SMJ // May 1986, Volume 79 - Issue 5
Primary Article
Mortality From Presenile and Senile Dementia in the United States
ABSTRACT: From 1968 through 1973, 1,915 deaths in the United States were attributed to senile dementia, and 1,463 deaths were attributed to presenile dementia. The corresponding average annual age-adjusted mortality rates per million population (adjusted to the 1970 US population) were 5.2 and 3.9, respectively, suggesting considerable underreporting. In view…
Primary Article
Excess Medical Care of Women With Somatization Disorder
ABSTRACT: We compared 50 women with somatization disorder to 25 women with major depression. The somatizers had three times as many operations and hospitalizations as the depressed women. Hospitalizations for headache and backache, abdominal and pelvic operations, and radiologic studies for abdominal complaints occurred frequently in the somatizers. Important factors…
Primary Article
Hepatotoxicity After Long-Term Methotrexate Therapy
ABSTRACT: To reassess the need for repeat liver biopsies in patients receiving long-term methotrexate therapy, we reviewed the results of 15 biopsies in 14 such patients seen from 1979 to 1984 at the Medical University of South Carolina. Significant changes in liver histology were found in seven patients. These findings…
Primary Article
Kaposi’s Sarcoma: A Comparative Analysis in 17 White and 19 Black Patients
ABSTRACT: Kaposis sarcoma is a multicentric, malignant, neoplastic process that manifests itself as multiple vascular tumors. We present a comparative, retrospective analysis of demographic and survival data involving patients with Kaposis sarcoma seen at Charity Hospital, New Orleans, over a 35-year period. The proportion of blacks and women is significantly…
Primary Article
Cystosarcoma Phyllodes
ABSTRACT: We present four cases of cystosarcoma phyllodes in which mammograms revealed a small or large lobulated mass occupying the entire breast. Preoperative diagnosis was a benign lesion with a low probability of nodular carcinoma. Histologically, all tumors were classified as malignant. Although uncommon, cystosarcoma should be considered in the…
Primary Article
Postoperative Pain Relief: A Double-Blind Comparison of Dezocine, Butorphanol, and Placebo
ABSTRACT: The safety and efficacy of single intramuscular doses of dezocine (10 or 15 mg) were compared with butorphanol (2 mg) and placebo in 157 patients with moderate to severe postoperative pain. A verbal pain intensity scale, an analog pain intensity scale, and a verbal pain relief scale were used…
Primary Article
Nerve Root Cut-off on Metrizamide-Enhanced Computerized Tomography
ABSTRACT: The “wink” sign of nerve root cut-off seen on metrizamide-enhanced computerized tomography correlates well with compression of a lumbar nerve by a herniated disk. Seven of 46 patients had normal or equivocal myelograms, but had definite nerve root cut-off on metrizamide-enhanced CT scan. All seven patients were found to…
Primary Article
Fetal Distress After Hydralazine Therapy for Severe Pregnancy-Induced Hypertension
ABSTRACT: Hydralazine is the most commonly used antihypertensive agent for patients with severe toxemic states. Its use, however, can produce hypotension and acute uteroplacental insufficiency, resulting in fetal distress. Our review of hospital charts of severely preeclamptic or eclamptic patients observed during a two-year period showed that 24 of 77…
Primary Article
Hyperfibrinogenemia as a Cause of Prolonged Thrombin Clotting Time
ABSTRACT: Recognized causes of a prolonged thrombin clotting time (TCT) include a decreased plasma fibrinogen level, dysfibrinogenemia, paraproteinemia, heparin contamination, elevated levels of fibrin degradation products, and liver failure. We have frequently seen patients with an isolated prolonged TCT in the absence of any of these conditions and without obvious…
Primary Article
Detection and Quantitation of Fetomaternal Hemorrhage
ABSTRACT: Failure to administer additional doses of Rh immune globulin (RhIG) to patients with excessive fetomaternal hemorrhage (FMH) is one of the causes of continued Rh isoimmunization. We compared the fetal cell ratio (FCR) with the other laboratory methods currently used at our hospital to quantitate FMH, ie, fetal cell…
Primary Article
Adnexal Torsion: A Mind-Twisting Diagnosis
ABSTRACT: We have reviewed cases of adnexal torsion surgically managed at Scott and White Clinic during the past seven years, and have found that a high index of suspicion is the clinicians best tool in diagnosing adnexal torsion.
Primary Article
Symptomatic Separation of the Pubic Symphysis
ABSTRACT: We present seven cases of pubic symphyseal discomfort in pregnancy or parturition. These patients were unable to walk and had other signs and symptoms similar to those of osteitis pubis. We differentiate this condition from classical osteitis pubis by the lack of a prolonged course, symptoms, and clinical findings…
Primary Article
Biliary Atresia: An Evolving Perspective
ABSTRACT: From 1967 to 1984, 50 of our patients with extrahepatic biliary, atresia had surgical exploration. Of 40 biliary drainage procedures, bile drained in 21 (52%). Thirty-four patients had portoenterostpmy, three had portocholecystostomy, and the most recent six patients had a valved hepatoduodenal conduit. Successful biliary drainage was related to…
Primary Article
Child Abuse Reporting by Physicians
ABSTRACT: Despite the prominent role of physicians in the child abuse reporting statutes of all 50 states, there is little published information concerning child abuse reporting by physicians. Our study examines the number and type of child abuse reports originating from physicians compared to other reporting sources. Reports by physicians…
Primary Article
Pseudo-occlusion of the Internal Carotid Artery How Not To Miss It
ABSTRACT: Although pseudo-occlusion of the internal carotid artery has been previously reported, it is not widely appreciated. The purpose of this report is to demonstrate methods of making the diagnosis. We present two cases illustrating the angiographic findings in pseudo-occlusion of the internal carotid artery. Its recognition is important to…
Primary Article
Analysis of Peritoneal Fluid in Urinary Ascites
ABSTRACT: Urinary ascites may be the most common cause of ascites in the neonate, and should be suspected in an infant with abdominal distention, oliguria, hyponatremia, and hyperkalemia. The diagnosis is confirmed when analysis of the peritoneal fluid shows creatinine, urea, and potassium concentrations higher than corresponding serum concentrations. The…
Primary Article
Internship: What Is Stressful?
ABSTRACT: We periodically evaluated 27 interns for mood states and psychophysiologic functions during their internship year. At the end of the year they were questioned as to what they had found to be stressful and/or supportive during the year. Stressful issues were inadequate sleep, inadequate time to pursue personal matters,…
Review Article
Pseudoseizures: An Overview
ABSTRACT: Pseudoseizures, formerly called hysterical seizures, have become an acknowledged clinical entity in their own right. Diagnosis of pseudoseizures is a complex process; depending primarily on clinical neurologic observation of the spell pattern and negative response to anticonvulsant therapy. Diagnosis is aided by psychiatric evidence of psychopathology, and in difficult…
