SMJ // October 1984, Volume 77 - Issue 10
Editorial
CME REVISITED WHY ITALY?
Editorial
DISHONESTY IN MEDICINE
Primary Article
Changing Patterns in Pulmonary Tuberculosis
ABSTRACTWe reviewed the intial chest roentgenograms of 182 consecutive adult patients with proven active tuberculosis. Less than 50% of all cases were known or suspected at the time of initial presentation. There is a low degree of correlation between radiologically discernible active pulmonary tuberculosis and extrapulmonary tuberculosis. A high percentage…
Primary Article
Pseudomonas aeruginosa Causing Osteomyelitis After Puncture Wounds of the Foot
ABSTRACTOsteomyelitis of the foot caused by Pseudomonas aeruginosa has been a recognized complication of puncture wounds since 1968. This is a report of two cases, one of which had evidence that the source of the P aeruginosa was the inner sole of the footwear. Factors such as warm, moist environment,…
Primary Article
Gastric Microbial Flora in Patients With Gastrointestinal Disease
ABSTRACTWe designed a prospective study to test the hypothesis that the stomach may be a bacterial reservoir in some patients and function as a potential source of aspiration-induced bacterial pneumonia. Quantitative cultures of fasting gastric contents were obtained in 100 consecutive patients having fiberoptic endoscopy for evaluation of gastrointestinal disease….
Primary Article
Meningococcal Meningitis in Children Clinical Comparison of Disease Produced by the Minor and Major Serologic Groups of Neisseria meningitidis
ABSTRACTSince 1972, there has been an increased incidence of meningococcal disease due to the minor serologic groups, “serogroups,” of Neisseria meningitidis. Few cases, however, have been reported in pediatric patients. We present 24 cases of meningococcal meningitis, ten of them (42%) due to serogroups X, Y, and Z N meningitidis….
Primary Article
Occurrence of Bacteremia in Febrile Children Seen in a Hospital Outpatient Department and Private Practice
ABSTRACTBlood cultures were obtained during a one-year period from 147 febrile children seen in the hospital outpatient clinic (group 1), and 42 seen in a private practice office (group 2). Although the two clinics were located in the same geographic area, they served different socioeconomic groups. Bacteremia was detected in…
Primary Article
Opsonic Fibronectin After Operation or Trauma Effect of Hemodilution and Duration of Operation
ABSTRACTFibronectin is an essential opsonin for phagocytosis of nonbacterial particulate matter by the reticuloendothelial system (RES). Fibronectin deficiency causes RES phagocytic depression and repletion of fibronectin reverses RES depression. Fibronectin depletion has been linked with multiple organ failure after surgery and trauma in patients with intra-abdominal infection. The mechanisms for…
Primary Article
Nursing Intervention Scoring System in Management of a Surgical Intensive Care Unit
ABSTRACTHospital cost containment and nursing shortages have diminished resources available in surgical intensive care units (SICU). To provide a more quantitative approach to management of these resources, the nursing intervention scoring system (NISS) devised by Greenburg et al was instituted in the SIGU at the VA Medical Center, Gainesville, Fla….
Primary Article
Effects of Indomethacin on Pleural Pain
ABSTRACTIndomethacin (50 mg every eight hours) was given to 17 selected patients with pleurisy to control pain. Eleven of 17 obtained good to excellent relief of pain within 24 hours. Pain was not relieved in three patients and was only partly relieved in three others. Potentially serious side effects developed…
Educational Opportunities
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Educational Opportunities
Sequelae of Tubal Ligation An Analysis of 75 Consecutive Hysterectomies
ABSTRACTSeventy-five consecutive patients undergoing hysterectomy subsequent to elective sterilization were studied regarding the occurrence of the post-tubal-ligation syndrome of pelvic pain and/or menorrhagia. Twenty patients were clinically considered to have the syndrome. In none of the patients operated on specifically for menstrual abnormalities could the findings be remotely attributed to…
Educational Opportunities
Concentration of Serum Prealbumin and Retinol-Binding Proteins During Pregnancy
ABSTRACTConcentrations of the rapid-turnover plasma proteins prealbumin and retinol-binding protein are measured in nonpregnant subjects to detect subclinical malnutrition. In this study, blood samples were taken from 30 normal pregnant women to establish normative data on the concentrations of these two plasma proteins during pregnancy. Twenty-five normal adults were used…
Educational Opportunities
Comparative Antihypertensive and Endocrinologic Effects of Clonidine and Prazosin in Patients With Essential Hypertension
ABSTRACTThe acute and chronic effects of fixed dosages of clonidine and prazosin on supine and upright blood pressure, the renin-angiotensin-aldosterone system, and plasma catecholamines were compared in 24 patients with essential hypertension. The patients were randomized into two groups; 11 received chlorthalidone (50 mg daily) throughout the protocol, but 13…
Educational Opportunities
Is It Anxiety or Depression?
