SMJ // March 1989, Volume 82 - Issue 3
Primary Article
Reporting of Child Abuse: Influence of Characteristics of Physician, Practice, and Community
ABSTRACT: This survey of 120 Alabama pediatricians, family physicians, and general practitioners investigated the relationship between physician, practice, and community characteristics and the factors that impede reporting of detected child abuse. Solo practitioners and rural physicians were most concerned about the effect of reporting on their relationship with their patients….
Primary Article
Large Pericardial Effusion After Cardiac Surgery: Role of Echocardiography in Diagnosis and Management
ABSTRACT: We performed M-mode and two-dimensional (2-D) echocardiograms prospectively in 140 patients an average of eight days after open heart surgery. Large pericardial effusions occurred in 13 patients; three had complete circumcardiac pericardial effusion, four had local anterior adhesions, five had extensive anterior adhesions (posterior loculated effusion), and one had…
Primary Article
Preoperative Cardiac Consultations in a Teaching Hospital
ABSTRACT: Perioperative consultations may play a major role in the care of surgical patients in an era of prospective payments. Since insurance reimbursement policy favors limitations in the number of consultants on a case, general medicine (“holistic”) consultation services may become preferred perioperative consultants in the future. To focus curriculum…
Primary Article
Hypertension: Variations in Prevalence in the Black Population
ABSTRACT: Prevalence trends in hypertension in black men and women show an inversion at about ages 45 to 54 years. Incidence, mortality, and treatment of hypertension after age 35 can probably be related to this inversion. Incidence data are inconsistent and scanty. Morbidity data are incomplete and mostly unreliable. Mortality…
Primary Article
Hospital Costs, Use of Resources, and Dynamics of Death Associated With Diabetes Mellitus
ABSTRACT: The federal Medicare DRG (diagnosis-related group) system is entering its sixth year. The hospital industry contends that DRGs are under-reimbursing for the hospital care provided. Our analysis by outcome (ie, survival vs death) of 3,329 patients with insulin-dependent or non-insulin-dependent diabetes mellitus showed that the 242 diabetes-related deaths were…
Primary Article
Surgical Management of Colonic Inertia
ABSTRACT: Fourteen patients with chronic constipation due to colonic inertia were treated with total abdominal colectomy and ileorectal anastomosis at the Cleveland Clinic Foundation from 1981 to 1986. All patients were white women ranging in age from 28 to 64 years (mean 41 years). The duration of symptoms averaged 21…
Primary Article
Incarceration of the Retroverted Gravid Uterus: Report of Four Patients Managed With Uterine Reduction
ABSTRACT: Incarceration of the retroverted gravid uterus may have an adverse effect on pregnancy. To evaluate these effects, we reviewed obstetric records to identify parturients with the diagnosis of incarceration of the retroverted uterus during the years 1977 to 1987. Four such patients were identified by this retrospective review, for…
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Primary Article
Abdominal Leiomyosarcoma: Aggressive Management
ABSTRACT: We retrospectively reviewed 34 cases of intra-abdominal leiomyosarcoma treated between 1967 and 1986. Thirty-three patients had operation, and the primary tumor was removed in all but one. Fifteen patients had peritoneal implants at initial surgical exploration; 14 had tumor recurrence and had at least one reoperation. Five-year survival was…
Primary Article
Biochemical Testing in Patients With Alcoholic Liver Disease
ABSTRACT: We evaluated physicians laboratory utilization patterns for hospitalized patients with alcoholic liver disease and examined the relationship between the frequency of test ordering and certain variables in clinical outcome. During the study, 185 patients with alcoholic liver disease were hospitalized 378 times at the VA Medical Center, Long Beach,…
Primary Article
Lupus Nephritis: Efficacy of Monthly Pulse Therapy With Intravenous Methylprednisolone
ABSTRACT: Fourteen patients with severe systemic lupus erythematosus and nephritis were treated with high-dose intravenous methylprednisolone (IVMP) pulse therapy. Six patients (group 1) received one or two courses of 1 gm of IVMP when they were acutely ill with rapidly progressive renal failure or with multisystemic disease. All patients had…
Primary Article
Digital Subtraction Angiography of the Foot in Atherosclerotic Occlusive Disease
ABSTRACT: Digital subtraction angiography (DSA) provides additional information regarding patency or occlusion of vessels that is not always detected by conventional angiography. Patency of distal vessels is a positive prognostic factor in predicting salvage of the foot in patients having various treatment procedures for occlusive atherosclerotic disease. I evaluated the…
Primary Article
Carcinoma of the Prostate: Changing Incidence Associated With Annual Urologic Screening
ABSTRACT: The Urology Service at Brooke Army Medical Center has conducted routine screening rectal examinations for early diagnosis of carcinoma of the prostate since 1979. A review of the incidence of carcinoma of the prostate reveals that routine screening has yielded a significant increase in disease incidence. This incidence appears…
Primary Article
Tracheoesophageal Compression Syndromes Related to Vascular Ring
ABSTRACT: Seventeen cases of vascular ring have been encountered at Ochsner Clinic over the past 22 years. Anatomic configurations consisted of double aortic arch in 11 cases, right aortic arch with left ligamentum arteriosum in five cases, and aberrant right subclavian artery in one case. In four cases chest x-ray…
Primary Article
Nurse-Initiated Health Promotion Prompting System in an Internal Medicine Residents Clinic
ABSTRACT: Although cure of many diseases depends on early detection, screening schemes have been difficult to implement in busy clinic environments. We describe the testing of a nurse-initiated prompting system for six health promotion and disease prevention procedures in an internal medicine residents clinic at a university-affiliated community program. Maneuvers…
Review Article
Physical Treatments in Psychiatry: Current and Historical Use in the Southern United States
ABSTRACT: Several surveys during the 1970s showed a decline in the use of electroconvulsive therapy (ECT). Psychosurgery, insulin coma, and continuous sleep treatment are widely assumed to be in total disuse. This is the first comprehensive survey on the use of physical treatments in psychiatry in the southern United States….
Current Concepts
Psychiatric Manifestations of AIDS Spectrum Disorders
ABSTRACT: This paper reviews the proposed etiology and epidemiology of the acquired immunodeficiency syndrome (AIDS). It summarizes the psychiatric symptoms associated with members of high-risk groups, patients who have AIDS-related complex (ARC) or AIDS, and patients who are seropositive yet asymptomatic. It differentiates between psychiatric manifestations predating and following prodromal…
Current Concepts
Intraoperative Radiation Therapy for Locally Advanced Cancers
Medical Education
Why Perform a Routine History and Physical Examination?
ABSTRACT: Science uses two types of data—one for generating hypotheses and a second for testing hypotheses. In clinical medicine the history and physical examination generate the data used for making hypotheses about what could possibly be wrong with the patient; but the various laboratory and imaging procedures are used for…
