SMJ // April 1980, Volume 73 - Issue 4
Editorial
KEEPING MEDICAL COSTS TO A MINIMUM
Article
Internists Perceptions and Performance in Office Practice
Thirty-one internists in private practice chose items of care that they considered essential and likely to be recorded in the evaluation and management of diabetics, hypertensives, women with symptoms of dysuria or frequency, and patients requesting a general examination. Records of patients with these conditions, in those practices, were reviewed…
Article
Prognostic Value of a Prepartum and Intrapartum Risk-Scoring Method
A simple prepartum and intrapartum scoring technic for the identification of high-risk patients was applied to 1,224 patients managed at the Charleston Area Medical Center, Memorial Division. The patients were classified as being at low, moderate, or high risk, according to the total risk score. Perinatal mortality worsened as the…
Article
Percutaneous Transhepatic Cholangiography Using the Chiba Needle Comparison With Retrograde Pancreatocholecystography
We have reviewed 103 consecutive percutaneous transhepatic cholangiograms (PTC). Although 70% of these examinations were performed by inexperienced radiologists, the success rate for entering bile ducts (overall 87.4%; in obstruction 98.5%; in nonobstructed cases 65.7%) and the complication rate (12.6%) is similar to that reported in large series by experienced…
Article
Hemodialyzability of Acetazolamide
Because the dialyzability of acetazolamide is not known, we undertook a study to determine the in vivo dialysance of this drug and found it to average 22 ml per minute. The quantity of the drug removed by four hours of dialysis was approximately 30% of the dose administered intravenously one…
Article
Prophylaxis Against Acute Stress Erosions
Acute gastroduodenal erosions and ulcerations, often with life-threatening gastrointestinal hemorrhage, contribute to high mortality in critically ill patients. Hypersecretion of gastric acid to some degree seems to be necessary. Antacids and recently cimetidine, a histamine H2-receptor antagonist, have been used for prophylaxis against bleeding from these acute “stress” erosions. Review…
Article
Isolation and Evaluation of Clostridia From Clinical Sources
During a two-year period, 133 isolates of clostridia from clinical sources were obtained. These isolates are reviewed as to clinical significance and antimicrobial susceptibility. Adequate charts were available on 63 patients, nine (14%) of whom had their clinical course significantly altered by the presence of clostridia. Clostridia of little or…
Article
Low-Dose Insulin for Treatment of Diabetic Ketoacidosis in a Private Community Hospital
We evaluated 21 patients with the diagnosis of diabetic ketoacidosis, involving 25 admissions to a large private community hospital, to evaluate the efficacy of low-dose insulin therapy by measuring time required for correction of hyperglycemia and acidosis, and to evaluate any associated morbidity or mortality. The protocols and laboratory tests…
Article
Scapulocostal Syndrome Diagnosis and Treatment
The scapulocostal syndrome is an often encountered yet infrequently diagnosed cause of back and/or shoulder pain. Results of examination and treatment in the three cases described point out the necessary differential diagnosis to effectively screen these groups of patients from among those with more complex diseases.
Article
Serologic Diagnosis of Toxocara cards Infection
Visceral larval migrans (VLM) caused by Toxocara canis presents a wide spectrum of clinical manifestations with eosinophilia. Although the presence of increased serum IgE and isohemagglutinin titers are useful screening tests, the specific diagnosis rests on identification of larvae in biopsy specimens of tissues or serologic tests for specific antibody…
Article
Prevalence of Clinical Gallbladder Disease in Mexican-American, Anglo, and Black Women
Clinical observations have suggested that gallstones are increased in frequency in Mexican-Americans compared to other ethnic groups. Past autopsy surveys have demonstrated a low prevalence in blacks compared to whites. We retrospectively reviewed 1,018 charts to study the prevalence of cholelithiasis in ambulatory women of these three racial/ethnic backgrounds. Mexican-American…
Article
Oculoplethysmography in Diagnosing Obstruction of the Superior Vena Cava
Preoperative evaluation of a patient with symptomatic obstruction of the superior vena cava secondary to sclerosing mediastinitis demonstrated abnormal plethysmographic findings in the central venous and carotid systems. Arteriography confirmed diminished blood flow to the arms and cerebral vessels. Following in continuity saphenous vein conduits to the jugular system, he…
Article
Antibiotic-Associated Colitis A Persistent Clinical Problem
Examination of this series of 19 patients with antibiotic-associated pseudomembranous colitis revealed that most of the patients were given the antibiotics for trivial reasons. Many different antibiotics were identified as being related to the development of colitis. There were three deaths in this series: two of the 15 patients treated…
Article
Midtrimester Dilatation and Evacuation Abortion
At a university referral hospital where midtrimester abortions are performed by prostaglandin F2α instillation, interest in reports of lower morbidity with dilatation and evacuation (D&E) led to the development of a D&E technic for outpatient use at 13 to 16 weeks gestation. Of the first 19 women offered this method…
Article
Surgical Therapy for Diffuse Granulomatous Colitis
Of 16 patients with diffuse granulomatous colitis treated surgically, nine initially had total proctocolectomy and seven had abdominal colectomy with ileorectal anastomosis. There was no mortality in either group, and there was no anastomotic leak from ileorectal anastomosis. Disease recurred in 22% of patients after proctocolectomy and in 57% of…
Article
Aspiration After Overdosage of Sedative or Hypnotic Drugs
We have reviewed the charts of 329 patients admitted to our hospital because of overdosage from sedative or hypnotic agents. Of this population 11.2% were believed to have aspirated. Included in this group were 13 patients who were observed to aspirate and 24 who were suspected of aspiration because of…
Article
Follow-up of Adolescents Treated in a Psychiatric Hospital Measurement of Outcome
Treatment planning that is highly individualized and systematically improved must be based on careful assessments of the effectiveness of current technics. This report describes the long-term (three to eight years) outcome of psychiatric hospitalization for 120 severely disturbed adolescent patients as it is measured on three dimensions: peer and social…
Article
Nonsurgical Diagnosis of Pancreatic Mass
Because of recent advances made in various diagnostic procedures, it has become easier to diagnose cancer of the head of the pancreas. Chronic pancreatitis, however, may show morphologic mass findings similar to pancreatic cancer. Twenty-three patients with a pancreatic head “mass,” identified through surgical exploration, have been reviewed retrospectively with…
Review Article
New Pituitary Peptide Relationships
A glycoprotein molecule discovered in pituitary glands of experimental animals is thought to be the precursor molecule for the pituitary peptides ACTH and beta-Iipotropin, molecules themselves known to contain the amino acid sequences of several smaller peptides subsequently isolated. Evidence now exists to suggest the enzymatic cleavage of ACTH to…
Review Article
Diagnosis and Treatment of Shock
Current Concepts
Cytologic Screening for Gynecologic Cancer
In the past 30 years there has been no improvement in the five-year survival rate for endometrial carcinoma. Any change comparable to improved survival in cervical carcinoma will be accomplished only by similar detection of the early asymptomatic and precursor lesions of endometrial carcinoma. Reasons why the conventional Pap smear…
