SMJ // December 1986, Volume 79 - Issue 12
Primary Article
Ethics, Technology, and the High Cost of Dying A Public Forum
ABSTRACTTo increase public awareness of the complexity of the issues surrounding care for the terminally ill, a county medical society and a local hospital council co-sponsored a public forum in October 1985. Panel members discussed the case of a terminally ill cancer patient from the medical, psychologic, economic, legal, and…
Primary Article
Alcoholism The Missed Diagnosis
ABSTRACTPhysicians fail to recognize the early signs and symptoms of alcoholism in their patients. This results in delays in the proper diagnosis and treatment for alcoholism, the underlying cause for many common complaints. Reasons for missing the diagnosis include inadequate education opportunities for physicians in the field of chemical dependency,…
Primary Article
Infections of the Lower Extremities Due to Gas-Forming and Non-Gas-Forming Organisms
ABSTRACTFrom 1977 to 1984, 87 above- and below-knee amputations were done on 77 patients for ischemic ulcerations and gangrene of the lower extremities. The overall three-month mortality was 14% and was mainly related to generalized atherosclerosis. Patients having infections with gas formations were more likely to be diabetic (80% vs…
Primary Article
Bacteremia During Bronchoalveolar Lavage
ABSTRACTWe prospectively evaluated the incidence of bacteremia during fiberoptic bronchoalveolar lavage (BAL) and its relationship to postlavage symptoms in 12 volunteers. Qualitative and quantitative blood cultures were obtained before and during BAL. Three persons had qualitative blood cultures positive for organisms typical of normal skin flora. Quantitative blood cultures done…
Primary Article
Gram-Negative Bacillary Meningitis in the Adult Review of 39 Cases
ABSTRACTFrom 1976 through 1984, the period covered in this report, we reviewed our total experience with gram-negative meningitis in adult patients, looking especially at how treatment and mortality had changed. Thirty-nine adults had 45 episodes of gram-negative meningitis. Twenty-five patients had had a dura-arachnoid disruption, 12 a septic episode, and…
Primary Article
Splenorrhaphy in Patients With Abdominal Trauma
ABSTRACTSplenorrhaphy has become increasingly used for management of the traumatized spleen. This approach has been advocated to obviate the potential for fulminant postsplenectomy sepsis. We reviewed the records of 42 patients with penetrating or blunt trauma treated by splenectomy or splenorrhaphy at Norfolk General Hospital between 1979 and 1983. Twenty-six…
Primary Article
Major Surgical Procedures for Gynecologic Malignancy in Elderly Women
ABSTRACTWe review 89 patients more than 75 years old who had major operations for various gynecologic malignancies. The recent routine use of perioperative intensive care decreased hospital mortality from 8.9% to 3.2%, and helped in decreasing and anticipating intraoperative and postoperative cardiorespiratory complications. Availability of visiting nurses since 1980 decreased…
Primary Article
Gastric Bypass Surgery for Obesity Weight Loss, Psychosocial Outcome, and Morbidity One and Three Years Later
ABSTRACTIn two nonoverlapping cohorts of consecutive patients receiving gastric bypass for obesity, we interviewed 100 patients one year after operation and 60 patients at three years. Weight loss among patients in both cohorts averaged 45 kg; all had improved physical and emotional health, had stable marriages, and had made satisfactory…
Primary Article
Iatrogenic Hand Injuries in Outpatients
ABSTRACTPotentially serious iatrogenic hand injuries occurred in three patients in a general medicine practice. All resulted from technologic advances in patient care. Each resulted in substantial economic and emotional costs. One patient sustained a serious residual disability. Such injuries have rarely been reported in the past, but advances in medical…
Primary Article
Carotid Revascularization After Cervical Irradiation
ABSTRACTCarotid revascularization after cervical irradiation is often made more difficult by decreased vascularity, development of fibrosis, and loss of covering tissue by previous surgery. We present three cases to illustrate alternative approaches to carotid revascularization in these circumstances. One case describes the usual direct approach to carotid endarterectomy. The second…
Primary Article
Bolus Intramuscular Methylprednisolone Acetate as a Therapeutic Adjunct in Rheumatoid Arthritis
ABSTRACTEighty adult patients with classical or definite rheumatoid arthritis were given 200 bolus injections of intramuscular methylprednisolone acetate (MPA) over four years. This was used strictly as a therapeutic adjunct for polyarticular flares (≥5 swollen joints), not as a singular form of long-term treatment. Good clinical responses, lasting an average…
Primary Article
Hemoglobin E Another Cause of Microcytic Anemia in North America
ABSTRACTThe influx of Southeast Asians has expanded the differential diagnosis of microcytic, hypochromic anemia in this country. We describe four patients with hemoglobin E, all of whom had microcytic, hypochromic anemia. Hemoglobin E is benign in both the heterozygous and homozygous states. On routine hemoglobin electrophoresis at pH 8.4, hemoglobin…
Primary Article
Minnesota Multiphasic Personality Inventory as a Predictor of Operative Results in Thoracic Outlet Syndrome
ABSTRACTTwenty-one women and four men who had been operated upon for thoracic outlet syndrome were evaluated for symptom relief, and the results were blindly correlated with their scores on a Minnesota Multiphasic Personality Inventory (MMPI). Of the 14 patients who had abnormal results on the MMPI, five rated themselves improved,…
Review Article
Diethylstilbestrol in Pregnancy An Update
ABSTRACTSeveral decades ago, diethylstilbestrol (DES) was considered efficacious in improving pregnancy outcome. Later data did not support this, and the exposed mothers and offspring have suffered from a variety of problems attributed to the drug. Knowledge of these problems is essential in dealing with these patients.
