SMJ // September 1984, Volume 77 - Issue 9
Editorial
ELECTROCONVULSIVE THERAPY FOR DEPRESSION
Educational Opportunities
Educational Opportunities
Primary Article
Impact of Early Recognition on Outcome in Nonpenetrating Wounds of the Small Bowel
ABSTRACT: During a recent ten-year period, 20 patients were treated for nonpenetrating, small-bowel trauma requiring resection. Despite the relative infrequency of this injury, jejunoileal trauma must be suspected in all patients sustaining blunt force to the abdomen. Physical signs suggesting major intra-abdominal wounds usually occur at admission or immediately thereafter,…
Primary Article
Duodenal Rupture Due to Blunt Trauma A Problem in Diagnosis
ABSTRACT: In our review of ten cases of duodenal disruption due to blunt trauma, we found a 30% mortality. Since early diagnosis would have lowered morbidity and mortality, a high index of suspicion needs to be maintained, combined with an aggressive diagnostic approach. Successful operation demands thorough duodenal exploration and…
Primary Article
Foreign Bodies of the Upper Gastrointestinal Tract: Current Mangement
ABSTRACT: The popularity of the flexible esophagogastroduodenoscope prompted us to reevaluate our management of foreign bodies. In this paper we report our experience and update treatment guidelines. In our series (from December 1975 to May 1982), 74 foreign bodies were removed: 12 with the rigid endoscope, 60 with the flexible…
Primary Article
Malignant Tumors of the Small Bowel
ABSTRACT: The four common types of small bowel malignancies have different clinical presentations, routes of metastatic spread, and prognoses, and may require selective treatment. A review of our experience over a 16-year period revealed 45 cases: 16 adenocarcinomas, 13 carcinoids, nine leiomyosarcomas, five lymphomas, and two fibrosarcomas. Adenocarcinomas tend to…
Primary Article
Endoscopic Variceal Sclerotherapy Experience With 30 Patients
ABSTRACT: Endoscopic sclerotherapy is used to obliterate esophageal varices in an attempt to decrease bleeding episodes. First reported in the 1940s, sclerotherapy has recently enjoyed renewed interest because surgical shunting procedures, though effective in preventing rebleeding, are associated with significant mortality and provide no increase in long-term survival. Sclerotherapy, using…
Primary Article
Renal Transplantation in a Developing Country: Anesthesia and Other Considerations
ABSTRACT: The Renal Transplant Team at Tulane University Medical Center has been involved in training a multispecialty group of Guatemalan physicians to perform renal transplantations in Guatemala. The purpose is to train the physicians in their own country, using available equipment and personnel so that they can perform successful operations…
Primary Article
Malnutrition and Immunocompetence in Older and Younger Outpatients
ABSTRACT: To determine the relationship between malnutrition and immune status in older and younger outpatients, we assessed 179 outpatient men according to nine markers of malnutrition and assigned them to a well nourished or a malnourished group. Immune status was measured by mixed lymphocyte culture, lymphocyte response to three mitogens,…
Primary Article
Chronic Pain
ABSTRACT: Chronic pain has attracted more and more attention lately as a condition in its own right, regardless of the disorder that started it. We now know more about the central mechanisms involved in modulation and modification of pain perception and understand better the multitude of factors involved in bringing…
Primary Article
Sleep Disorders Among Psychiatric Outpatients
ABSTRACT: Mental health clinics, particularly the ones serving middle-aged and elderly patients, are usually Confronted with serious problems of insomnia, which could trigger or aggravate physical or emotional ailments. It could also lead to drug dependence or contribute to polypharmacy. In this study, we have attempted to make a profile…
Primary Article
Incest and Physician Responsibility
ABSTRACT: This paper examines the epidemiologic, psychologic, and clinical aspects of incest, and emphasizes the need for action by physicians. The apparent increase in the incidence of this emotionally damaging experience makes it essential for the physician to understand the dynamics of incest, individually and in the family, so as…
Primary Article
Factors Contributing to Delay in Diagnosis of Bacterial Meningitis
ABSTRACT: I reviewed factors contributing to diagnostic delay in 12 children who had symptoms of meningitis for more than three days before diagnosis. Prior antibiotic therapy was more common in children with delayed diagnosis. Parental factors included possible neglect in one child and passivity and failure to recognize the seriousness…
Primary Article
Neglect of Syphilis in Hospitalized Patients
