SMJ // August 1983, Volume 76 - Issue 8
Primary Article
Ovarian Masses in the Child and Adolescent
ABSTRACTOver a five-year period, we treated 16 children ranging in age from 8 weeks to 16 years for ovarian masses. The most frequent clinical manifestation was abdominal pain and/or mass. Ultrasonography correctly localized the lesion and delineated its nature in nine of ten cases. Operation in 15 showed teratoma (six…
Primary Article
Hypokalemia in Acute Myelogenous Leukemia
ABSTRACTForty-two patients with acute myelogenous leukemia or one of its variants were studied at diagnosis to determine the incidence and cause(s) of hypokalemia. Forty-three percent of patients were hypokalemic, and an inappropriate renal loss of potassium was noted. This potassium wastage could not be explained by antibiotic-induced renal tubular dysfunction,…
Primary Article
Sickle Cell Trait in Pregnancy
ABSTRACTIn pregnancy, sickle cell trait is associated with an increased incidence of urinary tract infection. Hemoglobin S levels vary from 25% to 44%. Patients with lower hemoglobin S levels are less likely to have urinary tract infections than patients with higher levels of hemoglobin S.
Primary Article
Activity of Rifampin Against Viridans Streptococci
ABSTRACTOptimal antimicrobial therapy for viridans streptococcal endocarditis remains controversial. Rifampin was bactericidal at <0.2 μg/ml for ten strains of viridans streptococci isolated from patients with endocarditis. Administration of rifampin to one endocarditis patient already receiving penicillin and gentamicin increased the serum bactericidal activity fourfold. Rifampin has been effective in combination…
Primary Article
Hematoma Formation After Bone Biopsy A Canine Model
ABSTRACTBarium sulfate was used to study postoperative hematoma formation in 17 canine bone biopsies. If the bone window was left open, x-ray films showed a tune-dependent spread of barium from the bone into the soft tissues. Wound drainage and cast immobilization of the extremity minimized this spread. A methylmethacrylate plug…
Primary Article
Extended Clinical Utility of a Sensitive and Reliable Radioimmunoassay of Thyroid-Stimulating Hormone
ABSTRACTWe have developed a radioimmunoassay for thyroid-stimulating hormone (TSH) that is sufficiently sensitive to permit reliable measurement of subnormal serum TSH levels. We report our evaluation of the utility of this radioimmunoassay in the diagnosis and management of thyroid disease. In 59 normal subjects, the mean serum TSH level was…
Primary Article
Early and Late Complications After Thyroid Operations
ABSTRACTThe cases of 387 patients who had 407 operations for thyroid disease between 1958 and 1982 at a university-affiliated city-county hospital were evaluated to assess the morbidity and mortality associated with thyroid operation. A mortality of 0.7% was found, owing to coexisting systemic disease, advanced patient age, and delayed treatment….
Primary Article
“Shpos”
ABSTRACTThe term “shpos” is popular among residents to describe a demanding and difficult patient. On closer examination, a shpos primarily reflects the clash of various narcissistic needs between the resident and his difficult patient. This paper presents several specific observations about the relationship and a short review of narcissism.
Primary Article
Delusional Symptoms Associated With Enlarged Cerebral Ventricles in Depressed Patients
ABSTRACTComputerized tomograms (CT scans) were completed on 75 melancholic depressed patients. Enlarged lateral cerebral ventricles were noted in eight of 36 delusional depressives (22%) in contrast to one of 39 nondelusional depressives (3%) (P< .005). There were no demographic or clinical differences between patients with enlarged ventricles and those with…
Primary Article
Differentiating Between Post-Vietnam Syndrome and Preexisting Psychiatric Disorders
ABSTRACTThe scientific literature and the news media have suggested that the symptoms of post-Vietnam syndrome are being overlooked by society and mental health workers. The literature relating to psychiatric problems in Vietnam combat troops and veterans was confusing, and reporting of the posttraumatic stress syndrome was slow. However, the Veterans…
Primary Article
Loxapine in the Treatment of Psychotic-Depressive Disorders Measurement of Antidepressant Metabolites
ABSTRACTPsychotic patients who also have endogenous depressive symptoms often require treatment with several drugs (usually a neuroleptic-antidepressant combination) or electroconvulsive therapy. Loxapine is a neuroleptic of the dibenzoxazepine class; it is metabolized in vivo to desmethylloxapine (amoxapine) and 8-hydroxyamoxapine, two compounds with antidepressant activity. We traced the serum levels of…
Primary Article
Identification of Internal Carotid Artery Stenosis in Coronary Artery Bypass Candidates
ABSTRACTIdentification of stenotic internal carotid arteries in neurologically asymptomatic coronary artery bypass candidates is difficult. We correlated carotid arteriograms with carotid bruits in 422 vessels and demonstrated a sensitivity of 79% and a specificity of 65% with regard to the bruits identification of vessels with a 50% or more reduction…
Acknowledgement
BOOKS RECEIVED
Primary Article
Uncommon Visceral Artery Aneurysms
ABSTRACTAneurysms of the hepatic, celiac, and superior mesenteric arteries are uncommon visceral artery aneurysms. They are often difficult to diagnose, and symptoms of expansion or rupture may easily be misinterpreted as suggestive of primary gastrointestinal disease. These aneurysms appear to have a significant propensity toward rupture. Indications for surgery include…
Primary Article
Vertebrosubclavian Angioplasty in the Treatment of Vertebrobasilar Insufficiency
ABSTRACTVertebrobasilar insufficiency is not an uncommon disorder. Five patients with vertebrobasilar syndrome due to stenosis of the vertebral artery at its origin from the subclavian artery were treated surgically by vertebrosubclavian angioplasty, with good results. When vertebral reconstruction is indicated, the results of operation are satisfactory.