ABSTRACTPhysicians are often confronted with the problem of differentiating between depression and anxiety. In accumulated data on 500 patients with subsequent diagnosis and successful treatment of primary depression, only a few had had a tentative diagnosis of depression rather than anxiety. Failure to differentiate between depression and anxiety results in…
Educational Opportunities
Management of Attention Deficit Disorder
ABSTRACTAttention deficit disorder occurs in 5% to 10% of school-aged children. Retrospective studies have shown an increased incidence of academic and social failure in untreated children. This paper reviews the natural course of the disorder and describes some therapeutic interventions.
Educational Opportunities
Myofascial Trigger Points in Persistent Posttraumatic Shoulder Pain
ABSTRACTPersistent pain and disability after injuries to the shoulder sometimes create a difficult diagnostic and therapeutic problem. In many such cases, myofascial trigger points seem to cause symptoms. Three cases in which pain had persisted for eight to 33 months after injury illustrate the manifestations of posttraumatic myofascial trigger point…
Educational Opportunities
Cimetidine Usage for Unlabeled Conditions in an Ambulatory Care Service
ABSTRACTWith the intent of cost containment, we conducted a survey of cimetidine usage in the Ambulatory Care Service of our Veterans Administration Medical Center. During a period of six months, this drug was prescribed for 132 patients. Only about 20% received cimetidine for FDA approved conditions. Treated conditions hot approved…
Educational Opportunities
Predicting the Outcome of Hospitalization for Elderly Persons Home Versus Nursing Home
ABSTRACTFifty elderly persons who had been admitted to an acute care hospital from Home and discharged to nursing homes were compared with 50 elderly persons who had been admitted to the same hospital from home and discharged to home during the same period. Discriminant function analyses were done to predict…
Educational Opportunities
Splenic Trauma A Trial at Selective Management
ABSTRACTThe experience with splenic trauma at the Metropolitan Nashville General Hospital and at Vanderbilt University Hospital between 1972 and 1983 is the subject of this report. Of 154 emergency cases involving splenic injury, 134 were due to blunt trauma, with 20 cases resulting from penetrating injury. In 124 patients, exploratory…
Review Article
Clinical Spectrum of Pulmonary Aspergillosis
ABSTRACTAspergillus produces diverse pulmonary manifestations, its clinical spectrum extending from harmless saprbphytic colonization to universally lethal disseminated infection. Management of the conditions produced by Aspergillus is also diverse and may consist of either observation or treatment with corticosteroid agents or amphotericin B. The factors that influence the expression of Aspergillus…
Current Concepts
Management of Variceal Hemorrhage
Case Report
Calcified Abdominal Castlemans Disease Plain Film and Sonographic Features
SUMMARYBenign lymph node hyperplasia or Castlemans disease is an unusual entity, which rarely calcifies and is characteristically found near the hila of the lungs or in the mediastinum. In the case we have reported, a calcified mass in the left upper abdominal quadrant proved to be a rare case of…
Case Report
Goldblatt Phenomenon in a Single Kidney The Importance of Subselective Renal Vein Renins
SUMMARYWe have reported a case of renovascular hypertension in a patient with a solitary kidney with a significant stenosis of one of three separate renal arteries. Elevated renins were detected only with segmental sampling. We believe cases of renovascular hypertension may be overlooked on angiography and consequently, without segmental renin…
Case Report
Hyponatremia Induced by Thiazide-like Diuretics in the Elderly
SUMMARYWe have presented five episodes of hydrochlorothiazide-induced hyponatremia in three elderly nursing home patients. Fortunately all our patients survived. The common use of thiazide diuretics in this population and the nonspecific symptoms that follow toxicity make it imperative to monitor closely elderly patients who are taking thiazide diuretics.
