SMJ // December 1988, Volume 81 - Issue 12
Primary Article
Pediatric Prehospital Care in a Southern Regional Emergency Medical Service System
ABSTRACT: A retrospective review of 2,302 ambulance run reports from the Birmingham Regional Emergency Medical Service System indicated that 6% of all runs are for patients in the pediatric age group (less than 18 years of age). Injuries related to emergencies were responsible for more than 65% of pediatric runs,…
Primary Article
Pediatric Appendicitis: Efficacy of Laboratory and Radiologic Evaluation
ABSTRACT: We retrospectively reviewed 54 consecutive children (mean age, 12 years) evaluated for possible appendicitis to determine the efficacy of laboratory and radiologic procedures in establishing the diagnosis. The final diagnosis was appendicitis in 24 and abdominal pain not necessitating operation in the remaining 30. Two hundred two laboratory tests…
Primary Article
Synovectomy of the Knee in Young Patients With Hemophilia
ABSTRACT: We performed 16 synovectomies of the knee in 14 children, adolescents, and young adults with hemophilia A for boggy synovium due to hemophilia. Pain was eliminated or decreased in all patients postoperatively. The number of bleeding episodes was dramatically decreased in all patients at three-year follow-up. Some knee motion…
Primary Article
Differential Diagnosis of Severe Back Pain Using MRI
ABSTRACT: Back pain, despite its prevalence, often presents a diagnostic dilemma. Infection, degeneration, and neoplasm comprise major etiologic categories of severe nonspecific back pain. Diagnostic evaluation includes plain roentgenograms, computerized tomography, and radionuclide studies, all of which are often equivocal or misleading. We retrospectively analyzed 21 presentations of severe back…
Primary Article
Adrenal Insufficiency in the Acquired Immunodeficiency Syndrome
ABSTRACT: Patients with the acquired immunodeficiency syndrome (AIDS) often have signs and symptoms suggestive of adrenal insufficiency. Reports in the literature suggest that adrenal insufficiency may be relatively common in patients with AIDS based on the finding of destructive adrenal lesions in a large number of the patients studied. In…
Primary Article
Infections Caused by Central Venous Catheters in Patients With Acquired Immunodeficiency Syndrome
ABSTRACT: We assessed infectious complications of long-term percutaneous central venous catheterization in patients with acquired immunodeficiency syndrome (AIDS). We evaluated 98 consecutive patients, accounting for 6,298 catheter days. Catheter-associated bacteremia occurred in 3% of patients, a rate of 0.128%/patient-catheter day. Only bacterial pathogens—Pseudomonas, Serratia, and Staphylococcus species—were isolated. Five patients…
Primary Article
Diagnosis of Hypertension in a Family Practice Setting: A Preliminary Study of Published Protocol Versus 24-Hour Ambulatory Blood Pressure Monitoring
ABSTRACT: Although there have been many recommendations in the medical literature regarding the proper evaluation of hypertensive patients, there have been few reports regarding physician compliance with such diagnostic protocols. To assess physician compliance with the diagnostic protocol published by the Joint National Committee for the Detection, Evaluation, and Treatment…
Primary Article
Immunohistochemistry: A Useful Adjunct in the Evaluation of Malignant Cutaneous Spindle Cell Tumors
ABSTRACT: We used immunohistochemistry to evaluate four cytologically malignant cutaneous neoplasms on the face or neck of elderly individuals. All four lesions were composed of a dermal proliferation of spindle and pleomorphic giant cells. Differential diagnosis included spindle cell carcinoma, atypical fibroxanthoma, malignant melanoma, leiomyosarcoma, and angiosarcoma. All four neoplasms…
Primary Article
Gestational Breast Cancer: A Ten-Year Experience
ABSTRACT: During the period 1973 to 1983, eight pregnant women were treated for breast cancer at Richland Memorial Hospital. These patients were compared with 36 nonpregnant premenopausal women with breast cancer treated at the same institution. Pregnant patients averaged two years older than the nonpregnant patients. Five of eight pregnant…
Primary Article
Secondary Inflammatory Breast Cancer: Treatment Options
ABSTRACT: Patients with inflammatory breast cancer (IBC) have either a short history of a tender, swollen, red breast (primary IBC) or skin changes that develop in the breast after a long history of carcinoma (secondary IBC). Between 1954 and 1981, 96 patients with secondary IBC were given radiotherapy (n =…
Primary Article
Previous Pelvic Surgery in Patients With Ovarian Cancer
ABSTRACT: We retrospectively analyzed 291 patients with ovarian cancer treated at our institution between 1961 and 1985. In an attempt to identify those who might have benefited from prophylactic oophorectomy, we analyzed stage, status, previous pelvic surgery, and age at previous surgery. Seventy-one patients had 77 laparotomies before ovarian cancer…
Primary Article
Cytogenetic Studies in Couples With Recurrent Pregnancy Loss
ABSTRACT: We reviewed the results of lymphocyte karyotypes from 232 couples who had had two or more pregnancy losses (spontaneous abortions or stillbirths). Despite the use of strict criteria to correct for possible bias of ascertainment, 8% of these couples (19 of 232) had a chromosome abnormality. Six of these…
Primary Article
Early Closure of Posthysterectomy Vesicovaginal Fistulas
ABSTRACT: This report presents the results of early closure of 11 posthysterectomy vesicovaginal fistulas, using a modified transvaginal approach. Early repair of this complication is acceptable and probably desirable. Review of the English literature indicates that these 11 patients comprise the single largest series of patients treated by early vaginal…
Primary Article
Depression and Alcoholism: Clinical Considerations in Management
ABSTRACT: When alcohol abuse occurs with depression, both the substance abuse and the mood disorder necessitate treatment. These conditions may have some similar manifestations, making differential diagnosis difficult. Depressed alcoholics report more previous treatment for substance abuse, withdrawal symptoms, and marital problems than those without depression. They also incur greater…
Primary Article
Field Evaluation of Polycarbonate Versus Conventional Safety Glasses
ABSTRACT: Of all the causes of eye injury, gunshot has recently been cited as resulting in the highest rate of blindness and the lowest rate of visual recovery. Many of these cases are hunting accidents in which safety glasses could have prevented or lessened ocular damage. To evaluate the effectiveness…
Review Article
Lingual Thyroid and Associated Epiglottitis
ABSTRACT: A relatively rare genetic anomaly, lingual thyroid has a reported incidence of 1:100,000. Histologically, it may consist of normal or fetal-type tissue, and may show lymphoid infiltration. Differential diagnosis should include consideration of various benign and malignant diseases. We review diagnostic procedures as well as medical and surgical management,…
Current Concepts
Blunt Injuries of the Cervical Trachea: Review of 51 Patients
ABSTRACT: The low incidence of blunt trauma to the cervical portion of the trachea limits management experience in most centers. Hence, we combined our patients with those in published reports containing essential information on injury, treatment, and results. Among 51 patients (93% male), ages ranged from 3 to 65 years….
Medical Education
Improving Compliance With Preventive Medicine Procedures in a House Staff Training Program
ABSTRACT: Performance of health maintenance procedures by internal medicine house staff is inadequate, yet little has been published outlining means to improve performance rates. We prospectively studied the effectiveness of a reminder system to improve screening by Pap smear, rectal examination with stool guaiac test, breast examination, and pneumococcal vaccine…
Article
Doctoring: The Philosophic Milieu
ABSTRACT: To understand fully a physicians role in society, and to deal successfully with the current sense of crisis, the medical profession must evolve a world-view that appropriately relates a physician to the patient, to the practice environment, to the base of knowledge, and to the physicians own sense of…
