SMJ // July 1980, Volume 73 - Issue 7
Editorial
OVER THE RAINBOW
Commentary
PRIMARY CARE AS A MEDICAL CAREER
Primary Article
Estimating Survival for Patients With Late-Stage Cancer
The accuracy of physicians in estimating survival is known to be poor. This paper describes a statistical method for determining length of survival which was developed as a potential adjunct to clinical prognosis for patients with late-stage cancer. Age at diagnosis, staging, histology, and treatment were collected from the tumor…
Primary Article
Fatal Pulmonary Embolism in Cancer Patients Is Heparin Prophylaxis Justified
The incidence of fatal and nonfatal pulmonary embolism (PE) was evaluated in a series of 578 patients, to quantify the suspected higher risk in cancer patients of death from massive PE when compared with patients not having cancer. PE occurred in 13% and was fatal in 8% of noncancer patients….
Primary Article
Diagnostic Imaging in Pediatric Emergencies
Evaluation of pediatric emergencies by diagnostic imaging technics can involve both invasive and noninvasive procedures. Nuclear medicine, conventional radiography, ultrasound, computerized axial tomography, and xeroradiography are the major nonangiographic diagnostic technics available for patient evaluation. Appropriate decisions regarding choice of these imaging technics can be made only if the advantages…
Primary Article
Adrenoleukodystrophy Characteristic Appearance on CT and Brain Scan
I recently observed two patients with adrenoleukodystrophy who had similar, distinctive CT scans of the head. The first patient also had a characteristic nuclear brain scan; the second patient was initially thought to have subacute sclerosing panencephalitis until the CT scan was obtained. Classification of leukodystrophies has been controversial and…
Primary Article
Bone Scanning in Detecting Soft Tissue Abnormalities
ABSTRACTWith bone scanning, as in other imaging modalities, important clues may be overlooked if attention is too much focused on the major features displayed. In discussing bone scanning we have avoided the more obvious focal bone abnormalities and addressed our observations to peripheral changes, predominantly of soft tissues.
Primary Article
Meiges Syndrome
We present two women with Meiges syndrome, a condition in which the clinical presentation differs from tardive dyskinesia by the lack of exposure to neuroleptic drugs, greater severity of blepharospasms, and more prolonged dystonic contractions of oromandibular muscles. In this condition we used triaxial accelerometry to detect dystonia, which may…
Primary Article
Psychotic Depression The Common Therapeutic Principle
ABSTRACTCholinergic prevalence together with a monaminergic deficit characterize the neurotransmitter imbalance underlying psychotic depression. Correction of this neurotransmitter imbalance is the principal purpose and goal of all treatment methods for the relief of psychotic depression. This can be accomplished by reducing the acetylcholine predominance or increasing the level of monaminergic…
Primary Article
Hemodialysis and Schizophrenia A Double-blind Study
Partial or total remission of schizophrenic symptoms after exchange transfusion or hemodialysis have been reported in the literature. Although the results of these reports are encouraging, they have not been confirmed by controlled studies. We have conducted a double-blind placebo-controlled study to evaluate the effect of hemodialysis on chronic schizophrenia….
