SMJ // November 1984, Volume 77 - Issue 11
Editorial
…AND ALSO A PHYSICIAN
Primary Article
Surgical Procedures in Patients Aged 90 Years and Older
ABSTRACT: During the past five years 75 patients aged 90 years or more had 85 major surgical procedures at the Metropolitan Nashville General and Vanderbilt University, hospitals. The most common operation was exploratory laparotomy. The second was lower extremity amputation for peripheral vascular disease and/or gangrene. Fifty-seven percent had general…
Primary Article
Carcinoma of the Cervical Esophagus: Diagnosis, Management, and Results
ABSTRACT: Nine of 168 patients (5.3%) with carcinoma of the esophagus had primary tumors in the cervical esophagus. The principal symptoms and signs of carcinoma of the cervical esophagus were dysphagia, hoarseness, neck mass, and weight loss. The esophagogram was a very reliable study, revealing the abnormality in all nine…
Primary Article
Anal Syphilis
ABSTRACT: We report an unusual case of anorectal syphilis. The literature reviewed supports the difficulty in identifying the varied presentations of this disease. Diagnostic and therapeutic maneuvers are based on an understanding of the pathophysiology of luetic infections. Penicillin remains the drug of choice in treating all stages of syphilis.
Primary Article
Early Detection in Suspected Herpes Simplex Encephalitis
ABSTRACT: In a retrospective study of ten patients who had brain biopsy because of suspected herpes simplex encephalitis, the diagnosis was confirmed in only three patients. However, in four patients whose clinical presentation was indistinguishable from that of herpes simplex encephalitis, biopsy revealed other treatable conditions. These findings, together with…
Primary Article
Chronic Mononucleosis Syndrome
ABSTRACT: We present data on 14 patients with chronic symptoms of disabling fatigue in association with serologic evidence of active Epstein-Barr virus (EBV) infection. Two thirds were women, and the average age at onset was 29.6 years. Forty-three percent were known to have had previous infectious mononucleosis, but the usual…
Primary Article
Unexpected Diagnosis of Cystic Fibrosis at Autopsy
ABSTRACT: Over an 11-year period, we encountered four cases in which an unexpected diagnosis of cystic fibrosis (CF) was first established on the basis of typical autopsy findings. Our experience suggests that the occurrence of such cases is more common than generally appreciated and emphasizes the often crucial role of…
Primary Article
Continuing Neonatal Morbidity in Infants of Women With Glass A Diabetes
ABSTRACT: Despite having implemented rigorous glucose control for women with gestational diabetes early in the third trimester, we found excessive morbidity among the neonates of these women. To accurately assess the risk of newborn complications, we did a five-year review (1977 to 1981) of infants of class A diabetic mothers…
Primary Article
Neonatal Necrotizing Enterocolitis: An Update
ABSTRACT: We reviewed 91 cases of neonatal necrotizing enterocolitis (NNEC), which continues to be a devastating disease occurring in 2% to 4% of all newborn intensive care unit admissions. Onset now occurs in older infants (11.9 days). The morbidity is significant (22%), with strictures (8%) and recurrences (8%) the primary…
Primary Article
Computerized Tomography in Acute and Chronic Pancreatitis
ABSTRACT: Modern imaging techniques have revolutionized the diagnostic evaluation of pancreatitis, primarily demonstrating its complications. Computerized tomography (CT) is a more sensitive method than ultrasonography and pancreatic ductography. A chart review revealed 214 patients at our hospital with a discharge diagnosis of pancreatitis. Sixty patients had CT for evaluation of…
Primary Article
Incidental Lesions Discovered on Intravenous Digital Subtraction Angiography
ABSTRACT: Recognition of the clinically significant incidental lesion has always been a challenge to the diagnostic radiologist. We present a series of such lesions discovered in patients undergoing intravenous digital subtraction angiography (DSA). The increasingly widespread use of DSA and the subsequent large numbers of patients involved will no doubt…
Primary Article
Serial Dexamethasone Tests for Predicting Relapse in Depressive Disorder
ABSTRACT: The dexamethasone suppression test (DST) was given to 86 patients with unipolar depression at the time of admission to the hospital. Thirty-three patients (38%) had abnormal DST responses. There was no difference in treatment response or outcome between patients with normal or abnormal DST responses on admission. Of the…
Primary Article
Enhancing Supervision of Psychotherapy
ABSTRACT: This paper reports the efforts of a psychiatry training faculty to explicitly study the supervisory process and enhance the facultys supervisory skills. To accomplish this, a psychiatry resident permitted the videotaping of her supervision. These videotapes were then reviewed and presented in an ongoing conference to members of the…
Primary Article
Small Fenestra Stapedectomy: Technique and Advantages
ABSTRACT: We discuss the rationale and advantages of the small fenestra technique (SFT) of stapedectomy. When results from conventional stapedectomy techniques are compared with those of SFT, the small fenestra technique shows improved hearing in the high frequencies of 2,000, 4,000, and 8,000 Hz, improved speech discrimination, reduced vestibular disturbance,…
Primary Article
Selenium Availability in Texas: Possible Clinical Significance
ABSTRACT: In light of recent reports that have indicated that selenium is an essential micronutrient and possible natural cancer inhibitor, data on the geographic distributions of selenium in Texas were gathered and compared with the distribution of age-adjusted cancer mortality rates. We considered concentrations of selenium measured in ground and…
Current Concepts
Sunscreens: Efficacy, Use, and Misuse
ABSTRACT: To provide a rational approach in the selection and use of sunscreens, we have reviewed some aspects of sun damage, the importance of genetically determined skin types, and the skins natural protective mechanisms. In this review, we classify sunscreens, explain the sun protection factor (SPF), discuss characteristic features of…
Medical Education
The Internship Year: A Study of Sleep, Mood States, and Psychophysiologic Parameters
ABSTRACT: Previous reports have suggested that first-year graduate physicians have a high incidence of psychologic distress and may show cognitive impairment as a result of sleep deprivation. We periodically evaluated 27 interns during their training year to determine amount of sleep, mood states, reaction time, critical flicker fusion, and symptoms…
