Issue - Southern Medical Association

Editorial

Splenic Injury and Repair During Bariatric Surgical Procedures

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…

Our Medical Heritage

Osler’s Brain and Related Mental Matters

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…

Editorial

Screening for Glycosuria During Pregnancy

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…

Editorial

Patient-Initiated Mobile Mammography: Analysis of the Patients and the Problems

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…

Article

Is There Divine Justice in AIDS? Why Now, and Not Before?

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…

Editorial

Trauma in the Elderly Determinants of Outcome

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)….

Editorial

Idiopathic Scoliosis Correction of Lateral and Rotational Deformities Using the Cotrel-Dubousset Spinal Instrumentation System

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…

Article

Business and Managerial Education in the Medical School Curriculum

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…

Editorial

Oropharyngeal Function: Study Radiologic Means of Evaluating Swallowing Difficulty

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…

Editorial

Cancer Mortality in the South: 1950 to 1980

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…

Editorial

Spongiform Encephalopathies The Physician’s Responsibility

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…

Editorial

Long-term Buspirone Therapy for Chronic Anxiety: A Multicenter International Study to Determine Safety

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…

Editorial

Uterine and Umbilical Artery Flow Velocity Waveform Analysis in Pregnancies Complicated by Chronic Hypertension or Preeclampsia

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…

Editorial

Group A β-Hemolytic Streptococcal Bacteremia and HIV Infection

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…

Editorial

Retrospective Analysis of Cervical Cerclage Procedures at the Louisiana State University, Shreveport (1980 to 1987)

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&percnt; to 72&percnt;. Emergency cerclage resulted in a fetal salvage rate of only 12&percnt;, in…

Case Report

Survival After Malignant Pericardial Effusion and Cardiac Tamponade in Advanced Ovarian Cancer

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…

Case Report

Fetal Intestinal Obstruction Necessity for Percutaneous Umbilical Blood Sampling to Assess the Severity of Rh Sensitization

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…

Case Report

Hyperosmolar Nonketotic Hyperglycemia Manifested as Ascending Polyneuropathy

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…

Case Report

Unusual Cause of Traumatic Diaphragmatic Hernia in a 12-Year Old Boy

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…

Case Report

Enterouterine Fistulas: Two Rare Cases of Intestinal Neoplasms Manifested by Gynecologic Symptoms

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…

Case Report

Oropharyngeal Histoplasmosis

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…

Case Report

Primary Oligodendroglioma of the Lateral Ventricle

OLIGODENDROGLIOMAS constitute 5&percnt; to 7&percnt; 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…

Case Report

Fulminating Staphylococcus epidermidis Bacteremia

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…

Case Report

“Ring Around the Artery” as a Presenting Feature in Undiagnosed Asthma With Pneumomediastinum

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&percnt; of 479 chest roentgenograms of children admitted for acute exacerbations of asthma. Since chest roentgenograms are not…

Case Report

Ruptured Abdominal Aortic Aneurysm and Horseshoe Kidney

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…

Case Report

Secondary Bacterial Peritonitis Due to Listeria monocytogenes After Paracentesis

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…

Case Report

Electrocardiographic Abnormalities After a Transient Ischemic Attack

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.

Case Report

Liver Abscesses Successful Treatment With Choledochoduodenostomy

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…

Case Report

Reflections on the Nature of Lung Cancer

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.

Case Report

Pseudoepitheliomatous Hyperplasia and Pyoderma Gangrenosum After a Brown Recluse Spider Bite

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…

Case Report

Retrotracheal Goiter

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…

Case Report

Herpes Zoster Infection of the Chest Wall and the Syndrome of Inappropriate Antidiuretic Hormone Secretion

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…

Case Report

Salvage of an Avulsed Expanded Scalp Flap to Correct Burn Alopecia

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&percnt; to 48&percnt;. Major complications have been associated with implant failure, infection, and exposure of the implant itself. Exposure of…

Editorial

HISTOPHOBIA

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….

Article

As a Matter of “Tact”

Truth is one forever absolute, but opinion is truth filtered through the moods, the blood, the disposition of the spectator.

Letter to the Editor

A New Intrathoracic Foreign Body

Letter to the Editor

Group A β-Streptococcal Penile Ulceration Associated With Asymptomatic Heterosexual Pharyngeal Transmission

Editorial

JUST MESSIN’ AROUND

Letter to the Editor

More on English

Letter to the Editor

Reply

Letter to the Editor

Successful Thrombolytic Therapy for Acute Myocardial Infarction In a Renal Transplant Patient

Letter to the Editor

Trigger Point Origin of Musculoskeletal Chest Pain