Issue - Southern Medical Association

Editorial

A MIRROR UP TO NATURE

When I became editor of this Journal, one of the decisions I made was that except in a very few individualized instances we would only list books sent to us for review. There were several reasons for this decision. In the first place, space in this Journal is at a…

Editorial

STATUS OF PUVA THERAPY

Treatment of psoriasis with oral methoxsalen (psoralen) followed by long-wave ultraviolet light (PUVA) was first introduced in 1974.1 A consensus report of 29 clinical investigators participating in two cooperative clinical trials with psoriatics in the most thorough review of PUVA published to date discusses guidelines for patient selection, application of…

Commentary

RECOGNIZING THE TEEN-AGER WHO NEEDS TO BE PREGNANT

Commentary

Recognizing the Teen-ager Who Needs To Be Pregnant A Clinical Perspective

Based on the last three years clinical experience with 600 inpatient adolescents at the Adolescent Center of Houston International Hospital, this paper reviews the pregnancy issue in terms of primary, secondary, and tertiary prevention. The majority of the patients were white middle-class girls ranging in age from 12 to 17….

Commentary

Erythrocytosis Associated With Carboxyhemoglobinemia in Smokers

During a two-year period, we evaluated 14 patients with erythrocytosis. Carboxyhemoglobinemia secondary to cigarette or cigar smoking or both caused elevated hematocrit values in ten of the patients, and in all 14 either red cell volume was increased or plasma volume was decreased. There was no correlation between the number…

Commentary

Prognostic Value of Teichoic Acid Antibodies in Staphylococcus aureus Bacteremia A Reassessment

Teichoic acid antibodies were measured in serum using counter immunoelectrophoresis and immunodiffusion technics with a partially purified antigen. Immunodiffusion titers of ≥1:4 were obtained in 15/16 patients with S aureus endocarditis but in only two of 122 noninfected individuals and in no patients with endocarditis caused by other gram-positive bacteria….

Commentary

Yersinia enterocolitica Septicemia

We present a patient with Yersinia enterocolitica septicemia who relapsed after a course of apparently appropriate antibiotic therapy. A literature review of successfully managed patients with this infection suggests clinical efficacy of aminoglycosides if therapy is continued for at least two weeks. Guidelines for treating bacteremia with localized and nonlocalized…

Commentary

Pseudomonas Infections of the Foot After Puncture Wounds

Evaluation of ten children with Pseudomonas bone and joint infections resulting from puncture wounds of the foot identified a definite pattern to sequelae. The longer the symptoms were present before adequate treatment was instituted the greater was the risk of bone and joint destruction along with the development of chronic…

Commentary

Acute Calcareous Deposits of the Hand and Wrist

Acute calcareous deposits of the hand and wrist have been infrequently reported. A review of the literature and five recent cases indicate that these painful lesions will respond rapidly to immobilization and medication. Differentiation from infection is important.

Commentary

Acute Pancreatitis in Reyes Syndrome A Fatal Complication During Intensive Supportive Care

Acute pancreatitis was an unexpected complication during the course of intensive supportive management in five patients with Reyes syndrome. Four of the five patients died and one survived with transient neurologic deficits. Although corticosteroid therapy, fluid restriction, and hypothermia may have contributed to the development of this complication, acute pancreatitis…

Commentary

Medical Complications of Hemophilia

The modern, comprehensive care of patients with hemophilia requires an awareness that complications other than those caused by acute hemorrhage can occur. The use of newer, more potent plasma concentrates has been accompanied by an increased incidence of liver disease in transfusion-requiring hemophiliacs. The progression to chronic active hepatitis and…

Commentary

Cholecystectomy With Closed Suction Drainage

In this prospective, consecutive, and nonrandomized study, 200 patients had cholecystectomy in a seven-month period. Half of them had drainage with Penrose drains and the other half with a closed suction system. The average hospitalization was one day shorter in the latter. No complications related to its use were found….

