SMJ // July 1984, Volume 77 - Issue 7
Editorial
THE GHOST OF CHRISTMAS FUTURE
Editorial
BREVITY TAKES TIME
Editorial
ACKNOWLEDGMENT
Primary Article
Use of a New Generation Ophthalmoscope
ABSTRACTA new optical configuration for an ophthalmoscope is a hybrid of the present direct and indirect instruments, combining the strengths of both to increase overall efficiency. Cross polarization is used as a means of reducing glare and increasing clarity of detail. A fiberoptic light source increases light intensity, but reduces…
Primary Article
Five-Year Evaluation of Reconstructive Tympanoplasty Using a Goblet Prosthesis
ABSTRACTThis article reviews tympanoplasty using a stainless steel goblet alloplastic prosthesis with a repositioned incus and presents a five-year follow-up report on 51 patients who had this kind of ossicular chain reconstruction. The five-year evaluation shows a better than average success rate compared with other allographic and alloplastic materials.
Primary Article
Acute Rheumatic Fever in North Florida
ABSTRACTBecause of the declining incidence and severity of acute rheumatic fever reported in the United States and Europe, we reviewed our clinical experiences with 128 cases of acute rheumatic fever. No decline in the rate of admissions for patients with rheumatic fever was found in our hospital. The most common…
Primary Article
Indolent Meningococcal Meningitis A Cautionary Tale
ABSTRACTBacterial meningitis is a medical emergency that is ordinarily rapidly progressive. We present three patients who had meningococcal meningitis with an indolent course. Symptoms were present from two days to four weeks before hospitalization. Cerebrospinal fluid cultures grew Neisseria meningitidis one to eight days before antibiotic therapy, yet all patients…
Primary Article
Association of Adenovirus Type 16 With Reyes-Syndrome-Like Illness and Pneumonia
ABSTRACTThirty-eight antigenically distinct viruses have been described as adenoviruses, though only about one third have been commonly associated with human illnesses. In mid-January 1981, adenovirus 16, one of the more rarely encountered ones, was isolated from three patients in separate hospitals in the Little Rock, Arkansas, area, even though it…
Primary Article
Symptomatic Cardiac Amyloidosis in an American Family
ABSTRACTThis report describes an American family with a high incidence of symptomatic cardiac amyloidosis among four siblings, and explores the role of echocardiography and technetium pyrophosphate myocardial scintigraphy in the detection of this infiltrative cardiomyopathy within the involved family.
Primary Article
Vitamin D Metabolism and Anticonvulsant Therapy Effect of Sunshine on Incidence of Osteomalacia
ABSTRACTTo study the association between anticonvulsant therapy and osteomalacia or rickets, we evaluated 450 epileptic patients receiving anticonvulsants and residing in an institution for the mentally retarded in Florida. Fifty-five of them with increased mean serum alkaline phosphatase and mildly depressed mean serum calcium levels were identified as being at…
Primary Article
Cope Needle Biopsy
ABSTRACTI reviewed the results of 143 Cope needle biopsies in 121 patients. Diagnostic biopsies were obtained in 26 patients. Two patients with rheumatoid pleuritis had suggestive pleural fluid. Seventeen of the 19 patients with malignancy had diagnostic pleural fluid cytology. Seven additional patients with nondiagnostic biopsies had diagnostic pleural fluid…
Primary Article
Sputum Cytology in the Management of Patients With Lung Cancer
ABSTRACTAlthough more informative and precise diagnostic methods have become available, cytologic analysis of sputum is still considered the first step in evaluating bronchogenic carcinoma. We hypothesized that the cost of sputum examinations far outweighed their usefulness in actual patient management. To substantiate this, we retrospectively reviewed the charts of 190…
Primary Article
Diagnosing Myocardial Infarction With a Radioimmunoassay for the B-Monomer of the Creatine Phosphokinase Isoenzymes
ABSTRACTA diagnosis of myocardial infarction (MI) is usually established by the evaluation of clinical symptoms, electrocardiographic changes, and serum-enzyme levels, specifically creatine phosphokinase, subunit MB (CK-MB), by electrophoresis. A total of 215 patients were evaluated in this study. One hundred two of them were admitted to the coronary care unit…
Primary Article
Arsenic Homicidal Intoxication
ABSTRACTArsenic-induced deaths have been known to occur from accidental poisoning, as a result of medical therapy, and from intentional poisonings in homicide and suicide. Twenty-eight arsenic deaths in North Carolina from 1972 to 1982 included 14 homicides and seven suicides. In addition, 56 hospitalized victims of arsenic poisoning were identified…
Primary Article
Michigan Alcoholism Screening Test to Diagnose Early Alcoholism in a General Practice
ABSTRACTGeneral medical patients can be easily screened for alcohol dependence on a routine basis. The Michigan Alcoholism Screening Test (MAST) is a 24-item yes-no questionnaire concerning alcohol-related behavior. When it was included in the history self-administered to new patients in an internal medicine faculty-resident outpatient practice, it uncovered unsuspected alcohol…
Primary Article
Xeromammographic Screening is it Helping?
