SMJ // October 1983, Volume 76 - Issue 10
Errata
Man and Mayhem
Announcement
CALL FOR NOMINATIONS……
Primary Article
Toxoplasma Encephalitis in Recent Haitian Entrants
ABSTRACTWe evaluated clinical features of five cases of Toxoplasma encephalitis (TE) occurring in recent Haitian entrants into the United States. None of the patients had any underlying malignancy or known immunosuppressive therapy. Histopathologic findings of TE at autopsy were confirmed by peroxidase-antiperoxidase method. Four patients had an antecedent episode of…
Primary Article
Gastric Bypass Roux-en-Y Gastrojejunostomy From the Lesser Curvature
ABSTRACTWe describe a new technique for the surgical treatment of exogenous morbid obesity. The stomach is partitioned from the angle of His toward the lesser curvature, and a Roux-en-Y proximal jejunal limb drains the proximal gastric pouch, which is 25 to 35 ml in capacity. By use of the enteroanastomosis…
Primary Article
Reassessment of Graham-Steele Closure in Acute Perforated Peptic Ulcer
ABSTRACTWe studied 67 patients who had operation for perforated peptic ulcer. Operative treatment included plication with omentum (Graham closure) in 27 patients, vagotomy and pyloroplasty in 32 patients, or vagotomy and antrectomy in eight patients, depending on antecedent ulcer history, degree of contamination, and general patient condition. Mortality was high…
Primary Article
Clinical Value of Exercise Testing in Handicapped Subjects
ABSTRACTThis report describes the use of exercise testing in handicapped subjects to determine work capacity and the safety of exercise. Arm crank, bicycle, and wheelchair exercise studies are described by means of a few selected cases.
Primary Article
Management of Hirschsprungs Disease in the Adolescent
ABSTRACTOccasionally Hirschsprungs disease is misdiagnosed until the patient reaches adolescence. The disease of these young people may present technical problems not encountered in the neonate. I describe three such patients, ages 10, 13, and 19 years, who were managed successfully by slightly different surgical methods.
Primary Article
Segmental Spinal Instrumentation in the Management of Fractures of the Thoracic and Lumbar Spine
ABSTRACTEleven cases of fracture of the thoracic and lumbar spine were treated with segmental spinal instrumentation (Luque rods). The majority of these injuries occurred in motor vehicular accidents or falls from a height and were usually associated with multisystem trauma. This method of instrumentation provided immediate rigid internal fixation, which…
Primary Article
Ambulatory Function in Total Knee Arthroplasty
ABSTRACTThrough the use of gait analysis, this study attempts to characterize gait after total knee arthroplasty as a function of postoperative time to quantify the effectiveness of the surgery and to evaluate prostheses of several different designs. Gait analysis on 32 preoperative and 50 postoperative patients included measurement of velocity,…
Primary Article
Amputations After Vascular Trauma in Civilians
ABSTRACTIn a ten-year retrospective study of 233 patients who sustained a vascular injury to an extremity, eight (3.4%) extremities were amputated. Factors that affect the incidence of amputation after peripheral vascular trauma include early operation, fasciotomy, preoperative antibiotics, appropriate vascular reconstruction with adequate tissue coverage, use of arteriography during and…
Primary Article
Gradual Versus Abrupt Weaning From Respiratory Support in Acute Respiratory Failure and Advanced Chronic Obstructive Lung Disease
ABSTRACTTwo methods of weaning from mechanical ventilation were compared in 18 instances of acute respiratory failure requiring mechanical ventilation for more than 30 days in patients with advanced chronic obstructive lung disease. All patients were ventilated using intermittent mandatory ventilation. Abrupt weaning (AW) consisted of abruptly discontinuing mechanical ventilation when…
Primary Article
Spontaneous Biliary Enteric Fistulas
ABSTRACTBiliary enteric fistulas usually occur as a complication of chronic cholelithiasis, may be difficult to document preoperatively, and often pose problems in surgical management. We reviewed 13 cases of spontaneous biliary enteric fistulas to identify methods of diagnosis, management, and complications. There was no specific set of clinical symptoms or…
Primary Article
Diagnostic Evaluations in Pediatric Cases of Congenital Bilateral Sensorineural Deafness
ABSTRACTThe earliest possible diagnostic evaluation of hearing impairment among infants and children is of the utmost importance for their future well-being. The essential features of the family history and the pediatric physical examination are reviewed, discussed, and illustrated in studies and actual case histories of congenital bilateral sensorineural hearing loss.
