73 - Issue 10
Editorial
SECONDARY DOCTORS
Editorial
CHEST PAIN AND DIFFUSE ESOPHAGEAL SPASM
Primary Article
Prostatic Carcinoma A Trilogy of Clinical Expressions
A review of the available clinical and pathologic information suggests that the biologic behavior of prostatic carcinoma can be characterized by one of three different tumor-growth kinetic curves. Failure to identify the biologic potential of the tumor, as indicated by the pattern of its growth curve, can result in inappropriate…
Primary Article
Carcinoma of the Cervix Complicating Pregnancy
Of 266 cases of invasive carcinoma of the cervix, 17 cases were complicated by pregnancy. All were treated by radical Wertheim hysterectomy with Taussig node dissection followed by postoperative irradiation, resulting in a 100% five-year survival rate. Of these 17 cases of invasive carcinoma of the cervix, 12 were stage…
Primary Article
Surgical Treatment of Carcinoma of the Anus
We studied 37 cases of carcinoma of the anus treated from 1950 to 1977, reviewing preexisting anorectal disorders, presenting symptoms, anatomic location, and histologic classification. There was a fivefold female-to-male predominance. Most patients presented in the seventh decade of life and exhibited alarming delays in seeking professional care. The crude…
Primary Article
Acute Leukemia During Pregnancy
The management of acute leukemia during pregnancy is difficult. We induced remission in a 23-year-old woman with thioguanine and cytarabine therapy during the 27th week of pregnancy. There were no apparent drug-related, long-term effects on the newborn.
Primary Article
Basophilic Transformation of Chronic Myelogenous Leukemia
Two patients with chronic myelogenous leukemia (CML) and basophilic transformation are reported because of unusual clinical and cutaneous features. One patient had the hyperhistaminemic syndrome (HHS) during relapse of the accelerated phase of CML. The literature on this topic is reviewed. The second patient had a basophilic crisis in the…
Primary Article
F-Wave Conduction Velocity in Alcoholic Polyneuropathy
We used the F-wave conduction velocities to estimate the motor nerve conduction along the proximal segment (spinal cord to knee) of the axon of tibial and common peroneal nerves in ten patients with alcoholic polyneuropathy and compared these to the motor nerve conduction velocities in ten normal subjects. All the…
Primary Article
Noninvasive Determination of Core Temperature During Anesthesia
A noninvasive, zero heat flux method of determining core (intracardiac blood) temperature was studied in ten anesthetized patients having whole body hyperthermia for the treatment of cancer. True intracardiac blood temperature was determined by a calibrated pulmonary artery thermistor. Accuracy, precision, and responsivity for the noninvasive system were comparable to…
Primary Article
Axillofemoral Bypass Grafts Using Polytetrafluoroethylene
More liberal indications for axillofemoral bypass grafts have recently been advocated if long-term patency were comparable to aortic bypass procedures. A clinical trial of polytetrafluoroethylene (PTFE) axillofemoral grafts was instituted in an attempt to maximize graft patency. The theoretic advantages of this material were: (1) a more rigid tube graft,…
Primary Article
Celiac Plexus Block Diagnostic and Therapeutic Applications in Abdominal Pain
The celiac plexus block has been “rediscovered” by the modern multidisciplinary pain clinic. Local anesthetic blocks aid in diagnosing unusual syndromes of abdominal pain. Neurolytic blocks are important in the management of intractable pain from abdominal cancer. Therapeutic use of celiac plexus block in managing the pain of chronic pancreatitis…
Primary Article
Vancomycin Penetration into CSF During Treatment of Patients Receiving Hemodialysis
Penetration of vancomycin into CSF was determined during therapy with the regimens recently used to treat staphylococcal infections in patients receiving hemodialysis: 1 gm weekly or 750 mg twice weekly. During three episodes in two patients with proved or suspected central nervous system infection, CSF levels of vancomycin ranged from…
Primary Article