Primary Article
Phlegmonous Gastritis Clinical Presentation and Surgical Management
Phlegmonous gastritis is an acute inflammatory process of the stomach clinically characterized by acute localized noncolicky epigastric pain, purulent vomiting, fever, and leukocytosis. The disease often occurs in patients with preexisting gastric abnormalities or in the elderly and is easily confused radiologically with infiltrating gastric carcinoma. The mortality exceeds that…
Primary Article
Sepsis After Gastroduodenal Operations Relationship to Gastric Acid, Motility, and Endogenous Microflora
We reviewed 254 consecutive gastroduodenal operations done at Charity Hospital of Louisiana in New Orleans between June 1974 and June 1977. Forty-one septic complications occurred in 30 patients, for an overall infection rate of 11.8%. Statistically higher infection rates followed operations for bleeding gastric or duodenal ulcer, obstructed duodenal ulcer,…
Primary Article
Hepatic Abscesses in Diverticulitis
Liver abscess is an uncommon but potentially lethal complication of diverticulitis. Either may be present in an occult form. We present two cases to illustrate the diagnostic and therapeutic problems created by these occult presentations. A high index of suspicion and an aggressive diagnostic approach are necessary to ensure early…
Primary Article
Torsional Fractures and the Third Dimension of Fracture Management
Torsional strength is the weakest structural property of bone. Fractures produced by common indirect mechanisms are likely to have significant rotational components that bear on their management. The characteristics of torsional fracture lines in bone specimens are completely predictable and reproducible. The physician who is aware of these biomechanical consistencies…
Acknowledgment
BOOK RECEIVED
Primary Article
Outpatient Meniscectomy of the Knee
This paper reviews 218 patients who had outpatient meniscectomy at the University of Virginia between January 1974 and June 1977. Only one patient (0.46%) returned before his scheduled visit. Three patients (1.4%) had superficial wound infections. One (0.46%) had a pulmonary embolus several weeks postoperatively. Twelve percent underwent knee aspiration…
Primary Article
High-Pressure Injection Injuries to the Hand
Despite their appearance for over 20 years, high-pressure injection injuries to the hand are often grossly undertreated or mistreated, resulting in usually avoidable permanent impairment—often with amputation. Primary care physicians, and especially emergency room physicians, must be aware of the serious nature of this usually innocuous-appearing injury and immediately refer…
Primary Article
Smear Platelet Counts
The average number of platelets per oil immersion field, in a count of ten oil fields, multiplied by 20,000 has proved to be a reliable estimation of platelets in normal and thrombocytopenic states. In the presence of thrombocytosis, ie, 25 or more platelets per oil immersion field, the smear count…
Primary Article
Outbreak of Meningococcal Disease in a Family
An outbreak of three cases of meningococcal disease occurring in a family of 14 is presented. Three of the children, between the ages of 10 months to 10 years, were hospitalized. Two of them showed positive signs of meningitis, and one had evidence of bacteremia. Neisseria meningitidis was isolated from…
Primary Article
Bacteremia in Childhood
Review of the bacteriology records of a University Hospital pediatric service for a 30-month period revealed 42 patients with Hemophilus influenzae type b bacteremia and 30 patients with Streptococcus pneumoniae bacteremia, all under age 10. Eighty-eight percent of the Hemophilus bacteremias and 72% of the pneumococcal bacteremias occurred in children…
Primary Article
Hepatic Coma After Open Heart Surgery
Fulminant hepatic failure has been reported in pateints with chronic congestive heart failure. Two patients in whom jaundice and coma followed cardiac surgery were studied to find the possible etiology. Clinical, biochemical, and histologic evaluations revealed low cardiac output; elevated levels of bilirubin, lactic dehydrogenase, serum glutamic oxaloacetic transaminase, and…
Primary Article
Cardiac Transplantation—1980 The Medical College of Virginia Program
Within the last three years, advances in the fields of cardiac surgery and immunology have established the value of cardiac transplantation for patients with irreversible myopathic disease. Long-distance donor procurement has increased the availability of the donor pool and made possible a more critical selection of donor hearts. The development…
Primary Article
Lecithin-Sphingomyelin Ratio and RDS in Patients With Diabetes Mellitus Possible Mechanisms
Controversy exists concerning the positive correlation of maternal diabetes mellitus and the propensity for the progeny to develop respiratory distress syndrome (RDS). The increased incidence of RDS in these offspring seems to occur despite the various physical and biochemical assessments which indicate a mature lung profile. Recent data seem to…
Review Article
Urticaria and Angioedema A Practical Approach
The perplexing problem of urticaria and angioedema is frequently frustrating for both the physician and patient. A systematic approach to the differential diagnosis of these disorders will be discussed.
Current Concepts
Diagnosis and Treatment of Common Adolescent Depressive States
Article
Selection of Primary Care as a Medical Career Demographic and Psychosocial Correlates
A study analyzing demographic and psychosocial correlates associated with the selection of primary care as a medical career was conducted on 357 physicians who were graduated from medical school between 1963 and 1966. Results suggest that individuals who were reared in smaller communities, who were among the younger siblings of…
Article
Specializing in Being Human
Advancements in science and technology have provided us with the ability to deliver the most sophisticated health care in the world. Yet health professionals have come to rely on technology to such a degree that it is intruding on the doctor-patient relationship. An effective, comprehensive system for delivering health care…