Primary Article
Use of an Elemental Diet as a Nutritionally Complete “Medical Colostomy”
ABSTRACTDuring the past 24 months I have used a defined formula diet (High Nitrogen Vivonex) as a nutritionally complete “medical colostomy” (NCMC) in 16 patients. This diet,“ via continual gastric drip, provided an average of 2,238 kcal/day and 92.4 gm of protein per day. Separately or in combination, loperamide HCl,…
Review Article
Hematologic and Immunologic Abnormalities in Anorexia Nervosa
ABSTRACTAnorexia nervosa has been associated with various hematologic and immunologic abnormalities, including characteristic bone marrow changes, red cell acanthocytosis, leukopenia, complement deficiencies, and defective bactericidal activity of granulocytes. Dietary and psychogenic factors may play a role in these abnormalities, which are readily reversible after resolution of the underlying anorectic state….
Review Article
Peripheral Arterial Thrombosis Due to the Nephrotic Syndrome The Clinical Spectrum
ABSTRACTWe reviewed the literature concerning arterial thromboses associated with the nephrotic syndrome and the hypercoagulable state. An illustrative case of peripheral arterial thrombosis and pulmonary emboli attributed to the hypercoagulable state of the nephrotic syndrome is included. In our patient, serum levels of antithrombin III, plasminogen, factor VII activity, factor…
Current Concepts
A Clinical Approach to Non-A, Non-B Hepatitis
ABSTRACTNon-A, non-B agents are currently the major cause of posttransfusion hepatitis and a major cause of chronic active hepatitis in the United States. Recent investigations suggest the clinical entity of non-A, non-B hepatitis results from infection with one of at least two distinct viruses. These viruses produce hepatitis with different…
Medical Education
Some Assets of Vanderbilt Medical School and How to Destroy Them
Case Report
Variegate Porphyria and Heavy Metal Poisoning From Ingestion of “Moonshine”
SUMMARYA patient with cavitary tuberculosis, hepatic cirrhosis, bullous skin lesions over sun-exposed surfaces, disorientation, and a chronic, as well as recent, history of illicit alcohol consumption was found to have acute variegate porphyria by characteristic fecal and urinary porphyrin studies. Elevated levels of lead and arsenic were found in serum…
Case Report
Syphilis and Axial Arthropathy
Case Report
Metastatic Adenocarcinoma From the Lung Occurring as Occult Gastrointestinal Bleeding
SUMMARYWe believe this is the first reported case of metastatic carcinoma of the lung occurring with occult gastrointestinal bleeding. Most small bowel metastatic tumors of various primaries are asymptomatic and are usually diagnosed at emergency operation. Since the prognosis is generally poor, operative resection should be conservative.
Case Report
Acute Renal Failure With Hypocreatininemia in Guillain-Barré Syndrome
SUMMARYA 68-year-old woman with Guillain-Barresyndrome had profoundly depressed serum creatinine concentration and 24-hour urinary creatinine excretion despite maintenance of her weight by hyperalimentation. Because of hypocreatininemia, the development of aminoglycoside-induced acute renal failure was initially missed. A retrospective study of seven patients with Guillain-Barré syndrome who were treated with hyperalimentation…
Case Report
Solitary Subcutaneous Meningioma Appearing as an Osteolytic Skull Defect
SUMMARYIntraosseous meningiomas rarely present with osteolytic skull lesions. This case shows that meningioma must be added to the differential diagnosis of an osteolytic skull lesion.
