SMJ // September 1982, Volume 75 - Issue 9
Editorial
RETURN OF RICKETS
Primary Article
Anorexia Nervosa A Disorder With Severe Acid-Base Derangements
Fluid and electrolyte derangements occur frequently in patients with vomiting and anorexia nervosa and contribute to protracted morbidity and a mortality reported to be as high as 22%, probably from hypokalemia. Hypochloremic, hypokalemic metabolic alkalosis is characteristic, in conjunction with significant intravascular volume depletion and hypotension. Exceedingly low urinary chloride…
Primary Article
Performance of a Level II Nursery in a Neonatal Regional Program Part I. Patient Population and Role of the General Pediatrician
We examined the performance of a level II nursery in a regional neonatal program during a 30-month period. Of 3,851 live-born infants, 527 (13.7%) were admitted to the special care nursery and 70 (1.8%) were transferred to a level III nursery. There were 23 neonatal deaths, ten of them in…
Primary Article
Part II. Analysis of Transferred Patients and Criteria for Maternal Transfer
Our review of deliveries at a level II hospital for a 30-month period showed 3,851 live births and 23 deaths (NMR 6/1,000 LB); 527 neonates (13.7%) required admission to the Special Care Unit, and 70 (1.8%) required transfer to a level III nursery. The 70 transferred patients received 1,592 days…
Primary Article
Aerotolerance of Common Anaerobic Bacteria—Fact or Fancy?
Quantitative studies of cultures from mixed aerobic-anaerobic intra-abdominal infections in both human patients and experimental animals showed no significant reduction in the concentrations of anaerobic bacteria after exposure to room air for up to 24 hours. Clinically significant anaerobic bacteria appear to be relatively aerotolerant when present in a mixed…
Primary Article
Chemoprophylaxis in Cardiac and Orthopedic Surgery Comparison of Cephalothin and Cephapirin
In a retrospective sequential study we determined the rate of infection occurring despite cephalothin or cephapirin chemoprophylaxis in orthopedic and cardiac surgery done from 1973 to 1977. The incidence of infection after prosthetic hip placement or open reduction of hip fracture was 3.4% and 1.0% in patients receiving cephalothin or…
Primary Article
Rocky Mountain Spotted Fever in Pregnancy Differential Diagnosis and Treatment
Rocky Mountain spotted fever (RMSF) presents both diagnostic and therapeutic difficulties in the pregnant patient. Early clinical manifestations may be mistaken for normal pregnancy changes. Accurate diagnosis is essential, since several of the disorders in the differential diagnosis may have important obstetric implications. Antibiotics generally used to treat serious infections…
Primary Article
Cirrhosis, Variceal Bleeding, and Distal Splenorenal Shunt in Hemophilia A
Chronic liver disease has become a significant complication of the therapy of hemophilia disorders. We describe two patients with hemophilia A and hepatitis B virus hepatitis who progressed to cirrhosis with bleeding esophageal varices. Each underwent distal splenorenal shunt under plasma concentrate therapy without difficulty. One patient died 19 months…
Primary Article
Management of Cecal Volvulus in Debilitated Patients
We retrospectively evaluated ten cases of cecal volvulus. The average age of these patients was 57 years. Five patients were more than 60 years old and three were over 70. All patients had significant delays in coming to the hospital, and all had concomitant medical problems that made them poor…
Primary Article
Refined Carbohydrate as a Contributing Factor in Reactive Hypoglycemia
To assess the effects of diet on symptoms in patients with idiopathic reactive hypoglycemia, we obtained by dietary recall histories the dietary composition from eight of these patients. The data obtained represented the dietary content of each individual before and after instruction on a diet containing 100 gm of carbohydrate…
Primary Article
Delayed Cutaneous Hypersensitivity Testing
The topic of delayed cutaneous hypersensitivity testing is reviewed. When skin tests are used to determine whether an individual is anergic, T cell immunity is evaluated. Skin testing can be used to determine the causative organisms of infection or to discover an immunologic deficiency state. Characteristic skin lesions usually develop…
Primary Article
Comparison of Physician and Patient Perceptions of Communications Issues
Sixty-three adolescent cancer patients and 53 physicians participated in a study designed to compare physician and patient perceptions of (1) the delivery of information at diagnosis, (2) patient reactions to treatment-related concerns, and (3) physician utilization patterns. Both patients and cancer center physicians appeared comfortable with the designation of the…
Primary Article
Villonodular Synovitis Pigmented and Nonpigmented Variations
During the past 20 years, 34 cases of pigmented villonodular synovitis have been seen at Jackson Memorial Hospital, University of Miami Medical Center. There were 18 cases in the knee, eight in the hip, one in the elbow, two in the finger, three in the ankle, one in the wrist,…
Primary Article
Revascularization of Kidneys With Totally Occluded Renal Arteries
Nephrectomy has been the accepted treatment for renovascular hypertension due to an occluded renal artery but successful revascularization of occluded renal arteries has resulted in partial return of function and relief of hypertension. We performed aorticorenal bypass operations on four patients whose renal arteries were not patent. One graft failed…
Primary Article
Use of Subclavian Catheters for Hemodialysis
In 98 patients, we cannulated the subclavian and internal jugular veins with modified Shaldon catheters, using the Seldinger technic. Catheters were left for long periods, and multiple dialyses were accomplished with each catheter. The incidence of major complications was less than 5%. None of the catheters were believed to be…
Primary Article
Incidence of Malnutrition Among Patients Admitted to a VA Hospital
We studied 1,225 consecutive patients admitted to a large Veterans Administration Medical Center over an eight-week period to assess the degree of malnutrition. The parameters of malnutrition were visceral protein pool, lymphocyte count, delayed cutaneous hypersensitivity, and anthropometric measurements. More than one third of the patients had one or more…
Primary Article
Brachial Artery Reconstruction After Traumatic Disruption
We describe a series of 21 cases of traumatic disruption of the brachial artery that required surgical intervention. Stab wounds were most frequent (11), followed by gunshot wounds (six) and blunt trauma (four). Ten patients had associated upper extremity injuries including bone, nerve, and vein. Arterial repair with lateral sutures…
Review Article
Anorexia Nervosa Review of Current Treatment Practices
The etiology of anorexia nervosa has defied elucidation for over 100 years and no systematic treatment has yet been developed for the illness. We have reviewed some current findings that relate to both neuroendocrinologic and psychologic defects. Review of current treatment practices reveals that a variety of approaches are used,…
Article
Words
Medical Education
Undergraduate Medical Education for Primary Care A Case Study in New Mexico
To address the dual problems of maldistribution of physicians and an increasing need for physicians who are lifelong learners, an experimental curricular track was developed at the University of New Mexico School of Medicine. Increased student responsibility for learning is encouraged by student-centered, small-group, problem-based tutorial learning, and early, primary…
