Editorial

INCONVENIENCES—MINOR AND MAJOR

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…

Article

Suicide The Cry of the Depressed Patient

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

Profound Neutropenia Associated With Benzylpenicillin

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

Localized Invasive Pulmonary Aspergillosis Treated by Surgical Excision

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

Meningitis Due to Streptococcus milleri (Streptococcus MG-intermedius)

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…

Letter to the Editor

Oxygen Concentrations in Commercial Aircraft Flights

Errata

Acute Renal Failure as a Result of Physalia physalis Sting

Errata

Corticosteroids in the Management of Allergic Rhinitis

Letter to the Editor

Lasegues Sign

Letter to the Editor

Caution Regarding Peppermint Mints

Announcement

Richard D. Richards, MD

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