Issue - Southern Medical Association

Editorial

WHO IS GOING TO LIMIT (RATION) WHOSE MEDICAL CARE?

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…

Evagations

IDIOPATHIC

Case Report

Primary Adamantinoma of Rib: Thoracic Manifestations of a Rare Bone Tumor

Case Report

Exercise Radionuclide Angiography and Thallium Scintigraphy in Anomalous Coronary Anatomy

Case Report

Gastric Neurofibroma in an Adolescent

Case Report

Displacement of Mediastinal Clips by Postoperative Mediastinal Hemorrhage

Case Report

Mesenteric Artery Aneurysms

Case Report

Herpes Without Vesicles: Limited, Recurrent Genital Lesions in an Immunodebilitated Host

Case Report

Unusual Pulmonary Lesion of Vascular Origin A Noninvasive Diagnostic Approach

Case Report

Sonographic Diagnosis of a Liver Cell Adenoma

Case Report

Infarction of an Epiploic Appendix

Case Report

Malignant Fibrous Histiocytoma Manifesting as a Cavitary Lung Metastasis

Case Report

CT Diagnosis of Torsion of Benign Cystic Teratoma of the Ovary

Breif Report

Vancomycin-Induced Vasculitis

Breif Report

Pseudallescheria boydii Infection of the Central Nervous System in a Cardiac Transplant Recipient

Breif Report

Late Perforation by Pacemaker Catheter Loop in the Neck: A Preventable Complication of the External Jugular Approach

Breif Report

Trigerminal Teratoma of the Tonsil

Breif Report

Influence of Mitotane on the Hypoprothrombinemic Effect of Warfarin

Letter to the Editor

Methyldopa-lnduced Skin Rash

Letter to the Editor

Warfarin Sodium Therapy for Chronic Urticaria and Angioedema

Letter to the Editor

“Diabetic Foot” Complicated by Pneumococcal Cellulitis

Letter to the Editor

Fever and Petechiae in an Infant With Pneumococcal Bacteremia