SMJ // April 1985, Volume 78 - Issue 4
Article
Improved Perinatal Knowledge in Community Hospitals Through a Self-Instructional Program
ABSTRACT: The Perinatal Continuing Education Program (PCEP) was conducted throughout South Carolina. The program was well received and greatly valued; however, participants requested more information covering obstetrics. To meet this need, we developed the Perinatal Education Program for Community Hospitals (PEPCH), patterned after and similar to PCEP, and tested it…
Article
Amniotic Fluid Embolism: Prophylaxis With Heparin and Aspirin
ABSTRACT: The thromboplastic activity of amniotic fluid (AF) from women in labor may be a significant factor in amniotic fluid embolism (AFE) and obstetric disseminated intravascular coagulation (DIC). Infusion of AF from women in labor into laboratory animals was found to depress the platelet count, as seen in DIC. In…
Article
Simultaneous Antepartum Testing of Twin Fetal Heart Rates
ABSTRACT: Assessment of twin gestation in the antepartum period has been a problem because most methods either fail to distinguish twins individually or require serial study over several weeks before reaching diagnostic end points. Electronic monitoring of the fetal heart rate (FHR) allows individual focus on each twin with a…
Primary Article
Painful Crises and Menstruation in Sickle Cell Disease
ABSTRACT: Fifty-two women with sickle cell disease, having genotypes of hemoglobin SS, SC, and S-thalassemia, participated in a questionnaire study pertaining to the relationship of their menses and the occurrence of painful crises. The data indicated that those patients who had sickle cell crises were significantly older and had been…
Primary Article
Intracranial Tuberculosis: Manifestations on Computerized Tomography
ABSTRACT: Intracranial tuberculosis is often insidious, may be difficult to diagnose clinically, and is neurologically devastating if untreated. The advent of computerized tomography has permitted earlier detection of the structural abnormalities associated with intracranial tuberculosis than was possible with older techniques. Correct radiologic interpretation can heighten the index of suspicion…
Primary Article
Mediastinal Tumors and Pseudotumors: Evaluation by Computerized Tomography
ABSTRACT: In this series, thorough evaluation of 250 mediastinal lesions by various diagnostic methods showed that contrast enhanced CT scans of the mediastinum were superior to other modalities in differentiation and precise localization of the various types of lesions. Such superior evaluation may have a profound effect on the management…
Errata
Correction
Primary Article
Psychiatric Disorders in Geriatric Medical/Surgical Patients Part II: Review of Clinical Experience in Consultation
ABSTRACT: Of a consecutive series of 1,000 psychiatric consultation requests, 195 were for patients 60 years of age or older. The most frequent psychiatric diagnoses assigned by the consultant were organic psychiatric and depressive spectrum disorders. This communication reviews frequently encountered syndromes and the other major clinical issues relevant to…
Primary Article
Medical Consequences of Eating Disorders
ABSTRACT: While much has appeared in the recent literature about various psychotherapeutic techniques used to treat eating disorders, little attention has been paid to the medical complications. Prominent among these are heart damage, failure of the endocrine system, infarction and perforation of the stomach after acute dilatation, multiple suicide attempts,…
Primary Article
Proper Management of Renal Artery Injury From Blunt Trauma
ABSTRACT: Blunt trauma to renal arteries often receives suboptimal management because of delayed diagnosis, incomplete preoperative evaluation, associated injuries, or unknown functional capacity of the contralateral kidney. We propose a rational treatment plan from an analysis of our three cases and a review of 118 cases. Two thirds of the…
Primary Article
Spigelian Hernia: Uncommon or Unrecognized?
ABSTRACT: Spigelian hernia may be a more common clinical entity than previously recognized or reported. We report seven cases, four diagnosed and treated in the past 12 months at a large military hospital. Diagnosis can be difficult because of failure to consider it, incomplete understanding of the anatomy, and the…
Primary Article
Syndactyly Reconstruction by a Modified Cronin Method
ABSTRACT: In 11 patients (1 to 28 years of age) having elective surgical release of congenital or burn syndactyly in 1982-1983, we used the modified Cronin method of web reconstruction with double opposing, inverted V-shaped flaps and full-thickness skin grafts. Postoperatively, the hands were splinted for three weeks, at which…
Primary Article
Infected Abdominal Aortic Aneurysm
ABSTRACT: In the surgical literature, 37 survivors of infected abdominal aortic aneurysmorrhaphy have been reported. The diagnosis is suspected if a patient with fever, leukocytosis, and abdominal pain is noted on physical examination to have a pulsatile abdominal mass. Confirmation is best obtained with computerized tomography and angiography. We used…
Primary Article
Effect of Alterations of Pleural Pressure on Cardiac Output
ABSTRACT: Cardiac output is determined by the interaction of cardiac pump function and the mechanical properties of the peripheral circulation that govern venous return. Increasing pleural pressure impedes peripheral venous return but aids cardiac ejection; on the other hand, decreasing pleural pressure can augment venous return but impedes the emptying…
Primary Article
Intracranial Complications of Ear Disease in a Pediatric Population With Special Emphasis on Subdural Effusion and Empyema
ABSTRACT: Between the years 1963 to 1982, 84 consecutive cases of intracranial complications of ear disease in pediatric patients were diagnosed and treated at the North Carolina Baptist Hospital. This group consisted of 65 patients with otitic meningitis, four with otitic brain abscess, four with otitic hydrocephalus, three with lateral…
Primary Article
Childhood Sarcoidosis in Arkansas
ABSTRACT: Sarcoidosis, a granulomatous disease of unknown etiology, is most often seen in young adults. Childhood cases have been reported primarily from Virginia, North Carolina, and South Carolina. Thirty children have been seen in Arkansas between 1957 and 1982, which suggests that the endemic area for childhood sarcoidosis should include…
Primary Article
Clostridial Sepsis: Unusual Clinical Presentations
ABSTRACT: We present four cases exhibiting the widely diverse nature of clinical infections due to anaerobic Clostridium perfringens. These cases exemplify the need for a thorough initial physical examination, immediate Gram staining of fluid from involved tissue, and recognition of the severity of the disease in any patient who has…
Primary Article
Patient-Physician Communication and Interaction: A Unifying Approach to the Difficult Patient
ABSTRACT: Many difficult patients encountered by the primary care physician may be understood in terms of severe unmet dependency needs. These patients often evoke negative feelings on the part of physicians. A mutual participation approach to the patient-physician relationship is a means of providing effective care for these patients, at…
Review Article
Relapsing Polychondritis
ABSTRACT: Relapsing polychondritis is an uncommon disease consisting of inflammation of the eyes, inner ears, cardiovascular system, and cartilaginous portions of the joints, respiratory tract, and external ear. Cutaneous manifestations are the presenting feature in more than 50% of patients. These usually consist of erythema, swelling, and pain, reflecting involvement…
Current Concepts
Reflux Esophagitis: An Update
ABSTRACT: In recent years, much has been learned about the pathogenesis, diagnosis, and treatment of gastroesophageal (GE) reflux disease. Mucosal resistance, gastric contents, esophageal acid clearance, gastric emptying, and incompetency of the lower esophageal sphincter are contributing factors to GE reflux. Use of the various diagnostic tests and an overview…