Infective Endocarditis in the Elderly
We reviewed 56 cases of infective endocarditis (IE) in patients 65 years of age and older. The clinical features, laboratory manifestations, and bacterial etiology of IE in our patients were similar to those in younger patients. Ninety-three percent were febrile, 86% had heart murmurs, and 36% had peripheral stigmas. Streptococci…
Primary Article
Sodium Bicarbonate in the Management of Systemic Acidosis
Primary Article
Clinical Evaluation of the Sliding Compression Screw in 121 Hip Fractures
Between August 1975 and June 1978, the orthopedic residents at the Jacksonville Health Education Program have used the sliding compression screw to treat 135 hip fractures. The 121 of these being reported include 27 subcapital and femoral neck fractures, 88 intertrochanteric fractures, and six subtrochanteric fractures. Patients ages ranged from…
Primary Article
Articular and Skeletal Infections Caused by Pasteurella multocida
Pasteurella multocida infections of joints and bones generally occur in individuals who have contact with cats or dogs. Osteomyelitis usually follows penetrating trauma such as an animal bite. Septic arthritis tends to occur in patients who have preexisting inflammatory joint disease, especially if a systemic condition which is known to…
Review Article
Supraglottitis in Children Evaluation and Management
Supraglottitis is a life-threatening illness characterized by inflammation of the supraglottic structures including the epiglottis, arytenoids, aryepiglottic folds, and ventricular bands. This paper is a comprehensive review of the etiology, epidemiology, pathology, differential diagnosis, natural course, complications, and management of supraglottitis. A high index of suspicion is required to properly…
Article
The Unnecessary Hysterectomy
After a short statement on unnecessary surgery, the background of the ripple effect of the McCarthy report of 1974 was briefly summarized. A review of the vaginal hysterectomies on my service for 1971 through 1976 revealed that hysterectomies for functional diagnoses comprised 46% of the total and that hysterectomy for…
Article
Routine Pregnancy Testing is it a Standard of Care?
Increasingly the courts are expanding the scope of viable causes of action and the nature of damages, as well as the spectrum of plaintiffs to include the unborn. Generally the courts accept medically established standards of care, but on occasion courts create the standard of care. Predicated on this type…
Current Concepts
Management of Psychologic Responses to Myocardial Infarction
The psychologic responses of denial, anxiety, and depression occur in a natural, predictable sequence in patients suffering acute myocardial infarction. Therapeutic interventions are possible to smooth the patients passage through these psychologic stages: cognitive structuring, environmental manipulation, relaxation exercises, anticipation, encouragement, physical conditioning and activity, and group interactions. Multidisciplinary cooperation…
Medical Education
Impact of a Family Practice Residency Program on Physician Location in Small Communities
We conducted a study to determine the practice location pattern among graduates of a family practice residency program with respect to the distribution of the physicians in nonurban areas of the country. One of the primary goals of The University of Texas Southwestern Medical School at Dallas Family Practice Residency…
Our Medical Heritage
Dr. Samuel Mudd Justice at Last
Case Report
Rapid Development of Massive Pleural Effusion in Legionnaires Disease
SUMMARY The rapid development of a massive exudative pleural effusion was documented in a case of Legionnaires disease. This clinical event can be considered an established though unusual feature of the widening clinical spectrum of infection by Legionella pneumophila.
Case Report
Mediastinitis Complicating Cellulitis of the Head and Neck
SUMMARY A patient with mediastinitis caused by Streptococcus pyogenes and/or Staphylococcus aureus responded to antibiotic therapy without surgical intervention, although fever was prolonged and recovery slow. The medical and surgical management of mediastinitis is discussed.
