SMJ // November 1980, Volume 73 - Issue 11
Editorial
THE DELICATE BALANCE
Primary Article
“Ecologic Niche” of Undetected Hypertensives at Increased Risk
ABSTRACTThe “ecologic niche” where large numbers of young black hypertensive males can be found is in the emergency clinics of our public general hospitals. Unfortunately, present medical practices in these clinics do not adequately identify the hypertensive patient. Because educational measures are unlikely to change this deficiency, the present organization…
Primary Article
Logical Handling of Clinical Data
Primary Article
Primary Carcinoma of the Female Urethra
ABSTRACTA retrospective review of women with carcinoma of the urethra is reported. Twelve patients treated between 1947 and 1978 have been characterized as to presenting features, therapy, and prognosis. The average age of patients at diagnosis was 68 years; the most frequent presenting symptom was bleeding (92% of patients); average…
Announcement
GENERAL ANNOUNCEMENT
Primary Article
Laboratory Diagnosis of Rocky Mountain Spotted Fever
ABSTRACTTo examine the use of the laboratory in the diagnosis of Rocky Mountain spotted fever and to determine the specificity and sensitivity of the Weil-Felix test, hemagglutination, complement fixation, and skin biopsy immunofluorescence in the hospital, we reviewed our experience during the year 1978. Sera were submitted from 142 patients…
Primary Article
Treatment of Otitis Media With Cefaclor, a New Oral Cephalosporin
ABSTRACTCefaclor, a new semisynthetic cephalosporin, was evaluated for efficacy in the treatment of otitis media in 46 pediatric patients who had aspiration of the middle ear for culture. The dose of cefaclor ranged from 29 to 42 mg/kg/day administered in three divided doses. No organism was isolated in nine of…
Primary Article
Spontaneous Vitreous Hemorrhage Etiology and Management
ABSTRACTSpontaneous vitreous hemorrhage, without trauma, accounted for 317 patients (375 eyes) seen during a four-year period from July 1, 1975, to June 30, 1979. The most common causes were proliferative diabetic retinopathy, 39.2%; retinal tear, 12.1%; posterior vitreous detachment, 12%; vein occlusion, 10.4%; retinal detachment, 6.7%; intraocular lens, 3.2%; proliferative…
Primary Article
Hypercalcemia After Acute Renal Failure
ABSTRACTIn a patient recovering from acute renal failure, hypercalcemia abruptly developed at a time when the serum creatinine level remained high (5 mg/dl) but well after the serum phosphate level had been restored to normal by oral aluminum hydroxide therapy. The renal damage had been severe, with oliguria lasting six…
Primary Article
Zinc Changes After Renal Allotransplantation
ABSTRACTIn 72 patients the plasma zinc concentration and the urinary zinc excretion were studied immediately after renal allotransplantation and during a 71/2-year follow-up period. The plasma zinc concentration was below that of healthy control subjects during the first three weeks after transplantation (mean 39/μg/dl) and returned to the control level…
Primary Article
Investigation of a Stigmatic
ABSTRACTWe report the case history of a 23-year-old Mexican-American female stigmatic whom we studied using psychophysiologic, psychologic, and laboratory measures. The stigmata have appeared often since 1971 and usually consist of bleeding through unbroken skin from her palms, feet, side, and head. The bleeding is painful and is usually (but…
Primary Article
Femoral Neuropathy After Renal Transplantation
ABSTRACTWe report nine cases of neuropathy occurring after renal transplantation, seven of them femoral and two lateral femoral cutaneous. The average time of onset of symptoms is 2.2 days after surgery. Quadriceps weakness, hypoesthesia, and abnormal results of EMG and nerve conduction studies are common and occur on the same…
Primary Article
Psychiatrists Preferred Patients
ABSTRACTThis is an empirical study of eighty psychiatrists preferred patients. Although these patients show many common characteristics that make them suitable for psychotherapy, it appears that the therapists unique experience seems to be the most important factor in determining his preference for a particular one of these suitable patients.
Primary Article
Extensive Tissue Necrosis Associated With Warfarin Sodium Therapy
ABSTRACTSkin and soft tissue necrosis is an uncommon but increasingly recognized complication of coumarin anticoagulant therapy. A patient is described with extensive involvement of all four extremities and the nose, requiring amputation of three extremities. The characteristic clinical features of the disorder are reviewed, with a discussion of the pathology,…
Primary Article
Use, Misuse, and Cost of Parenteral Cephalosporins at a County Hospital
ABSTRACTWe reviewed total usage of parenteral cephalosporins at a county hospital during 1978 with regard to appropriateness, pattern of use, and cost. In addition, we determined the impact of replacing cephalothin with cephapirin in the hospital formulary. During the 12-month study 366 patients received 409 courses of parenteral cephalosporins: 167…
Primary Article
Prostaglandins An Alternative Concept for Induction of Labor
ABSTRACTVaginal suppositories of prostaglandin E2 constitute a highly efficient and acceptable method for inducing labor in patients with both favorable and unfavorable cervices. Both the failure of induction and consequent cesarean section rates can be dramatically reduced.
