SMJ // March 1984, Volume 77 - Issue 3
Original Article
Tumors of the Appendix I. Neoplastic and Nonneoplastic Mucoceles
ABSTRACT: We reviewed the clinical data and pathologic material on 46 patients with lesions originally interpreted as appendiceal mucocele or mucinous adenocarcinoma from two medical centers. The mucoceles, characterized by accumulation of mucus in a dilated lumen, could be divided into three distinct entities: nonneoplastic retention mucoceles (eight cases), cystadenomas…
Original Article
II. The Spectrum of Carcinoid
ABSTRACT: We reviewed the clinical data and pathologic material from 30 patients with appendiceal carcinoids. Most of the tumors were discovered incidentally in appendectomy specimens. Approximately two thirds were tiny lesions identified only by microscopic examination. One tumor metastasized to a regional lymph node. Five histologic patterns were identified. Problems…
Original Article
Incidental Sonographic Detection of Renal Cell Carcinoma
ABSTRACT: Renal cell carcinoma is not an uncommon finding in our population. Since the symptoms of renal cell carcinoma may mimic those of other abdominal disease, we strongly advocate ultrasonic evaluation of the entire abdomen when screening patients with pain. Whether our three patients symptoms were due to gallbladder disease…
Original Article
Ultrasonography in the Diagnosis and Management of Empyema of the Thorax
ABSTRACT: Ultrasonic examination is useful to detect and localize empyema within the thoracic cavity in order to perform fine-needle aspiration. In six cases in which we used these procedures no complications were detected. Three of them are presented to illustrate the usefulness of ultrasonographically guided fine-needle aspiration of thoracic empyema…
Original Article
Adolescent Abuse of Typewriter Correction Fluid
ABSTRACT: A new form of substance abuse in adolescents is the inhalation of fumes from typewriter correction fluids (Liquid Paper, Wite-Out, Snopake, etc), which are composed of various chlorinated solvents, to induce euphoria. Medical complications of such abuse and medical management of acute toxic episodes are discussed herein, along with…
Original Article
Propoxyphene Dependence: Problems in Management
ABSTRACT: Propoxyphene dependence presents a difficult treatment problem: the patients subjective discomfort and concomitant craving during gradual withdrawal of the drug is more intense and more poorly tolerated than that observed with other narcotic analgesic agents. Of the six patients we describe, only one has achieved successful detoxification.
Original Article
Abuse of Antibiotics by Abusers of Parenteral Heroin or Cocaine
ABSTRACT: We studied antibiotic intake in 97 abusers of alcohol, sedatives, or parenteral heroin or cocaine. Thirteen patients, all abusers of parenteral heroin or cocaine, had taken antibiotics without prescription, obtained from friends, from old prescriptions, or by purchase on the street. Past or present street purchase of antibiotics was…
Original Article
Counterfeit Calculi
ABSTRACT: We describe two patients whose initial clinical presentation was that of nephrolithiasis. Eventually, an incontrovertible diagnosis of factitious illness was established. We describe this syndrome, review the underlying psychodynamics, and suggest an approach to treatment, with a plea to physicians to recognize the compulsive behavior as a sign of…
Original Article
Effect of a Publicly Funded Tuberculosis Service on the Diagnosis of Tuberculosis at a Teaching Hospital
ABSTRACT: The speed and accuracy of diagnosis of tuberculosis on general medical teaching services were retrospectively compared to that on a designated publicly funded tuberculosis service and to recent discouraging reports in the literature. The diagnosis was confirmed in all patients on the designated service and in 78.8% of patients…
Original Article
Oral Candidiasis in Cancer Patients
ABSTRACT: Oral candidiasis in cancer patients is an infection for which inconsistent diagnostic and therapeutic strategies currently prevail. Recent studies have shown its potential importance in the development of systemic candidiasis. A clinical and cytologic study was undertaken on 52 consecutive cancer patients admitted to our institution. Although the incidence…
Original Article
Hypokalemia and Massive Transfusion
ABSTRACT: To investigate the etiology of the hypokalemia that is more commonly associated with massive transfusions than hyperkalemia, we determined the plasma potassium concentrations of 26 stored packed cell preparations and reviewed a series of 15 patients who received massive transfusions with whole blood or packed cells. Our results confirm…