ABSTRACTWe have reviewed our experience with xeromammography over a five-year period in a setting where there is no protocol for mammographic screening. Only 8.9% of breast carcinomas were found by xeromammography alone, a ratio substantially smaller than that found in large screening programs. While 80% of the occult carcinomas were…
Primary Article
Operative and Conservative Treatment of Tubo-ovarian Abscess Due to Pelvic Inflammatory Disease
ABSTRACTOf 83 patients with tubo-ovarian abscess studied retrospectively, 18 were treated within 24 hours of admission with total abdominal hysterectomy and bilateral salpingo-oophorectomy. The other 65 patients were treated conservatively. In six patients, conservative therapy proved an immediate failure, and 14 patients had delayed failure. Thirty-nine patients were successfully treated…
Primary Article
Antibiotic Prophylaxis in Surgery improvement After a Multihospital Educational Program
ABSTRACTThe use of antibiotic prophylaxis in surgical patients was evaluated in studies before and after an educational program designed to improve the appropriateness of surgical prophylaxis. The first study included 1,021 patients hospitalized in 27 institutions. The repeat study involved 949 patients hospitalized in 24 of these 27 hospitals. After…
Review Article
Postmenopausal Osteoporosis The Role of Estrogens
ABSTRACTIn 1980, the combined incidences of vertebral and hip fractures necessitating hospitalization of women living in Knox County, Tennessee nearly doubled each five years after the age of 50. These data led us to review the pathogenesis, diagnostic methods, and therapeutic measures used to control or minimize the occurrence of…
Current Concepts
Ionizing Radiation for Treatment of Benign Conditions
ABSTRACTIonizing radiation has been used much more frequently in the past than at the present in the treatment of benign conditions. As progress continued in the medical sciences, the use of radiotherapy narrowed considerably due to better understanding of the nature of ionizing radiation and its potential complications. Other agents…
Article
History of Drinking in America
Abstract
Ketoacidosis
Our Medical Heritage
Angina From Heberden to Prinzmetal
Case Report
Epicranial Arachnoid Cyst
SUMMARYWe have reported a case of epicranial arachnoid cyst, a developmental abnormality that occurs at the obelion, and have reviewed characteristic clinical and radiologic features that facilitate diagnosis.