Primary Article
Amniotic Fluid Phosphatidylglycerol A Predictor of Fetal Lung Maturity Using Conventional One-Dimensional Thin-Layer Chromatography
ABSTRACTWe present a retrospective comparative analysis of 209 amniotic fluid samples and the neonatal outcome. The presence of phosphatidylglycerol in 159 transabdominal amniotic fluid samples and the associated lung status indicated a 98% prediction rate for absence of respiratory distress syndrome with 1.8% false-positive results corrected to 0%. Twenty-nine vaginal…
Primary Article
Cesarean Hysterectomy at Louisiana State University, 1975 Through 1981
ABSTRACTOne hundred four cesarean hysterectomies were done on the obstetric service of Louisiana State University School of Medicine over a six-year period, for an incidence of 1/110 cesarean sections or 1/824 deliveries. We categorize the indications for both nonemergency and emergency cases and present the chief components of perioperative morbidity,…
Primary Article
Recognition of Cognitive Impairment in Primary Care Outpatients
ABSTRACTWe evaluated 100 primary care outpatients for signs of cognitive impairment using the Mini-Mental State Examination (MMSE). The 23 subjects scoring abnormal values (less than 24/30) were found to be cognitively impaired. Seventeen had previously undetected cognitive impairment, while six had prior diagnoses consistent with cognitive impairment. Independent psychiatric evaluation…
Primary Article
Late-Onset Variant of Huntingtons Chorea
ABSTRACTWe identified a large Georgia kinship in which a hereditary autosomal dominant chorea appeared at an average age of 65 years, much later than usual for Huntingtons chorea. Progression was slow. Dementia was not an obvious initial feature. Family members denied that affected persons became demented, and those affected cognitively…
Primary Article
Droperidol in the Treatment of Vertigo
ABSTRACTTwenty-one patients with vertigo related to inner ear disease were treated with droperidol as their sole form of therapy. I report the results and discuss droperidol therapy in detail with regard to its pharmacology, dosage techniques, and the necessary precautions.
Primary Article
Professional Stress and the Practicing Family Physician
ABSTRACTTo investigate the physician stress syndrome among practicing family physicians, we mailed a questionnaire regarding stress, depression, locus of control, social and peer support, and medical practice characteristics to a sample of practicing family physicians. The response rate was 64%. Significant positive correlations were found between perceived stress in medical…
Review Article
Renal Venous Thrombosis in Children Changes in Management
ABSTRACTRenal venous thrombosis, a clotting process that originates in the venous radicles and progresses into the main renal vein and vena cava, predominantly affects newborn infants. It may be manifest in one or both kidneys and follow maternal diabetes, diarrhea and dehydration, congenital heart disease, acute blood loss, sepsis, asphyxia,…
Current Concepts
Approach to Patients With Ventricular Ectopy
ABSTRACTVentricular ectopy (VE) in the absence of organic heart disease is most often a benign condition that requires no treatment. Diagnostic evaluation should be aimed at assessing the frequency and complexity of VE, correlating symptoms to ventricular arrhythmias, and uncovering underlying heart disease when it is present. Ambulatory Hotter monitoring…
Case Report
Captopril-Induced Membranous Glomerulopathy
Case Report
Streptococcus MG-intermedius (S milleri) Hepatic Abscesses in Two Patients With Regional Enteritis
SUMMARYTwo patients with relatively quiescent regional enteritis had liver abscesses caused by S MG-intermedius. The occurrence of two such cases in a single hospital in the space of a few weeks, while possibly coincidental, suggests that infections with this organism, particularly hepatic abscesses, may be more common in patients with…
Case Report
Giant Avascular Hepatocellular Carcinoma Mimicking Metastatic Tumor
SUMMARYWe have described the radiographic features of a case of solitary giant hepatocellular carcinoma in a noncirrhotic liver. It was angiographically avascular and resembled a massive metastatic tumor. Most hepatocellular carcinomas appear highly vascular on angiography. Hypovascularity may sometimes be encountered in the presence of cirrhosis.
Case Report
Esophageal Candidiasis Treatment With Ketoconazole
SUMMARYThree patients with esophageal candidiasis were treated with a new orally administered antifungal agent, ketoconazole. Favorable results were obtained in two patients; in the remaining patient other foci of candidal infection developed while the patient was receiving ketoconazole.