Original Article
Reexpansion Pulmonary Edema After Pneumothorax
ABSTRACT: Spontaneous pneumothorax is a common disorder that is easily recognized and treated. Occasionally reexpansion of the collapsed lung is complicated by unilateral pulmonary edema, heralded by tachypnea, unilateral rales, and profuse expectoration of frothy secretions within several hours of reexpansion. Severe morbidity and death may result. Increased duration of…
Original Article
Rapid Radioimmunoassay for Parathyroid Hormone: Its Use in Hypercalcemic Crisis
ABSTRACT: Patients with severe hypercalcemia often require intensive medical therapy to avoid a fatal outcome. When therapy with saline and loop diuretics cannot control the hypercalcemia, use of the toxic drug mithramycin is most appropriate for malignancy-associated hypercalcemia, but parathyroidectomy is indicated for parathyroid crisis. Although differentiation of these two…
Original Article
Glycohemoglobin Determinations in Pregnant Diabetic Patients
ABSTRACT: Glycohemoglobins (GH), minor variants of hemoglobin A, are elevated in patients with diabetes mellitus. We examined the clinical usefulness of GH levels in human pregnancy. There was no correlation between GH levels and gestational age or neonatal birth weight. Insulin-dependent diabetics had higher GH levels than did normal controls…
Original Article
Simple Method to Predict Digoxin Serum Concentration
ABSTRACT: The predictability of a method of determining serum digoxin concentration was assessed in a retrospective study of 35 hospitalized patients taking digoxin orally for maintenance therapy. Simple pharmacokinetic expressions were used to estimate digoxin concentration. Clinically, the mean measured digoxin concentration (1.35 ng/ml) was in close agreement with the…
Original Article
Intussusception: A Case Review
ABSTRACT: This study is a review of all cases of intussusception from December 1971 to December 1981 at the Erlanger Medical Center in Chattanooga. Only 24 cases were found. A disproportionate number of patients were white (92%). The male to female ratio was 2 to 1. There was no regular…
Original Article
Endotracheal Administration of Emergency Medications
ABSTRACT: When vascular access is delayed or unreliable in emergency situations, an endotracheal tube provides a rapid and reliable route for administration of medication. Epinephrine, lidocaine, and atropine have shown clinical efficacy when given by the endotracheal route. There is evidence that other medications including naloxone and diazepam may also…
Original Article
Bibliotherapy for Hospitalized Children
ABSTRACT: Allegorical stories can be used to help children cope with the worries and fears precipitated by illness, medical procedures, and hospitalizations. They supplement explicit discussions of illness and preparation for procedures and hospitalization. Stories with appropriate symbolic themes are readily available in childrens literature. Individuals without special training in…
Original Article
Compound Frontobasal Skull Fractures Surgical Management of the Acute Phase
ABSTRACT: The management of frontobasal skull fractures must be dealt with in a multidisciplinary manner. The advent of computed tomography has simplified the emergency radiologic investigation and expedited immediate surgical intervention. The major problem to be dealt with is closure of the frontobasal dura, which we accomplish by using an…
Review Article
Role of Immunologic Mechanisms in Tubulointerstitial Nephropathies
ABSTRACT: The immunologic basis of various glomerulonephropathies has been widely investigated and highly publicized. Little recognition, however, has been given to the possible role of the immune system in the genesis of tubulointerstitial nephropathies. Considerable clinical and experimental data have recently appeared suggesting the possible role of immunologic mechanisms in…
Current Concepts
Systemic Antibiotic Therapy in Surgical Patients
Medical Education
Impact of a Surgical Postgraduate Course on Undergraduate Surgical Performance
ABSTRACT: Postgraduate medical education generally has one of two basic goals: to improve general cognitive knowledge or to impart technical and management skills in a narrower area of medicine. Physicians invest enormous amounts of time and money in acquiring continued medical education, but there are little data on the objective…