ABSTRACT: Of 9,375 inpatients consecutively discharged from a major university hospital during a six-month period, 2,912 (31%) had a serologic test for syphilis (STS) before or during hospitalization. Seventy-five patients (2.6%) had reactive serology, and further testing confirmed the diagnosis of syphilis in at least 56 patients (75%). Forty-seven (84%)…
Primary Article
Malaria: Recent Experience in a Community
ABSTRACT: Although a global resurgence of malaria has occurred along with the appearance of drug resistant organisms, this illness rarely is encountered by physicians in the United States. We report our experience with 15 cases of malaria seen during the last five years. The diagnosis should be considered in any…
Primary Article
Squamous Cell Carcinoma of the Fingers Treated With Chemosurgery
ABSTRACT: Squamous cell carcinomas of the fingers are uncommon tumors. While most of them pose little threat of metastasis, the clinician should know which tumors are likely to metastasize. Conservative surgical excision is the treatment of choice for squamous cell carcinoma of the finger. We present 19 cases treated conservatively…
Primary Article
Acute Myocardial Infarction in Elderly Patients
ABSTRACT: We conducted a retrospective chart review on 50 patients under age 65 (average age 52.9 years) and 55 patients over 65 (average age 75.6 years). The older patients were much more likely to have atypical pain or no pain (38% vs 4%, P < .0001). They were less likely…
Primary Article
M-Mode Echocardiographic Abnormalities in Rocky Mountain Spotted Fever
ABSTRACT: Rocky Mountain spotted fever is a serious acute systemic illness frequently complicated by cardiac involvement. To evaluate the spectrum of myocardial dysfunction, we obtained M-mode echocardiograms on nine consecutive patients with Rocky Mountain spotted fever within 72 hours of admission. Seven of the nine patients had echocardiographic evidence of…
Primary Article
Bacterial Colonization of Amniotic Fluid in Patients With Intact Membranes During Labor
ABSTRACT: Amniotic fluid from gravidas with intact membranes was obtained for bacteriologic culture at the time of cesarean section. The incidence of positive cultures from patients not in labor was 8%. When the length of labor was eight hours or less (mean 6.1 hours) and the membranes were intact, the…
Primary Article
Adult Respiratory Distress Syndrome Radiologic Manifestations and Course
ABSTRACT: During a 36-month period, the serial chest x-ray films of 26 patients with the adult respiratory distress syndrome (ARDS) were evaluated for the patterns of onset, course, and followup appearance when possible. An exudative phase appearance can be recognized, which can clear. The exudative phase appearances are (1) a…
Primary Article
Pulmonary Artery Malformation Syndrome
ABSTRACT: We present a case to illustrate that pulmonary artery malformation is a potential diagnosis in patients with nonresolving perfusion defects. The diagnosis can usually be made by the history, physical examination, chest roentgenogram, and ventilation-perfusion scanning. If the patients clinical symptoms are inconsistent with the scan, then pulmonary angiography…
Primary Article
Gastrocnemius Musculotendinous Rupture: A Condition Confused With Thrombophlebitis
ABSTRACT: Over a 24-year interval I have seen 22 cases of rupture of the medial head of the gastrocnemius muscle where it inserts into the soleus aponeurosis. The rupture may result in a swelling that is easily confused with thrombophlebitis and result in unnecessary hospitalization and anticoagulant therapy with its…
Primary Article
Solitary Cold Thyroid Nodule Cost-Ineffectiveness of Ultrasonography
ABSTRACT: We reviewed our experience with thyroid sonography of 60 patients with nonfunctioning (cold) solitary thyroid nodules proven by iodine 123 scan. Twenty-two patients had surgery; the remaining 38 had thyroid scan and ultrasound only. In the first group, the echograms did not demonstrate the surgically proven nodules in seven…
Review Article
Herpes Zoster: Epidemiology, Clinical Features, and Management
ABSTRACT: Herpes zoster is a commonly encountered infectious disease primarily affecting the elderly and immunosuppressed. The natural history and complications of the disease and the principles of management are often not appreciated by clinicians in a variety of disciplines who may see the patient during the acute phase. Recent literature…
Current Concepts
Pharmacologic Management of Raynauds Phenomenon
ABSTRACT: Raynauds phenomenon (RP) represents a wide spectrum of disease activity. Specific pharmacologic therapy, when indicated, should be based upon the clinicians understanding of drug effectiveness and side effects. We present an update of currently available pharmacologic agents being used for RP and review the effectiveness and side effects of…