Case Report
Unusual Blood Pressure Response in a Patient With Secondary Adrenocortical Insufficiency
SUMMARY A patient with suspected exogenous hyper-adrenocorticism and hypertension was treated with cessation of steroids, a low-sodium diet, and moderate doses of diuretics. Hypertension persisted, and severe dehydration and hyponatremia developed, but all responded to normal saline administered intravenously. The concurrence of (1) hypoadrenocorticism and its attendant fluid and electrolyte…
Case Report
Ophthalmooestriasis Externa
Case Report
Ultrasonography in the Diagnosis of a Type 1 Choledochal Cyst
SUMMARY We have described an adult patient with a type 1 choledochal cyst and without jaundice. Ultrasonography demonstrated a cystic mass in the right upper quadrant and dilated bile ducts.
Case Report
Choledochal Cyst Sonographic Evaluation of an Unusual Case
SUMMARY The preeminence of sonography in the diagnosis of obstructive jaundice has already been established.7 Earlier reports have described a variety of radiologic modalities used to establish the diagnosis of choledochal cyst.1,2 Our case illustrates the usefulness of sonography in differential consideration, though either transhepatic or operative cholangiography is necessary…
Case Report
Alternating Painful Ophthalmoplegia
The ultimate evolution of our case and its atypical features of unilateral blindness, bilateral involvement, and extensive involvement of the trigeminal nerve revealed the pathogenesis of this case of alternating painful pohthalmoplegia resembling the Tolosa-Hunt syndrome to be that of a parasellar pituitary adenoma.Similar cases of painful recurrent ophthalmoplegia should…
Case Report
Gonadal Dysgenesis in a Neonate With 45,X/47,XXX Karyotype
SUMMARY A case of X/XXX mosaicism in a neonate with dysgenetic gonads is presented because of the rarity of the X/XXX karyotype and the presence of dysgenetic ovaries and congenital heart anomalies. We suggest that the X/XXX mosaicism may not have a protective effect on the gonads as does X/XX…
Case Report
Candida Endophthalmitis A Manifestation of Candidiasis in the Neonate
SUMMARY Candida endophthalmitis is a frequent complication of systemic candidiasis. The case reported emphasizes the usefulness of indirect ophthalmoscopy in evaluating infants suspected of having disseminated candidal infection and describes the pathologic findings of Candida endophthalmitis in the neonate.
Case Report
Cushings Syndrome Associated With Functional Black Adenoma of the Adrenal Cortex
SUMMARY A 35-year-old woman who had bone pain in the extremities was found to have Cushings syndrome, for which she had adrenalectomy. Pathologic examination revealed a solitary black adenoma. Bone scan and roentgenograms showed regional osteoporosis of the extremities and avascular necrosis of the hip. Her cushingoid manifestations and bone…
Breif Report
Renal Agenesis After First Trimester Exposure to Chlorambucil
SUMMARY One of a set of twins aborted at 20 weeks gestation had unilateral renal agenesis after exposure to chlorambucil and prednisone since conception. There are no firm clinical data suggesting that second or third trimester exposure to any of the immunosuppressive drugs is toxic to the fetus, and no…
Breif Report
Ectopic ADH Production Before Clinical Recognition of Small Cell Carcinoma of the Lung
SUMMARY Although the syndrome of inappropriate antidiuretic hormone secretion may be seen in several disorders, small cell bronchogenic carcinoma is probably the most commonly reported cause. We have reported a case of excessive production of ADH preceding the detection of the underlying small cell anaplastic bronchogenic carcinoma by nearly seven…
Breif Report
Clomiphene-Citrate-Induced Hydatidiform Mole
SUMMARY The reported incidence of molar pregnancies induced by clomiphene citrate is 1:659. Only nine cases, including this one, were found in an extensive search of the literature. Several questions are raised regarding the true incidence of molar pregnancy in clomiphene-induced pregnancies. Evaluation of the induced pregnancy with diagnostic ultrasound…
Breif Report
CT-Verified Brain Stem Hemorrhage With Survival
SUMMARY A 38-year-old hypertensive woman presented with acute onset of cranial nerve and long tract signs referable to a lesion in the right dorsolateral pons. A hemorrhage in the suspected area was demonstrated by CT. Although brain stem hemorrhage was previously thought to be only rarely compatible with survival, our…
