Issue - Southern Medical Association

Editorial

LOST BLUE SIGN WITH A BIG WHITE “H”

Primary Article

Late Effects of Poliomyelitis Part I Report of Five Cases

ABSTRACTWe present five case reports to illustrate the late effects of acute paralytic poliomyelitis occurring many years after recovery. We emphasize the importance of ruling out common medical causes for the symptoms and address the question of a “postpolio syndrome.” The cause of progressive muscle weakness 30 to 40 years…

Primary Article

Part II Results of a Survey of 201 Polio Survivors

ABSTRACTWe present the results of a survey on the late effects of poliomyelitis in 201 persons. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from poliomyelitis to onset of new problems ranged from 30 to 40…

Primary Article

Neurologic Complications of Rocky Mountain Spotted Fever

ABSTRACTRocky Mountain spotted fever, a serious systemic infectious illness, is common in the southeastern United States. Approximately one fourth of the cases in the United States occur in North Carolina. Widespread organ involvement occurs, with central nervous system involvement being common and occasionally severe. Since the onset of treatment with…

Primary Article

Chronic Low Back Pain Results of Treatment at the Pain Therapy Center

ABSTRACTWe evaluated the outcome of 100 consecutive patients with chronic benign low back pain admitted for comprehensive interdisciplinary rehabilitation at the Pain Therapy Center. The average patient had been disabled for nearly two years and had had two unsuccessful operations for pain relief. Seventy-two percent of the patients treated had…

Primary Article

Anterior Herniation of the Nucleus Pulposus Radiologic and Clinical Features

ABSTRACTA prospective study disclosed eight patients (three children and five adults) with anterior herniation of the nucleus pulposus (AHNP); in five of the eight, AHNP was an incidental finding. Radiologic findings included erosion and/or fracture of the anterior aspect of the vertebra, usually with interspace narrowing. The complete blood count…

Primary Article

Cervical Chlamydial Infections Diagnostic Accuracy of the Papanicolaou Smear

ABSTRACTTo assess the reliability and accuracy of the Papanicolaou smear for the detection of cervical Chlamydia trachomatis infections, we obtained chlamydial cultures and cervical smears from 252 patients attending a gynecologic service during an eight-month time period. In 12 of these patients (4.8%), the cervical culture was positive for chlamydiae…

Primary Article

Current Status of Sphincter-Saving Operations for Chronic Ulcerative Colitis

ABSTRACTWhen surgery is demanded by the course of a patient with ulcerative colitis, the sphincter mechanism can be spared. The straight ileoanal anastomosis without a reservoir has not been satisfactory for adults because of frequent diarrheal stools. The ileorectal anastomosis has the advantage of minimal morbidity, but the patient is…

Primary Article

Surgical Management of Esophageal Achalasia

ABSTRACTBetween 1970 and 1983, 46 patients were hospitalized in the Vanderbilt University Medical Center and the Metropolitan Nashville General Hospital for treatment of achalasia. All patients had been symptomatic for at least two years. Efforts were made initially to manage most of these patients (40) with periodic esophageal dilatation. This…

Primary Article

Gastric Partition After Reversal of Jejunoileal Bypass for Morbid Obesity Three-Year Follow-up

ABSTRACTThe jejunoileal bypass (JIB) has met with increasing disfavor as a result of its unacceptably high complication rate. JIB reversal was done in 54 patients at the University of Florida, with a gastric partition done concomitantly to avoid regaining weight. Weight control was generally adequate up to six months after…

Primary Article

The Impact of Routine Isolation Techniques for Campylobacter jejuni in Stool Cultures

ABSTRACTCampylobacter jejuni is recognized as a leading cause of bacterial diarrhea. We studied the impact of performing routine isolation techniques for C jejuni in stool cultures in a community hospital. Since instituting such techniques, we have found C jejuni to be the leading cause of bacterial diarrhea at our hospital….

