SMJ // July 1986, Volume 79 - Issue 7
Editorial
THE MOLOCH OF THE QUICK FIX
Primary Article
Evaluation of Abdominal Pain Clinicians Performance Compared With Three Protocols
ABSTRACTClinical findings in ambulatory patients with abdominal pain, presenting themselves to general medical practitioners, were analyzed by three different protocols: an algorithm using a branched-chain logic, a linear discriminant rule, and bayesian analysis. All methods missed some serious diagnoses. None was as effective as the clinician at distinguishing nonspecific abdominal…
Primary Article
A Personal Experience With Guillain-Barré Syndrome Are the Psychologic Needs of Patient and Family Being Met?
ABSTRACTWe present a dialogue that illustrates how difficult an episode of severe illness is for both the suffering patient and the confused family. The powerful emotions engendered can be successfully managed only when physicians and nurses are aware of and address this turbulence that the patient and family are experiencing.
Primary Article
Computerized Tomographic Abnormalities in Patients With Hemispheric Transient Ischemic Attacks
ABSTRACTIn 100 patients with transient ischemic attacks, correlations between clinical features and CT findings were analyzed. In 77 patients, CT scans were normal. Five percent had mass lesions and 18 had vascular lesions (ischemia, infarction, hematoma) delineated by CT. In two patients whose CT showed a hypodense lesion indicating cerebral…
Primary Article
Digital Subtraction Arthrography of the Prosthetic Hip
ABSTRACTDigital subtraction techniques are easily adapted to the evaluation of loosening in total hip prostheses, allowing real time review of injection dynamics and data manipulation after the study. We have successfully used both standard radiographic and digital imaging techniques in the evaluation of 15 prosthetic hip joints. The digital results…
Primary Article
Low Back Pain and X-ray Films of the Lumbar Spine A Prospective Study in Primary Care
ABSTRACTWe prospectively studied 96 men with low back pain to evaluate the association of x-ray findings with clinical diagnosis, treatment, functional outcome, and satisfaction with care. Degenerative joint disease (DJD) was the most common radiologic finding (70%). Making the diagnosis of spinal DJD has little effect on patient management, but…
Primary Article
Biomechanical Studies of an Anterior Pelvic External Fixation Frame Intended for Control of Vertical Shear Fractures
ABSTRACTBiomechanical testing of an experimental pelvic external fixation frame incorporating a large tubular horizontal member was carried out on formalin-fixed cadaver pelves with simulated vertical shear injuries. The device was tested with 5 mm standard and 6 mm experimental pins, and was compared to a Pittsburgh triangular (PT) frame constructed…
Primary Article
Knee Flexion Contractures in Myelodysplasia
ABSTRACTFrom 1976 to 1982, 12 children with myelodysplasia had surgery at our institution for knee flexion contractures (21 affected knees). Follow-up was a minimum of 18 months and averaged 47 months. Soft tissue lengthening of the hamstring tendons and release of the posterior capsule with or without femoral osteotomy yielded…
Primary Article
Pseudotumor of the Supraclavicular Fossa
ABSTRACTMinor musculoskeletal variants of the upper thoracic spine or of the ribs can cause effacement of the supraclavicular fossa, simulating a mass (“pseudotumor”). These variants may occur singly or in combination, and include unilateral prominence or asymmetry of the first rib, unilateral prominence or asymmetry of a cervical rib, and…
Primary Article
Avascular Necrosis of Bone A Manifestation of Cushings Disease
ABSTRACTCushings disease is endogenous hypercortisolism due to a pituitary adenoma. Although exogenous hypercortisolism is a well known cause of avascular necrosis and although there have been many reports of avascular necrosis associated with endogenous Cushings syndrome, there has only been a single well documented case report associating avascular necrosis of…
Primary Article
Cervical Dilation With Prostaglandin F2α for First Trimester Abortion
ABSTRACTMechanical cervical dilation in the first trimester has been associated with some risk of cervical injury and incompetence of the cervix resulting in premature labor and spontaneous abortion. Several chemical agents have been used in trying to prevent this mishap in the last few years. Prostaglandins have been shown to…
Primary Article
Alcoholic Pancreatitis and Parotitis Utility of Lipase and Urinary Amylase Clearance Determinations
ABSTRACTAcute alcoholic pancreatitis is a clinical diagnosis made in patients who have acute upper abdominal pain, emesis, and hyperamylasemia soon after ingesting alcohol. We sought to determine whether the clinical diagnosis of pancreatitis was supported by elevated serum levels of pancreatic isoamylase, currently the most specific test for pancreatitis. Serum…
Primary Article
Heterophilic Antibody as a Source of Error in Immunoassay
ABSTRACTWe describe our experience with a young woman believed to be hypothyroid and menopausal because of erroneously elevated TSH, LH, and FSH estimates. These errors were found to be due to the presence of antibodies to rabbit IgG in the patients blood. We found that antibody-limited assays for TSH, LH,…
Primary Article
Simplified Retrorectal Pull-Through Procedure for Hirschsprungs Disease
ABSTRACTWe have used a modified retrorectal pull-through procedure with a circular anastomotic stapler to fashion the ehd-to-side colorectal anastomosis in six children with Hirschsprungs disease. The modification allows a more rapid, wide, and precise anastomosis than previous techniques, and has been done without complications.
