Commentary

Cardiovascular Screening in Army Personnel Over Age 40 in the State of Hawaii

ABSTRACTA cardiovascular screening protocol was applied prospectively to 1,900 soldiers over 40 years of age to identify individuals with latent coronary artery disease. Primary screening included a cardiovascular history, physical examination, electrocardiogram, serum cholesterol and serum glucose determinations, and calculated Framingham risk index. Seven hundred ninety-six individuals required secondary screening,…

Commentary

Splenic Vein Thrombosis

ABSTRACTA retrospective review of all admissions to the University of Kentucky Medical Center from 1977 to 1987 revealed six persons in whom splenic vein thrombosis could be documented. The patients had either upper gastrointestinal bleeding from gastroesophageal varices or abdominal pain. Pancreatic disease was present in five patients (83%), three…

Commentary

Early Glottic Carcinoma Patterns and Predictors of Relapse After Definitive Radiotherapy

ABSTRACTAlthough definitive radiotherapy in the management of early glottic carcinomas continues to offer excellent control, a small proportion of patients will have relapse. Between January 1972 and December 1984, 148 patients with squamous cell carcinoma of the glottis (stage I in 95 patients and stage II in 53 patients) had…

Commentary

Transurethral Prostatectomy Analysis and Comparison of Four Clinical Series

ABSTRACTCharts of 302 patients from four groups who had transurethral prostatectomy were reviewed with respect to patient characteristics and complications. The four groups were similar in average age and amount of tissue resected. Patients from the University of Alabama Hospital and Veterans Administration Hospital tended to have more associated illnesses…

Commentary

Diagnostic Peritoneal Lavage in Evaluation of Acute Abdominal Disease

ABSTRACTDiagnostic peritoneal lavage (DPL) is an established procedure in evaluation of trauma victims but is less well established for use in patients suspected of having acute intra-abdominal disease. Twenty-six seriously ill patients at our institution who had DPL for acute intra-abdominal disease form the basis of this report. Use of…

Commentary

Long-term, Follow-up After Leptospirosis

ABSTRACTHuman leptospirosis is an infectious disease that is a substantial problem in the Third World, but it can occur in developed countries as well. Survivors of the acute disease are considered to recover without sequelae, though little literature exists on long-term follow-up among these patients. Eleven patients, at an average…

Commentary

Elevated Serum Levels of Angiotensin-Converting Enzyme in Patients With Diabetic Retinopathy

ABSTRACTSerum levels of angiotensin-converting enzyme (ACE) were measured in 53 patients with type II (non-insulin-dependent) diabetes (25 without ophthalmologic complications, 20 with background retinopathy, and eight with proliferative retinopathy) and in 33 healthy nondiabetic subjects. Diabetic subjects were excluded if they had hypertension, ischemic heart disease, peripheral vascular disease, or…

Commentary

Ampicillin/Sulbactam Versus Clindamycin in the Treatment of Postpartum Endomyometritis

Sixty-eight patients with postpartum endomyometritis were enrolled in this open randomized comparative study. Forty-two patients received ampicillin/sulbactam and 26 received clindamycin. The cure rates were similar in the two groups: 83% in the ampicillin/sulbactam group and 88% in the clindamycin group. The most frequent endometrial bacterial isolates were Bacteroides bivius,…

Commentary

Ciguatera Fish Poisoning An: Outbreak Associated With Fish Caught From North Carolina Coastal Waters

ABSTRACTTen persons who had eaten at a seafood meal in North Carolina had gastrointestinal and neurologic symptoms suggestive of ciguatera fish poisoning. In five persons, the neurologic morbidity lasted 30 days or longer. The meal included barracuda, dolphin fish (mahimahi), and yellow-fin tuna, all of which were caught in North…

Commentary

Obstructive Sleep Apnea Syndrome: Correction by Mandibular Advancement

ABSTRACTThe obstructive sleep apnea syndrome (OSAS) is being recognized with increasing frequency in patients whose loud “heroic” snoring is coupled with significant and frequently debilitating daytime somnolence. Polysomnographic testing can clearly establish the diagnosis of this problem, but the etiology is multifactorial and the treatment options are varied. Although mandibular…

Commentary

Corticosteroids in Asthma

ABSTRACTThe use of corticosteroids in the treatment of asthma has significantly decreased the morbidity and mortality from this disease. However, corticosteroids have devastating side effects when given frequently or for prolonged periods. High doses of systemic corticosteroid preparations should be used only during bouts of acute bronchospasm, whereas the lowest…

Commentary

Computerized Tomography in the Evaluation of Myasthenia Gravis

ABSTRACTThymomas occur in 10% to 15% of patients with myasthenia gravis. Since not all patients are referred for thymectomy, a test that could reliably predict the presence or absence of a thymoma would be of great assistance in the management of these patients. We studied all patients referred for thymectomy…

Commentary

Clindamycin/Primaquine Therapy and Secondary Prophylaxis Against Pneumocystis carinii Pneumonia in Patients With AIDS

ABSTRACTWe found a program of intravenous and subsequent oral clindamycin, combined with oral primaquine, to be effective for Pneumocystis carinii pneumonia in nine patients with AIDS. The pneumonias were either primary or recurrent and sometimes severe, with cavity formation and/or pneumothorax. Maintenance therapy at lowered dose by mouth was effective…

Commentary

Cost Analysis of Kinetic Therapy in the Prevention of Complications of Stroke

ABSTRACTWe prospectively evaluated the costs of medical care in a group of 43 patients with acute severe stroke. Patients were assigned to either a routine hospital bed or a rotational bed. The rotational study bed (kinetic therapy) is designed to prevent complications of prolonged bed confinement by keeping patients in…

Commentary

Carcinoma of the Colon and Rectum in Patients Less Than 20 Years of Age

ABSTRACTWe report the cases of eight children and adolescents with adenocarcinoma of the colon treated at three large referral hospitals over a 25-year period. We recorded demographic factors, initial symptoms, stage at operation, type of operation, pathologic grade, and survival, and compared our results to those in the English literature….

