SMJ // April 1988, Volume 81 - Issue 4
Editorial
LEARNING MEDICINE
Primary Article
Reflections From a Decade of Carotid Reconstructive Surgery
ABSTRACT: Carotid artery reconstructive surgery for atherosclerotic lesions of the extracranial cerebral circulation has become the most common operation in peripheral vascular surgery. A better understanding of the indications for operative intervention, enhanced monitoring during surgery, and more precise management of intraoperative anesthesia have all helped decrease the risks associated…
Primary Article
Graded Exercise Testing for Diagnosis of Coronary Artery Disease in Elderly Patients
ABSTRACT: We tested the clinical utility and predictive value of graded exercise testing in the diagnosis of coronary artery disease in 153 patients aged 65 years or more. Based on changes of the ST segment from baseline, the test was considered positive with 1 mm of depression lasting 0.08 seconds,…
Primary Article
Emergency Department Infraclavicular Subclavian Vein Catheterization in Patients With Multiple Injuries and Burns
ABSTRACT: We assessed the complications associated with emergency department placement of subclavian vein catheters in trauma and burn patients, reviewing the charts of all of the 441 patients admitted to the burn-trauma unit through the emergency department during 1983. Fifty-two patients (12%) had infraclavicular placement of subclavian catheters while in…
Primary Article
Bleeding Due to Portal Hypertension: The Role of Surgery
ABSTRACT: Several therapeutic options are available to stop acute variceal bleeding or prevent its recurrence. Sclerotherapy has emerged as the optimal method for stopping acute bleeding, and as primary therapy for preventing recurrence. Surgery is required for the 30% to 40% in whom sclerotherapy fails. Selective variceal decompression has emerged…
Primary Article
Renal Artery Reconstruction: Extended indications
ABSTRACT: Renal artery reconstruction has traditionally been limited to cases of documented renal artery hypertension. We report our experience with renal artery reconstruction on 32 arteries in 23 patients over a three-year period. These procedures were done for renovascular hypertension in nine patients, for renal preservation in seven patients, and…
Primary Article
Catheter Drainage of Ischiorectal Abscesses
ABSTRACT: We retrospectively reviewed the charts of 55 patients with ischiorectal abscesses treated from 1980 to 1983 at the Cleveland Clinic Foundation. The patients were treated by placement of a 10F to 16F soft latex mushroom catheter into the abscess cavity under local anesthesia as an office procedure. The end…
Primary Article
Syphilis in Pregnancy
ABSTRACT: The course and outcome of 356 pregnant patients who had a positive serologic test for syphilis and who had delivery at the LSU Medical Center between Jan 1, 1982 and Dec 31, 1984 were compared to those of our general obstetric population. Records of these women and their infants…
Primary Article
Diagnosis of Neurosyphilis: A Critical Assessment of Current Methods
ABSTRACT: Clinical features of 74 patients with neurosyphilis and 38 syphilitic patients with nonsyphilitic neurologic disorders were correlated with results of their serum and cerebrospinal fluid (CSF) VDRL and FTA tests, and with the WBC count and total protein level in the CSF. The most common clinical features in those…
Primary Article
Effect of Intravenous Glucagon on Intraoperative Cholangiography
ABSTRACT: Intravenous glucagon has been advocated as a useful adjunct to intraoperative cholangiography. Thirty patients scheduled for elective cholecystectomy were entered into a prospective, randomized, double-blind study to test the effects of glucagon on intraoperative cholangiography. All patients randomly received either glucagon or normal saline (control group) and had two…
Primary Article
Infantile Botulism
ABSTRACT We present the first two known cases of infantile botulism in Oklahoma. The first case was due to type B toxin; the second was due to type A toxin. Both cases demonstrate most of the classic features of what now appears to be the most common form of botulism….