Review Article
Neonatal Poisoning Causes, Manifestations, Prevention, and Management
ABSTRACTNeonates are exposed to a growing list of potentially toxic environmental and therapeutic agents. Such exposure may be through mishap, misjudgment in both drug dosage and route of administration, inadvertent misuse of medications, or improper baby care. In addition, the newborn infant may show signs of adverse reactions to a…
Current Concepts
Corticosteroids in the Treatment of Asthma
ABSTRACTCorticosteroid medications have been regularly used in the management of asthma for more than 30 years. Review of the published literature suggests that steroids may enhance sensitivity to β-adrenergic agonists and reduce local inflammation. These effects may not be clinically evident for six to 12 hours after steroid administration. Optimum…
Current Concepts
Anesthetic Management of Chemonucleolysis With Chymopapain
ABSTRACTChemonucleolysis and lumbar laminectomy after unsuccessful chemonucleolysis are now common and accepted surgical procedures that require precise perioperative management based on a thorough understanding of the pathophysiology of chymopapain-induced anaphylaxis and the herniating nucleus pulposus syndrome. Preoperative management with appropriate screening tests, antihistamines, and steroids, combined with thoughtful premedication and…
Medical Education
Intern Ranking Versus Subsequent House Officer Performance
ABSTRACTThe rankings of candidates for pediatric internship by the Pediatric Intern Selection Committee (ISC) of the University of Virginia Medical Center were compared with subsequent performance rankings of house officers by faculty members and chief residents. Although a positive correlation was found between the rankings, the absolute magnitude of the…
Case Report
Neuroleptic Malignant Syndrome Three Episodes With Different Drugs
SUMMARYThis is an illustrative case of a patient with neuroleptic malignant syndrome whom we believe is the first described in the worlds literature to have this syndrome on three occasions, each time after having received a different neuroleptic agent.
Case Report
Surgical Implications of Actinomycosis
Case Report
Multiple Pseudoaneurysms in a Tuberculous Patient
SUMMARYI have presented the case of a 20-year-old woman with tuberculous pseudoaneurysm of the innominate artery associated with another pseudoaneurysm of the abdominal aorta. I believe this is the first report of such a case in the literature.
Case Report
Malignancy Arising in the Transplanted Vagina
SUMMARYWith the increasing use of radical surgery for genital carcinoma in younger women, vaginal reconstruction is likely to be done more commonly. One of the complications to be considered is neoplasia arising in the vaginal graft. We have reported two cases of squamous cell carcinoma arising in a neovagina three…
Case Report
Carolis Disease New Diagnostic and Therapeutic Approaches
SUMMARYCystic dilatations of the intrahepatic and extrahepatic biliary trees are common congenital anomalies that frequently require surgical intervention. We have presented a case of Carolis disease in which an accurate diagnosis was made noninvasively preoperatively, using computerized tomography, ultrasonography, and cholescintigraphy.
Clinical Brief
Unrecognized Esophageal Placement of Endotracheal Tubes
SUMMARYUnrecognized esophageal placement of endotracheal tubes during general anesthesia or in apneic unanesthetized patients is not an uncommon occurrence. Allowing this mishap to proceed to asphyxia and catastrophe is inexcusable. If one is uncertain, proper placement can be quickly verified by mouth-to-tube insufflation of a subjects lungs with ones own…
Breif Report
Nasopharyngeal Dermoid With an Unusual Presentation
Breif Report
Infarction of the Quadriceps Muscle A Complication of Diabetic Vasculopathy
SUMMARYAccelerated atherosclerosis is a common and recognized complication of diabetes mellitus. We have reported the fifth case of spontaneous infarction of a portion of the quadriceps muscle group in a patient with diabetes mellitus.
