ABSTRACTIncidental splenectomy during exploratory laparotomy significantly increases morbidity and mortality. These rates, elevated in the morbidly obese, prompted a splenic preservation policy for any splenic injury during bariatric surgery. This review was needed to assess how this policy affected this population's intrinsically high perioperative risks. Six of 200 patients having…
ABSTRACTInterest in the relationship between the morphology of the brain and mental and behavioral characteristics was evident in the 18th century; it flourished in the 19th century and waned during this century. This concern has been expressed in several activities. The weight and cortical area and gyral patterns of brains…
ABSTRACTIt is currently recommended that every pregnant woman have a blood glucose screening test for gestational diabetes at 24 to 28 weeks' gestation. Random urine samples are also tested for glucose at each prenatal visit. In 500 consecutive pregnant women, random urine glucose screening values from each prenatal visit were…
ABSTRACTPatient initiation of mammographie screening is one method of increasing compliance with screening mammography guidelines. A low-cost screening project using a mobile van was developed at the University of Alabama at Birmingham. Analysis of the first 2,099 patients revealed that the participants were generally white (92%), more likely to have…
ABSTRACTRetroviruses emerged before Homo sapiens in the course of vertebrate evolution. The first human retrovirus was isolated in 1979; the human immunodeficiency virus (HIV-1) assumed epidemic importance in 1981. That such a novel threat to the survival of our species struck only when we had in place, for the first…
ABSTRACTSeverity of injury, patient age and preexisting medical conditions, time from injury to treatment, and quality of care rendered are generally recognized as major determinants of outcome after trauma. In a retrospective review, we compared 456 elderly patients (age ≥65 years) with traumatic injuries to 985 younger patients (age <65)….
ABSTRACTThe Cotrel-Dubousset instrumentation (CDI) system developed between 1982 and 1984 is now being used extensively for the posterior correction of idiopathic scoliosis. In this study we compared the lateral and rotational correction obtained with CDI to that obtained with Harrington rod instrumentation and Drummond wiring. We matched 14 patients who…
ABSTRACTThe need for medically related business and managerial training for medical students and physicians is an area of education that has been frequently discussed among physicians in private and academic practice. However, little has been done by physicians or in formal programs of medical or graduate medical education to address…
ABSTRACTThe oropharyngeal function study is a videotaped radiographic examination of the oropharynx and cervical esophagus used in patients who are at major risk for aspiration because of swallowing difficulty. Preceding the radiographic evaluation, the patient is assessed clinically by a swallowing therapist who attends the examination with the radiologist. Close…
ABSTRACTThe overall cancer mortality for white and nonwhite men rose twice as rapidly in the South as in the rest of the nation, largely influenced by the rapid growth in lung cancer mortality among southern men in both race groups, and by the significant increase in prostate cancer mortality among…
ABSTRACTThe spongiform encephalopathies encompass several diseases affecting humans and animals. In the United States, the most common of these disorders in humans is Creutzfeldt-Jakob disease. The most frequent manifestations include dementia, pyramidal tract signs, and extrapyramidal movement disorder. Several clinically distinct syndromes can be identified. Often the diagnosis is confused…
ABSTRACTThis report presents results from an international multicenter trial of the safety of buspirone in the treatment of anxiety disorders for periods up to one year, if needed; 424 patients were treated for six months, and 264 patients completed a full year of treatment. Chronic use of buspirone for up…
ABSTRACTUsing continuous wave Doppler ultrasound, we studied the umbilical and uterine flow velocity waveforms in 68 pregnant women who had chronic hypertension and/or preeclampsia. The systolic-diastolic (S/D) ratio was considered an expression of vascular resistance peripheral to the point of insonation. Abnormal umbilical artery S/D ratio (>95th percentile) alone or…
ABSTRACTWe describe a case of group A β-hemolytic streptococcal bacteremia in an individual infected with the human immunodeficiency virus (HIV). The organism was also recovered from the stool, but not from the throat. A review of 19 cases of group A β-hemolytic streptococcal bacteremia shows an association between an underlying…
ABSTRACTWe retrospectively reviewed 76 cerclage procedures done in 62 patients from January 1980 through October 1987 at the Louisiana State University Medical Center, Shreveport. The study showed a significant increase in fetal salvage after cerclage—from 23% to 72%. Emergency cerclage resulted in a fetal salvage rate of only 12%, in…
APPROXIMATELY 19,000 new cases of ovarian cancer with 11,600 deaths are seen annually. The behavior of epithelial ovarian cancer is predictable, with intraperitoneal surface dissemination and retroperitoneal lymphatic spread being the dominant modes of spread. As platinum-based combination therapy provides longer periods of disease-free survival, new manifestations of disease are…
BEVIS first used amniotic fluid as a source of information in predicting hemolytic disease of the newborn in 1952. At present, sampling of amniotic fluid is customary in evaluation for Rh isoimmunization. Spectrophotometric interpretation is based on the premise that breakdown products from hemolysis, such as bilirubin, will be present…
