SMJ // March 1985, Volume 78 - Issue 3
Primary Article
Psychiatric Disorders in Geriatric Medical/Surgical Patients Part I
We reviewed psychiatric consultations (N = 195) for patients aged 60 years or more from a consecutive series of 1,000 psychiatric consultation requests. Consultations for geriatric patients were requested disproportionately less frequently than for nongeriatric patients and significantly more frequently for elderly women than for elderly men. The most frequent…
Primary Article
Use of Hypnosis for Improving Medication Compliance in Psychiatric Patients
Factors involved in failure to comply with medication regimens may be divided into four categories: patient characteristics, physician-patient relationship, psychosocial environment, and treatment regimen features. Although several methods aimed at improving medication compliance have been described in the literature, hypnosis was not among them. Three cases in which hypnosis was…
Primary Article
Medical Interview of Sexually Abused Children
Physicians seeing sexually abused children in their practices often fail to recognize the abuse. Recognizing the frequency of child sexual abuse and variety of presentations will alert physicians to seek explanation. Physicians should know the common behavior of perpetrators and how to encourage children to reveal and describe the abuse….
Primary Article
Biologic Implications of Steroid Hormone Receptors in Cancers of the Colon
In follow-up investigations on 41 patients with primary cancer of the colon that had been assayed for the presence of steroid-binding activity, six of eight patients whose tumors showed steroid-binding activity for at least one steroid were free of disease one to three years postoperatively. In contrast, only two of…
Primary Article
Retrograde Endoscopy of the Bypassed Stomach Segment After Gastric Bypass Surgery Unexpected Lesions
Surgical measures for the treatment of morbid obesity include gastric bypass of the stomach and duodenum. We endoscopically evaluated the bypassed segments in 51 patients three to 24 months after a standard gastric bypass procedure. Retrograde endoscopy was successful in 33 of the patients (65%). There was significantly more gastritis…
Primary Article
Hepatic Trauma Evaluation of Routine Drainage
Routine drainage of liver wounds created by trauma has recently been challenged, prompting a prospective, randomized trial of drainage via a Penrose dam versus no drain in patients having emergency laparotomy for abdominal trauma. We excluded cases in which definite bile leak was noted at operation. Of 167 patients studied,…
Primary Article
Treatment of the Ruptured or Exposed Carotid Artery A Rational Approach
Review of 15 cases of carotid artery exposure or rupture in patients with no recurrent tumor demonstrated several important principles. Irradiation was a risk factor in 90% of cases of carotid blowout. Only one of five patients (20%) with carotid exposure who had not had irradiation had carotid perforation. Immediate…
Primary Article
Effect of Nasal Surgery on Snoring
When 113 patients who had had nasal surgery for chronic obstruction were questioned about their snoring habits before and after operation, 42% said they had snored before nasal surgery. Of that group, 77% had either elimination or improvement of snoring after nasal surgery. Nasal obstruction is one of several factors…
Primary Article
Management of the Chronically Draining Ear
Management of the chronically draining ear requires careful assessment as to the source and predisposing factors leading to recurrent infections. Surgery should be planned to remove all irreversible disease and to seal the middle ear in a single operation, whether this requires a simple myringoplasty or extensive mastoidectomy, ossicular chain…
Primary Article
Esthesioneuroblastoma Diagnosis and Management
Esthesioneuroblastoma is an uncommon nasal tumor originating from cells of neural crest origin. An increased awareness of this neoplasm by clinicians and pathologists has led to an increase in its diagnosis. In the Department of Otolaryngology—Head and Neck Surgery at the University of Virginia Medical Center, 22 cases have been…
Primary Article
Do Brown Recluse Spider Bites Induce Pyoderma Gangrenosum?
