SMJ // June 1988, Volume 81 - Issue 6
Editorial
THE PHYSICAL EXAMINATION-AN ART
Primary Article
Coronary Thrombolysis in a Community Hospital: Experience With an Intravenous Streptokinase Protocol
ABSTRACT: To determine whether intravenous streptokinase can be delivered safely and effectively in a community hospital without acute angiography, we treated 120 patients with intravenous infusion of 1.5 million units of streptokinase shortly after arrival in the emergency room. Average time from onset of pain to treatment was 2.7 hours….
Primary Article
Hypertensive Concentric Left Ventricular Hypertrophy: When Is Ventricular Ectopic Activity Increased?
ABSTRACT: The Framingham Study has indicated that patients with left ventricular hypertrophy (LVH) have a greater risk of cardiovascular complications and sudden death than subjects with a normal heart. We have previously demonstrated that ventricular ectopy was more prevalent and complex in hypertensive patients with LVH by electrocardiographs (ECG) criteria…
Primary Article
Trachea–Innominate Artery Fistula: Retrospective Comparison of Treatment Methods
ABSTRACT: A fistula between the trachea and the innominate artery, a potentially fatal complication of tracheostomy, can be managed successfully. We have derived several guidelines from our experience with one such case and from a review of the 36 cases reported in the literature over the last decade. Diagnosis must…
Primary Article
Learning Curve for Carotid Endarterectomy
ABSTRACT: It is generally accepted that training and experience are necessary to obtain acceptably low perioperative mortality and permanent neurologic morbidity for carotid endarterectomy. To test this hypothesis I analyzed the results of 600 consecutive primary carotid endarterectomies that I performed over a 13-year period beginning with my senior residency….
Primary Article
Complications of Carotid Endarterectomy: The Influence of Case Load
ABSTRACT: We reviewed the records of 508 consecutive carotid endarterectomies done by 19 surgeons during a five-year period in one medical center to evaluate postoperative complications (stroke and death). Each of 16 surgeons did 32 operations or fewer, with case loads ranging from one to 32. Three surgeons did 70,…
Primary Article
Correlates of Cervical Cytologic Screening
ABSTRACT: We investigated factors associated with the frequency of Papanicolaou cytologic screening among women between the ages of 20 and 54 years in metropolitan Atlanta. In a sample of 393 women who had not had a hysterectomy, the frequency of screening was uniformly high for women aged 20 to 49…
Primary Article
Gastrostomy: A Simple and Effective Technique
ABSTRACT: To provide a comfortable and effective method for gastrointestinal decompression or feeding, we developed an alternate technique for gastrostomy. Under local or general anesthesia a No. 18 red rubber catheter with multiple openings cut into the distal 8 to 10 cm is passed through a stab wound in the…
Primary Article
Progressive Roentgenographic Appearance of Caustic Esophagitis
ABSTRACT: We observed progressive roentgenographic changes in five patients who had caustic esophagitis after accidental ingestion of a liquid alkali. Initial endoscopic examination showed moderate caustic esophagitis in all patients, and esophageal atony and poor distension were early roentgenographic observations. Esophageal strictures developed 13 to 44 days after caustic ingestion…
Primary Article
Systemic Mastocytosis and Mastocytosis-Like Syndrome: Radiologic Features of Gastrointestinal Manifestations
ABSTRACT: Mastocytosis is a disorder of unknown etiology characterized by an abnormal proliferation of tissue mast cells, and/or by degranulation of abnormally behaving mast cells that show no proliferation, but release myriad active metabolites. This results in a wide spectrum of signs and symptoms that fluctuate considerably. The presently available…
Primary Article
Antecedent Factors in Urinary Tract Infections Among Nursing Home Patients
ABSTRACT: By a retrospective relative risk analysis for conditions associated with urinary tract infection over a four-year period in a defined teaching nursing home population (n=97), we reached the following conclusions: (1) UTI was associated with cerebrovascular accident (relative risk 2.2, 95% confidence interval 1.4 to 3.2), decreased activities of…
Primary Article
Treatment of Keloids by Single Intraoperative Perilesional Injection of Repository Steroid
ABSTRACT: Keloid management remains controversial, and recurrence and untoward side effects limit the use of many techniques. During a seven-year period, I surgically treated 19 children, aged 3 to 17 (mean 10.5 years), with a total of 28 keloids. After aseptic skin preparation, the interface between the keloid and normal…
Primary Article
Complications of Endotracheal Intubation
ABSTRACT: Tracheal intubation for airway control, once done only by anesthesiologists during surgical procedures, is now being done by physicians in other specialties and by nurses, technicians, and paramedics in areas other than the operating room. Intubation, however, does not always assure a patent airway. Unrecognized esophageal placement of endotracheal…
Primary Article
Assessment of Psychosocial Functioning of Patients With Sickle Cell Disease
ABSTRACT: The Chronic Illness Problem Inventory (CIPI) was used to assess level of psychosocial functioning in 89 patients with sickle cell disease. The results indicated that sickle cell patients have significant psychosocial distress in the areas of employment and finances, sleeping and eating, and performance of normal daily activities. Fear…
Review Article
Ganglions of the Hand and Wrist
ABSTRACT: The ganglion is the most common soft tissue tumor of the hand and wrist, originating from the joint capsule or tendon sheath. Accurate diagnosis and proper treatment of these entities require a thorough knowledge of the anatomy of the wrist and hand as well as of the ganglion itself….
Current Concepts
Treatment of Asthma With Glucocorticosteroids
ABSTRACT: Glucocorticosteroids (GCS) are used to treat asthma that does not respond to accepted first-line therapy. Because they have potent anti-inflammatory properties, facilitate β-adrenergic responsiveness, suppress the late-phase reaction and reduce secretion of mucus, GCS are indicated in the treatment of severe acute asthma and chronic asthma not responsive to…
Article
Physical Examination: A Revered Skill Under Scrutiny
ABSTRACT: Clinicians in the 1980s rely on the physical examination to a lesser degree than their predecessors in making diagnostic and therapeutic decisions. The major criticisms are that the physical examination lacks sensitivity for many common diseases and has not been subjected to the same scientific scrutiny afforded laboratory testing….