Primary Article
Risk of Bacteremia After Endotracheal Intubation for General Anesthesia
ABSTRACTBlood cultures were obtained before and after endotracheal intubation to assess the risk of bacteremia associated with this procedure and to evaluate the need for prophylactic antibiotics to prevent bacterial endocarditis in patients with structural heart disease requiring general anesthesia. Blood cultures were obtained immediately before intubation and two and…
Primary Article
Radiation Therapy for Esophageal Cancer The Medical College of Virginia Experience
ABSTRACTIn a retrospective review of 70 patients with carcinoma of the esophagus treated by external beam irradiation therapy from 1968 to 1977 at the Medical College of Virginia, we correlated survival with race, age, sex, histology, and site of tumor. Results of treatment were also analyzed in relation to the…
Primary Article
Intracystic Papillary Carcinoma of the Breast
ABSTRACTThe occurrence of a breast carcinoma within a breast cyst is rare. These tumors are usually papillary adenocarcinomas arising from the wall of macrocysts of the breast. The clinicopathologic course in seven patients is reviewed. Modified radical mastectomy has provided satisfactory surgical management and is the recommended therapy.
Primary Article
Arrest of Severe Liver Hemorrhage by an Omental Pack
ABSTRACTFrom Jan 1, 1971 through June 30, 1979, 113 cases of massive liver injury were managed by insertion of a viable omental pack. Significant active hemorrhage was present in all cases, while the source of hepatic bleeding was primarily venous in the 102 injuries due to blunt trauma. Associated injuries…
Primary Article
Hypothermia in the Sunny South
ABSTRACTAccidental hypothermia has increased in prevalence among the aged poor, probably because of a marked increase in heating costs. Most cases of accidental hypothermia in the past have been reported from either England or the northern United States. We report our experience with this disorder in the Tampa (Florida) General…
Primary Article
Malignant Melanoma Associated With Breast Cancer
ABSTRACTThe experience of the population-based Connecticut Tumor Registry was analyzed for the occurrence in the same patient of breast cancer and malignant melanoma. A total of 18,010 women with breast cancer were followed up for the subsequent development of malignant melanoma of the skin or eye. Similarly, 835 women with…
Primary Article
Examination and Treatment of the Male Rape Victim
ABSTRACTThe number of known male rape victims is on the increase. Rape treatment centers which formerly cared only for female victims have now opened their doors to male victims. The examination and treatment of these victims are discussed.
Primary Article
Subclavian-Axillary Venous Thrombosis Role of Noninvasive Diagnostic Methods
ABSTRACTThe diagnosis of primary subclavian axillary venous thrombosis (SAVT) was evaluated in eight patients to compare the accuracy of clinical diagnosis and noninvasive vascular evaluation with phlebography. Clinical evaluation led to three misdiagnoses: lymphedema (1), and inflammatory breast carcinoma (2). Doppler ultrasound detection of venous flow performed on three patients…
Review Article
The Many Faces of Meckels Diverticulum
ABSTRACTMeckels diverticulum usually presents as a diagnostic problem. Its most common clinical manifestations—lower GI bleeding, small bowel obstruction, and features suggesting acute appendicitis—are fairly well known. Other clinical presentations include a Meckels diverticulum in an omphalocele, lower GI bleeding followed by perforation, perforation secondary to blunt trauma, and presentation as…
Current Concepts
Micropore Filters in Blood Transfusion
Article
Obstetrics Through the Retrospectroscope
ABSTRACTThis essay is a personal comparison of obstetrics in the 1930s and the 1970s. Maternal and perinatal mortality are contrasted for the two eras. Hospital delivery then and now, and hospital versus home delivery are compared. Changing patterns of operative delivery are presented with special reference to the increasing incidence…
Medical Education
The High Cost of Recruiting Residents
ABSTRACTWe have developed estimates for the cost of recruiting first-year residents through the National Resident Matching Program. The cost to our medical center was estimated to be $1,469 for each resident obtained through the matching program. The cost to each applicant averaged $659, and the cost to the applicants medical…
