SMJ // October 1985, Volume 78 - Issue 10
Primary Article
Sacral Pressure Sores Treatment With island Gluteus Maximus Musculocutaneous Flaps
ABSTRACTWe have used the island gluteus maximus musculocutaneous flap to cover sacral pressure sores. In this report, we describe the surgical anatomy, cadaveric dissections (n = 25), and postoperative follow-up (one to 40 months) in 13 clinical cases. Our results compare favorably with those of other previously reported series. Postoperative…
Primary Article
Abdominal Vascular Injuries
ABSTRACTTreatment of major abdominal vascular injuries is a challenge. Since 1973, 93 patients have been treated at our institution for 147 abdominal vascular injuries. The majority of these injuries (67%) resulted from penetrating trauma in young men between 21 and 30 years of age. Upon admission 72% of the patients…
Primary Article
Deep Venous Thrombosis in Surgical Patients Possible Laboratory Predictors
ABSTRACTWe tested 18 surgical patients before and after operation in an effort to determine whether or not laboratory tests could be used as predictors of deep venous thrombosis. During the period of study, none of the patients tested had deep venous thrombosis. Coagulation tests showed no significant changes, but all…
Primary Article
Prolonged Hospitalization Because of Inappropriate Delay of Warfarin Therapy in Deep Venous Thrombosis
ABSTRACTCurrent anticoagulation practices of physicians in an academic medical center were examined by retrospective review of records of 26 patients admitted for uncomplicated deep venous thrombosis (DVT) between 1978 and 1982. Patients received intravenous heparin for an average of 11.5 ± 2.8 days. Warfarin therapy was started on day 8.3…
Primary Article
Continuous Epidural Anesthesia for Elective Cesarean Hysterectomy
ABSTRACTContinuous lumbar epidural anesthesia was the primary anesthetic technique used for 25 patients having elective cesarean hysterectomy at Duke University Medical Center during a 121/2 -year interval. Seven patients (28%) with initially satisfactory epidural anesthesia required intraoperative induction of general orotracheal anesthesia because of patient discomfort and resultant suboptimal operating…
Primary Article
Self-Examination of the Breast Use and Effectiveness
ABSTRACTUsing data from a sample of more than 2,000 women with breast cancer, we examined relationships between 11 variables. In Oklahoma, breast self-examination (BSE) seems to be practiced more among younger, white, metropolitan women, indicating that educational efforts should be directed toward other groups. Tumors found by BSE were found…
Primary Article
Inhospital CPR 25 Years Later Why Has Survival Decreased?
ABSTRACTSince the introduction of cardiopulmonary resuscitation (CPR) 25 years ago, there have been many advances in cardiopulmonary technology and in our understanding of the factors leading to a successful outcome. Despite these advances, our study of outcomes in 88 patients having CPR at Johns Hopkins Hospital in 1981 revealed a…
Abstract
79th Annual Scientific Assembly
Abstract
Hypophosphatemic Rickets Still Misdiagnosed and Inadequately Treated
ABSTRACTWe studied the presentation and results of medical therapy in 25 children with sex-linked dominant hypophosphatemic rickets. The average age at diagnosis was 3.8 years. Reasons for the delay included misdiagnosis and failure to recognize the normal range of serum phosphorus levels in children. Early diagnosis and treatment (before age…
Abstract
Surgical Aspects of Limb Deformity in Hypophosphatemic Rickets
ABSTRACTOur assessment of the surgical correction of bowleg deformity in eight patients with sex-linked dominant hypophosphatemic rickets showed the best results in patients having staged, proximal tibial osteotomies at completion of growth. Lack of medical therapy was associated with recurrent genu varum or markedly delayed union. Undercorrection may be prevented…
Abstract
Sustained-Release Procainamide Use of Serum Concentrations to Determine Dosage
ABSTRACTThe utility of the antiarrhythmic drug procainamide (PA) is limited by the required dosage schedule (every three to four hours). A commercially available, slow release procainamide (P-SR) is recommended to be given every six hours. We compared procainamide capsules (P-Caps) given every four hours with P-SR given every six hours…
Abstract
Impact of Removing Gentamicin From an Antibiotic Restriction Program
ABSTRACTPrescribing physicians at our institution were required to obtain approval from the Section of Infectious Disease for use of gentamicin sulfate and other aminoglycosides. We studied the effect of removing gentamicin from the list of restricted antibiotics, noting that gentamicin usage increased while tobramycin sulfate usage decreased during the six-month…
Abstract
Neonatal Circumcision
ABSTRACTBecause of an economically motivated study, there has been an attempt to shift insurance dollars from neonatal circumcision to neonatal intensive care. Negative comments regarding the advisability of early circumcision have created confusion for both physicians and parents. Neonatal circumcision is the most common surgical operation in the United States,…
Abstract
Cryptorchidism The Role of Medical Education in Diagnosis
ABSTRACTThe hospital records in a community of 63,000 were reviewed for a five-year period (1978 to 1983) with regard to the diagnosis of cryptorchidism. There were 123 hospitalized patients with unilateral cryptorchidism and 17 patients with bilateral cryptorchidism. The diagnosis was made in 35 newborn infants from a total of…
Abstract
Physician Suicide in North Carolina
ABSTRACTPrevious research suggests that physicians are two to three times as prone to suicide than the general population. Review of North Carolina death certificates from 1978 to 1982 showed that the physician suicide rate is not substantially different from that of the white male population aged 25 years or older….