Primary Article
Total Parathyroidectomy and Forearm Autotransplantation for Chronic Renal Failure A Useful Tool for the General Surgeon in Private Practice
ABSTRACTWe reviewed 12 cases of chronic renal failure in patients with secondary hyperparathyroidism who had total parathyroidectomy and forearm autotransplantation during the years 1978 to 1984. All had elevated parathyroid hormone and calcium levels before the procedure. Using a technique previously described, with relatively large parathyroid grafts in the forearm,…
Primary Article
Nifedipine Therapy for Diffuse Esophageal Spasm
ABSTRACTAlthough nifedipine therapy resulted in substantial relief of dysphagia in six patients with diffuse esophageal spasm, significant side effects, particularly in young working subjects, precluded prolonged use.
Review Article
Lymphomatoid Papulosis
ABSTRACTIn this review, we discuss the clinical and histologic features of lymphomatoid papulosis, a cutaneous disorder characterized by recurrent eruptions of self-healing papules and small nodules with histologic findings suggestive of malignant lymphoma. Possible causes of this peculiar disease are discussed in the light of recent investigation. Recognition is important…
Review Article
Clinical Aspects of Sjögrens Syndrome
Current Concepts
Clinical Experience With Amphotericin B in Acute Myelogenous Leukemia
ABSTRACTThe empirical use of amphotericin B in febrile leukemic patients not responding to antimicrobial agents has previously led to a significant decrease in fatal fungal infections and a significant increase in complete remissions. In this series of 66 patients receiving induction therapy for acute myelogenous leukemia (AML), 49 (74%) received…
Current Concepts
Eating Disorders Diagnosis and Management by the Internist
ABSTRACTAnorexia nervosa and bulimia are two of the four eating disorders that appear to be increasingly prevalent. Each has its own diagnostic criteria and medical hazards, though certain features are shared. It is important for internists to be aware of these disorders, since their management is best accomplished by a…
Abstract
Confined Perforation of a Prepyloric Ulcer Into the Duodenum Forming a Gastroduodenal Fistula
SUMMARYI have reported a case in which a prepyloric ulcer perforated into the first part of the duodenum to form a persistent gastroduodenal fistula.
Case Report
Interstitial Lung Disease Associated With Vindesine and Radiation Therapy for Carcinoma of the Lung
SUMMARYDiffuse interstitial lung disease and pulmonary fibrosis occurred after the use of vindesine and radiation therapy in a patient with squamous cell carcinoma of the lung. Clinical improvement occurred after the drug was discontinued and corticosteroid therapy was initiated. Review of the literature reveals no previously reported cases of pulmonary…
Case Report
Respiratory Failure After Percutaneous Cordotomy
SUMMARYA 33-year-old woman who had Ondines curse after high cervical cordotomy for relief of chronic pain maintained adequate ventilation while awake but became apneic as she progressed from light sleep toward stages of deep sleep. After 14 months of successful nocturnal ventilatory support, she died suddenly. Central sleep apnea is…
Case Report
Hydatid Cyst Preoperative Sterilization With Mebendazole
SUMMARYAn infected echinococcal cyst of the liver was diagnosed in a 48-year-old male immigrant from Spain. After preoperative treatment with mebendazole, microscopic examination of the operative cyst contents showed no viable scoleces or brood capsules of Echinococcus. We recommend the preoperative use of mebendazole in the management of hepatic hydatid…
Case Report
Gallbladder Carcinoma With Gastric Outlet Obstruction and Gallstone Ileus
SUMMARYWe have presented a case of gallbladder carcinoma with gastric outlet obstruction and gallstone ileus, a combination apparently not reported in the literature previously.
Case Report
Thymoma, Hypogammaglobulinemia, and Pernicious Anemia
SUMMARYWe have described a patient with thymoma, hypogammaglobulinemia, pernicious anemia, and malignant schwannoma. Review of the literature yielded only one other case of the triad of thymoma, hypogammaglobulinemia, and pernicious anemia. We propose that autoimmunity was the common etiology for the coexistence of thymoma, hypogammaglobulinemia, and pernicious anemia in our…
Case Report
Aphthous Lesions in Nodular Lymphoma of the Colon
SUMMARYThe umbilicated nodules in colonic lymphoma may simulate aphthous ulcers of inflammatory or infectious colitides. Our report illustrates that in an immunosuppressed patient it may be difficult to distinguish on double contrast barium enema between the aphthous ulcers of opportunistic colitis and the umbilications of nodular colonic lymphoma.
Clinical Brief
Anesthetic Considerations in Traumatic Tracheobronchial Rupture
SUMMARYIn patients with tracheobronchial injuries, the site and extent of injury is determined by physical, radiologic, and bronchoscopic examination. The L choice of airway management depends on the location of the lesion. Close cooperation between the anesthesiologist and surgeon is necessary.
Breif Report
Vasculitis in a Suspected AIDS Patient
SUMMARYA 29-year-old male Haitian refugee had generalized lymphadenopathy, weight loss, and bilateral lung infiltrates diagnosed by transbronchial lung biopsy as tuberculosis. He had previously been labeled as haying “pre-AIDS,” which led to multiple suicide attempts. Four months later, cyanosis and gangrene of both lower extremities necessitated amputation, which revealed vasculitis.
Breif Report
Candida glabrata Meningitis
SUMMARYWe have reported an unusual case of Candida glabrata meningitis causing acute changes in mental status in a chronically ill, elderly patient with non-insulin-dependent diabetes mellitus. Candida glabrata was identified by Gram stain, culture, and fermentation pattern from the CSF. Although the patient died of foreign body aspiration, an excellent…
Breif Report
Small Bowel Obstruction From an Antacid Bezoar A Ranitidine-Antacid Interaction?
SUMMARYA 63-year-old man had an acute small bowel obstruction while being treated with ranitidine and self-prescribed antacid. On exploration, a firm mass, chemically similar to the ingested antacid, was found impacted in the terminal ileum. We believe the effect of ranitidine on gastric secretory volume was the cause of the…
