Issue - Southern Medical Association

Editorial

ADDLED BRAINS AND COFFIN NAILS

Editorial

Progressive Parkinsonism in Boxers

ABSTRACTParkinsonism associated with boxing has attracted recent media attention, yet little has been written about it in the medical literature. This report presents a typical case with a review of the literature.

Editorial

Boxing-Related Ocular Injuries in the United States Army, 1980 to 1985

ABSTRACTBoxing is a controversial sport in which neurologic and ocular injuries can be particularly devastating. Currently, competitive boxing is promoted throughout the military. Ocular injuries attributable to military boxing were studied as a subset of a larger study of boxing-related injuries. Ocular injuries occurred in 5% (22/401) of soldiers hospitalized…

Editorial

Amantadine and the End-Stage Dementia of Alzheimers Type

ABSTRACTSignificant improvement of mental status was noted with amantadine therapy in three patients in whom autopsy subsequently showed Alzheimers disease. Two patients showed a dramatic improvement during the treatment. Their mute, immobile states were reversed and they were able to speak a few coherent words. Their mental status deteriorated when…

Editorial

Naloxone and Mortality in the Gerbil Stroke Model

ABSTRACTEndorphins and narcotics have been implicated in the exacerbation of neurologic deficits after stroke. To test the theory that narcotic antagonists might offer an improvement in neurologic sequelae following stroke, we administered various doses of naloxone intraperitoneally to 50 adult gerbils 45 minutes after carotid artery transsection. Low-dose naloxone therapy…

Editorial

Renal Revascularization in Anuric Patients Determinants of Outcome

ABSTRACTWe describe three patients who recently had surgical revascularization for prolonged anuria due to renal artery occlusion. A review of the literature revealed 31 similar patients with sufficient data to allow comparison. There was no correlation between the interval of anuria and the surgical outcome regarding survival, renal function, and…

Editorial

Intracranial Complications of Sinusitis

ABSTRACTSinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is…

Editorial

Xanthelasma Clinical Indicator of Decreased Levels of High-Density Lipoprotein Cholesterol

ABSTRACTThe fasting plasma lipid and lipoprotein levels were measured prospectively in 41 consecutive patients with xanthelasma seen over a four-year period. The study group included 25 women and 16 men with mean ages of 60 and 56 years, respectively. Each patient had clinical evaluation for medications or illnesses that might…

Editorial

Diabetic Retinopathy A Leading Cause of New Blindness

ABSTRACTSome of the basic underlying processes in the development of diabetic retinopathy include changes in the walls of retinal vessels, with occlusion and leakage. These result in edema, hemorrhage, hard exudates, plaques, and ischemia, leading to neovascularization. When proliferative retinopathy supervenes, it may result in complete blindness. Internists and family…

Editorial

Musculoskeletal Chest Pain in Patients With “Angina” A Prospective Study*

ABSTRACTWe prospectively evaluated 62 adults referred for coronary arteriography, using a systematic physical examination protocol to identify musculoskeletal sources of chest pain. In seven patients (11%) the chest pain was reproduced on physical examination; six of them ultimately had a diagnosis of nonanginal chest pain made by their cardiologist, based…

Editorial

Blunt Pancreatic Trauma Prospective Evaluation of Early Endoscopic Retrograde Pancreatography*

ABSTRACTMajor ductal injury is a determining factor in the outcome after pancreatic trauma. The purpose of this study was to determine the value of early endoscopic retrograde pancreatography (ERP) in patients with blunt pancreatic trauma. We attempted ERP in nine patients. Indications were abnormal pancreatic findings on CT scanning in…

Editorial

Osteoplastic Pterional Craniotomy

ABSTRACTWe describe a new method for small frontotemporal craniotomies. Adequate exposure is obtained. Sparing of the trunk of the frontotemporal branch of the facial nerve as it passes near the eyebrow preserves forehead mimetic function, and maintenance of the blood supply to the bone flap helps to prevent resorption.

