SMJ // October 1981, Volume 74 - Issue 10
Announcement
GENERAL ANNOUNCEMENTS
Primary Article
Seat Belt Use and Automobile Safety Counseling by Pediatricians
Safety restraints have proven effective in the prevention of serious automobile injuries and deaths, but safety education has been ineffective in getting consumers to use restraints. We surveyed the personal and counseling practices of a group of pediatricians over a one-year period to determine whether prenatal and postpartum safety education…
Primary Article
Clinical Application of Decision Analysis
The threshold approach to clinical decision making proposed by Pauker and Kassirer is a potentially useful tool in actual patient care situations. By adapting this method to a hand-held programmable calculator, this approach makes decision analysis a functional part of clinical medicine. Two examples illustrate its use.
Primary Article
Surgical and Pathologic Aspects of Asbestosis
We studied 12 patients with occupational exposure to asbestos to evaluate the pulmonary diseases that result from protracted exposure to this fibrogenic and oncogenic fiber. The spectrum of diseases includes diffuse interstitial fibrosis, bronchogenic carcinoma, and malignant mesothelioma. Cigarette smoking is found to be a cocarcinogen with asbestos. Because of…
Primary Article
Analysis of Patients Referred to the Gastroenterology Service of a VA Medical Center
We recorded clinical information over a 12-month period on consecutive consultations to the gastroenterology service of the Durham VA Medical Center. Of 902 consultations, 789 were prospectively collected. Eighty-five percent of the patients were between 40 and 70 years old. Seventy-five percent of the referrals were from the internal medicine…
Primary Article
Geriatric Asthma Treatment With Beclomethasone Dipropionate Aerosol
I selected a study group of 39 geriatric patients with asthma to evaluate the therapeutic effects of beclomethasone dipropionate aerosol (BDA) over a two-year period. Twenty-seven were steroid-dependent and. 12 were not. BDA was a valuable adjunct to the treatment of asthma in this geriatric population.
Primary Article
Computerized Tomography in the Diagnosis of Adrenal Masses
The adrenal glands are inaccessible to diagnostic evaluation except by indirect or invasive means. Computerized tomography (CT) allows consistent visualization of normal glands and accurate detection and characterization of adrenal disease. CT is the screening procedure of choice for the diagnosis of adrenal masses.
Primary Article
Hyperlipoproteinemia, Hyperinsulinism, and Menieres Disease
Since first reporting the association of hyperlipoproteinemia with inner ear disease in a study of 300 patients in 1973, I have continued to focus attention on the presence of lipid abnormalities in patients with inner ear dysfunction. With over 1,400 patients now identified with both abnormal lipids and inner ear…
Primary Article
Overdiagnosis of Temporal Arteritis
Temporal arteritis is not a common disease, but it is often incorrectly diagnosed in elderly patients with a high ESR and pain in the temporal area. Such an incorrect diagnosis can subject the patient to needless biopsy and the serious side effects of therapy with large doses of prednisone. When…
Primary Article
A Clinical Review of Small Bowel Neoplasms
Small bowel neoplasms represent 3% to 6% of all gastrointestinal tumors and less than 1% of all malignancies. Of 92 cases of small bowel tumor seen between 1950 and 1978, 26% were benign and 74%, malignant. The symptoms and sighs are related to the specific disease. Of the malignant neoplasms,…
Primary Article
Revision of the First Web Space Technics and Results
Between 1975 and 1980, 91 patients in our series with involvement of 103 webs had revision of a contracted first web space. The five main causes of impairment were burns, trauma, congenital defects, cerebral palsy, and cerebrovascular accident. Technics used were simple Z-plasty; four-flap Z-plasty; modified double-opposing Z-plasty; and rotational…
Primary Article
Methylmethacrylate Seeks an Appeal
We measured hemodynamic and respiratory parameters before and after applying methylmethacrylate (MMC) to acetabular and femoral sites during neuroleptanesthesia and prosthetic hip surgery. No significant major changes were documented. Previously reported adverse effects probably have been due to medullary emboli, humoral responses, or a negative action of MMC on the…
Primary Article
Semi-elective Portal Systemic Shunts for Variceal Bleeding
Between June 1977 and November 1980, we performed portal systemic shunt operations on eight patients for esophageal bleeding secondary to portal venous hypertension. One patient had operation as an emergency and the other seven semi-electively during the same hospitalization as admission. The patient operated upon as an emergency was the…
Primary Article
Dementia A Treatable Syndrome?