Commentary

Asymptomatic Primary Biliary Cirrhosis

Ten asymptomatic patients with biochemical, immunologie, and histologie features of primary biliary cirrhosis are described. Their liver disease was first suggested by an elevated alkaline phospliatase level upon routine biochemical screening tests. Increasing awareness of this disease has led to its increased detection in asymptomatic patients. It is this group…

Commentary

Avulsion of the Common Bile Duct by Blunt Trauma

Two cases of common bile duct avulsion by blunt trauma are presented. These injuries are rare and the treatment is controversial, but the better repairs are choledochoduodenostomy and choledochojejunostomy. Primary repair is not indicated.

Commentary

HDL Cholesterol and Coronary Heart Disease

Of the risk factors related to coronary heart disease, three clearly stand out: elevated blood pressure, cigarette smoking, and elevated levels of serum cholesterol. Recently, considerable evidence has accumulated indicating that, in addition to concentration of total blood cholesterol, the manner in which cholesterol is distributed or transported in the…

Commentary

Screening for Hypertension in Adolescents The Search for Normal Values

Appropriate control of adult hypertension is currently challenging our health care system. Evaluation of juvenile hypertension may assist in alleviating this massive medical problem by helping to identify potentially remediable risk factors. Assessment of “normal” blood pressure values for children and adolescents must first be accomplished before attempting modification of…

Commentary

Prostatic Needle Examination Current Clinical Concepts

A survey of urologic training programs was undertaken to determine the clinical usage of needle biopsy technics in evaluating prostatic disease. The most popular procedure was transperineal (57%), performed on an inpatient basis (62%). Transrectal biopsy was slightly less popular (43%), with 100% of the surveyed institutions using prebiopsy antibiotic…

Commentary

Urethral Urinary Extravasation and Complications

Ten cases of urinary extravasation from the male urethra are reviewed. Parameters include etiology, symptoms, diagnosis, treatment, and complications. Prognosis may be predicted by extent of extravasation, associated disease states, and presence of shock. All cases were treated with antibiotics and surgical therapy which varied from simple minimal drainage to…

Commentary

Sickle Cell Centers of Tomorrow Part I Regional Information Centers

Regional sickle cell organizations are needed to assemble, catalogue, and distribute information, to maintain teaching programs, to serve as referral agencies, and to aid individuals with sickle cell hemoglobinopathies in obtaining maximal benefit from existing community services. The governing body should be representative of the entire area. More than half…

Commentary

Economic Impact of Quality Control in Diagnostic Radiology

With ever-increasing costs confronting health care facilities, much attention is being focused on various cost-containment projects. Although it is generally assumed that a radiology department quality control program will increase costs, institutional savings may also result. A comprehensive quality control program involving continuing education, simplification of technic, processor control, standardization…

Review Article

Arsenic Poisoning

Arsenic poisoning continues to require awareness of its diverse clinical manifestations. Industry is the major source of arsenic exposure. Although epidemiologic studies strongly contend that arsenic is carcinogenic, there are little supportive research data. Arsenic poisoning, both acute and chronic, is often overlooked initially in the evaluation of the patient…

Current Concepts

Intra-arterial Vasopressin Infusion in Treating Acute Gastrointestinal Bleeding

IN 1963, Nusbaum and Baum1 developed the technic of arteriography in the diagnosis of gastrointestinal bleeding. Since that time, it has developed into a sophisticated diagnostic and therapeutic tool. A number of vasoactive substances have been selectively infused into the abdominal vessels with the rationale that local vasoconstriction reduces blood…

Abstract

UNIVERSITY OF OREGON HEALTH SCIENCES CENTER Hepatosplenomegaly and Diffuse Lymphadenopathy in a Young Woman

Our Medical Heritage

Tissue Preservation A Technology in the History of Our Knowledge of the Cranial Nerves