Case Report

Long-term Medical Management of Aldosterone-Producing Adenoma

ALTHOUGH SURGERY is the appropriate treatment for an aldosterone-producing adenoma (Conn's syndrome) only 80% of patients are cured of their hypertension. Few instances of long-term medical management of Conn's syndrome have been reported, but drug therapy is the treatment of choice for idiopathic hyperaldosteronism. Spironolactone has been the preferred drug…

Case Report

Recurrent Aphthous Stomatitis and Vitamin B12 Deficiency

APHTHOUS STOMATITIS is a common disorder. Even though the etiology is usually not known, possible causes should be considered in the differential diagnosis. Recurrent aphthous stomatitis can be a forme fruste of Behcet's disease and an infrequent symptom of vitamin B12 deficiency.Colchicine therapy is being used for a growing number…

Case Report

Cancer of the Gallbladder

CARCINOMA of the gallbladder is a relatively rare malignancy usually found in an elderly, predominantly female population. Histologically, adenocarcinoma predominates, with only 10% to 15% being of other varieties (usually squamous and oat cell). We recently treated a patient with oat cell carcinoma of the gallbladder, which prompted this review…

Case Report

Antiarrhythmic Properties of Amitriptyline

CARDIAC EFFECTS of cyclic antidepressants have been recognized by physicians as potentially hazardous to patients with preexisting cardiac disease. In recent years clinical investigators have shown that cyclic antidepressants exert antiarrhythmic effects when plasma concentrations are therapeutic for depression. Previous studies have examined the role of imipramine and nortriptyline as…

Case Report

Gentamicin-Resistant Enterococcal Endocarditis: The Need for Routine Screening for High-Level Resistance to Aminoglycosides

ENTEROCOCCI are unique among the streptococci because of their relative resistance to penicillin. Consequently, a combination of penicillin and an aminoglycoside is needed for eradication of serious infections, such as endocarditis. During the past decade enterococci have been reported to be resistant to gentamicin at concentrations of 2,000 μg/ml or…

Article

Cholesterol: Myth or Reality?

IN a remarkable polemic published in the September issue of The Atlantic, Thomas J. Moore, a well known investigative reporter, attacks what he calls “the cholesterol myth.” The article is extremely well written and contains many valid criticisms of the National Cholesterol Education Program (NGEP). It is already touching off…

Case Report

Disseminated Cutaneous and Synovial Mycobacterium marinum Infection in a Patient With Systemic Lupus Erythematosus

INFECTION is often cited as the primary cause of death in patients with systemic lupus erythematosus (SLE), commonly due to gram-negative bacteria, fungi, and other opportunistic organisms. The prevalence of tuberculosis associated with SLE has been reported to be as high as 5%, whereas atypical mycobacterial infection has been reported…

Case Report

Acute Abdominal Conditions in Mesenteric Lymphangioma

MESENTERIC LYMPHANGIOMA is a benign, endothelium-lined, cystic tumor of the lymphatic system; it may be unilocular or multilocular, and is composed of cyst-like cavities of varied size filled with a clear serous, chylous, or hemorrhagic fluid. The tumor is more commonly found in the pediatric age group, the youngest patient…

Case Report

Myoclonus Caused by a Tricyclic Antidepressant

MYOCLONUS—an involuntary, repetitive, instant contraction of a muscle or a muscle group—has been reported as an unusual side effect of tricyclic antidepressants. Because it is considered relatively rare, myoclonus represents a diagnostic puzzle to the physician inexperienced in neurologic diagnosis, and there may be a consequent delay in starting appropriate…

Case Report

Pentamidine-Induced Torsades de Pointes in a Renal Transplant Recipient With Pneumocystis carinii Pneumonia

PENTAMIDINE is an antiprotozoal agent that is becoming increasingly important in the treatment of Pneumocystis carinii pneumonia, a common clinical problem in immunocompromised patients. Nearly half of all patients receiving pentamidine parenterally have serious adverse reactions. Trimethoprim-sulfamethoxazole is generally given as initial therapy for Pneumocystis pneumonia, and pentamidine is reserved…

Case Report

Hypertension and Renal Failure in a Patient With Tuberous Sclerosis

TUBEROUS SCLEROSIS (Bourneville's disease) is a neurocutaneous disorder characterized by particular pigmentary changes and the occurrence of angiomyolipomas in multiple organ systems. Its expression may vary greatly, with some individuals showing no clinical signs of the disorder and others manifesting severe seizure disorders, mental retardation, and involvement of multiorgan systems…

Case Report

Recurrent Bacterial Endocarditis in a Man With Tetralogy of Fallot Earliest Recurrence on Record

WITHIN the past 50 years, remarkable changes have occurred in the epidemiology and treatment of infective endocarditis. Developments in antimicrobial therapy and cardiac surgery have resulted in a better than 75% cure rate in this once uniformly fatal disease. The prevalence of rheumatic valvular disease, formerly the most common substrate…

Editorial

CIGUATERA FISH POISONING BARRACUDA’S REVENGE

Commentary

EARLY GLOTTIC CARCINOMA

Grand Rounds: Grand Rounds

How Physicians Deal With Their Own Impending Death

Editorial

LONE EAGLE

Letter to the Editor

Subcutaneous Port or What Is in a Name?

Letter to the Editor

Survival of Patients With Sickle Cell Anemia Living at High Altitude

Letter to the Editor

The Changing Face of Radiation Oncology

Clinical Brief

The Endocrine Heart Studies of Atrial Natriuretic Factor