SMJ // May 1988, Volume 81 - Issue 5
Editorial
Cooperative Neuro-otologic Management of Acoustic Neuromas and Other Cerebellopontine Angle Tumors
ABSTRACT: Over a recent 16-month period, 35 cerebellopontine angle tumors were removed at our institution by a surgical team consisting of one neurosurgeon and one otologist. Nineteen tumors were 4 cm. There were 26 acoustic neuromas, six meningiomas, two epidermoid tumors, and a glossopharyngeal schwannoma. A suboccipital transmeatal approach was…
Editorial
Selected Tricyclic Antidepressants in the Management of Chronic Benign Pain*
ABSTRACT: Depression is often considered a symptom of intractable benign pain and is usually a situational or exogenous subtype. At our four hospital-based pain management centers we have evaluated and treated more than 5,000 patients for chronic pain. The treatment of more than 2,000 of these patients has included the…
Editorial
Phencyclidine-Induced Psychosis Eight-year Follow-up of Ten Cases*
ABSTRACT: In 1978, we identified ten patients who were hospitalized for phencyclidine-induced psychosis. Over the next eight years, we used their medical records to document their subsequent hospitalizations and psychosocial functioning. The overall outcome for this group of patients was poor, with chronic unemployment, continuing use of illicit drugs, dependence…
Editorial
Psychogenic Fugue States A Review
ABSTRACT: In this paper we review psychologic theories on the development of fugue states, as well as organic causes of the disorder and the history of its diagnostic classification from DSM-I through DSM-III-R. We believe the diagnostic criterion that requires the patient to assume a new identity as part of…
Editorial
BOOKS RECEIVED
Editorial
Identifying Psychiatric Disorders in Children With Renal Disease
ABSTRACT: We gave a structured diagnostic interview to determine what psychiatric disorders were present in 15 children aged 8 to 16 years who had renal disease; eight of the children had end-stage renal disease, and the seven children in the control group had mild renal disease. We calculated the psychiatric…
Editorial
Insertion of Peritoneal Dialysis Catheters The Lateral Approach*
ABSTRACT: Potential complications of peritoneal dialysis catheters include ventral herniation, dialysate leakage, and catheter dysfunction. Using local anesthesia and a paramedian, muscle-splitting approach, we have significantly reduced the morbidity of the procedure. Security of fascial closure and identification of the peritoneum, even in obese patients, has been facilitated through this…
Editorial
Comparison of a Totally Implantable Access Device for Chemotherapy (Port-A-Cath) and Long-term Percutaneous Catheterization (Broviac)*
ABSTRACT: Because of the difficulty in maintaining vascular access in patients receiving aggressive parenteral chemotherapy, a growing number of patients have had implantation of either percutaneous or subcutaneous devices allowing permanent intravenous access. In our study, between July 1980 and July 1985, 110 patients had placement of a Broviac catheter,…
Editorial
Restaging Laparotomy and Ovarian Cancer
ABSTRACT: We retrospectively reviewed the records of 41 patients who had restaging laparotomy after initial surgery and chemotherapy for ovarian cancer. In 37 of them, the cancer was epithelial. Stage and amount of residual disease after initial cytoreductive surgery correlated with laparotomy outcome. There were no operative deaths, and perioperative…
Editorial
Carcinoma in Situ of the Vulva 24 Years Experience in Southwest Florida*
ABSTRACT: We retrospectively studied 125 patients treated for carcinoma in situ of the vulva from 1961 through 1984, with follow-up ranging from one to 24 years. Patients ages ranged from 24 to 90 years, with a mean age of 53 years. Multifocal disease was more common in women under age…
Editorial
Preventing Vault Prolapse and Enterocele After Vaginal Hysterectomy*
ABSTRACT: In this paper I describe a modified surgical technique for vaginal hysterectomy designed to prevent posthysterectomy vaginal prolapse and enterocele. Of the 112 vaginal hysterectomies done by this method over a 2.8-year period, none has resulted in prolapse.
