SMJ // March 1986, Volume 79 - Issue 3
Primary Article
A Teaching Nursing Home: The Vanderbilt Experience
ABSTRACT: A program to provide exposure to geriatrics as a teaching nursing home project was initiated at a large urban university medical center. Positive experiences, changes of attitude, and personal growth were noted among those involved in teaching, learning, and care of patients. A description of the program, its expansion,…
Primary Article
Impact of Aminoglycoside Serum Assays on Clinical Decisions and Renal Toxicity
ABSTRACT: To determine whether serum aminoglycoside assays aided clinicians in treating infections and avoiding aminoglycoside nephrotoxicity, we reviewed the charts of patients treated with aminoglycoside antibiotics parenterally. We compared 78 episodes of aminoglycoside-treated infections during which serum assays were done (group B) to 51 episodes without serum assays (group A)….
Primary Article
Renal Revascularization for Preservation of Renal Mass and Function
ABSTRACT: We advocate renal revascularization for preservation pf renaj mass and function. That revascularization can improve glomerular filtration and reverse vasculogenic renal failure appears well established. Proper selection of patients appears to be the key for achieving improvement of renal function after renovascular reconstruction.
Primary Article
Clinical Characteristics of Hospitalized Diabetic Patients
ABSTRACT: In an inpatient diabetes control unit established to fulfill the special needs of hospitalized diabetic patients, 29% of the admissions were for control of diabetes. In 71 % the metabolic abnormalities of diabetes were incidental to the cause of admission. Of the first 232 patients, 162 had type II…
Primary Article
Diagnosis of Reactive Hypoglycemia: Pitfalls in the Use of the Oral Glucose Tolerance Test
ABSTRACT: The signs and symptoms of reactive hypoglycemia mimic the manifestations of other clinical disorders. The oral glucose tolerance test (OGTT) is a widely accepted diagnostic procedure to evaluate patients suspected of having reactive hypoglycemia. The reproducibility of the OGTT has not been previously assessed in a large group of…
Primary Article
Isolated Perfusion of Extremities for Metastatic Melanoma From an Unknown Primary Lesion
ABSTRACT: Since 1957, 822 patients with invasive malignant melanoma of the limbs were treated by regional perfusion at the Tulane Medical Center. Between 1958 and 1982, there were 32 patients with regional metastatic melanoma from an unknown primary site involving either the upper limb and axillary lymph nodes or lower…
Primary Article
Motorcycle-Associated Fatalities in Georgia, 1980-1981
ABSTRACT: In 1980-1981, 158 motorcycle-associated fatalities occurred in Georgia, accounting for an estimated 6,113 lost years of productive life. Death ratios were highest for men 20 to 29 years of age, and motorcycle-associated fatalities occurred most frequently during summer months, on weekends, and during afternoon and evening hours. Forty-six percent…
Primary Article
Prevalence of Health-Risk Behavior Among Seventh Grade Students in North Carolina
ABSTRACT: Data from 386 seventh grade students, 48% male and 65% white, were collected at two sites in North Carolina. The purpose of the study was to estimate the prevalence of alcohol and drug use among adolescents as part of a continuing study of preventive health behaviors. The data were…
Primary Article
Plastic and Reconstructive Surgery: Perspectives on Recent Advances
ABSTRACT: The challenging and rapidly developing field of plastic and reconstructive surgery warrants a brief introduction. To define the field, we can say that plastic surgery is clinical judgment, surgical techniques, and new frontiers.
Primary Article
Coronary Artery Bypass Surgery in Older Patients: Psychiatric Morbidity
ABSTRACT: Coronary artery bypass grafting in older patients usually results in a favorable surgical outcome. To assess whether age confers greater risk for postoperative psychiatric symptoms in these patients, we retrospectively examined 58 cases (mean age 62.5 years) comparing pertinent clinical features of the index patients to matched controls (mean…
Primary Article
Modified Thiersch Procedure With Silastic Mesh Implant: A Simple Solution for Fecal Incontinence and Severe Prolapse
ABSTRACT: Most of the surgical procedures proposed for the treatment of fecal incontinence associated with prolapse are associated with considerable morbidity and mortality. We used a modified Thiersch procedure with a Silastic mesh implant (Dow-Corning 501-3) on a series of 12 patients over a period of 2½ years. Nine patients…
Primary Article
Caring for the Patient With Multiple Somatic Complaints
ABSTRACT: Patients with multiple somatic complaints but little disease are commonly seen in most medical practices. Their behavior can be understood by considering the contribution of psychologic, perceptual, and social factors in the etiology and maintenance of the illness complaint. Because these patients cling to their symptoms, care rather than…
Primary Article
In Vitro Detection of Heparin-Induced Humoral Antiplatelet Activity
ABSTRACT: We investigated the etiology of thrombocytopenia, with or without platelet thrombi, occurring while patients are receiving parenteral heparin. We used two in vitro methods to.detect possible humoral factors in the sera of patients who became thrombocytopenic while receiving heparin. In the presence of heparin, four of four such patients…
Primary Article
Cystic Fibrosis in Adults: Delayed Diagnosis in Three Siblings
ABSTRACT: Cystic fibrosis (CF), which is transmitted as an autosomal recessive trait, is the most common lethal genetic disease in the United States. Median survival age for patients followed up at CF centers in the US is now 21 years. While the disease is diagnosed in most patients before the…
Primary Article
Treatment of Hypertension in the Elderly
ABSTRACT: We have evaluated the effectiveness of antihypertensive therapy for predominant systolic hypertension in 55 patients, aged 61 to 76 years, with untreated systolic blood pressures of at least 160 mm Hg and diastolic blood pressures less than 100 mm Hg. In this retrospective analysis, 41 of the patients had…
Primary Article
Effectiveness of Foaming Antacid in Relieving Induced Heartburn
ABSTRACT: A double-blind, placebo-controlled, randomized crossover study was made of 60 patients with chronic heartburn to test the efficacy of foaming antacid in promoting symptom relief. Heartburn was induced by a meal consisting of chili, black coffee, and a spicy tomato drink mix. Of the 60 patients, 40 (67%) had…
Review Article
Neuroleptic Malignant Syndrome
ABSTRACT: The neuroleptic malignant syndrome (NMS) is a rare but potentially lethal disorder associated with the administration of neuroleptic agents. This syndrome may be underdiagnosed because it is poorly understood and often unrecognized. It affects all age groups and has a 20% mortality. Presenting features include extrapyramidal symptoms, altered mental…
Current Concepts
Oral Sulfonylureas for the Treatment of Type II Diabetes: An Update
ABSTRACT: Oral hypoglycemic agents have been in clinical use since 1956 in the United States. Two new second-generation sulfonylureas, glipizide and glyburide, have been marketed recently. This article reviews the pharmacology of the oral sulfonylureas, compares the drugs from a safety and efficacy standpoint, and provides updated information regarding their…
Article
Time in Therapeutic Relationships: Myths and Realities
ABSTRACT: Both physicians and patients hold myths about the uses and value of time in therapeutic relationships. The realities about time differ. A review of studies of patient compliance and satisfaction with health care indicated that the amount of time spent with patients was not as important as the quality…
