SMJ // March 1988, Volume 81 - Issue 3
Primary Article
Diagnostic Peritoneal Lavage in Blunt Trauma
ABSTRACT: We reviewed the records of 274 trauma patients who had 275 diagnostic peritoneal lavages from Feb 1, 1983 through Jan 31, 1986. Lavage was done in 271 of 560 (48%) cases of blunt trauma and three of 245 (1%) penetrating injuries (gunshot wounds to the chest). The open lavage…
Primary Article
Penetrating Facial Trauma: A Management Plan
ABSTRACT: Penetrating wounds of the face present a spectrum of injuries and multiple management dilemmas. The surgeons first concern remains the establishment of a proper airway and control of life-threatening injuries. Selected ancillary diagnostic procedures should be used to confirm vascular, aerodigestive, or central nervous system injuries. Diagnosis of injuries…
Primary Article
Painful Edema of the Arm After Insertion of Single-Needle Subclavian Vein Dialysis Catheters: Pathogenesis and Treatment
ABSTRACT: The percutaneous subclavian vein hemodialysis catheter, which is widely used for vascular access in patients with renal failure, can give rise to several complications. Asymptomatic stenosis or occlusion of the subclavian vein due to these catheters can lead to painful arm edema if further dialysis accesses are constructed in…
Primary Article
Phlegmasia Cerulea Dolens: Therapeutic Considerations
ABSTRACT: Phlegmasia cerulea dolens (PCD) is a rare venous disorder that continues to be a major therapeutic challenge. We reviewed 16 cases of PCD treated during the past 15 years; 11 of the patients were male, and the average age of all the patients was 59 years. Malignant disease was…
Primary Article
Cecal Diverticulitis: Changing Trends in Management
ABSTRACT: Diagnosis of cecal diverticulitis remains a dilemma. Preoperatively it can mimic appendicitis, and intraoperatively the surgeon is confronted with an inflammatory mass that may masquerade as a neoplasm. We reviewed 18 cases of pathologically documented cecal diverticulitis and one case of solitary diverticulitis of the ascending colon. Ileocolonic resection…
Primary Article
Treatment of Mild Exacerbations of Recurrent Alcoholic Pancreatitis in an Emergency Department Observation Unit
ABSTRACT: Patients with mild exacerbations of recurrent alcoholic pancreatitis are occasionally treated in the emergency department observation unit with parenteral hydration and analgesia in hopes of avoiding hospitalization. To determine whether such treatment is efficacious and cost-effective, we reviewed 27 consecutive admissions to the emergency department observation unit for exacerbation…
Primary Article
Percutaneous Endoscopic Gastrostomy: Clinical Experience and Follow-up
ABSTRACT: To assess our clinical experience with this method of enteral feeding, we conducted a retrospective study and follow-up of 73 patients having percutaneous endoscopic gastrostomy (PEG). In addition, we conducted a telephone survey of 42 persons who cared for the PEG tube. The most common indication was neurologic impairment…
Primary Article
Pediatric Lateral Ventral (Spigelian) Hernias
ABSTRACT: Lateral ventral (spigelian) hernias may not be recognized if the physician is unaware that they can occur in pediatric patients. Diagnosis depends on finding a protrusion in the spigelian fascia lateral to the rectus sheath at the junction of the arcuate and semilunar lines, below the umbilicus. We report…
Primary Article
Bilateral Renal Agenesis: Clinical Implications
ABSTRACT: Bilateral renal agenesis is a common congenital defect, with an incidence of 1 per 3,000 births. Though prenatal diagnosis is possible with ultrasound examination, sonographic findings may be equivocal, making the management of such pregnancies difficult. I report three cases that represent the diversity of the condition, and discuss…
Primary Article
Prevalence of Non-Group-A β-Hemolytic Streptococci in Childhood Pharyngitis
ABSTRACT: We studied the prevalence of non-group-A β-hemolytic streptococci (NGAS) in the pharyngeal cultures of symptomatic and asymptomatic children. Throat cultures were obtained by house officers in the Emergency Department at Childrens Hospital of Pittsburgh to aid in the evaluation of children with symptoms or signs of pharyngitis, or both….
Primary Article
Bacteriology of Middle Ear Effusions
ABSTRACT: We studied fluid obtained from middle ear effusions (MEEs) during 908 myringotomy and tube insertion procedures on 495 children aged 4 months to 12 years. Under general anesthesia the external auditory canal was sterilized with povidone-iodine (Betadine) and alcohol, and myringotomy was done. Fluid was aspirated into a Luki…
Primary Article
Lung Cancer, Tuberculin Reactivity, and Isoniazid
ABSTRACT: We determined the incidence of tuberculosis in lung cancer patients with known tuberculin status. All patients received chemotherapy with or without radiation therapy, corticosteroid therapy, or both, and none received isoniazid prophylaxis. Positive tuberculin reactivity was found in 89 of the 257 patients; among these 89, tuberculosis developed in…
Primary Article
Cardiovascular Risk in Parents of Children With Extreme Lipoprotein Cholesterol Levels The Bogalusa Heart Study
ABSTRACT: Fasting serum lipids, lipoprotein cholesterol, and other cardiovascular disease risk factors were examined in 321 natural parents of children with low and/or high levels of β- and pre-β-lipoprotein cholesterol. Parents of children from low pre-β-lipoprotein groups had elevated α- and lower pre-β-lipoprotein cholesterol levels. Parents whose children had high…
Primary Article
Changes in Calcium and Magnesium Metabolism in Essential Arterial Hypertension
ABSTRACT:We studied 60 hypertensive patients (35 men and 25 women with an average age of 40 years) for signs of metabolic changes, with special emphasis on the relationship between the calcium and magnesium levels. The control group comprised 37 normotertsive subjects (19 men and 18 women with an average age…
Primary Article
Pocket Computer for Interpretation of Office Spirometry
ABSTRACT: Office spirometry is an integral part of the evaluation of any patient with known or suspected lung disease. Though accurate and affordable bellows-type spirometers are available to clinicians, the available microprocessors that calculate test results markedly increase the cost of the equipment. I have successfully used an inexpensive pocket…
Review Article
History of the Cerebrohepatorenal Syndrome of Zellweger and Other Peroxisomal Disorders
ABSTRACT: The history of the peroxisomal disorders (PDs), including the most frequent variant, the cerebrohepatorenal syndrome of Zellweger, can be divided into four phases. During the first phase, lasting from 1964 to 1972, the clinical and pathologic manifestations of Zellwegers syndrome (ZS) were explored and delineated. In 1973 it was…
Current Concepts
Automated Hematology: Where We Stand
ABSTRACT; Rapid, accurate, and relevant laboratory testing is essential in an era of cost-effective medicine. The routine manual complete blood count (CBC) is a labor-intensive test that lacks reproducibility. The new automated instruments such as the Coulter S+ series offer “state of the art” precision and accuracy in counting more…
Article
Orthopedic Pitfalls in Emergency Medicine
ABSTRACT: Acute orthopedic problems make up a large part of everyday emergency department practice. Misdiagnosis of these injuries often results from failure to consider certain clinical entities as a cause of the patients complaints, and may result in unnecessary complications for the patient. Indeed, missed orthopedic injuries are the leading…