Article

Bibliotherapy Rx—Literature

Bibliotherapy is the use of any literary work in the treatment of physical or emotional problems. It is practiced by a variety of professionals including librarians, psychoanalysts, educators, and behavioral scientists. Patrons, outpatients, inpatients, students, clients, and parishioners are some of the participants in bibliotherapy sessions. The literature used may…

Medical Education

Semantics of General Medicine

The words “education” and “training” are examined in the context of contemporary general internal medicine. Based upon the definitions of these two words, the words “practical” and “management” are assuming new meanings which reflect an approach to the patient distinct in a number of ways from the classic one. Conflict…

Case Report

Hypokalemic Hypoventilation Complicating Severe Diabetic Ketoacidosis

Hypokalemia has been previously reported as a cause for respiratory impairment complicating therapy for diabetic ketoacidosis. A case is presented with a short interval of hypoventilation documented by hypercapnia. A reversal from hypercapnia to hypocapnia occurred when the serum potassium level became normal after potassium replacement. Causes of muscular weakness…

Case Report

Unilateral Pulmonary Artery Aplasia Presenting With Chest Pain and Pleural Effusion

A 58-year-old woman with a pleural effusion and left chest pain was found to have unilateral absence of the left pulmonary artery. She is unique in that she had recurring pleural effusions and chest pain for 26 years, which has not been previously described with this rare disorder.

Case Report

Fatal Myocarditis Associated With Abortion in Early Pregnancy

Primary myocardial disease in early pregnancy is a rare phenomenon. We describe four abortion-related deaths in the United States from 1975 through 1978 which were attributed at postmortem examination to myocarditis in the first trimester of pregnancy. Three of the four deaths were associated with conditions which have a presumed…

Case Report

Propranolol-Related Bronchospasm in Patients Without History of Asthma

PROPRANOLOL HYDROCHLORIDE is a beta-adrenergic antagonist used for the treatment of a variety of clinical disorders, including hypertension.1 Patients with a history of bronchospasm should not be given propranolol, since beta-antagonists may potentiate bronchospasm.2 However, there have been no case reports of propranolol-induced bronchospasm in the absence of a previous…

Case Report

Fatal Cat-Transmitted Tularemia Demonstration of the Organism in Tissue

TULAREMIA is primarily a zoonosis of considerable complexity in which over 100 vertebrate and invertebrate species act as reservoirs and/or vectors, with man being the most susceptible to infection.1 In humans, the disease can have a variable clinical course depending upon the site of inoculation of the causative organism, Francisella…

Case Report

Adenomyomatous Polyp of the Stomach

ADENOMYOMA of the stomach, a benign tumor located in the distal antrum, is uncommon, with only 33 reported cases. Two major gastrointestinal textbooks fail to acknowledge its existence.1,2 Although more than 90% of tumors of the stomach are malignant, recognition that benign tumors, including the adenomyoma, exist may save the…

Case Report

Coexistence of Systemic Lupus Erythematosus and Myasthenia Gravis

THERE HAVE BEEN 19 case reports of the coexistence of myasthenia gravis (MG) and systemic lupus erythematosus (SLE).1–17 SLE and MG are considered autoimmune diseases and as such may have clinical and serologic overlap.12 A critical analysis of the literature reveals that in many of these case reports the diagnosis…

Case Report

Medroxyprogesterone in Metastatic Renal Cell Carcinoma

ALTHOUGH VARIABLE DEGREES of subjective responses have been described in patients with advanced renal cell carcinoma (RCC) treated with medroxyprogesterone acetate (MPA), only few complete regressions have been reported.1,2 We describe complete regression of pulmonary metastases in a patient receiving MPA.