Primary Article
Pneumonia Due to Aeromonas hydrophila-complex Epidemiologic, Clinical, and Microbiologic Features
ABSTRACT: Review of published data examining the various types of infections produced by strains of the Aeromonas hydrophila-complex demonstrates a paucity of information on lower respiratory tract infections due to this organism. Although it is rarely cited as a cause of pneumonitis, we have been able to collect epidemiologic, clinical,…
Primary Article
Ovarian Tumors in Children
ABSTRACT: Ovarian tumors in the pediatric age group, although rare, can be malignant and lethal; the most common is the germ cell tumor. Operation and chemotherapy with multiple drugs is recommended to improve survival. For children with benign ovarian tumors, preservation of ovarian tissue should be a priority. Thirty children…
Primary Article
Plasma Apolipoprotein C-III Levels in Children With Type I Diabetes
ABSTRACT: The serum concentrations of apolipoproteins C-III, B, and A-I were determined in children with type I diabetes mellitus to establish whether they correlated with the level of glycosylated hemoglobin (Hb A1) and to determine whether these values differ between diabetic children and a population of normal children. Triglyceride (TG),…
Primary Article
Brooks Fusion for Atlantoaxial Instability in Rheumatoid Arthritis
ABSTRACT: Atlantoaxial instability in rheumatoid arthritis has been recognized in the natural history of rheumatoid arthritis, but successful surgical stabilization has proven to be elusive. We review our experience using the Brooks technique of wedge compression arthrodesis combined with halo immobilization in five women with rheumatoid arthritis with symptomatic Cl-2…
Primary Article
Bone Mineral Content in Smokers
ABSTRACT: We did a cross-sectional evaluation of the effect of heavy cigarette smoking on bone mass using single photon absorptiometry (SPA) of the radius in 35 smokers (24 women, 11 men) and 35 nonsmokers (24 women, 11 men). Individuals from the two groups were carefully matched for sex, age, weight,…
Primary Article
Cartilage Tumors of the Larynx
ABSTRACT: Tumors of cartilage in the larynx arise either from the cartilaginous skeleton of the larynx or as metaplastic nodules in laryngeal soft tissues, unassociated with the hyaline cartilages of the larynx. Chondrosarcomas, nearly always histologically low-grade, make up the largest numbers of the neoplasms and arise principally from the…
Primary Article
Subtypes of Depression in Patients With Chronic Pain
ABSTRACT: Recent studies have shown that depression can be assessed in patients who have chronic pain. This study shows that various subtypes of depression can be differentiated in such patients using a standardized diagnostic schema for psychiatric disorders and a self-rating instrument for assessing the level of psychologic distress. In…
Primary Article
Communication Difficulty of Patients With Schizophrenia and Physical Illness
ABSTRACT:Our study was done to determine whether patients with schizophrenia and a coexisting physical disorder could adequately discuss the physical illness with a physician. We defined the minimal standard of adequate communication as the ability to acknowledge and name a physical problem during an index hospitalization. Of the 110 patients…
Review Article
Coagulase-Negative Staphylococci
ABSTRACT: Coagulase-negative staphylococci, long considered to be harmless commensals or contaminants, have emerged as major pathogens as medical technology has advanced. They are a major cause of intravenous-catheter-associated bacteremia, endocarditis, otitis media, and infection of joint prostheses, vascular grafts, cardiac pacemakers, cerebrospinal fluid shunts, postoperative wounds, the urinary tract, and…
Current Concepts
Initial Resuscitation and Assessment of Patients With Multisystem Blunt Trauma
Abstract: In the vast majority of blunt trauma victims, shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clear-cut, the rapid identification and control of the bleeding source may not be. Such patients often have injuries to several body systems and thus have numerous possible sources…
Current Concepts
Adenotonsillectomy in Children: Indications and Contraindications
ABSTRACT: Adenoidectomy and tonsillectomy are the most common major operations done on children. The indications for tonsillectomy in certain clinical situations are constantly being debated in the literature and among professionals. We studied the efficacy (or lack of it) of adenotonsillectomy for chronic tonsillitis (recurrent throat infections), oral nasal obstruction,…