Primary Article

Children With Marfans Syndrome and Pectus Excavatum

ABSTRACTPectus excavatum occurs in two thirds of children with Marfans syndrome. The characteristics of seven children with Marfans syndrome and pectus excavatum were compared with those of 38 children who had pectus excavatum without Marfans syndrome. The children with Marfans syndrome presented later, had progressive defects, and were more likely…

Primary Article

Nonaccidental Burns in Child Abuse

ABSTRACTNonaccidental or inflicted burns account for a significant subset of children hospitalized for the treatment of burns and are a form of child abuse. We review our experience with inpatient treatment of pediatric burns and examine the characteristics of patients with accidental and nonaccidental burns. Abused children were of a…

Primary Article

Hickman Catheter Tip Displacement

ABSTRACTIn a series of 60 consecutive patients in whom Hickman catheters were placed for treatment of malignancy, four properly positioned catheter tips migrated secondarily from the superior vena cava to the ipsilateral jugular vein 2, 4, 21, and 25 days after placement. Three of the four patients had begun to…

Primary Article

Periodic Health Examination Effect of Costs on Patient Expectations

ABSTRACTThe periodic health examination accounts for many visits to primary care practitioners and is a major source of preventive care. The purpose of this study was to compare our results with results of previous studies suggesting that patients desire periodic check-ups, including extensive laboratory studies. The effect of knowledge of…

Article

Intervention and Alcoholism

ABSTRACTIt is difficult for some alcoholics to admit their illness and recognize their need for help. From experience a process called intervention has evolved. Basically it consists of a well planned and rehearsed scenario, devoid of coercion arid criticism, in which the alcoholic can find no acceptable alternative to treatment….

Our Medical Heritage

Spontaneous Rupture of Hepatoma Historical Perspectives

Clinical Brief

Intracholedochal Irrigation With Saline Through a Nasobiliary Catheter An Adjunct to Endoscopic Sphincterotomy in the Treatment of Large Stones in the Common Bile Duct

Clinical Brief

Laparoscopic Salpingectomy for Ectopic Pregnancy

Clinical Brief

“Hidden” Disks and Computerized Tomography

Case Report

Psychosis and Herpes Simplex Encephalitis

SUMMARYWe have reported an unusual presentation of herpes simplex encephalitis in a patient with a 31/2 -year history of a schizo-affective disorder. In the month immediately before diagnosis, the patient lost contact with reality and became violent. After successful treatment with antipsychotic medication, he had agitation and disorientation, as well…

Case Report

Atypical Manifestations of Herpes Simplex Encephalitis

Case Report

Juxtaglomerular Apparatus Tumor A Rare but Curable Cause of Secondary Hypertension

SUMMARYWe have reported our experience at Duke University Medical Center with juxtaglomerular apparatus tumor, a rare but remediable cause of significant hypertension. Our three cases illustrate markedly different clinical courses and diagnostic difficulties. Results of the usual diagnostic studies, including intravenous pyelogram and renal angiogram with selective renal vein renin…

Case Report

Ruptured Aneurysm of the Internal Iliac Artery

SUMMARYOur case and others reported in the literature illustrate that isolated aneurysms of the internal iliac artery are uncommon lesions with a highly lethal potential. The classic signs of ruptured abdominal aneurysm—pain, palpable mass, and shock—are usually altered with rupture of these aneurysms because of their deep location in the…

Case Report

Cervicovaginal Fistulas Management of Subsequent Pregnancy

Case Report

Multicentric Müllerian Squamous Neoplasia

Case Report

Nasogastric Tube Perforation of the Nasopharynx

SUMMARYWe have presented two unusual cases of naso-gastric tube perforation of the posterior nasopharynx. Complications included subcutaneous emphysema, pneumomediastinum, and pleural effusion. Both patients recovered. Recommendations to improve nasogastric tube safety include gentle placement using lubricant and an appropriately sized tube, confirmation of tube placement before any infusion, and awareness…