Abstract
Treatment of Myasthenic Crisis in Late Life
ABSTRACTIn 32 patients with the onset of myasthenia gravis after age 50, myasthenic crisis occurred in 53% and persisted for a mean of 33 days (range six to 84 days). Three of the patients had a second crisis. Precipitating factors were found in 60% of the episodes. Treatment of 20…
Review Article
Rabies A Review and Current Approach for the Clinician
ABSTRACTRabies is an acute viral encephalomyelitis with virtually a 100% case fatality rate. Only three cases of human survival after rabies have been documented. The current epizootic of raccoon rabies in the United States centered over the South Atlantic states mandates a working knowledge of rabies management and postexposure prophylaxis…
Current Concepts
Local Anesthetics Who Should Give Them?
Current Concepts
Topical Anesthetics Use and Misuse
Abstract
Rape and the Rape Trauma Syndrome
Article
Malpractice A Way of Life
The current system for recovery of medical malpractice is in efficient and unfair. At one of the spectrum, many clderly victims of malpractice are not compensated because they do not have adequate access to the current system. At the other end of the spectrum, society is bearing the cost of…
Case Report
Chylous Ascites in Adults
Case Report
Temporomandibular Joint Pain as a Manifestation of Temporal Arteritis
SUMMARYWe have described a patient whose temporal arteritis had several unusual manifestations. Except for a number of systemic complaints of longer duration, her predominant symptom was that of temporomandibular joint pain. Subsequent to the development of acute visual loss, her fundi remained normal, suggesting a posterior neuropathy. A high index…
Case Report
Advanced Periampullary Carcinoma Endoscopic Palliation by Sphincterotomy
SUMMARYWe have described a 50-year-old woman with periampullary carcinoma with extensive infiltration of the duodenal wall arising from advanced tumor of the pancreatic head. Endoscopic sphincterotomy induced complete relief from jaundice and pruritus before definitive surgical therapy was done. This procedure should not be restricted to small tumors confined to…
Case Report
Fatal Coxsackievirus B4 Infection in a Neonate
SUMMARYWe reported a fatal coxsackievirus B4 infection in a neonate. The CSF WBC was elevated, with polymorphonuclear leukocytes predominating initially and lymphocytes predominating later in the illness. Autopsy findings included inflammation of the heart and liver. Coxsackievirus B4 was isolated from the heart and quantitated as 103 50% tissue culture…
Case Report
Common Bile Duct Stricture Without Obvious Cause
SUMMARYCommon bile duct strictures without apparent cause are unusual, yet probably occur more often than has been recognized. Whether this condition represents a different cause of biliary stricture or is just a forme fruste of recognized injuries or causes is not clear. Nonetheless, the surgeon should be aware that such…
Breif Report
Corynebacterium hemolyticum Endocarditis on a Native Valve
SUMMARYWe have described a patient with fatal Corynebaclcrium hcmolyticum endocarditis on a native bicuspid aortic valve. This is the first report of endocarditis and the first fatal infection of any kind caused by Corynebacterium hemolyticum. This organism and other nondiphtheria corynebacteria must be considered as potentially serious pathogens in man.
Breif Report
Septic Phlebitis Caused by Candida albicans and Diagnosed by Needle Aspiration
SUMMARYWe have described a patient who had Candida albicans suppurativc thrombophlebitis at the site of an indwelling intravenous catheter. The microbial etiology was established by needle aspiration of the venipuncture site, affording rapid and accurate identification of the infecting organism and providing prompt institution of therapy. Phlebectomy and a brief…
Breif Report
Non-Hodgkins Lymphoma in Pregnancy
SUMMARYPregnancy in patients who have non-Hoclgkins lymphoma is unusual. We have reported a case of diffuse, poorly differentiated lymphocytic lymphoma, stage IIIa, in a patient whose disease went into remission after she received six courses of CHOP therapy (cyclophosphamide, doxorubicin, vincristine, and prednisolonc). She became pregnant soon afterward and was…
Breif Report
Diverticulitis Complicated by Gandidal Pylephlebitis
SUMMARYA 58-year-old woman had fever, diarrhea, and polymicrobial bacteremia (hat progressively worsened despite appropriate antibiotic therapy. At autopsy, a diverticular abscess and pylephlebitis were found, both demonstrating hyphal forms consistent with Candida on microscopy.
