SMJ // February 1981, Volume 74 - Issue 2
Editorial
ELEPHANT MEDICINE
Primary Article
Multidisciplinary Approach to Breast Cancer Control
A multidisciplinary approach to breast cancer control was developed through a network of 22 hospitals, and data were collected over two time periods to evaluate the impact of the network. A total of 1,800 cases of female breast cancer treated during the baseline period of 1971 to 1973 were compared…
Primary Article
Mixed Streptococcus pneumoniae and Gram-Negative Bacillary Pneumonia in the Elderly
Of 24 elderly patients with Streptococcus pneumoniae pneumonia confirmed by transtracheal aspiration, six had concomitant infection with gram-negative aerobic bacilli. All six patients were elderly men with underlying cardiopulmonary disease. Three had had recent prior episodes of gram-negative pneumonia and four had previously received antibiotics. The clinical, laboratory, and epidemiologic…
Primary Article
Cefamandole Failure in Ampicillin-Resistant Haemophilus influenzae b Pneumonia
A woman with rheumatoid arthritis and ampicillin-resistant Haemophilus influenzae type b (Hib) pneumonia complicated by bacteremia and empyema is reported. Initial therapy with cefamandole failed to eliminate bacteria from the pleural space and did not substantially affect the clinical course. However, cultures became negative and fever resolved when therapy was…
Primary Article
Systemic Haemophilus influenzae Infections in a Community Hospital Prevalence of Ampicillin Resistance
Ampicillin-resistant strains are presently known to account for 10% to 20% of type b Haemophilus influenzae infections in the United States. To determine whether the incidence in a community hospital parallels that of several university hospitals, we reviewed medical records of the 99 children with type b Haemophilus systemic infections…
Primary Article
Sporadic Military Meningococcal Disease A Diversity of Presentations
Thirty-four cases of meningococcal disease were identified in a retrospective survey of nine US Army posts in the southeastern United States from June 1977 to August 1979. Group B organisms predominated in dependents and civilian communities surrounding two of the posts, while active-duty personnel had a greater variety of organisms,…
Primary Article
Campylobacter fetus SSp jejuni Isolation From Patients With Gastroenteritis
Within a seven-month period, Campylobacter fetus ssp jejuni was isolated in East Tennessee from 18 patients with gastroenteritis; 83% of these patients had bloody diarrhea. Absence of other enteric organisms such as Salmonella, Shigella, and Yersinia implicated C fetus ssp jejuni as the causative agent. A fourfold increase in titer…
Primary Article
Primary Splenic Neutropenia—Revisited
A patient with acquired, isolated, chronic, severe neutropenia, minimal splenomegaly, and myeloid hyperplasia in the bone marrow is described. Splenectomy resulted in a rise into the normal range of the absolute neutropbil count within 18 hours after ligation of the splenic artery. No other underlying disorders were found, and efforts…
Primary Article
Urine Culture After Treatment of Uncomplicated Cystitis in Women
The follow-up urine culture for urinary tract infection (UTT) is widely recommended, but it is done relatively infrequently in everyday practice. We thought an investigation of its effectiveness was warranted. The study population consisted of 141 women with a culture-proven symptomatic lower UTI. Of these, 56.7% (80) had a follow-up…
Primary Article
Clinical Determinants of Tuberculosis Screening
Because of declining prevalence of tuberculosis in the United States, standard laboratory tests detect fewer actively infected patients. Of 6,884 cultures for Mycobacterium tuberculosis (MTB) in three years at our hospital, only 2% were positive. To select other effective screening variables, we retrospectively reviewed patients in whom cultures were ordered….
Primary Article
Abdominal Angina in Patients Receiving Long-term Hemodialysis
The syndrome of abdominal angina is described in three patients receiving long-term hemodialysis. This clinical entity has not yet been described in patients with chronic renal failure. The classic triad of abdominal pain, weight loss, and diarrhea produces fear of eating. Most laboratory and radiologic investigations are inconclusive. Remarkable relief…
Primary Article
Cardiac Arrhythmias in End-Stage Renal Disease
In 16 patients with end-stage renal disease (ESRD), 24-hour electrocardiographic recordings showed an incidence of supraventricular and ventricular arrhythmias similar to that in patients who had had myocardial infarction and in low-risk subjects. Eight patients (50%) with ESRD had supraventricular complexes. This incidence was significantly higher than that after myocardial…
Primary Article
Abdominal Aortic Aneurysmectomy A Community Hospital Experience
Resection of abdominal aortic aneurysms during a five-year period at two community hospitals was reviewed. The low mortality compares very favorably with results from large university hospitals.
Primary Article
Early Treadmill Testing and Coronary Arteriography After Myocardial Infarction
Thirteen male patients underwent early symptom-limited treadmill testing and coronary arteriography after their first myocardial infarction. All were functional class I at the time of evaluation, and none sustained any complications. Of five patients with a negative treadmill test, two had single-vessel disease, one had double-vessel disease, and two had…
Primary Article
Renal Imaging Comparison of Technetium Tc 99m Glucoheptonate With Conventional Arteriography
We compared technetium Tc 99m glucoheptonate renal scan with standard renal arteriography in 22 patients with various renal abnormalities. The diagnostic accuracy and degree of image resolution indicates this study is a useful and safe clinical addition to the diagnostic armamentarium.
Primary Article
Alcoholic Liver Disease in Black Men With G6PD Deficiency
Glucose-6-phosphate dehydrogenase (G6PD) deficiency of the type commonly encountered in Afro-American blacks has been associated with an increased severity of viral hepatitis. Decreased activity of the enzyme has been demonstrated in liver tissue of affected individuals. We studied 21 patients with alcoholic liver disease and G6PD deficiency who were identified…
Primary Article
Munchausens Syndrome and the Technologic Imperative
A patient with Munchausens syndrome is reported. We note that certain technologic advances of the last three decades seem to have increased the possibilities for confusion when applied to a patient with this particular disorder.
Review Article
Primary Hyperparathyroidism and the Gastrointestinal Tract
To determine the frequency of gastrointestinal symptoms in primary hyperparathyroidism, we retrospectively analyzed 100 consecutive patients seen at Emory University Hospital from Jan 1, 1977 through March 1, 1979. At the time of diagnosis, 28 patients complained of nausea, 19 of vomiting, 29 of abdominal pain, and 33 of constipation….
Current Concepts
Inflammatory Carcinoma of the Breast Therapeutic Perspective
The management of inflammatory carcinoma of the breast remains a therapeutic dilemma because of two basic conceptual problems: local control and systemic micrometastatic disease. Appropriate management requires a multidisciplinary approach involving radiation therapy, surgery, and medical oncology.
Current Concepts
Chronic Pain A Multiaxial Approach to Psychosocial Assessment and Intervention
With the advent of new and improved psychiatric treatment of chronic pain, increased interest has been directed toward psychosocial factors that contribute to chronic pain. Attention has been focused on assessing chronic pain and selecting therapy according to desired changes in symptoms or behavior. This report presents a conceptual framework…
Article
Physicians Opinions Toward Legislation Defining Death and Withholding Life Support
We explored attitudes and practices of Alabama physicians regarding two bills considered in the 1978 State Legislature. One bill defined death to permit the withdrawal of life supports; the other permitted the cessation of active treatment when demanded by terminal patients. Members of the Medical Association of the State of…