Editorial

Reconstruction of Heel Defects

ABSTRACTIn the mechanics of normal walking, the heel plays an important role, and injuries to the heel often result in limitation, and occasionally loss, of that ability. We review the three categories of heel injuries based on their severity and discuss the available methods of treatment for each. We also…

Editorial

Height-Adjusted, Rate-Specific, Single-Stage Step Test for Predicting Maximal Oxygen Consumption

ABSTRACTA suitable ergometer that is generally favored for estimating maximal oxygen consumption (VO2 max) under field conditions or in environments where testing equipment is limited is the step test. Recently a mathematical model was reported to standardize the height of stepping for individuals of various heights. We designed a study…

Editorial

Wound Hematoma Prophylaxis With Topical Thrombin

ABSTRACTWe studied 123 patients having elective exploratory laparotomy through a midline vertical incision for gynecologic disease; patients were randomized to receive wound irrigation with either saline or topical thrombin before closure of the incision. Seven patients were not evaluable. No patient received low-dose heparin therapy perioperatively. No patient in either…

Editorial

STATE MEDICAL ASSOCIATIONS IN THE SOUTHERN REGION ANNUAL MEETINGS

Review Article

Weight Gain Associated With Psychotropic Drugs

ABSTRACTThe weight increase that is an often reported side effect of psychotropic drug use has implications for health risks as well as medication noncompliance. In this article I review the literature on the association between the use of several classes of psychotropic drugs and weight gain, discuss the possible mechanisms…

Review Article

BOOKS RECEIVED

The receipt of the following books is acknowledged, and this listing must be regarded as sufficient return for the courtesy of the sender. Books that appear to be of particular interest will be reviewed as space permits.

Current Concepts

Colloid Oncotic Pressure as a Guide for the Anesthesiologist in Directing Fluid Therapy*

ABSTRACTOne useful but underused parameter of fluid replacement is colloid oncotic pressure. Colloid oncotic pressure (COP) is one of the Starling forces that maintain a balance between intravascular and extravascular fluid. Systemic and pulmonary circulations exhibit differences that limit the usefulness of COP manipulation in the treatment of pulmonary edema,…

Article

Dante and Medicine The Circle of Malpractice

DANTES Commedia is a literary epic of almost unimaginable breadth and complexity that infolds recursively via one of the most condensed poetic dictions in world literature. The poem is rigorously mathematically structured to present a summa (a comprehensive treatise) of knowledge in the 13th century. Ancient and then-modern history, biography,…

Medical Education

Why Medicine Residencies?

ABSTRACTOver the last several decades the context of the medicine residency has changed. These changes are described and attributed in considerable degree to bureaucratic impositions. I consider it paradoxic that there is finally a move afoot to reverse the changing nature of medicine residencies, yet this effort appears in the…

Evagations

SNACKS TO SECURE SOLVENCY or Confessions of an Editor-in-Chief

Case Report

Group G Streptococcal Bacteremia in a Healthy Young Man

GROUP G Streptococcus has been cited with increasing frequency as an agent of significant infection. Local group G infections such as pharyngitis, cellulitis, and erysipelas have been reported, reflecting the normal existence of group G streptococci in the oropharynx and on the skin. Systemic diseases attributable to group G streptococci…

Case Report

Septic Shock and Acute Respiratory Distress Syndrome After Salpingitis Caused by Streptococcus pyogenes Group A

SINCE THE ERA of childbed fever came to its long-delayed conclusion, cases of sepsis caused by Streptococcus pyogenes group A arising from the female reproductive tract have been unusual in the absence of foreign bodies, notably intrauterine devices or retained products of conception. Vaginal and anal carriers of Streptococcus pyogenes…

Case Report

Biliary Lithotripsy in the United States

THE FIRST CHOLECYSTECTOMY was done by Langenbuch in Berlin more than 100 years ago. Since that time it has become a safe and effective method of treating cholelithiasis; nevertheless, it is a major operation, and in recent years non-operative alternatives have been sought. The use of orally administered bile acids…

Case Report

Viscerotropic Rocky Mountain Spotted Fever in Southeastern Texas Report of a Survivor With Atypical Manifestations and Multiple Organ Failure

THE NUMBER of reported cases of Rocky Mountain spotted fever (RMSF) in the United States has increased from 204 cases in 1960 to 979 cases in 1982. The South Atlantic states accounted for 521 (53%) of the reported cases in 1982 and North Carolina had the highest RMSF infection rate.1…

Case Report

Mucoepidermoid Carcinoma of the Lacrimal Gland Fossa Confirmation by Ultrastructural Study

DESPITE its reasonably high prevalence in the salivary gland, mucoepidermoid carcinoma arises extremely sporadically in the lacrimal gland.1 In fact, the lesion as separate entity has been so difficult to document that its very existence as a lacrimal gland primary tumor has been challenged.2 Because of the elusiveness of the…

Case Report

Autoimmune Thyroiditis Manifested as a Systemic Febrile Illness Diagnosis by Gallium Scan and Fine Needle Aspiration Biopsy