Case Report
Loiasis and Renal Failure
SUMMARYA patient with a filarial infection due to Loa loa and renal failure was treated with a modified regimen of diethylcarbamazine while receiving hemodialysis. Infection with Loa loa may be associated with glomerulonephritis due to immunologically mediated injury. Serum immune complexes were elevated in our patient, and a kidney biopsy…
Case Report
Colonic Endometriosis Its Clinical Spectrum
SUMMARYWe have reviewed two cases of colonic enclometriosis. The first demonstrates the more frequently encountered symptoms of partial large-bowel obstruction. The second demonstrates the less frequently encountered cyclic rectal bleeding occurring at or near the time of menses. Conventional diagnostic methods may strengthen a preoperative suspicion, but definitive diagnosis rests…
Case Report
Isolated Duodenal Varix An Unusual Cause of Gastrointestinal Hemorrhage
SUMMARYWe have reported an unusual case of upper gastrointestinal hemorrhage due to an isolated varix involving the second portion of the duodenum. The varix originated directly from the inferior vena cava and did not communicate with the portal venous system. The diagnosis was made preoperatively by upper gastrointestinal endoscopy. Surgical…
Case Report
Myoglobinuria and Acute Renal Failure Associated With Intravenous Vasopressin Infusion
SUMMARYMyoglobinuria and acute renal failure were observed in two patients with vasopressin-treated gastrointestinal hemorrhage. Because there were no other obvious causes of renal failure in either patient, we propose that skeletal muscle ischemia developed during vasopressin infusion, followed by release of myoglobin and renal damage. This association should be considered…
Case Report
Abnormal Lactate Dehydrogenase Isoenzyme Pattern in a Critically Ill Patient
SUMMARYWe have described a patient who had an abnormal isoenzyme of lactate dehydrogenase in both serum and tissue. The presence of LDB is indicative of a poor prognosis. Some of the biochemical characteristics of the isoenzyme are (1) LD6 is not an artifact, (2) it contains an M subunit but…
Breif Report
Campylobacter Septic Abortion
SUMMARYWe have reported a case of a septic abortion caused by Campylobacter fetus ssp jejuni. This organism is best known for producing diarrhea, but is now being linked with more serious diseases, including pregnancy wastage.
Breif Report
Acute Anuria and Hypertension After Left Renal Vein Ligation Reversal After Decompression of Renal Venous System
SUMMARYLigation of the renal vein in a patient with a solitary left kidney resulted in acute anuria and hypertension. These conditions were reversed by decompressing the renal venous system through anastomosis of the end of the left renal vein to the side of the splenic vein. After the anastomosis there…
Breif Report
Campylobacter fetus ssp fetus Cholecystitis and Relapsing Bacteremia in a Patient With Acquired Immunodeficiency Syndrome
SUMMARYAcute gangrenous cholecystitis and relapsing bacteremia caused by Campylobacter fetus ssp fetus occurred in a patient with acquired immunodeficiency syndrome. Biliary tract colonization probably accounted in part for this unusual phenomenon. Whether the patients deficiency of cell-mediated immunity contributed to his disease is not known.
Breif Report
Bacillus cereus Meningitis and Bacteremia Associated With an Ommaya Reservoir in a Patient With Lymphoma
SUMMARYAfter placement of an Ommaya reservoir, meningitis and bacteremia due to Bacillus cereus occurred in a patient with stage IV lymphoblastic lymphoma and meningeal involvement. Bacillus species have been implicated as meningeal pathogens after lumbar punctures. These organisms have become an important cause of severe infection, especially in immunologically compromised…
Breif Report
Inability to Remove an Aspirated Straight Pin by Flexible Fiberoptic Bronchoscopy
SUMMARYThe patient we have described had severe hemoptysis caused by an aspirated straight pin, with subsequent tissue reaction. Foreign bodies can be successfully removed with the flexible fiberoptic bronchoscope, and they should be removed even if the patient is asymlptomatic.
Breif Report
Kaposis Sarcoma Associated With Multiple Myeloma
SUMMARYI have described a patient with multiple myeloma in whom Kaposis sarcoma of the skin developed during treatment with an alkylating agent. The association of a plasma cell dyscrasia, such as multiple myeloma, and Kaposis sarcoma is uncommon. The possible role of angiogenesis in deranged immunologic responses is addressed.
Breif Report
Diabetic Hyperglycemia and Glycosuria as a Manifestation of Bulimia
SUMMARYThis is the first reported case of insulin dose manipulation as a manifestation of bulimia. The patient was diabetic, with fluctuations in control. Despite the guarded prognosis in bulimia, the patients diabetic control improved with psychotherapy.
Letter to the Editor
Practical Clinical Medicine
Letters to the Editor are welcomed. They may report new clinical or laboratory observations and new developments in medical care or may contain comments on recent contents of the Journal. They will be published, if found suitable, as space permits. Like other material submitted for publication, Letters must be typewritten…