Case Report
Peritoneal Keratin Globules in Uterine Adendsquamous Carcinoma
SUMMARYWe have described a previously unreported lesion—peritoneal keratin globules in uterine adenosquamous carcinoma. We postulate that the keratin globules are derived from sloughed uterine adenosquamous carcinoma which gains access to the peritoneum through retrograde dissemination via the fallopian tubes, and we suggest that the finding of these globules does not…
Case Report
Primary Wegeners Granulomatosis of the Trachea Radiologic Manifestations
SUMMARYThis is the third reported case of Wegeners granulomatosis of the trachea occurring as the primary initial event in a young patient. Roentgenographic findings consisted of a 3 cm intraluminal mass with extensive tracheal narrowing. In a young patient with inspiratory stridor, a mass causing narrowing of the trachea, and…
Case Report
Pulmonary Pseudolymphoma
SUMMARYPseudolymphomas of the lung are extremely rare with approximately 30cases reported in the literature. Histologically it may be impossible to distinguish a benign pseudolymphoma from a malignant lymphoma. Immunoperoxidase staining has been proposed to help predict the benign or malignant potential of these conditions. Results thus far have been inconclusive,…
Case Report
Ampicillin-Associated Seizures
SUMMARYTwo patients had ampicillin-associated seizures. Although they had complex medical problems, the high serum concentrations of ampicillin at the time of seizures without their recurrence after discontinuing the antibiotic suggest that the seizures were related to the ampicillin therapy.
Case Report
Venous Aneurysm
SUMMARYA 19-month-old girl had a congenital aneurysm of the neck vein. We attribute the pathogenesis of venous aneurysm to a defective vascular wall. The treatment of choice is simple surgical excision.
Case Report
Kwashiorkor in Baltimore
SUMMARYAdvanced cases of malnutrition are rare in the United States. Since it is rarely suspected, a correct diagnosis of malnutrition, even in extreme form, may easily be missed. We present a recent case of the kwashiorkor form of the syndrome of protein-energy malnutrition to emphasize its diagnostic features and to…
Case Report
Antenatal Diagnosis of Turners Syndrome
SUMMARYThe prenatal identification of a cystic mass in the region of the fetal cervical neck should raise the possibility of a cystic hygroma which is commonly associated with Turners syndrome. Differential diagnosis should also include benign cystic teratoma, meningocele, encephalocele, and meningoencephalocele. Careful sonographic evaluation of the fetus can help…
Breif Report
Adenomyoma of the Stomach
SUMMARYWe have described three cases of adenomyoma of the stomach. These benign lesions are found almost exclusively in the antrum or pylorus and are composed of combinations of ducts, glands, pancreatic tissue, and smooth muscle. Malignancy arising in adenomyomas is rare.
Breif Report
Ileosigmoid Knot
SUMMARYA 30-year-old black man had emergency surgery for an acute abdominal condition. Intraoperative diagnosis of an ileosigmoid knot was made and gangrenous bowel was resected, with ilioileostomy, reanastomosis, end colostomy, and Hartmann pouch.
Breif Report
Unusual Complication of Swan-Ganz Catheter Requiring Mediastinotomy
SUMMARYWe were consulted to assist in the removal of an anchored Swan-Ganz catheter. After failing in several attempts to remove the catheter, we elected to return the patient to the operating room in the event that the catheter had been sutured to the right atrium. No evidence of this was…
Breif Report
Bilateral Anterior Dislocation of the Shoulder
Breif Report
Hairy Cell Leukemia A Case of Cryptococcosis Appearing as Hairy Cell Meningitis
SUMMARYHairy cell leukemia has rarely been shown to involve the central nervous system. We have reported a case of hairy cell leukemia with apparent hairy cell meningitis, later found to be cryptococcal meningitis. Spinal fluid abnormalities, including the hairy cell pleocytosis, resolved with treatment of the cryptococcal infection.