THYROIDAL UPTAKE of gallium citrate Ga 67 has been reported in patients undergoing investigations for systemic, febrile illness.1,4 We report the case of a patient in whom a gallium scan was done to delineate an apparently intra-abdominal source of fever. Localization of the isotope in the thyroid suggested thyroiditis, which…

Case Report

Reversible Profound Neurologic Deficits Associated With Transient Cranial CT Abnormalities and Systemic Lupus Erythematosus

THERE HAVE BEEN several documented reports of reversible cerebral radiologic abnormalities in the past. Most of the affected patients had partial or generalized seizures after a febrile illness or hypertensive encephalopathy. In the previous case reports, the patients involved had few if any neurologic deficits. To date, there has been…

Case Report

Trigeminal Neurilemoma Appearance on Magnetic Resonance Imaging

INTRACRANIAL NEURILEMOMAS are readily demonstrable by computerized tomography (CT), as has been shown over the past ten years. Small tumors located about the base of the skull and the posterior cranial fossa, however, can be difficult to detect by CT because of bone artifact. Though intracranial trigeminal neurilemomas can arise…

Case Report

Neonatal Lupus in Twins

NEONATAL LUPUS is a rare syndrome. In the approximately 100 cases reported in the literature, the syndrome has been characterized by cutaneous lupus erythematosus (LE) lesions, systemic disease such as hepatosplenomegaly and Coombs’-positive hemolytic anemia, and cardiac conduction defects.1 In this report, we describe the clinical and serologic features of…

Clinical Brief

Emergency Cricothyrotomy A Flexible Device in the Operating Room

CRICOTHYROTOMY via a large bore needle is an acceptable method of providing temporary oxygenation in emergency situations when intubation (oral or nasal) cannot be accomplished. Various devices have been constructed in recent years to facilitate puncture of the cricothyroid membrane. The use of many of these devices, however, necessitates surgical…

Breif Report

Profound Thrombocytosis in a Patient With Iron-Lack Anemia

IRON-LACK ANEMIA often develops in patients with thrombocytosis, but the platelet count usually returns toward normal levels with iron repletion.2 As a general rule, however, platelet counts in excess of 1 million per cubic millimeter are associated with primary hematologic disease (eg, a myeloproliferative disorder such as chronic myeloid leukemia…

Breif Report

Simultaneous Pneumococcal Arthritis and Osteoarticular Tuberculosis

PNEUMOCOCCAL PYARTHROSIS is an uncommon disease.1 Likewise, infection of joints with Mycobacterium tuberculosis remains uncommon.2,4 We report a case of acute pneumococcal pyarthrosis of the knee complicating and obscuring a chronic osteoarticular tuberculous infection.

Breif Report

“Nutcracker Esophagus” A Case of False-Negative Radionuclide Esophageal Transit Study

RADIONUCLIDE esophageal transit study (RETS) is gaining popularity as a simple and noninvasive test for detection and diagnosis of esophageal motility disorders (EMD).1–3 “Nutcracker esophagus” is an EMD in which peristaltic esophageal contraction waves of abnormally high amplitude and prolonged duration are associated with chest pain. We are describing here…

Breif Report

Intra-abdominal Bleeding After Rupture of Hepatic Cyst

IN 1981 Davis et al1 reported in this journal a case of fatal intra-abdominal bleeding after rupture of a hepatic cyst. We add the description of a similar case, which is the first successfully treated.

Breif Report

Neonatal Hyperbilirubinemia After Treatment of Maternal Leprosy

SUMMARYLeprosy occurs rarely in women of reproductive age. Until this report, the treatment of leprosy with dapsone has not been associated with any adverse fetal or neonatal side effects. We have reported what we believe to be the first case of neonatal hyperbilirubinemia after maternal dapsone therapy for leprosy.

Breif Report

Ehrlichia in Tennessee

EHRLICHIA CANIS infection is a tick-borne disease that has been recently reported from many states across the United States, particularly from the South, though no case has been reported heretofore in Tennessee. We report a case of ehrlichiosis that was acquired and diagnosed in Tennessee.

Letter to the Editor

Religion and Medicine To the Editor

Letter to the Editor

Temporal Artery Biopsy To the Editor

Letter to the Editor

Reply

Letter to the Editor

Prophylactic Epidural Blood Patch in Parturients To the Editor

Letter to the Editor

Marijuana as a Potential Carcinogen

Letter to the Editor

Failure of Polymyxin B to Restore Sensitivity to Quinolones for Pseudomonas aeruginosa