Editorial
Postmenopausal Osteoporosis Treatment With Low-Dose Sodium Fluoride and Estrogen
ABSTRACT: Eleven menopausal patients were treated for 12 to 18 months with low-dose sodium fluoride and calcium. Six patients also received estrogen replacement. A significant increase in spine or hip bone mineral density measured by dual photon absorptiometry was observed in all patients. The estrogen-treated group had the greatest increase…
Editorial
Alteration of Radioactive Iodine Uptake After Treatment of Hyperthyroidism With Iodine 131*
ABSTRACT: To determine whether a therapeutic dose of iodine 131 affects the results of 24-hour radioactive iodine uptake (RAIU) testing, we reviewed records of hyperthyroid patients previously treated with 131I at Michigan State University and its affiliated hospitals. We identified 26 patients who had had clinical evaluation and determination of…
Editorial
Alternatives in the Treatment of Hemorrhoidal Disease*
ABSTRACT: Pain, bleeding, protrusion, soilage, itching, and burning are anorectal complaints associated with hemorrhoidal disease. Although hemorrhoidectomy remains the treatment of choice for grade 3 and 4 hemorrhoids, symptoms can be controlled short of hemorrhoidectomy, the alternative methods being effective in lesser degrees of involvement, such as grades 1, 2,…
Editorial
Comparison of Propofol and Thiopental for the Induction of Anesthesia*
ABSTRACT: We compared the safety, efficacy, and side effects of induction of anesthesia with propofol (2.5 mg/kg), a new intravenous agent, and thiopental (4.0 mg/kg) in 62 patients in American Society of Anesthesiologists class I or II. There was no significant difference between induction times for the propofol (40.0 ±…
Editorial
White Clot Syndrome*
ABSTRACT: Heparin therapy is currently a vital component in the medical management of thromboembolic events. Despite its widespread use, it is associated with relatively few complications, and these are usually minor and quickly reversible. Recently a much more dramatic and serious complication of heparin therapy has been identified. In heparin-induced…
Review Article
Proctalgia Fugax A Clinical Enigma
ABSTRACT: Proctalgia fugax is a benign condition characterized by paroxysms of anorectal pain in the absence of identifiable anorectal lesions. The cause is unknown but may involve spasm of smooth or striated muscle. Surveys indicate the disorder is common in the general population, with only a minority of victims seeking…
Article
Creating Risk-Sensitive Persons The Roles of Choice and Chance in Staying Healthy
ABSTRACT: Having examined the relationships between risk-attitude and the practice of preventive health behavior, I suggest practical ways of creating more risk-sensitive patients and health professionals. Personalizing risk and relating health behavior to individual values is a more effective way to create risk-sensitive persons than relating risk behavior to specific…
Article
Use of Parables in Medicine
Current Concepts
Update on the Management of Obesity
ABSTRACT: This article updates a paper published in this journal more than a decade ago. We detail the ensuing decades developments in the treatment of obesity, reviewing innovations, established techniques, and the current status of behavior modification. We evaluate newer developments, such as anorectic drugs, very low calorie diets, and…
Current Concepts
The Violent Patient What to Do?
ABSTRACT: Violence is a common clinical problem that must be quickly assessed to be properly managed. The examiner should keep at a safe distance from the patient and conduct the interview in a firm but nonthreatening manner. Verbal intervention, pharmacotherapy, and occasionally, physical restraints are indicated as a first-line approach…
Our Medical Heritage
Great Men Among Us*
Evagations
IN THE HEALING BUSINESS TO LOOK GOOD
Accept no high-risk patients for whom a good outcome cannot be assured otherwise, we would risk the accreditation of our surgical program. Patients may die with or without surgical consultation, and it is our obligation to be sure that they do not succumb to the inevitable on the surgical service…
Case Report
Calcified Uterine Leiomyoma Simulating Metastatic Disease on Bone Scan
SUMMARYWe have reported a case in which focal uptake in a uterine fibroid simulated a sacral metastasis on bone scanning. CT suggested the correct diagnosis. However, a repeat bone scan using single photon emission computerized tomography (SPECT) was definitive in correctly localizing the abnormality. This method should be used when…
Case Report
Variable Response to Intravenous γ-Globulin Therapy in a Patient With Autoimmune Neutropenia, Thrombocytopenia, and Pemphigoid
SUMMARYIntravenous high-dose γ-globulin has been shown to be useful in some patients with immune thrombocytopenia or neutropenia. In the case we have reported, this regimen elevated the platelet but not the neutrophil count. This observation emphasizes the heterogeneity in patients with immune cytopenia, and shows that treatment outcome is likely…
Case Report
Mucinous Carcinoma of the Breast Recurrence 30 Years After Mastectomy
SUMMARYWe have reported a case of mucinous breast carcinoma that recurred in the form of lung and lymph node metastases 30 years after definitive resection. This case emphasizes the indolent nature of this neoplasm and the need to lengthen the period of follow-up for patients with this form of cancer.
