Issue - Southern Medical Association

Editorial

“I Swear by Apollo the Physician…‘

Editorial

STARTING OVER

Commentary

MINICHOLECYSTECTOMY

Primary Article

Dollars and Cents Minicholecystectomy and Early Discharge

ABSTRACTWe present minicholecystectomy as a means of cost containment and discharge from the hospital 24 to 48 hours later. Among 450 patients undergoing this form of cholecystectomy through a 4 cm incision, only 49 stayed longer than an average of 1.2 days; all of those patients had preexisting surgical problems,…

Primary Article

Assessment of Monocyte Function in Breast Disease

ABSTRACTMonocyte dysfunction has been reported in patients with cancer. The generation of a procoagulant tissue factor is a marker of the monocytes activation. Since the only blood cell capable of generating tissue factor is the monocyte, the incubation of citrated blood with either saline (control) or endotoxin (monocyte activator) followed…

Primary Article

Breast Hamartoma A Mammographic Diagnosis

ABSTRACTThe mammographic appearance of breast hamartoma, a benign cause of a breast mass, is characteristic. We present four cases from the University of Virginia to review the mammographic, pathologic, and clinical features of this unusual entity.

Primary Article

Fractures of the Sacrum and Sacroiliac Joint Evaluation by Computerized Tomography With Multiplanar Reconstruction

ABSTRACTConventional roentgenographic views of the pelvis provide inadequate assessment of complex bony trauma. Computerized tomography (CT) allows simpler patient positioning, more reliable detection of subtle fractures, better characterization of complex fractures, and detection of associated soft tissue and joint space abnormalities. The addition of multiplanar reconstructions (MPR) provides a better…

Primary Article

Continuous Spinal Blockade An Old Technique Revisited

ABSTRACTIn this paper we describe a technique for continuous spinal anesthesia, first described at the turn of the 20th century and long thought to have become obsolete. We discuss reasons for discontinuance and neglect of the technique, as well as its indications, applications, and specific advantages, and we report a…

Primary Article

Brown Recluse Spider Bites of the Upper Extremity

ABSTRACTBrown recluse spider bites may cause painful, necrotic, slow-healing wounds. When these bites involve the hand and upper extremity, they can also create severe functional deficits and long-term disability. We reviewed an 11-year experience with brown recluse bites to the hand and upper extremity. Data from patients (n = 31)…

Primary Article

Cefotetan Comparative and Noncomparative Studies in Obstetric and Gynecologic Infections

ABSTRACTCefotetan is a recently introduced cephamycin antibiotic for parenteral administration, with a broad spectrum of antibacterial activity. Its elimination half-life of three hours or more allows a twice-daily dosage schedule. A noncomparative trial of cefotetan yielded a satisfactory clinical response in the treatment of all of ten patients with pelvic…

Primary Article

Recreational Waterslide Injuries

ABSTRACTRecreational waterslide facilities are a growing phenomenon in the United States, and injuries associated with their use are beginning to appear. Although there have been fatalities, the vast majority of injuries are minor, and occur over a large denominator of slide rides. The overall incidence of injuries is low, though…

Announcement

CALL FOR ABSTRACTS

Announcement

Shunt Surgery in Menieres Disease A Follow-up Report

ABSTRACTBetween December 1969 and May 1986, 140 patients were treated for Menieres disease using the endolymphatic sac subarachnoid shunt. The technique and results are contrasted with an earlier report. The surgical technique described includes modifications of the originally described procedure. A microcomputer was used for the storage and manipulation of…

Announcement

Thoracoabdominal Radiculopathy

ABSTRACTThoracic nerve root dysfunction (TNRD) manifested as abdominal pain is an infrequently reported condition. We present data on six patients who had chronic intermittent thoracoabdominal pain originating in the back. Diabetes and osteoarthritis of the spine were the chief causes of these symptoms. The electromyogram in all patients showed changes…

Announcement

Cognitive Dysfunction After Coronary Artery Bypass Surgery A Case-Controlled Study

ABSTRACTTwenty-two patients screened from a sample of 391 having coronary artery bypass grafting (CABG) showed significant declines on the Mini-Mental State Examination (MMSE) administered preoperatively and four days postoperatively. The MMSE is a 30-point cognitive function screening instrument for dementia and delirium. These patients were compared with 22 matched control…

Announcement

Postpartum Depression

ABSTRACTThe occurrence of mood changes in the postpartum period is common. This presentation will discuss three cases of postpartum mood changes illustrating the “normal” changes, depression with suicidal ideation requiring brief hospitalization, and psychotic depression requiring intensive psychiatric treatment.

Announcement

Pregnancy-Induced Hypertension Without Proteinuria Is It True Preeclampsia?

