SMJ // January 1987, Volume 80 - Issue 1
Primary Article
Atypical Mycobacteria Causing Pulmonary Disease: Rapid Diagnosis Using Skin Test Profiles
ABSTRACT:Purified protein derivatives (PPDs) prepared from M tuberculosis (PPD-S), M kansasii (PPD-Y), M scrolulaceum (PPD-G), M avium (PPD-A), M intracellulare (PPD-B), and M fortuitum (PPD-F) were used simultaneously as skin tests to elicit profiles of reactivity in patients with clinical pulmonary disease roentgenologically suggestive of mycobacteriosis. These profiles were useful…
Primary Article
Diffuse Bacterial Bronchiolitis With Bronchiolar Pneumonia in Adults
ABSTRACT: Three patients had diffuse reticulonodular shadowing on chest roentgenogram, dyspnea, cough, purulent sputum, airways obstruction, variable fever, and leukocytosis. Lung tissue from two showed inflammatory exudate in bronchioles and peribronchiolar alveoli; all had multiple isolates of either Haemophilus influenzae or Streptococcus pneumoniae from sputum or lung tissue. When examined…
Primary Article
Effect of Sleep Loss on β-Endorphin Activity, Epinephrine Levels, and Ventilatory Responsiveness
ABSTRACT: Sleep loss impairs ventilatory responsiveness to hypercapnia and hypoxia, and also interferes with performance on spirometry. To test the hypothesis that the decline in hypercapnic drive due to sleep loss is mediated by endorphin production, we measured loaded and unloaded CO2 response after injection of placebo and naloxone in…
Primary Article
Penetrating Wounds of the Back and Flank Analysis of 77 Cases
ABSTRACT: To determine the factors that allow early recognition of injuries to the intrathoracic and intra-abdominal organs in patients with penetrating wounds to the lower thorax and abdomen with site of entrance located in the back or flanks, we retrospectively analyzed the cases of 77 such patients. There were 65…
Primary Article
Penetrating Neck Injuries: Experience With Selective Exploration
ABSTRACT: Although many authors have stated that surgical exploration should be mandatory for all neck wounds that penetrate the platysma, recent reports from many centers now claim that selective exploration is both safe and reasonable. A policy of selective exploration based on clinical presentation, anatomic location, and results of diagnostic…
Primary Article
Needle-Localized Biopsy of Occult Breast Lesions
ABSTRACT: Over a 3½-year period, we did 121 needle-localized breast biopsies for nonpalpable, mammographically suggestive lesions. The presence of a mass lesion on mammography with or without microcalcifications was associated with malignancy more frequently than microcalcifications alone. In 15 cases (12.4%), biopsy showed malignancy; 13 patients had modified radical mastectomy,…
Primary Article
Abnormalities of the Cervical Spine in Downs Syndrome: Diagnosis, Risks, and Review of the Literature, With Particular Reference to the Special Olympics
ABSTRACT: Over a four-month period, we did roentgenographic examinations of the cervical spine on 35 individuals with Downs syndrome, most of whom planned to participate in the Special Olympics. There were abnormalities in 40%, the most frequent being atlantoaxial subluxation. The presentations, risks, and recognition of this abnormality are discussed,…
Primary Article
Latissimus Dorsi Flap: A Valuable Resource in Lower Arm Reconstruction
ABSTRACT: Lower arm reconstruction of soft tissue defects and after ablation for cancer leaves the reconstructive surgeon few alternatives. We have used latissimus dorsi muscle (n = 1) and musculocutaneous flaps (n = 3) with good functional and cosmetic results. Defects in one patient with traumatic amputation, another with extravasation…
Primary Article
Transsphincteric Approach to Lesions of the Rectum
ABSTRACT: Transsphincteric posterior resection of villous adenomas and small carcinomas restored gastrointestinal continuity and preserved continence in 25 of 26 patients in this study. No patient had local recurrence. This procedure is suitable for villous tumors that are too high for transanal or too low for transabdominal resection, and for…
Primary Article
Correlation of Standard Diagnostic Studies With Surgically Proven Lumbar Disk Rupture
ABSTRACT: One hundred patients with surgically proven ruptured lumbar disks were studied in terms of their diagnostic work-up. Four studies—electromyogram, CT scan, myelogram, and epidural venogram—were evaluated independently and in combination. No one study was consistently abnormal; however, epidural venography was diagnostic in 74% of cases. CT scanning and electromyographic…
Primary Article
Ultrasonography in the Diagnosis of Pyloric Stenosis
ABSTRACT: We evaluated 101 children for hypertrophic pyloric stenosis (HPS) at Arkansas Childrens Hospital. Diagnosis was based upon a palpable epigastric “olive” characteristic of HPS, or sonographic measurements of the pylorus. In 28 children, the diagnosis was confirmed by physical examination alone; the remaining 73 had ultrasound examination. Pyloric measurements…
Primary Article
Mastocytosis: One Years Experience
ABSTRACT: The diagnosis of systemic mastocytosis without urticaria pigmentosa has been made with increasing frequency since modern methods of histamine assay have been used clinically. We examined the incidence of urticaria-angioedema and mastocytosis over a recent 12-month, period. Of 490 new patients we saw, 52 had urticaria-angioedema, and ten had…
Primary Article
Contemporary Use of the Disease Concept II. The Question of Anemia
ABSTRACT: Of 105 admissions to a medical service, 64 involved anemia (defined as a hematocrit value of less than 38%) at some time during the admission. Chart review revealed that the disease concept was not being used, as most of the anemias were unnoticed or undiagnosed, and most of the…
Review Article
The Binge-Purge Syndrome: A Common Albeit Unappreciated Cause of Acid-Base and Fluid-Electrolyte Disturbances
ABSTRACT: The binge-purge syndrome (bulimarexia) is one of the four major eating disorders. It is a very important entity with which all clinicians should have some familiarity. This is true not only because of its frequency and the potential severity of several of its numerous complications, but because it has…
Current Concepts
Male Sexual Dysfunction: Evaluation and Treatment
ABSTRACT: This review of the causes of erectile dysfunction and the salient points involving the history and physical examination outlines the studies necessary to distinguish between organic and psychologic causes and to further delineate the specific organic causes. Various types of treatment for organic dysfunction, such as oral, intramuscular, or…
Article
Cervical Cancer
ABSTRACT: This conference concerns economic, psychosocial, preventive, and medical aspects of the care of an indigent, unemployed, 22-year-old mother of three who died of an invasive, large cell, nonkeratinizing cervical cancer 35 months after her last Pap smear, 19 months after the onset of vaginal discharge, 12 months after consulting…