Case Report

Invasive Aspergillosis of the Sphenoid Sinus Manifested as a Pituitary Tumor

SUMMARYAspergillus infection of the paranasal sinuses is rare but is the most common fungal infection of these structures and should be suspected when sinusitis does not respond to antibacterial drugs. Our case involved the sphenoid sinus, and was initially thought to be a nonfunctioning pituitary tumor. Treatment of Aspergillus sinusitis…

Case Report

Combined Ketoconazole and Amphotericin B Treatment of Acute Disseminated Histoplasmosis in a Renal Allograft Recipient

SUMMARYWe have reported the first case of successful treatment of disseminated histoplasmosis in a renal allograft recipient using a short course (14 days) of amphotericin B in combination with prolonged therapy (161 days) with ketoconazole. This regimen should decrease the risk of antibiotic induced nephrotoxicity, but it requires further study….

Case Report

Retrocardiac Densities Due to Paraesophageal Varices Roentgenographic Detection

SUMMARYWe have described a patient with portal hypertension and retrocardiac paramediastinal density on upright PA chest x-ray film. Splenoportograms showed this density to be paraesophageal collateral veins.

Case Report

Malignant Histiocytosis Appearing as Cold-Agglutinin Disease

Case Report

Ovarian Torsion Diagnosed by Ultrasonography

Case Report

Multivessel Resolution of Coronary Artery Stenosis

Case Report

Peripheral Neuropathy With Hypophosphatemia in a Patient Receiving Intravenous Hyperalimentation

SUMMARYWe have described a patient receiving intravenous hyperalimentation in whom hypophosphatemia resulted in a neurologic syndrome characterized by ophthalmoplegia, ataxia, and areflexic paralysis of all extremities, requiring respiratory assistance. We have discussed pertinent literature related to neurologic dysfunction as a result of hypophosphatemia.

Case Report

Abdominal Tuberculosis Mimicking Neoplasia on Computerized Tomography

Case Report

Unusual Variant of Eosinophilic Fasciitis

SUMMARYWe have reported an unusual case of eosinophilic fasciitis with a prolonged prodrome of asymptomatic eosinophilia, episodic extremity swelling, and extreme eosinophilia. Such a case has not previously been reported.

Breif Report

Indomethacin-Induced Renal Insufficiency Recurrence on Rechallenge

Breif Report

Spontaneous Hemopneumothorax Requiring Thoracotomy

SUMMARYA spontaneous pneumothorax complicated by severe bleeding presents a potentially grave emergency. If bleeding continues, thoracotomy becomes necessary to control the hemorrhage, to evacuate residual blood and clots, and to repair the break in the continuity of the lung.

Breif Report

Spontaneous Hemothorax in a Patient With Osier-Weber-Rendu Disease

SUMMARYWe have reported a case of spontaneous hemothorax as a rare complication of Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia). Because of the possibility of confusion with pulmonary infarction and its attendant treatment with anticoagulants, physicians should be aware of possible hemothorax in Osler-Weber-Rendu disease.

Breif Report

Vernix Gaseosa Granuloma A Rare Complication of Cesarean Section

SUMMARYWe have described a case of vernix caseosa granuloma after cesarean section in a young woman. The granuloma necessitated a second laparotomy and bowel resection. Review of the literature failed to reveal a similar complication after cesarean section.

Breif Report

Progressive Destruction of the Hip Joint Due to Klebsiella Osteomyelitis

Breif Report

Metastatic Oat Cell Carcinoma of the Lung Producing Extrahepatic Bile Duct Obstruction

SUMMARYAlthough carcinoma of the lung metastatic to the pancreas is not unusual in autopsy series, it is rare as a cause of extra-hepatic bile duct obstruction among the living. We have reported two cases of oat cell carcinoma of the lung in which the first sign of metastatic disease was…

Letter to the Editor

Recurrent Laryngospasm A Neglected Symptom of Hypoparathyroidism

Letter to the Editor

Rhinosporidiosis

Letter to the Editor

Use of Cimetidine

Letter to the Editor

Tetanus Immunization of the Elderly

Letter to the Editor

Die Wacht am Rhine

Letter to the Editor

“Spigelian Hernia”