Case Report
Echocardiographic Findings in a Patient With Tamponade Due to Anterior Mediastinal Hematoma
SUMMARYA patient with blunt trauma to the sternum had clinical evidence of cardiac tamponade and echocardiographic findings highly suggestive of pericardial effusion. Bloody fluid was obtained by precordial pericardiocentesis. With the clinical diagnosis of pericardial tamponade, operation showed a large anterior mediastinal hematoma. In patients with anterior mediastinal hematoma, echocardiography…
Case Report
Bilateral Diaphragmatic Paralysis
SUMMARYVentilatory failure developed insidiously in a patient due to bilateral diaphragmatic paralysis from bilateral phrenic neuropathy. The ventilatory failure progressed to respiratory arrest. We assessed the patients diaphragmatic function by fluoroscopy, transdiaphragmatic pressure measurements during maximal inspiration, measurement of abdominal paradoxic motion, and electrical conduction measurements of the phrenic nerves….
Case Report
Exogastric Leiomyosarcoma With Ultrastructural Analysis
SUMMARYA 50-year-old man was found to have a large exogastric leiomyosarcoma during exploratory laparotomy for a bleeding duodenal ulcer. Although the tumor appeared grossly malignant and was associated with small bowel metastases, its light microscopic appearance was relatively benign. Electron microscopy helped to establish the diagnosis of gastric leiomyosarcoma.
Breif Report
Chronic Calcific Pancreatitis With Pancreatic Duct Lithiasis Due to Stenosing Papillitis
SUMMARYWe have described a case of chronic pancreatitis due to stenosing papillitis relieved by sphincteroplasty and removal of pancreatic duct stones, as opposed to a major pancreatic resection.
Breif Report
Normal Menstruation and Pregnancy in a Patient With Nelsons Syndrome
SUMMARYThe patient with Nelsons syndrome in this report represents an unusual case in which regular cyclic menstruation was preserved even though a large ACTH-producing pituitary adenoma was present. Despite normal menses and pregnancy, the radiologic findings of an enlarged sella turcica and an enhanced lesion on CAT scan were identified….
Breif Report
Streptococcus milleri Empyema
SUMMARYA 58-year-old woman who had recurrent aspiration due to atlantoaxial subluxation, a complication of rheumatoid arthritis, had S milleri empyema. This organism has been associated with purulent disease in previous series, and may be a relatively common but unrecognized cause of empyema.
Breif Report
Tracheal Stenosis in Sarcoidosis
SUMMARYA 58-year-old woman with sarcoidosis had dyspnea found to be caused by a rare manifestation of that disease—tracheal stenosis. Tracheal dilatation has been beneficial.
Breif Report
Solitary Metastasis to the Medulla Oblongata
SUMMARYOf 40 reported cases of solitary brain stem metastasis, only two patients had medullary lesions. We have presented a third case, suggesting that this infrequent occurrence may be due to the mid-brain and pons having a more abundant blood supply, with increased potential for metastatic deposits, and being larger targets…
Breif Report
Gonococcal Endocarditis With Initially Negative Blood Cultures
SUMMARYThis case of gonococcal endocarditis in a young man highlights the recognized capacity of Neisseria gonorrhoeae to destroy an infected valve, and illustrates that emergency valve replacement in the presence of congestive heart failure may be life-saving. The utility of the echocardiogram and the reportedly low yield of positive blood…
Breif Report
Pericardial Tamponade and Excessive Secretion of Antidiuretic Hormone
SUMMARYWe have described a case of presumed excessive antidiuretic hormone (ADH) secretion due to pericardial effusion and tamponade. Pericardiotomy and drainage produced dramatic resolution of the antidiuresis. In the setting of pericardial tamponade, increased antidiuretic hormone secretion may be “appropriate” in response to overriding stimuli from the left atrial stretch…
Breif Report
Rhabdomyolysis-Induced Acute Renal Failure in Legionnaires Disease
SUMMARYA 57-year-old man with legionnaires disease had acute renal failure as a result of nontraumatic rhabdomyolysis. This report documents an association between legionnaires disease and rhabdomyolysis, an association only rarely suggested previously. The mechanism of rhabdomyolysis is unknown. Rhabdomyolysis should be considered in patients with legionnaires disease who have acute…