SMJ // October 1986, Volume 79 - Issue 10
Primary Article
Treatment of Gastrointestinal Cancer: The Southeastern Cancer Study Group Experience, 1979 to 1983
ABSTRACT: The treatment of gastrointestinal cancer was studied in 20 phase I, II, and III clinical trials from 1979 to 1983 at 30 member institutions of the Southeastern Cancer Study Group (SECSG). These studies used both new and commercially available drugs, as well as surgery and/or radiation therapy in 1,087…
Primary Article
Dietary Fiber: Its Role in Preventing Gastrointestinal Disease
ABSTRACT: Only in relatively recent years has the role of dietary fiber, once thought to be an unnecessary and even undesirable by-product, begun to be appreciated in the maintenance of health. Research now indicates that a deficiency of fiber in the modern western diet may contribute to a host of…
Primary Article
Effects of Intensified Practitioner-Patient Communication on Control of Diabetes Mellitus
ABSTRACT: Control of diabetes mellitus requires active participation of patients in self-care and ongoing support from medical professionals. This study examines the hypothesis that control of diabetes can be improved by more frequent communication between patients and medical professionals. We instructed 233 insulin-requiring diabetic patients to mail the results of…
Primary Article
Erythroderma: Review of 82 Cases
ABSTRACT: We reviewed 82 cases of erythroderma, including clinical, laboratory, and biopsy material. The diseases most commonly associated with erythroderma were drug eruptions (34%), preexisting dermatoses (30%), and lymphoreticular neoplasms (20%), especially cutaneous T cell lymphomas (CTCL). The prognosis was related to the associated process; all deaths occurred in the…
Primary Article
Snowflake Degeneration: An Independent Entity or a Variant of Retinitis Pigmentosa?
ABSTRACT: We examined eight members of three generations of a family with a history of hereditary retinal degenerative disease. Four affected members have multiple whitish retinal dots resembling snowflakes. Other positive ocular findings in the four members with retinal flakes include myopia, cataract, fibrillary vitreous degeneration with occasional strands, attenuated…
Primary Article
Glaucoma Management in Pseudophakia
ABSTRACT: The ever-increasing number of cataract extractions followed by insertion of intraocular lenses has resulted in the emergence of a new group of patients with severe glaucoma. A series of 41 patients (45 eyes) referred for evaluation and management of uncontrolled glaucoma in pseudophakia is presented. Glaucoma had preexisted in…
Primary Article
Diabetes Mellitus and Hypertension in Black and White Populations
ABSTRACT: The occurrence of hypertension in the presence of diabetes mellitus was evaluated in a study of black and white populations in separate hospitals for one fiscal year, Each population was sufficiently large to be significant (blacks, 6,491 and whites, 16,184). Hypertension and diabetes mellitus each occur about twice as…
Primary Article
Drug Overdose: Changing Concepts for Modern Drugs
ABSTRACT: Chart review of all patients admitted over a six-month period to the University of Missouri-Columbia Medical Intensive Care Unit after intentional drug overdose revealed that the drugs ingested today are quite different from those used five to 20 years ago. I selected for review cases representative of overdose with…
Primary Article
Aphasic Syndromes and “Psychiatric” Symptoms: Diagnostic Dilemmas
ABSTRACT: Behavioral syndromes that occur in patients with aphasic disorders without localizing neurologic signs may appear strikingly similar to psychiatric disorders. In the absence of abnormal physical findings, the predominance of psychiatric symptoms, such as avoidance/withdrawal, irritability/hostility, paranoia, or depression, can lead the busy primary care clinician and the unsuspecting…
Primary Article
Infection Versus Disease Activity in Rheumatoid Arthritis: Eight Years Experience
ABSTRACT: Septic arthritis is a serious and sometimes fatal complication of rheumatoid arthritis. We have examined the clinical characteristics of 16 patients with infectious arthritis seen during an eight-year period. This represented 0.5% of all admissions to our hospital for patients with rheumatoid arthritis. Although rheumatoid arthritis is considered a…
Primary Article
Influencing Physician Distribution in the South Lessons From a Study in Texas
ABSTRACT: Analysis of recent and projected trends in the geographic distribution of Texas physicians indicates that maldistribution may continue to be a problem into the foreseeable future. A survey of manpower officials in other southern states and a review of research on the effectiveness of various policy interventions reveals that…
Primary Article
Mezlocillin Prophylaxis Against Infection After Cesarean Section: A Comparison of Techniques
ABSTRACT: We studied 212 patients undergoing emergency cesarean section at an urban hospital. Four techniques of antibiotic prophylaxis were used, including single-dose and triple-dose parenteral therapy, parenteral and lavage therapy, and lavage therapy alone. One agent, mezlocillin, was used for all patients. There was no significant difference in surgically related…
Primary Article
Total Hip Arthroplasty: Comparison of Infection Rates in a VA and a University Hospital
ABSTRACT: We reviewed charts of total hip arthroplasties from a ten-year period (January 1973 through December 1982) to determine the rate of infection at the Birmingham Veterans Administration Medical Center. Of 321 procedures, 296 were reviewed (92%). Overall, there were 24 infections (8.1%), 13 of which (4.4%) were deep infections….
Primary Article
Renal Tubular Acidosis in Infancy: A Clinical Approach to Diagnosis and Treatment
ABSTRACT: Renal tubular acidosis is defined as the failure of the kidneys to respond appropriately to systemic acidosis. The usual criterion for diagnosis involves titration curves to establish renal bicarbonate threshold. This evaluation is time consuming, expensive, and probably avoidable in selected patients. We report four cases in which a…
Primary Article
Forearm Neuropathy and Pruritus
ABSTRACT: Five adult patients (four of them men) had episodic brachioradial pruritus associated with forearm paresthesia and hypalgesia. No cervical, shoulder, or forearm trauma was known. Onset was variable, but two had had the condition for more than ten years. In each, sensory alteration was detectable by pinprick and temperature…
Primary Article
Prostatic Ultrasonography. Applicability in a Small Hospital
ABSTRACT: This paper reports the results of a prospective study undertaken to assess the applicability of prostatic ultrasonography in a small community hospital, and to determine the accuracy and technical feasibility of sonographic imaging using contact scanning technique.
Review Article
Endurance Athletes: Physiologic Changes and Nonorthopedic Problems
ABSTRACT: The current increased participation in long distance running and endurance events brings new challenges to the physician. Adaptive changes of exercise must be differentiated from disease states. Left ventricular hypertrophy, Wenckebach rhythm, elevated creatine kinase (myocardial fraction), gastrointestinal bleeding, hematuria, hemoglobinuria, amenorrhea, and apparent anemia may all be exercise…
Current Concepts
Diagnosing Depression in Primary Care: A Practical, Interdisciplinary Review and a Call for Change
ABSTRACT: Because recognizing depression is of critical importance, we have organized a comprehensive review of current literature on medical, psychiatric, and behavioral science to give primary care physicians a brief, practical, and multidisciplinary survey of diagnostic approaches to depression. The review is also designed to help clarify the disparate approaches,…
Article
Medical Malpractice and the Primary Care Physician: Lowering the Risks
ABSTRACT: The medical malpractice crisis is gaining increasing attention in the United States today. Before the early 1970s, physicians in primary care specialties considered themselves safe from the threat of malpractice suits. Today, however, primary care physicians are being named as defendants in malpractice suits at an accelerating rate. After…
