SMJ // April 1982, Volume 75 - Issue 4
Editorial
THE DISEASE WHOSE NAME WE WILL NOT SPEAK
Primary Article
Echocardiography in Patients With Suspected Cor Pulmonale
Echocardiography was used to evaluate left ventricular function in 43 consecutive patients with suspected cor pulmonale who clinically had no other heart disease or hypertension. Adequate echocardiographic evidence was obtained by either standard left parastemal position or subxiphoid position in 40 patients (93%). Echocardiographic evidence of either dilatation of the…
Primary Article
Handgrip Exercise in Normal Young Women A Noninvasive Cardiovascular Assessment
Blood pressure, heart rate, and echocardiographic parameters of left ventricular size and shortening were measured both under baseline conditions and during handgrip exercise (50% maximum handgrip effort held to fatigue) in 20 normal women (20 through 29 years of age). As a group, there was a significant increase in heart…
Primary Article
Use of Sclera in Tympanic Membrane Reconstruction
Because of its high density, high tensile strength, and low antigenicity, sclera appears to be an appropriate grafting material for tympanic membrane reconstruction. I have used preserved donor sclera in 100 such cases over a three-year period with an overall success rate for complete closure of the perforation of 96%….
Primary Article
Early Diagnosis and Airway Management of Acute Epiglottitis in Children
The technics for early diagnosis and airway management of acute epiglottitis in children continue to provoke disagreement. In 104 cases of children with acute epiglottitis, early diagnosis was confirmed by cervical roentgenograms, direct pharyngoscopy, or both. Airway maintenance was provided by nasotracheal intubation of conscious patients in most cases. No…
Primary Article
Tularemia Review of Eight Cases of Tick-borne Infection and the Epidemiology of the Disease in Georgia
In the period 1960 to 1979, 177 cases of tularemia occurred in residents of Georgia. A tick bite was the implicated source of exposure in eight cases (4.5%), whereas 91 cases (51.4%) were associated with direct contact with infected rabbits. In Georgia and other southeastern states, the epidemiology of human…
Primary Article
Comparison of Oral Penicillinase-Resistant Penicillins Contrasts Between Agents and Assays
We observed the comparative serum levels and mean peak serum antistaphylococcal activity in eight fasting adults who received 500 mg each of dicloxacillin, cloxacillin, oxacillin, and nafcillin. Dicloxacillin achieved higher and more prolonged serum levels and greater peak serum antistaphylococcal titers than the other drugs studied. The higher degree of…
Primary Article
Timed Repetitive Ankle Jerk Responses in Early Diabetic Neuropathy
A 14-year experience with timed repetitive ankle jerk (TRAJ) testing provides fundamental insights into diabetic neuropathy (DN), both its diagnosis and treatment. Advantages of TRAJ include ease of peformance, relative economy of the equipment, reproducibility of results, and a parameter that encompasses the entire reflex arc. Euthyroid patients with features…
Primary Article
Alkali Burns of the Eye Pathophysiology and Treatment
Primary Article
Desensitization Versus Intraturbinal Injection of Corticosteroid for Nasal Allergy indications, Effectiveness, and Patient Acceptance
Severe allergic nasal symptoms often require corticosteroids for control. Although I most often utilize intraturbinal injection, they may also be administered systemically (oral or intramuscular) or as nasal aerosols. I advise allergy testing and desensitization for refractory cases unresponsive to conservative management, or instances of recurrent severe symptoms requiring repeated…
Primary Article
Hyponatremia in Patients With Schizophrenia
Although there is a definite association between hyponatremia and schizophrenia, the true incidence and etiology have’ not been established. This report is a retrospective study of all admissions to the Baroness Erlanger Hospital over a three and one-half year period. There was a 5.8% incidence of hyponatremia in patients with…
Primary Article
Cost Effectiveness in an Internal Medicine Residency Program One Physicians Approach
The impact of a cost-effectiveness program on an internal medicine service in a teaching hospital has been assessed. Notable reductions were made by the study service as compared to the control services. Period of hospitalization, number and cost of laboratory tests, charges for medication, number and cost of radiologic examinations,…
Primary Article
Screening Test for Airflow Limitation
Forced expiratory time (FET), the time in seconds required to exhale the vital capacity forcefully, was examined as a self-test for airflow limitation. Following only written instructions, 180 subjects measured their own FET. Neither laboratory equipment nor personnel were used. Results were compared with usual spirometric measurements of airflow limitation….