DIABETES MELLITUS is classically manifested by polyuria, polydipsia, and weight loss. In patients with maturity-onset diabetes, however, complications such as neuropathy may already be present by the time of diagnosis.Diabetic peripheral neuropathy may be characterized by somatic sensory neuropathy, which involves the large diameter nerve fibers, affecting vibration and joint…
DIAPHRAGMATIC HERNIAS are usually due to penetrating trauma, automobile accidents, or industrial mishaps and are often associated with other injuries. In many cases, the hernia is not diagnosed until months or years later. The following case was exceptional because of the unusual nature of the accident responsible for the hernia…
FEW REPORTED CASES of enterouterine fistula are to be found in a review of 100 years of medical literature. In addition, most of the fistulas described were associated with inflammatory bowel disease, obstetric trauma, uterine perforation by a curet or intrauterine device, or endometrial carcinoma. During a six-month period in…
HISTOPLASMOSIS was first described by Samuel Darling in 1905 while he was working in the Panama Canal Zone as a US Army pathologist. Because he thought organisms found in histiocytes of a man who had died of a febrile illness were encapsulated protozoans, Darling named them Histoplasma capsulatum. Now it…
OLIGODENDROGLIOMAS constitute 5% to 7% of all primary brain tumors. Their dissemination through the ventricular system is common, and they are regarded by some as second only to medulloblastomas in their propensity to seed the cerebrospinal fluid (CSF) pathways. However, primary oligodendrogliomas of the ventricular system are rare, with fewer…
ONCE considered nonpathogenic commensals, coagulase-negative staphylococci have been cited with increasing frequency as pathogens. Currently, more than 20 species of coagulase-negative staphylococci have been delineated, but the majority of infections in man are caused by Staphylococcus epidermidis; this organism avidly infects in the presence of prosthetic devices and other foreign…
PNEUMOMEDIASTINUM has been recognized as a complication of asthma for more than a century and has been well described in children and adults. Pneumomediastinum is not infrequent and has been reported in 5.4% of 479 chest roentgenograms of children admitted for acute exacerbations of asthma. Since chest roentgenograms are not…
SINCE the first account by Julian in 1956, the combination of abdominal aortic aneurysm and horseshoe kidney has been the subject of many reports and several excellent reviews. Reports of ruptured abdominal aortic aneurysm, however, have been sporadic, only 12 cases having been reported worldwide. This entity deserves attention, since…
SPONTANEOUS bacterial peritonitis (SBP) is a well recognized complication of ascites and results in significant morbidity and mortality. There are multiple predisposing factors, causes, and clinical courses associated with this entity. We describe a patient with a perplexing presentation, microbiologic findings, and clinical course who had peritonitis due to Listeria…
SUMMARYI believe this is the first reported case of neurogenic ECG changes following a transient neurologic insult. The profound and long-lasting ECG changes that followed a brief neurologic derangement adds credence to the theory of actual myocardial damage as the genesis of neurogenic ECG changes.
SUMMARYI have described two cases of hepatic abscess due to E coli after choledochoduodenostomy for choledocholithiasis, and have discussed the relationship between abscess formation and size of the anastomosis. I conclude that a small anastomosis may in some cases predispose to this problem. Treatment by percutaneous drainage of the abscess…
SUMMARYThis case exemplifies the deceptive nature of some lung cancers and emphasizes the importance of necropsy in proper death certification. I conclude that like some breast cancers, many lung cancers seem to be disseminated from inception, and more conservative surgical management in selected cases may improve the quality of life.
THE BROWN RECLUSE spider, Loxosceles reclusa, is normally a nonaggressive arthropod that tends to bite humans only when trapped in clothing or when accidentally cornered. The diagnosis of brown recluse spider bite is often difficult to document because of the lack of a specific clinical test; therefore it is frequently…
THE INCIDENCE of multinodular goiter has declined dramatically during this century. Although a substantial proportion of thyroidectomies were once done for locally symptomatic goiters, this is currently uncommon. Goiters are successfully treated medically, and only the rare goiter causing tracheal, esophageal, or vascular compromise necessitates surgery.Mediastinal extension of a goiter…
THE SYNDROME of inappropriate antidiuretic hormone secretion (SIADH) is associated with hypo-natremia and decreased serum osmolarity combined with inappropriately increased urinary natriuresis and osmolarity. The syndrome can result from diverse conditions, including pulmonary infection or trauma. There have been only two published case reports of this syndrome in patients with…
THE USE OF tissue expansion to correct burn deformities is now an established method of reconstruction. The complication rate with the use of expanders has been reported to be from 10% to 48%. Major complications have been associated with implant failure, infection, and exposure of the implant itself. Exposure of…
There are men and classes of men that stand above the common herd: the soldier, the sailor, and the shepherd not infrequently; the artist rarely; rarlier still, the clergyman; the physician almost as a rule. He is the flower (such as it is) of our civilization….
Truth is one forever absolute, but opinion is truth filtered through the moods, the blood, the disposition of the spectator.
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