SMJ // September 1981, Volume 74 - Issue 9
Primary Article
Perineoscrotal Gangrene Two-staged Therapeutic Approach
With approximately 350 reported instances of Fourniers disease (fulminating gangrene of the scrotum) since its description in 1883, individual experience is largely anecdotal and treatment remains controversial. Clarification is specially indicated as to how extensive diagnostic evaluation should be, whether surgical incision and drainage is justified as initial therapeutic therapy,…
Primary Article
Necrotizing Fasciitis
Necrotizing fasciitis is a lethal and insidious disease with a high mortality. It often begins in areas exposed to fecal or urinary contamination, and about 70% of cases occur in diabetics. A high index of suspicion should be maintained in diabetic patients with an infection in the perineum, genitalia, thigh,…
Primary Article
Surgical Treatment of Pancreatic Carcinoma
We reviewed 75 patients operated on for carcinoma of the pancreas during the period 1973 to 1978. The role of surgery was examined in terms of contributing toward diagnosis, palliation, and cure. Computerized tomography, ultrasonography, upper gastrointestinal series, and arteriography were used to determine the presence or absence of a…
Primary Article
Medulloblastoma Treatment Results With Radiation Therapy
The treatment results in 18 patients with medulloblastoma were reviewed retrospectively. All patients were treated postoperatively with simultaneous craniospinal irradiation. Forty-four percent of the total group were alive without evidence of disease. Six of the 12 patients eligible for analysis at three years after completion of treatment had continuous disease-free…
Primary Article
Malignant Secondary Parotid Tumors
Malignant secondary parotid neoplasms are uncommon. Among 545 malignant parotid tumors, we found 52 (9%) that did not arise primarily in the parotid gland. Lymphomas or tumors of hematopoietic origin were excluded from this study. All patients had a parotid mass (two bilateral), one third of which were painful; 20%…
Primary Article
Recurrent Laryngeal Nerve Section in the Treatment of Spastic Dysphonia
Spastic dysphonia is a severe vocal disability in which the patient speaks with hyperadducted vocal folds. The resulting abnormality is characterized by excessively low pitch, vocal tremor, laryngospasms, and strain-strangle voice quality. Until recently the disorder was regarded as psychogenic and treated unsuccessfully with speech therapy and psychotherapy. New evidence…
Primary Article
Call For Nominations
Primary Article
Patellar Malalignment Syndrome
Patellar malalignment is one of the most common causes of knee pain in the young and must be considered in the differential diagnosis of any suspected internal derangement of the knee. At our institution from 1976 to 1980, 130 patients under the age of 25 had patellar malalignment syndrome diagnosed…
Primary Article
Outpatient Self-Management of Severe Diabetes
We initiated a five-point program to decrease acute and chronic complications in 25 unstable, insulin-dependent diabetics (study group A). The five points were home monitoring of blood glucose, use of multiple injections of a complex insulin mixture, strict dietary control with high protein feedings, carbohydrate loading before exercise, and use…
Primary Article
Comparison of the Barium Test Meal and the Gamma Camera Scanning Technic in Measuring Gastric Emptying
In 21 patients with nonresected stomachs and symptoms of delayed gastric emptying, obstruction was excluded by upper gastrointestinal series and upper endoscopy; all had abnormal results of barium test meal (BTM) study. Each had repeat BTM after the administration of 10 mg of metoclopramide. Each patient also had two gamma…
Primary Article
Changing Aspects of Peptic Ulcer Disease
A retrospective study of patients hospitalized for treatment of peptic ulcer disease at the University of Kentucky Medical Center and the Veterans Administration Medical Center, Lexington, Kentucky, for the periods 1967–1968 and 1977–1978 revealed in the later period a 1.3% decrease in the number of ulcer patients relative to total…
Primary Article
Diagnosis of Incipient Reflux Esophagitis A New Test
Sensitivity and reliability of a new esophageal perfusion test was evaluated and compared with those of the standard hydrochloric acid (N/10 HC1) perfusion test. Sixty-four patients including 43 with biopsy-proven reflux esophagitis (group A) and 21 with negative esophageal biopsy and equivocal symptoms (Group B) had esophageal perfusion with N/10…
Primary Article
BOOKS RECEIVED
Primary Article
Diazepam-Cimetidine Drug Interaction A Clinically Significant Effect
