SMJ // April 1984, Volume 77 - Issue 4
Primary Article
Cholelithiasis in Morbid Obesity
ABSTRACT: This study is based upon our experience with 477 morbidly obese patients who had gastric bariatric surgery during a five-year period. The incidence of biliary tract disease was 39.1%, about four times the incidence in the nonobese population. Intraoperative ultrasonic examination of the gallbladder was done in 50 patients….
Primary Article
Hiatal Hernia With Severe Reflux Esophagitis: Treatment by Superselective Vagotomy and Nissen Fundoplication
ABSTRACT: Thirty-two patients had surgical treatment for severe reflux esophagitis due to sliding hiatal hernia. A superselective vagotomy was done as an adjunct to a Nissen fundoplication as the antireflux procedure. All patients had severe esophagitis; 16 patients (53%) had dysphagia, nine patients (28%) had esophageal stricture, and all had…
Primary Article
Puborectalis Sphincteroplasty for Anal Incontinence
ABSTRACT: Difficulty in rectal emptying, incontinence, solitary ulcer with bleeding, physical finding of lax puborectalis musculature, obtuseness of the anorectal angle, and bulging of the anterior rectal wall into the proctoscope suggest incontinence amenable to puborectalis plication. Puborectalis plication sphincteroplasty is useful in correcting patulousness and incontinence attendant with rectal…
Primary Article
Systemic Combination Chemotherapy as Primary Treatment of Brain Metastasis From Lung Cancer
ABSTRACT: Five patients with primary lung cancer metastatic to the brain were treated with systemic combination therapy alone. One patient had had unsuccessful radiation therapy, while the other four received chemotherapy as the primary modality of treatment. Response was observed in all five patients. The concept of the blood-brain barrier…
Primary Article
Site-Specific Cancer Mortality Trends Among Kentucky Residents: Comparison of 1971 to 1975 With 1976 to 1980
ABSTRACT: We compared the average annual age-adjusted, sex- and site-specific cancer mortality rates among Kentuckians during two five-year time periods: 1971 to 1975 and 1976 to 1980. Lung cancer alone showed a statistically significant increase in mortality rates for both sexes, but significant increases were also found for skin cancer…
Primary Article
LD1and Several Ratios of Lactate Dehydrogenase Isoenzymes in Acute Myocardial Infarction
ABSTRACT: The sensitivity and specificity of three parameters—ECG, creatine kinase MB isoenzyme and LD isoenzymes—were compared in 385 consecutive patients hospitalized for clinically suspected acute myocardial infarction (MI). In 147 patients acute MI was diagnosed on the basis of three parameters. In the remaining 238 patients acute MI was ruled…
Primary Article
Behcets Disease: The Ochsner Experience, 1979 to 1982
ABSTRACT: Seven cases of Behcets disease were seen at the Ochsner Clinic between 1979 and 1982. The most common symptom was aphthous stomatitis; the next most common symptoms were arthritis and skin lesions. Treatment was not particularly satisfactory. Laboratory and pathology studies are reviewed, and the particular problems patients with…
Primary Article
Rocky Mountain Spotted Fever Vaccine: A Regional Need
ABSTRACT:Because the killed Rickettsia vaccines have failed to provide protection against Rocky Mountain spotted fever, we approached the problem of protective immunity to Rickettsia rickettsii with a closely related, live, less pathogenic spotted fever Rickettsia. Guinea pigs vaccinated with R conorii produced antibodies to spotted fever group rickettsiae and did…
Primary Article
Survey of Physician Acceptance of the Pneumococcal Vaccine
ABSTRACT: A group of 251 randomly selected physicians completed a survey designed to study their attitudes toward, knowledge about, and use of pneumococcal vaccine. Eighty-five percent of respondents believed the vaccine had been proven effective. For the use of the vaccine, respondents supported broad indications, including chronic lung disease, alcoholism,…
Primary Article
Short-Course Parenteral Antibiotic Therapy for Pyelonephritis in Pregnancy
ABSTRACT: A short-term course of an intravenous cephalosporin (cefuroxime) was used as therapy in 24 cases of pyelonephritis due to susceptible organisms in 23 pregnant women. Clinical cure was achieved in 96% of patients, and there were no adverse reactions to the drug. Bacteriologic cure was documented in 52% of…
Primary Article
Colonization of Central Venous Catheters
ABSTRACT: We studied etiologic factors important in colonization of 179 central venous catheters (CVCs) in patients randomized into group 1 (who received daily topical applications of povidoneiodine) or group 2 (who received only dry dressing changes). Colonization rates of CVC tips were similar between group 1 (18/84 or 21%) and…
Primary Article
Familial Polyposis in Children: Early Detection and Preferred Treatment
ABSTRACT: Familial polyposis is a disease with high malignant potential. When the diagnosis is established, surgical removal of the premalignant tissue should be complete. Reports of early malignant expression of the disease have led us to recommend early surveillance and treatment of children from affected families. We describe four children…
Primary Article
Mechanism and Management of Important Psychotherapeutic Drug Interactions
ABSTRACT: Interactions between drugs can result in unintended changes,in desired pharmacologic effects. Because psychotherapeutic drugs represent the most widely used class of pharmacologic agents, physicians must anticipate possible consequences of their interactions. An overview of drug interaction reports reveals that they can be usefully divided into those with either a…
Primary Article
People and Dollars: The Experience of One Hospice
ABSTRACT: The Hospice of the North Shore (HONS) provides home hospice care, using local hospitals when inpatient care is essential. The actual cost of 4,779 patient days of care delivered from May 1, 1980 through Dec 31,1981 was $14.26 per patient day. The median length of service was 31.5 days,…
Primary Article
Jehovahs Witnesses and Blood Transfusion Physicians Attitudes and Legal Precedents
ABSTRACT: Patients with significant medical problems who refuse some aspects of their medical care present medicolegal and management problems for their physicians. The selective refusal of transfusion of blood products by Jehovahs Witnesses typifies such situations. To explore physicians reactions to these constraints, we sent a questionnaire to medical students,…
Review Article
α1Antitrypsin Deficiency
ABSTRACT: α1-Antitrypsin, the major serum protease inhibitor, is a glycoprotein synthesized in the liver. Severe deficiency results in protease-antiprotease imbalance, which predisposes to severe emphysema at a young age. Reduced serum levels reflect inadequate release of α1-antitrypsin by the liver, which may be caused by specific defects in biosynthesis. The…
Current Concepts
Management of Short-Bowel Syndrome
Article
Veterans Administration and Ambulatory Care: The “Low-Priority” Veteran
ABSTRACT: We describe several consequences of an effort to reduce patient volume in a general medical clinic (GMC) by releasing “low-priority” veterans. With a before-after descriptive study, we determined what sources of medical care these veterans used and assessed changes in their medical status using hypertension as a tracer condition….
Article
Eponym: The Loop of Henle
Medical Education
Initial Experience With a Course in Medical History-Taking for First-Year Medical Students
ABSTRACT: A course in medical history-taking for first-year medical students is described. Examples of course objectives are given, illustrating a simplified, organized approach to historytaking suitable for first-year students. Course evaluation data show that first-year students are able to acquire history-taking skills and that they consider such a course involving…