Case Report
Perforation of the Hypopharynx Demonstration by Computerized Tomography
SUMMARYWe have presented a case of hypopharyngeal rupture demonstrated by computerized tomography, which plays an invaluable role in the evaluation of neck trauma.
Case Report
Traumatic Carotid-Cavernous Fistula
SUMMARYCarotid-cavernous fistulas are uncommon, although not rare, complications of trauma to the base of the skull; they may result in cranial nerve palsies, blindness, and occasionally in devastating subarachnoid hemorrhage. We have presented a case of carotid-cavernous fistula in a 17-year-old boy, treated successfully with balloon embolization. Although surgical treatment…
Case Report
Effect of Coronary Artery Revascularization on Left and Right Ventricular Ejection Fractions During Rest and Exercise*
SUMMARYWe have reported a case of a 55-year-old man who had improvement of both left and right ventricular ejection fractions during rest and exercise after coronary revascularization. Ventricular performance was assessed using radionuclide angiography. Although coronary artery bypass grafting has previously been shown to improve left ventricular function, we believe…
Case Report
Rapid Spontaneous Resolution of Cholelithiasis in a Newborn
SUMMARYWe have described a newborn who had rapid resolution of cholelithiasis after a gallstone was incidentally discovered during sonographic evaluation of a renal mass. This case emphasizes the importance of conservative management and serial sonograms in infants with tumefacient sludge or gallstones without clinical or imaging evidence of biliary tract…
Breif Report
Neuroleptic Malignant Syndrome Associated With Metoclopramide
SUMMARYThe case of neuroleptic malignant syndrome presented was associated with the use of metoclopramide, a dopamine-blocking agent, which is normally used in nonpsychiatric patients. The patient was successfully treated with dantrolene and bromocriptine. Nonpsychiatrist physicians should be aware of this complication of metoclopramide, as it is potentially fatal.
Breif Report
Posttraumatic Pasteurella multocida Meningitis
SUMMARYThe patient described was immunologically compromised by multisystem trauma. Pasteurella multocida was isolated from the respiratory tract and subsequently from the cerebrospinal fluid; direct spread apparently occurred by way of a basilar skull fracture. Sepsis was absent. He was successfully treated but subsequently had hydrocephalus, which has not previously been…
Breif Report
Korsakoffs Psychosis Due to Massive Beer Intake Provoked by Diabetes Insipidus
SUMMARYPosttraumatic diabetes insipidus, acute pancreatitis, and Wernickes encephalopathy and Korsakoffs psychosis in a 33-year-old white male alcohol abuser resulted in near-fatal cardiovascular collapse. The Wernickes encephalopathy and Korsakoffs psychosis resulted from drinking massive quantities of beer to satisfy the thirst induced by diabetes insipidus. Although the diabetes insipidus was controlled…
Breif Report
Aspergillosis in a Healthy Host
SUMMARYThis case report describes an unusual occurrence of invasive aspergillosis in a previously healthy, nonimmunocompromised woman. Repeatedly positive sputum cultures were misinterpreted as not significant, and the diagnosis was not made until after the patient died. Serial sputum cultures positive for Aspergillus in a patient with pneumonia who is not…
Breif Report
Diagnostic Peritoneal Lavage for Blunt Abdominal Trauma An Unusual Result
SUMMARYWe have reported the unusual finding of a grossly bile-stained peritoneal lavage 24 hours after blunt abdominal trauma, associated with neither enteric, hepatic, nor biliary tract injury at laparotomy. Intraoperative transcholecystic cholangiography is recommended in such a situation to rule out biliary tract injury.