Brown recluse spider bites are usually self-limited skin lesions that infrequently progress to bullae, ulceration, and scarring. We treated a patient with a documented brown recluse bite who had recurring lesions resembling pyoderma gangrenosum (PG) that persisted for months. Three other patients referred to Vanderbilt University because of probable brown…
Primary Article
Laser Iridotomy for Management of Angle-Closure Glaucoma
In this series, laser iridotomies were produced in 112 eyes, with a minimum of six months follow-up. Despite the need to reopen some laser-produced iridotomies, it has proved to be safe and effective therapy. When the cornea is clear, laser iridotomy is an alternative to surgical iridectomy and can be…
Primary Article
Chest Wall Masses in Children
A hard, fixed mass on the chest wall is usually considered to be malignant. Of 24 such lesions we have evaluated in children, only eight (33%) were malignant. Six of the eight children with malignant masses died of the disease. Benign lesions were often indistinguishable from malignant lesions by physical…
Primary Article
Computerized Tomographic Evaluation of Aortic Prosthetic Graft Complications
Computerized tomography has been found to be an accurate and sensitive method of diagnosing complications of synthetic aortic grafts. Complications in our series of four cases included aortoesophageal fistula, aortoduodenal fistula, pseudoaneurysm, and retroperitoneal hematoma.
Primary Article
Diagnosis of Bacterial Meningitis in Previously Treated Children
We reviewed the charts of 115 children with the clinical diagnosis of bacterial meningitis admitted to our hospital over a period of eight years. Of these, 47 patients had received antimicrobial agents before hospitalization and eight (17%) of them had negative cerebrospinal fluid (CSF) cultures. These eight children, however, had…
Primary Article
Segmental Spinal Instrumentation
Over a 21/2 -year period, I have treated 25 patients with segmental spinal instrumentation (SSI), using paired-wired Luque rods. Of 13 patients with unstable spinal fractures, seven were paraplegic. Nine had idiopathic scoliosis, and three had neurogenic scoliosis. Significant loss of correction after SSI occurred in five of the nine…
Primary Article
Intestinal Salmonella Carriage in Patients With Major Sickle Cell Hemoglobinopathies
The increased incidence of Salmonella osteomyelitis in patients with sickle cell disease has never been entirely explained. Problems such as cholelithiasis, intestinal infarction, and frequent antibiotic use in this population could possibly result in prolonged or chronic intestinal carriage of Salmonella after acute gastroenteritis. If prolonged carriage were a factor…
Primary Article
Primary Esophageal Motor Disorders Clinical
The effect of nifedipine on esophageal symptoms was evaluated in 20 patients with primary esophageal motor disorders. The patients were randomized to receive nifedipine (10 mg t.i.d;) or placebo for two weeks, and then crossed over to receive the other medication. Ten patients had hypertensive lower esophageal sphincter, four had…
Primary Article
Essential Vocal Tremor Clinical Characteristics and Response to Therapy
We evaluated four patients with an initial and predominant voice tremor. All were referred for evaluation for suspected parkinsonism, though vocal tremor was the only symptom. These three women and one man ranged in age from 37 to 59 years. Neurologic evaluation and laryngeal examination were unremarkable. No signs of…
Primary Article
Nephrotoxicity From Nonsteroidal Anti-inflammatory Drugs
We categorize the three types of renal dysfunction associated with the use of nonsteroidal anti-inflammatory drugs (NSAID): acute renal failure, acute interstitial nephritis, and hyperkalemia. The paper provides clinical examples of each type, discusses pathophysiology, and describes response to therapy, in addition to outlining the usefulness of labeled leukocyte nuclear…
Primary Article
Contraceptive Use in Georgia Estimation by Telephone Survey
Because household surveys are expensive and time consuming, determination of state or local family planning needs is based on national household survey estimates of contraceptive use rather than state-specific estimates. In June 1982, the University of Georgia Survey Research Center invited the Georgia Department of Human Resources (DHR) to add…
Current Concepts
Multiple Systems Organ Failure Is It a Specific Entity?
Multiple systems organ failure (MSOF) is a relatively new clinical syndrome that should be considered as a unified and identifiable clinical condition. In many ways it is a product of the technologic advances developed in the last few years to treat seriously ill patients. Failing respiratory, renal, and cardiovascular systems…
Article
Health Precautions for Travelers to Mexico
After Canada, Mexico is the most popular destination for Americans traveling outside the United States. As a developing country, Mexico presents numerous health hazards to American visitors, including the prevalent travelers diarrhea (turista), from which 40% will suffer, and the less common typhoid, dengue, rabies, malaria, taeniasis, cysticercosis, and trichinosis….
