Issue - Southern Medical Association

Editorial

PEDDLERS IN THE MARKETPLACE

Editorial

PUBLISH OR PERISH

Article

Splenic Injuries in Adults Selective Nonoperative Management

ABSTRACTAlthough nonoperative management is the standard initial treatment in children with splenic injury, this therapeutic option has been exercised infrequently in adults. Over the past two years we have hospitalized and observed 11 hemodynamically stable adults with splenic trauma and no other significant injury. Ten patients, sustained blunt trauma localized…

Article

Breast Cancer Presentation and Prognosis in the Community Hospital

ABSTRACTA retrospective analysis of all breast cancer primarily treated at this institution during the ten-year period from 1967 to 1977 revealed 336 cases; in 308 of these cases, complete follow-up of five or more years was available. Clinical staging using the TNM system (tumor, node, metastasis) showed stage I disease…

Article

Extrarectal Colonic Carcinoma Analysis of 138 Cases With Long-term Follow-up

ABSTRACTTo identify factors that determine long-term survival after resection of extrarectal colonic cancer, we analyzed 138 such patients operated upon in a five-year period. Because rectal tumors have lower survival rates, they were excluded hoping to enhance the prognostic accuracy of the study. The sigmoid colon was the most common…

Article

Squamous Cell Carcinoma of the Esophagus Continuing Poor Prognosis Among Veterans

ABSTRACTA retrospective analysis of 26 patients with squamous cell carcinoma of the esophagus treated at our center over a five-year period showed that the prognosis of this condition was still poor, with a mean length of survival of only 29 weeks after diagnosis; 88% of this period was spent in…

Article

Transthoracic Needle Aspiration Biopsy of Focal Pulmonary Lesions A Community Hospital Experience

ABSTRACTI reviewed my experience with transthoracic needle aspiration (TNA) biopsy in a community hospital. TNA is effective (91% diagnostic accuracy) and safe (28% incidence of pneumothorax, 6% requiring a chest tube for reexpansion). TNA has a definite role in the evaluation of selected patients with focal pulmonary lesions. Success and…

Article

Percutaneous Endoscopic Gastrostomy Technical Modifications for Improved Results

ABSTRACTPercutaneous endoscopic gastrostomy has gained acceptance as a primary means of placing enteral feeding tubes. Our adaptations of the basic technique lead to greater safety for and acceptance by the patient, long-term effectiveness of gastrostomy, and technical ease for the endoscopist.

Article

Cholelithiasis in Sickle Cell Anemia Surgical Considerations

ABSTRACTGallstones are frequently found in patients with sickle cell anemia. The differentiation between acute calculous biliary tract disease and sickle cell crisis can be difficult and should be based on the clinical presentation, comparison with previous episodes of abdominal pain, and judicious use of hepatobiliary radionuclide scanning. Emergency cholecystectomy is…

Article

Estimating Blood Supply of the Skin and Intestine With the Fluorescence Camera

ABSTRACTWe used fluorescein dye to evaluate the vascularity of flaps in 73 patients and of the left colon in 23 individuals after resection and replacement of the abdominal aorta. Instant photographs of the dye pattern were taken in the light using a specially modified Polaroid camera. All areas of skin…

Article

Norwalk Virus Outbreak at a College Campus

ABSTRACTAn epidemic of nonbacterial gastroenteritis affected nearly 100 students at a college campus in Jefferson County, Alabama. The outbreak closely resembled food poisoning, since there was a rapid occurrence of multiple cases within a short period. Vomiting occurred in 79% and diarrhea in 64%; fever was uncommon. We found a…

Article

Pyogenic Liver Abscesses in Nonimmunocompromised Children

ABSTRACTPyogenic liver abscesses are rare in previously healthy children. This review reports ten such cases of pyogenic abscess seen between 1963 and 1984. The mean age in these children was 6.3 years. One child died. Of the nine survivors, five had successful open surgical drainage. Two abscesses were drained percutaneously….

Review Article

Emphysematous Pyelonephritis Diagnosis and Treatment

ABSTRACTEmphysematous pyelonephritis is a rare life-threatening bacterial infection usually occurring in patients with diabetes mellitus and producing gas within the renal parenchyma and/or perirenal tissue. We add four cases to the 62 previously reported in the literature. The overall mortality is 38%, with only 29% survival for those treated medically…

Current Concepts

Newborn Metabolic Screening A Search for “Natures Experiments”

ABSTRACTThe rationale for metabolic screening includes discovery of new diseases, development of treatment methods, determination of the true incidence of disease in order to provide genetic counseling, and relief to the taxpayer when retardation is preventable. The number of diseases for which we can now screen is large and growing…

Current Concepts

Noninvasive Evaluation of Peripheral Vascular Disease Recent Advances and Future Implications

ABSTRACTNoninvasive diagnostic techniques have become a recognized adjunct in screening and follow-up of patients with peripheral arterial, venous, and cerebrovascular diseases. These techniques provide physiologic information at little or no risk to patients. Although primarily of diagnostic intent, these studies are also expanding our knowledge base about the natural history…

Article

New Medicare Criteria for Hospital Admission

Evagations

WARNING TRAINED ATTACK DOGS ON DUTY

Evagations

AIR TRAVEL

Case Report

Recurrent Bleeding From Meckels Diverticulum in an Adult Angiographic Demonstration After Normal Scans

SUMMARYWe have reported the case of a 26-year-old man who had had intermittent but severe gastrointestinal bleeding over a 30-month period from a Meckels diverticulum. Meckels diverticulum should be searched for angiographically, even in the face of normal isotopic scans, in cases of chronic or intermittent gastrointestinal hemorrhage, particularly in…

Case Report

Osseous Choristoma of the Tongue

SUMMARYI have reported three cases of asymptomatic osseous choristoma of the tongue and reviewed the 38 previously reported cases, 80% of which occurred in women and in patients less than 40 years old. Most osseous choristomas are located in the posterior third of the tongue and primarily in the vicinity…

Case Report

Adrenal Insufficiency Due to Invasion by Lymphoma Documentation by CT Scan

SUMMARYWe have presented the first documented description of the induction of adrenal failure from invasion by a lymphoma. Although adrenal involvement may be common in this disease, which often involves the retroperitoneum, adrenal failure is still unusual. Our case suggests that clinical suspicion must be heightened when lymphoma is present….

Case Report

Acute Leukemia in Patients With Breast Cancer

SUMMARYSymptoms related to pancytopenia were the earliest signs of acute myelogenous leukemia (AML) in two patients with breast cancer. Although some patients with breast cancer may be predisposed to AML, prolonged treatment with alkylating agents may be leukemogenic.

Breif Report

Fistulous Rheumatism

Breif Report

Maternal Ritodrine Hydrochloride Therapy Associated With Transient Leukemoid Reaction in the Infant

SUMMARYWe have described a preterm infant who had a transient self-limited leukemoid reaction apparently due to maternal ritodrine therapy.

Breif Report

Gastric Pneumatosis Intestinalis Associated With Cholangiocarcinoma

SUMMARYClassic roentgenographic features of gastric pneumatosis intestinalis in a 59-year-old woman were associated with gastric outlet obstruction due to cholangiocarcinoma. These findings must be distinguished from pneumoperitoneum.

Letter to the Editor

Interpreting EKGs

Letter to the Editor

Overdose With Baclofen

Author Index

AUTHOR INDEX