SMJ // February 1985, Volume 78 - Issue 2
Primary Article
Complex Thoracic Wounds: Muscle and Musculocutaneous Anatomy in Closure
ABSTRACT: Closure of the infected sternotomy has been facilitated by the use of the pectoralis major musculocutaneous flap and has been well described. This paper describes six cases of more complex infected thoracotomies and the methods of closure. Knowledge of the dual blood supply of many of the thoracic musculocutaneous…
Primary Article
Surgically Correctable Fecal Incontinence
ABSTRACT: A significant percentage of children who are fecally incontinent are so from improper operation or failure to recognize a surgically correctable problem. Over the past five years, we have managed ten children who had operations for anorectal problems and two with anterior anus. Seven were seen after poorly positioned…
Primary Article
Cholangiography and Bile Cytopathology in the Diagnosis of Biliary Tract Obstruction
ABSTRACT: Both percutaneous and endoscopic cholangiography identify strictures, stones,and other causes of biliary obstruction. With a radiologic diagnosis, benign and malignant causes of biliary obstruction can often be differentiated, but cholangiography does not provide a pathologic diagnosis. Therefore, we recommend cytologic excamination of bile obtained during cholangiography to provide pathologic…
Primary Article
Liver Cirrhosis and Biliary Surgery Assessment of Risk
ABSTRACT: Operations on the biliary tract in cirrhotic patients are reported to have a higher than normal risk of operative morbidity and mortality. We reviewed 39 cases from two university-based hospitals over a five-year period. Each patient had biliary tract surgery and biopsy-proven cirrhosis. Eight patients died (21%), and major…
Primary Article
Percutaneous Transhepatic Catheterization in Reconstructive Surgery of the Biliary Ducts
ABSTRACT: Preoperative placement of a No. 9 percutaneous transhepatic drainage catheter for two to three weeks greatly improves the condition of the patient who has suffered operative damage to the hepatic bile ducts. At operation the previously placed catheter serves to identify the proximal portion of the damaged bile duct,…
Primary Article
Carcinoma of the Duodenum
ABSTRACT: Primary duodenal carcinoma is an uncommon tumor that tends to be diagnosed late in its course because of a symptom complex compatible with many benign diseases. We reviewed the cases of five patients with duodenal adenocarcinoma treated at Norfolk General Hospital from 1973 to 1983. Periampullary tumors were excluded….
Primary Article
Inadequate Tetanus Protection Among the Rural Elderly
ABSTRACT: Three cases of tetanus occurring in a community in southern West Virginia in five years prompted a survey of. the immunization status of the population of this region. An immunization history was obtained from 540 consecutive patients seen at three different health care facilities. Of these, 386 (71.5%) had…
Primary Article
Hand Infections in the Elderly
ABSTRACT: Diagnosis and management of hand infections in the elderly can be challenging. The general principles of rest, elevation; compresses, and drainage when appropriate apply. Antibiotics are important to therapy. Review of data from elderly patients and comparison with a younger population having identical infections show a number of important…
Primary Article
Type 8 Pneumococcal Pneumonia: An Outbreak on an Oncology Ward
ABSTRACT: An outbreak of four cases of type 8 Streptococcus pneumoniae pneumonia occurred on an Oncology Ward during a five-day period. All four patients had underlying malignancy and were in close proximity to each other on an open ward. No other patients or hospital personnel had type 8 S pneumoniae…
Primary Article
Health Beliefs, Compliance, and Control of Diabetes Mellitus
ABSTRACT: The problem of compliance and control in the treatment of diabetic patients is widely recognized. However, compliance research is contradictory and impractical as a basis for intervention to improve the patients adherence to his medical regimen. Health beliefs may provide an opportunity to intervene to improve compliance and control…
Primary Article
Initial Experience With a New Prosthetic Angioaccess Device
ABSTRACT: Long-term vascular access has increased longevity for many patients with end-stage renal disease. Much of the hospitalization in this group of patients continues to be for maintenance of reliable vascular access. Thrombosis, infection, aneurysm, and stenosis lead to serious morbidity. The Hemasite angioaccess system has been introduced in an…
Primary Article
Brain Metastasis: Analysis of Patients Without Known Cancer
ABSTRACT: Our retrospective review of the charts of patients receiving radiation therapy for brain metastasis revealed that one third presented neurologic symptoms without prior diagnosis of cancer. Lung cancer was detected in two thirds of this group, and in one third, the primary site remained unknown. There was good clinical…
Review Article
Primary Sclerosing Cholangitis
ABSTRACT: Primary sclerosing cholangitis is a chronic, cholestatic disease affecting the biliary tree. Recent data suggest an autoimmune etiology. Clinical findings, roentgenographic characteristics, and compatible liver histology will help in establishing the diagnosis. There is no known treatment for cure, though relief of symptoms may be accomplished with certain drugs,…
Article
Defense Against Nuclear Weapons: A Decision Analysis
ABSTRACT: Response to the public health threat posed by nuclear weapons is a medical imperative. The United States, in contrast to other nations, has chosen a course that assures maximal casualties in the event of a nuclear attack, on the theory that prevention of the attack is incompatible with preventive…
