SMJ // June 1986, Volume 79 - Issue 6
Editorial
HEROES BESIEGED
Primary Article
Educating Medical Academicians: A Follow-up of the Vanderbilt Orthopaedic Training Grant
ABSTRACT: This study is the retrospective review of an orthopedic surgery training grant (USPHS Training Grant No. AM 05494) at Vanderbilt University that was funded from 1965 through 1969. This training grant was directed toward the production of academic orthopedic surgeons. The director of the training grant, J. William Hillman,…
Primary Article
Medical Care Costs Attributable to Cigarette Smoking in Kentucky
ABSTRACT: Cigarette smoking is well documented as a major cause of morbidity and mortality. Using recently available estimates of the prevalence of cigarette smoking among adult Kentuckians, I found that approximately 4,390 men and 1,615 women died in Kentucky in 1983 of causes attributable to cigarette smoking. Furthermore, the direct…
Primary Article
Stimulation of Hematopoiesis as an Alternative to Transfusion
ABSTRACT: Optimal parenteral nutritional support, provided concomitantly with extraordinarily large replacement doses of intravenous iron dextran can be safe, effective, and life-saving for severely anemic patients who cannot or will not accept erythrocyte transfusion. Five patients who had sustained massive acute blood loss and two who had severe chronic anemia…
Primary Article
Prescribing Postpartum Iron Supplementation A Survey of Practicing Obstetricians
ABSTRACT: Supplemental iron (excluding the amount in prenatal vitamins) is routinely recommended post par turn by standard obstetric textbooks. We surveyed practicing obstetricians in Maryland to examine their indications for and prescription of postpartum ironsupplements. The. survey was returned by 201 physicians (33% response rate). Iron was prescribed by 25%…
Primary Article
Cranial Nerve Deficits Due to Amyloidosis Associated With Plasma Cell Dyscrasia
ABSTRACT: Cranial nerve dysfunction is exceedingly rare in amyloidosis. Cranial nerve deficits have been described in the very rare form of familial amyloidosis in which there appears to be an autosomal dominant pattern of inheritance. By contrast, they are virtually unreported in the two common forms of amyloidosis, that is,…
Primary Article
Akinetic Parkinsonism and the Catatonic Syndrome: An Overview
ABSTRACT: The importance of considering organic diseases when evaluating catatonic patients is illustrated by two cases of akinetic parkinsonism in which the patients became catatonic, with waxy flexibility. The catatonic syndrome occurs in association with a variety of lesions that may affect any level of the central nervous system from…
Primary Article
Chronic Eosinophilic Pneumonia: A Cause of Adult Respiratory Distress Syndrome
ABSTRACT: It is important that physicians not overlook the diagnosis of chronic eosinophilic pneumonia (CEP), since this disorder is readily reversible with corticosteroid therapy. Six patients with CEP were seen at our institution between 1979 and 1983. We present their clinical features, chest films, and pathologic findings, and review the…
Primary Article
Fine Needle Aspiration in the Treatment of Ganglion Cysts
ABSTRACT: Twenty-eight ganglion cysts in 21 patients Were diagnosed by fine needle aspiration (FNA) in the Cytopathology Service of The George Washington University Medical Center from January 1979 to December 1984. Twenty-four of these were aspirated by a pathologist. One patient had two ganglions. Seven of the 21 patients had…
Primary Article
Transbronchoscopic Needle Aspiration in the Diagnosis and Staging of Lung Cancer
ABSTRACT: We examined the safety and yield of transbronchial needle aspiration (TBNA) in 28 patients who were subsequently proven to have lung cancer. TBNA in 48 sites produced no complications. TBNA was positive for carcinoma in the two patients whose tracheal carinae appeared abnormal on computerized tomography. When the carinae…
Primary Article
Chronic Mandibular Osteomyelitis
ABSTRACT: Chronic osteomyelitis of the mandible is an infrequently reported condition, but recent experience with six cases over a 14-month period suggests it is more common than appreciated. Chronic mandibular osteomyelitis results from odontogenic infection, postextraction complication, trauma, or irradiation to the mandible. Clinical findings include local pain and swelling…
Primary Article
Müller Curved-Stem Total Hip Arthroplasty Long-Term Follow-up of 185 Consecutive Cases
ABSTRACT: We reviewed 185 consecutive Miiller total hip arthoplasties ten to 14 years after operation. Of the 32 patients with 42 arthroplasties who had died within the ten-year period, three had had revisions and five had died of causes related to the operation, including two late infections; Sixty-five hips in…
Primary Article
Surgical Reconstruction of the Proximal Subclavian and Vertebral Arteries
ABSTRACT: The diagnosis and management of atherosclerotic lesions of the extracranial internal carotid artery has become fairly well established. Symptoms of basilar artery hypoperfusion may be due to stenotic lesions at the origin of either or both vertebral arteries or the proximal subclavian artery. Surgical correction can offer relief of…
Primary Article
Splenic Salvage Techniques in the Management of Pseudocysts of the Spleen
ABSTRACT: Nonparasitic splenic pseudocysts are an uncommon late sequela of splenic trauma. These cysts presumably develop from previously unrecognized subcapsular splenic hematomas. Classical therapy for splenic pseudocysts has been splenectomy. However, the recent recognition of the postsplenectomy sepsis syndrome has led to methods of surgical management that salvage the remainder…
Primary Article
Comparison of Automatic Staplers in Small Bowel Anastomoses
ABSTRACT: Automatic stapling instruments have been used in gastrointestinal operations with increasing frequency. As a result, newer staplers have been developed which use more staples and compress the tissue to a greater degree. Our study was designed to compare one of the newer devices (GIA Premium) with a conventional device…
Primary Article
Decreased Circumcision Rate With Videotaped Counseling
ABSTRACT: Despite the lack of medical indication for routine circumcision in the newborn, neonatal circumcision continues to be done on the vast majority of male infants in the United States. A trial of videotaped “informed consent” counseling was undertaken to determine whether such counseling could affect the parental choice about…
Primary Article
Brief Office Counseling and the Primary Care Physician
ABSTRACT: Primary care physicians may often see patients with transient emotional or behavioral problems. Brief office counseling is an action-oriented treatment method that requires the physician to develop both a therapeutic relationship and behavioral contract with the patient. The physician needs to create a secure, permissive, and confidential atmosphere in…
Review Article
Delayed Chest Wall Complications of Median Sternotomy
ABSTRACT: Chest wall pain after coronary artery bypass surgery is often attributed to incisional pain or anxiety. Although this assumption is often correct, a small number of patients have an unrecognized chest wall complication of the median sternotomy. In this paper we identify these delayed postoperative midsternotomy complications and discuss…
Current Concepts
Postconcussion Symptoms After Head Trauma Interpretation and Treatment
ABSTRACT: Postconcussion symptoms frequently present significant barriers to recovery after head injury. For most patients, emphasis on either organic or functional factors as the sole basis for such symptoms is unwarranted. In addition to the psychologic and behavioral impact of such deficits, recognition of cognitive deficits arising from head injury…
Article
Spirituality, Medicine, and Healing
ABSTRACT: Contemporary medicine has given little attention to the spiritual dimension of human experience despite its relevance to our fundamental goal of healing. This exploratory work takes the position that this dimension can and should be reintegrated into health care models and practice. After delineating the scope of inquiry and…