Case Report

Multicentric Glioma or Metastatic Disease A Problem in Diagnosis

COMPUTERIZED AXIAL TOMOGRAPHY (CAT) has had a major impact on neurologic diagnosis. Multiple intracranial neoplasms demonstrated by CAT may indicate either metastatic lesions or multiple primary cerebral lesions, since 2.5% of all gliomas have a multicentric origin.1 While case reports of multicentric glioma have appeared in the neurologic literature,2,3 a…

Case Report

Fludrocortisone Therapy for Hypercalcemia

HYPERCALCEMIA of varying severity is common in patients with malignancy. Patients with mild hypercalcemia may develop anorexia or vomiting, subsequent dehydration and worsened hypercalcemia, potentially to lethal levels. Long-term management of these patients should include an attempt to lower the serum calcium and reduce this risk. The purpose of this…

Case Report

Unilateral Arteriomegaly

WHILE ARTERIOMEGALY is an increasingly familiar entity, with from 1%1 to 10%2 of femoral arteriograms in symptomatic patients showing tortuous, ectatic arteries with prolonged flow, the disease is invariably symmetrical. The discovery of this unilateral case is considered unique.

Case Report

Aneurysm of Anomalous Right Subclavian Artery

ORIGIN of the right subclavian artery from the descending aorta distal to the origin of the other brachiocephalic vessels is the most common anomaly of the aortic arch. Aneurysms of this aberrant artery are rare.

Case Report

Pregnancy and Jejunoileal Bypass Treatment of Complications With Total Parenteral Nutrition

Case Report

Total Anomalous Systemic Venous Return

TOTAL anomalous systemic venous return is a rare variety of cyanotic congenital heart disease in which all systemic venous blood drains into the left atrium. We have been able to find only eight cases in the worlds literature.1–6The following case is an example of this condition and is the first…

Case Report

Rhabdomyolysis in a Patient With Nonoliguric Renal Failure Similarities to the Toxic-Shock Syndrome

MYOGLOBINURIA Secondary to rhabdomyolysis from any of multiple causes has been recognized as a cause of acute renal failure in adults1–4 and children5–10 with the predominance of cases being reported in adults. The rapid recognition of this entity with its pathophysiologic repercussions is critical in rendering appropriate therapy. We report…

Clinical Brief

Severe Local Reactions to Pneumococcal Vaccine

A DODECAVALENT pneumococcal polysaccharide vaccine (Pneumovax, MSD) has been commercially available in the United States since 1978 for use in specific patient populations in whom the risk of serious infections caused by the pneumococcus is high. Side effects from the vaccine occur frequently but usually are limited to mild pain…

Brief Review

Unilateral Lobar Pneumonia With Empyema Caused by Neisseria gonorrhoeae

A RECENT computerized search of the medical literature failed to yield a case of primary pneumonia caused by Neisseria gonorrhoeae, though Cecils Textbook of Medicine, circa 1943, lists a myriad of gonococcal complications, including “pneumonia (usually embolic).”1 In the Communicable Disease Centers recommended treatment schedules for gonorrhea, 1979,2 there is…

Brief Review

Nosocomial Cryptococcal Infection

NOSOCOMIAL Candida infections have become an increasingly common problem.1 Frequently, the source of infection is an indwelling intravenous catheter, and the clinical setting in which fungemia occurs is that of a debilitated, postoperative patient being treated with multiple antibiotics and receiving total parenteral nutrition.2 Other fungi, notably Torulopsis glabrata3 and…

Brief Review

Malignant Melanoma of the Oral Cavity

Primary malignant melanoma of the oral cavity is uncommon. Four cases are presented. The average age is in the sixth decade. Early diagnosis is difficult and prognosis is generally poor. Efforts toward earlier detection and treatment are recommended.

Brief Review

Vertical and Horizontal Nystagmus in Magnesium Deficiency

We report a patient with magnesium deficiency in whom both horizontal and vertical nystagmus subsided after magnesium replacement.

Brief Review

Meningitis in Typhoid Fever An Unusual Complication

Letter to the Editor

Migraine

Letter to the Editor

Reply

Letter to the Editor

“Popular Barbarisms”

Letter to the Editor

Tendon Rupture and Steroid Therapy

Letter to the Editor

The Art of Being Human

Letter to the Editor

The McDowell House