Case Report
Recurrent Pulmonary Thromboembolism After Initiating Fibrinolytic Therapy A Therapeutic Dilemma
SUMMARYA patient had pulmonary thromboembolism that was treated with streptokinase. Although and adequate thrombolytic state was achieved, pulmonary thromboemboli recurred. This patient then responded to conventional anticoagulation therapy.
Case Report
Mixed Bacterial Infection Of the Pericardium
SUMMARYPolymicrobic bacterial infection of the pericardium was detetected in a 59-year-old patent ultimately proven to have esophageal carcinoma. Such infections are be coming more frequent, often combine gram-negative bacilli and anerobes, and may be deceptively mild clinically. Origin from an occult head and neck or gas-trointestinal focus rater than from…
Case Report
Ultrasonic Findings in Pseudomyxoma Peritonei
SUMMARYThe ultrasonic findings of numerous thick-walled intraperitoneal septate cysts, with associated peritoneal liver scalloping, suggest the diagnosis of psedomyxoma peritonei.
Case Report
Hypernatremia With Choroid Plexus Hematomas and Elevated CSF Protein Level
SUMMARYA 3-month-lod infant had hypernaturemia, neurologic dysfunction, and an unusually high level of cerbrospinal fluid protein. The autopsy findings include cereberal edema, intravascular coagulation, and bilateral choroids plexus hematomas. Extensive destruction choroid plexus, in combination with diffuse intravascular coagulation may explain the much greater elevation of CSF protein than previously…
Case Report
Arterial thromboembolism and Associated Antithrombin III Deficiency
SUMMARYA patient with antithrombin III (ATT)deficiency after arterial embolism manifested and increasing requirement for heparin to adjust a partial thromboplastin time. This corrected by dramatically increasing doses of heparin and by conversion to warfarin sodium “Heparin-resistance” should direct the physician to examine antithrombin III levels, and ATT levels should be…
Case Report
Pulmonary Edema Due to Upper Airway Obstruction
Case Report
Dursen-Associated Visual Field Defects and Hemorrhages
SUMMARYRetinal hemorrhages and visual field defects can occur as complications of optic nerve drusen. The visual defects of optic drusen are of three types: (1)concentric constriction of the field, (2)enlargement of the blind spot, and (3) nerve fiber bundle defects. Retinal hemorrhages also fall into three categories (1)splinter hemorrhages overlying…
Case Report
Intratracheal Neurofibroma
Breif Report
Psychiatric Disturbances in a 6-Year-Old Boy With Klinefelters Syndrome
SUMMARYA 6-year-old with severe psychiatric problems was found to have Kilinefelters syndrome. He had a mixed emotional and behavioral clinical picture similar to and difficult to distinguish from that of other child psychiatric disorders. Klinefeltes syndrome should be considered in the differential diagnosis of a prepubertal boy with multiple emotional,…
Breif Report
Aortic Erosion by Duodenal Diverticulum An Unusual Aortoenteric Fistula
SUMMARYPrimary aortoduodenal fistula presenting as a diverticulum of the distal duodenum with GI bleeding may be a difficult kiagnostic entity with nondianostic endoscopy and angiography. We have described a patient in whom diagnosis was established at laparotomy, with treatment including debridement, repair, and extra-anatomic bypass.
Breif Report
Profound Acidosis in Infancy
Breif Report
Finger Clubbing Associated With Laxative Abuse
SUMMARYWe have added two cases of finger clubbing in laxative-abusing patients to the four other cases recorded in the literature. Laxative abuse should be added to the already long list of diseases in which clubbing may appear. The pathopysiologic basis of clubbing is still obscure.
Breif Report
Femoral Neuropaty Due to Common Iliac Artery Occlusion
SUMMARYA patient with anatheosclerotic common iliac artery occlusion had acute onset of femoral neuropathy, which resolved after revascularizationl. This case indcaates that ischemia can cause femoral neuropaty and that ischemia may be the explanation for some previously unexplainedpostoperative femoral neuropathies.
Breif Report
Listeria monocytogenes Prosthetic Valve Endocarditis
Breif Report
Hypocalicuric Hyperparathyroidism with chronic Renal Failure
SUMMARYA patient with hypertension and chronic renal disease was evaluated for hypercalcemia and hypophosphatemia. Serum parthyroid hormone and urine nephrogenous cyclic adenosine momophosphate levels were both elevated. Absolute and fracional urine excretion of calcium was low, thereby rasising the suspicionof hypoclcuric hyperclcemia. Surgical removal of a parathyroid ademoma led to…