Cimetidine has been shown to inhibit the liver microsomal metabolism of the benzodiazepines diazepam and chlordiazepoxide, resulting in an increase in half-life and decrease in the clearance of these two drugs. Patients receiving the combination of diazepam and cimetidine have been noted to be more sedated than when given an…
Primary Article
Coronary Artery Disease and Ventricular Function in Angina
Coronary arteriograms and left ventriculograms of 500 patients with coronary artery disease and angina pectoris were correlated with respect to coronary arterial pattern and left ventricular dyssynergy. We found that the severity of left ventricular dyssynergy was not altered by coronary arterial pattern. The concept of dividing the left ventricle…
Primary Article
The Anticoagulated Patient in Labor An Obstetric Dilemma
Anticoagulant therapy is becoming increasingly common in pregnant women for multiple indications. We discuss the problems associated with this therapy as to the choice between oral and parenteral anticoagulants and the management of the anticoagulated patient during labor and delivery. We present the case of a patient taking warfarin as…
Primary Article
Absence of Stainable Bone Marrow Iron in Hemochromatosis
Stainable bone marrow iron was absent from two patients who were found at autopsy to have hemochromatosis. Bleeding could have accounted for the absence of marrow iron in one patient, but there was no evidence of blood loss in the other. Both had cirrhosis and heavy iron deposits in the…
Primary Article
Recurrent Ventricular Tachycardia in the Absence of Overt Heart Disease Clinical Characteristics and Response to Drug Therapy
Eight patients, seven of them women, have been followed up for a mean of 8.1 years (range, three to 18) with the uncommon syndrome of recurrent frequent episodes of ventricular tachycardia in the absence of overt cardiac abnormality. The mean age at diagnosis was 25 years (range, 12 to 44)….
Primary Article
Branhamella catarrhalis in Respiratory Secretions Clinical Correlation in 16 Cases
During a two-month period 24 of 1,060 (2.3%) samples of respiratory secretions submitted for culture yielded Branhamella catarrhalis in quantities of more than ten colonies per primary plate. Fifteen cultures were “pure” (ie, mixed only with normal throat flora). Of the 16 patients with positive cultures, 14 showed preexisting disease,…
Primary Article
Smoking, Mortality, and Sex in a Community Hospital Necropsy Population
Analysis of 344 necropsies at a community hospital disclosed a male to female ratio of 1.9:1.0 and a smoking incidence over twice that of the general population. Overall longevity for men was less than for women. Intragroup comparisons showed an inverse relationship between smoking and longevity. Smokers in general and…
Primary Article
Detecting Ductal Shunting in Premature Infants by Range-Gated Doppler Echocardiography
Range-gated pulsed Doppler echocardiography has been reported to be a useful noninvasive bedside technic for detecting ductal left-to-right shunting in premature infants. We studied 30 premature infants with a birth weight of less than 1,500 gm, using a 5 MHz system developed by Advanced Technology Laboratories. An umbilical artery catheter…
Primary Article
Problems in a Statistical Study of Disease Based on Death Certificates
Data obtained from death certificates are used to establish the frequency of diseases for vital statistics. In Morgan County, Georgia, 5,787 death certificates registered between 1927 and 1979 were examined for this study. Data referable to age, sex, race, and the cause of death were recorded, with primary emphasis on…
Primary Article
Predicting the Need for Primary Care Specialists The Example of a Southwestern State
Because of a need to project the requirements for the training of primary care practitioners in the state of New Mexico, we reviewed available means of determining health manpower heeds. Combining several of these methods, we constructed a three-tiered model, taking into account different patterns of care-seeking in areas of…
Review Article
Abrupt Discontinuation of Antihypertensive Therapy
The abrupt cessation of antihypertensive medication is usually without immediate consequence but may be associated with symptoms and signs of enhanced sympathetic activity, severe hypertension, morbid ischemic cardiovascular events, or death. This syndrome is more common after discontinuation of high doses of centrally acting antiadrenergic and beta-adrenergic blocking drugs or…
Current Concepts
Microneurosurgical Treatment of Trigeminal Neuralgia and Hemifacial Spasm
A significant number of cases of trigeminal neuralgia and hemifacial spasm may be related to vascular compression and distortion of the associated cranial nerve near its exit from the brain stem. Microvascular decompression has been advocated as the definitive form of treatment when more conservative measures have failed. In the…