Patients thought to have dementia deserve a careful evaluation to detect treatable medical conditions or depression, since they may not be demented at all, or these conditions may be superimposed on a dementia. Treatment can include psychotherapy, psychotropic medications focused on specific symptoms, behavioral intervention, and assistance to family members…
Primary Article
Outpatient Evaluation of Mental Health Care
Consumer attitudes about outpatient psychiatric care were studied in 170 patients, using the reliable and valid satisfaction with mental health care (SMHC) scale. Patients were most satisfied with overall care and least with planning of and access to care. Higher satisfaction related to being older, less educated, more impaired, and…
Primary Article
Serologic Tests for Syphilis
Two major representative and currently available serologic tests for syphilis—the rapid plasma reagin test and the microhemagglutination-Treponema pallidum test—are reviewed and compared in terms of their sensitivity and specificity. Considerations in ordering the tests and interpreting the results will enhance proper use of the two tests.
Primary Article
Citywide Neonatal Program
A citywide neonatal program was initiated in Jacksonville, Florida, in July 1978. From 1978 through June 1980, admissions as well as the days of patient care served by both the Regional Perinatal Intensive Care Center (RPICC) and the level 2 nurseries have increased tremendously. More beds for “step-down” care are…
Primary Article
Safe Intraperitoneal Use of 32% Dextran 70 After Surgical Treatment of Infertility
It has been suggested that 32% dextran 70 be used to reduce adhesions after pelvic surgery. Other authors have investigated the use of this drug in animal studies and suggested it as an adjuvant to infertility surgery in humans. No previous report has mentioned the extensive use of this solution…
Primary Article
Screening for Asymptomatic Bacteriuria in Pregnant Patients Three Office Screening Systems Versus Quantitative Culture
We screened 691 asymptomatic prenatal patients by quantitative culture of clean voided urine specimens and one of three office screening devices to detect bacteriuria. The ability of each screening system to detect a single pathogenic organism in concentration equal to or greater than 100,000/ml was analyzed. Microstix-3 reagent strips had…
Primary Article
OPEN INVITATION TO PHYSICIAN-ARTISTS
Primary Article
Forearm Plethysmography in Normotensive and Hypertensive Pregnant Women
Forearm plethysmography affords a simple noninvasive method of studying dynamic changes in the microcirculation. This technic was used to study the peripheral circulation of normotensive nongravid women and normotensive and untreated hypertensive pregnant women during the third trimester. The variables of forearm blood flow, vascular resistance, venous capacitance, and capillary…
Primary Article
Breech Delivery Impact of Increasing Cesarean Section Delivery
We present a retrospective analysis of neonatal outcome and maternal morbidity in the delivery of 192 infants presenting by the breech position, weighing more than 1,000 gm, and exhibiting fetal heart tones upon admission. All of the deliveries occurred between Jan 1, 1975 and Dec 31, 1978. Over the study…
Review Article
Arthroscopic Meniscectomy
The first known operations on the meniscus were done in the late 1800s. Since that time, as the architectural and biomechanical aspects of the knee became known, the tide swung from advocacy of total meniscectomy regardless of the damage involved, to a procedure that removed only the damaged portion of…
Current Concepts
Selecting Patients for Penetrating Keratoplasty
Medical Education
Microcomputer-based Medical Education
This article describes an innovative, cost- and time-effective, microcomputer-based educational system that enables even the non-computer-oriented educator to economically write and implement instructional programs that make effective use of a fast, random access carousel slide projector and a high-quality, random access stereo cassette recorder/player.