Primary Article
Roentgenographic Pelvimetry in Single Vertex Pregnancies
Of the 4,529 women delivered of infants at The Johns Hopkins Hospital during 1976 and 1977, 212 (5%) had roentgenographic pelvimetry. An analysis of a subgroup of 142 single vertex pregnancies with radiographic pelvimetry during this two-year period is presented. The cesarean section rate was 40% among patients selected for…
Primary Article
Microsurgical Reanastomosis of the Fallopian Tube I Increasingly Successful Outcome for Reversal of Previous Sterilization Procedures
Reanastomosis of the fallopian tube represents a potential means of restoring fertility to women who have previously had sterilization procedures. During a 40-month period from January 1977 to June 1980, 46 such women had end-to-end reanastomosis at Vanderbilt University Hospital, 59% after a change in their martial status. The surgical…
Primary Article
Vulvovaginitis in Prepubertal Girls The Importance of Group A Streptococcus
We report four cases of group A streptococcal vulvovaginitis in prepubertal children. All cases were acute in onset. This illness presents with nonspecific signs and symptoms of labial inflammation. In a suburban community, streptococcal vulvovaginitis in prepubescent girls may be more common then genital infections due to Neisseria gonorrhoeae. Since…
Primary Article
Bacterial Meningitis Without Clinical Signs of Meningeal Irritation
A clinical diagnosis of meningitis in neonates is difficult because of the paucity of physical findings. In older infants and children, nuchal rigidity, Kernigs or Brudzinskis sign, or bulging fontanelles are sought. A review of 1,064 cases of bacterial meningitis beyond the neonatal period revealed that 16 (1.5%) patients had…
Primary Article
Effect of Scattered Radiation on the Ovaries of Young Women in the Early Stages of Hodgkins Disease
Three thousand women, many of them of childbearing age, had Hodgkins disease in 1980. Patients with early disease have an excellent chance for cure. Scattered radiation to the ovaries of four patients in the childbearing age was measured, and the results and effects on future generations are discussed.
Review Article
Psychosurgery
Psychosurgery emerged in the late 1930s as a powerful therapeutic tool with great promise for psychiatry. Because of initial favorable case reports and studies, some influential support, and the need to aid thousands of returning World War II veterans with mental disabilities, the prefrontal lobotomy was widely implemented. It soon…
Current Concepts
Chronic Lymphocytic Leukemia
The management of chronic lymphocytic leukemia has undergone major changes in the last decade. By using a staging system, the physician can distinguish those patients who would benefit from chemotherapy from those who need symptomatic therapy only.
Article
Continuing Medical Education Reflections on a Somewhat Different Approach
Following are reflections and comments by a family practitioner, 27 years postinternship, on a five-month miniresidence in internal medicine, conceived and carried out through the Department of Medicine, Baylor College of Medicine, in the Harris County Hospital District of Houston, Texas. I believe this type of program is valuable continuing…
Grand Rounds
Saturday Conference Stuporous Alcoholics
Alcoholics are predisposed to certain metabolic disorders that cause stupor and coma. These entities include acute ethanol intoxication, ethanol-induced hypoglycemia, alcoholic ketoacidosis, ethylene glycol and methanol intoxications, thiamine deficiency, and hepatic encephalopathy. The recognition and management of these entities and the evaluation of stuporous alcoholics are discussed.