ABSTRACTA profile scoring system has recently been developed as a standardized method of early identification and severity assessment of pregnancy-induced hypertension (PIH). The purpose of this study is twofold: (1) to compare the PIH profile scores of patients demonstrating mild PIH without proteinuria with those of patients demonstrating mild PIH…

Announcement

Triple Lumen Catheters for Parenteral Nutrition

ABSTRACTWe retrospectively reviewed the charts of 61 patients in whom a total of 101 triple lumen catheters (TLCs) were used for parenteral nutrition for a total of 1,512 days (mean 15 ± 11 days). Patients were categorized as those having culture-negative TLC tips either with or without infection elsewhere (groups…

Announcement

Uses and Limitations of Prostate-Specific Antigen in the Laboratory Diagnosis of Prostate Cancer

ABSTRACTWe have studied the clinical utility of a recently developed assay for a prostate specific protein (prostate-specific antigen). Histochemical demonstration of prostate-specific antigen has a higher sensitivity and specificity for the diagnosis of prostate carcinoma than does prostatic acid phosphatase. Similarly, measurement of prostate-specific antigen by immunoassay in serum is…

Announcement

Advance Health Care Planning Taking a “Medical Future”

ABSTRACTThis article describes the living will and durable power of attorney as legal mechanisms for advance health care planning, and discusses the role of the physician in health care planning. The concept of a “medical future” is a new but not radically different device for furthering the objectives of advance…

Announcement

Quality Assurance Review Improving Diagnostic Accuracy of Percutaneous Needle Biopsy

ABSTRACTAdequate pathologic slide preparation of percutaneous fine-needle biopsy (PFNB) specimens is necessary to maximize sensitivity and yield a tissue diagnosis. We present a quality control review of our biopsy technique and results in 71 aspiration biopsies done in 59 patients. Immediate cytology slide preparation in the radiology suite enabled us…

Review Article

Use of the Anion Gap in Clinical Medicine

ABSTRACTThe anion gap (AG) in the serum equals the concentrations of Na – (Cl + HCO3). It is becoming increasingly useful in the interpretation of acid-base disorders and in the diagnosis of other conditions. In an acidemic patient, an elevated AG usually indicates the presence of an organic acidosis, rhabdomyolysis,…

Abstract

Malignant Glioma

Article

Health Care in the 1990s Old Wine in New Bottles

Our Medical Heritage

Rational Medicine and Social Processes

Article

Gertrude Steins Neuroanatomic Investigations Roses or Thorns?

Acknowledgement

BOOKS RECEIVED

Case Report

Coombs'-Negative Spherocytic Hemolytic Anemia and Severe Necrotizing Renal Vasculitis

Case Report

Procainamide-Induced Lupus Anticoagulants and Thrombosis

SUMMARYThe specific factors predisposing to thrombosis in patients with LAs have not been resolved. With extensive cross-reactivity, and several proposed sites of action, LAs and their effects may be heterogeneous. While the risk of thrombosis with phenothiazine-induced LAs is probably low, the incidence of thrombosis in association with procainamide-induced LAs…

Case Report

Choledochocele A Rare Form of Choledochal Cyst

SUMMARYCholedochocele is the least common form of cystic dilatation of the biliary tree. Whether this condition is a congenital abnormality or the result of inflammation at the papilla of Vater is not clear. In most cases, the clinical presentation is that of intermittent abdominal pain, nausea, and vomiting, with biliary…

Case Report

Gangrenous Ligamentum Teres Hepatis Causing Acute Abdominal Symptoms

SUMMARYThis unusual case of a gangrenous round ligament manifested by acute abdominal symptoms underscores the importance of the recent radiologic descriptions of the round ligament in computerized tomography and ultrasonography. The cause of the gangrenous process in this case remains unresolved.

Case Report

Primary Carcinoid Tumor of the Testis

SUMMARYWe have presented a case of primary testicular carcinoid in an otherwise asymptomatic 50-year-old white man treated by right orchiectomy; a postoperative abdominal CT scan was normal. Histologically and cytologically the tumor resembled carcinoids of midgut origin. Most primary testicular carcinoid tumors are not clinically functional, and thus the diagnosis…

Case Report

Profound Muscle Weakness and Hypokalemia Due to Clay Ingestion

SUMMARYWe have presented the case of a 43-year-old woman with severe myositis due to clay ingestion and hypokalemia. EMG studies revealed a pattern consistent with myositis, and muscle biopsy showed a nonspecific diffuse myositis. The clay was shown to act as a potassium binder. With potassium replacement and discontinuance of…

Case Report

Estrogen-Secreting Adrenal Tumor Responsive to ACTH Localization by Adrenal Venous Sampling

Clinical Brief

Proximal Stapled Esophagogastric Anastomosis

Clinical Brief

Serum Bile Acid Levels in Liver Disease Is There a Clinical Application?

Breif Report

Necrotizing Enterocolitis Associated With Clostridium paraputrificum Septicemia

SUMMARYA 38-year-old woman with chronic, noncyclic neutropenia had an episode of acute abdominal pain associated with clostridial septicemia. Clostridium paraputrificum was isolated from blood and peritoneal cultures. The pathogenic potential of C paraputrificum was established by surgical biopsy specimens which demonstrated necrotizing enterocolitis with the typical gram-positive rods. This report…

Breif Report

Crohns Disease of the Vulva

SUMMARYWe have reported a case of Crohns disease of the vulva, an unusual manifestation of inflammatory bowel disease. The initial management of this condition should be medical, using antibiotics and established regimens to control gastrointestinal symptoms. Surgical therapy is appropriate when medical management fails, as it did in our patient.

Letter to the Editor

Necrotizing Fasciitis Complicating Appendicitis

Letter to the Editor

Rash From Nicotine Gum Nicotine as a Hapten

Letter to the Editor

Carpal Tunnel Syndrome

Letter to the Editor

X-rays and Stab Wounds

Letter to the Editor

Chronic Pain and Depression

Letter to the Editor

Very Low Glucose Concentrations in Hypocellular Malignant Pleural Effusions