Issue - Southern Medical Association

Primary Article

Endovascular Infections Caused by Enterococci Highly Resistant to Ampicillin

ABSTRACTEnterococci frequently cause endocarditis and are the most common gram-positive isolates in polymicrobial bacteremia. We report three cases of polymicrobial endovascular infections at a single institution during a 12-month period; the enterococcal isolates were highly resistant to penicillins. These cases comprised 18% of all enterococcal endovascular isolates during the same…

Primary Article

Flow Cytometry of Needle Aspirates From Bone and Soft Tissue Tumors

ABSTRACTFine needle aspiration specimens from 29 patients with bone and soft tissue neoplasms were analyzed by flow cytometry for DNA index and cell cycle analysis to determine whether such studies were helpful in cytologic diagnosis. Of 15 cases initially cytologically diagnosed as benign, 14 had a DNA index of 1.0,…

Primary Article

What to Say to Persons With HIV Disease

ABSTRACTI believe that the circumstances in which one learns of being infected with human immunodeficiency virus (HIV) can form a pattern that may either hasten or postpone the physical and psychologic progress of HIV to full-blown AIDS. The experience of learning about one's seropositivity from one's physician sets the stage…

Primary Article

Evaluation of Surgical Services in a Large University-Affiliated VA Hospital: Use of an In-House-Generated Quality Assurance Data Base

ABSTRACTIn this era of occurrence screening, increased documentation of surgical resident supervision, and overall efforts to alter quality of patient care through increased documentation, an in-house quality assurance data base can greatly facilitate these activities. To establish a data base, 6241 operative procedures over a 15-month interval were logged into…

Primary Article

Cutaneous Aging: Effect of Intrinsic Changes on Surgical Considerations

ABSTRACTIntrinsic age-related structural and functional changes in the skin, independent of sun-induced damage, directly affect wound healing in the elderly. These alterations, as well as concomitant medical illness, pharmaceutical intake, and dietary changes, result in delayed wound healing, decreased ultimate tensile strength, and increased rates of wound dehiscence, ecchymosis, tape-strip…

Current Concepts

Myths About Vitamin B12 Deficiency

ABSTRACTNeurologic manifestations of vitamin B12 deficiency are protean, including neuropathy, depression, and dementia. We present evidence to dispel confounding myths about vitamin B12 deficiency. Hematologic indices are normal in up to 30% of patients with vitamin B12 deficiency, and results of the Schilling test may be normal in patients with…

Review Article

Diet, Behavior Modification, and Exercise: A Review of Obesity Treatments from a Long-Term Perspective

ABSTRACTReviewed herein are the long-term weight loss outcomes of three fairly recent major modifications of standard dietary therapy for obesity. Appraised separately and in combination, these therapeutic approaches are very low calorie diets (VLCD), behavior modification, and exercise. The weight loss results from VLCD are impressive for only the first…

Primary Article

Analgesia After Thoracotomy in Children: A Comparison of Interpleural, Epidural, and Intravenous Analgesia

ABSTRACTThe cohort for this study included 39 patients, between the ages of 8 and 20 years, who had had thoracotomy. Postoperative analgesia was provided by one of three techniques: intravenous narcotics (20 patients), thoracic epidural catheter (10 patients), or interpleural analgesia (IPA) (nine patients). Both IPA and epidural analgesia were…

Article

Use of the Chaplaincy in the Neonatal Intensive Care Unit

ABSTRACTThe hospital chaplain is a relatively new member of the health care team, and there is little objective information on the chaplaincy's role in the hospital. To evaluate the chaplain's role, I collected information from the chaplain's daily logs and from a medical staff/parent questionnaire on the use of the…

Primary Article

Ectopic Pregnancy in an Urban Teaching Hospital: Can Tubal Rupture Be Predicted?

ABSTRACTWe evaluated the medical history, physical examination, and laboratory tests done on 245 patients with laparoscopically proven ectopic pregnancies. The absence of abdominal pain was the only clinically useful negative predictive value (91%) regarding tubal rupture. Although mean levels of serum human chorionic gonadotropin (hCG-β subunit) were significantly higher in…

Primary Article

Emphysematous Pyelitis and Emphysematous Pyelonephritis Characterized by Computerized Tomography

ABSTRACTWe report three cases of emphysematous pyelonephritis, all of them associated with perinephric emphysema, and one case of emphysematous pyelitis to demonstrate the value of computerized tomography (CT) in both diagnosis and patient management. The differentiation between air in the collecting system (emphysematous pyelitis), air within the parenchyma (emphysematous pyelonephritis),…

Primary Article

Inpatient Cardiopulmonary Resuscitation: Is Survival Prediction Possible?

ABSTRACTWe retrospectively reviewed 443 patients who had cardiopulmonary resuscitation (CPR). The focus of the study was to discover what preexisting factors should be assessed to determine the probability of survival. There were 88 successes out of 340 cases (25.9%). The absence of a previous myocardial infarction (MI), shock, partial pressure…

Primary Article

Awareness of Substance Abuse in Orthopedic Patients: A Survey of Orthopedic Surgeons

ABSTRACTWe surveyed 178 orthopedic physicians in the Washington, DC, area to ascertain the effect on patient care of previous education in the area of drug and alcohol issues. The return rate was 75%. Of the respondents, 99% were male, average age was 46.7 years (± 9.3), and average number of…

Clinical Brief

Incisional Hernias: Factors Influencing Development

SUMMARYWe have presented a study of 125 patients treated for incisional hernia. This complication occurred more frequently in women (81 %), and gynecologic and obstetric procedures were responsible for 58%. The method of surgical repair in all cases was peritoneal-aponcurotic transposition. The 5-year recurrence rate was less than 3%.

Case Report

Propranolol in the Treatment of Akathisia Caused by Antipsychotic Drugs

SUMMARYWe have reported the case of a patient with neuroleptic-induced akathisia who had rapid amelioration of his symptoms after treatment with the highly lipophilic β-blocker propranolol. His symptoms had previously failed to respond to traditional pharmacologic treatment. There is clearly a need for more double-blind studies to assess the efficacy…

Letter to the Editor

Aspartame

Author Index

AUTHOR INDEX

Commentary

CHAPLAINS AND THE HEALTH CARE TEAM

Editorial

CHRISTMAS GIFT: MOSTLY MOZART

Letter to the Editor

Comparing ECGs

Editorial

FROM BILLIONS TO NONE, OR A BUM RAP FOR THE BABE

Letter to the Editor

Hello, Central

Letter to the Editor

Hodgkin’s Disease in Epitrochlear Lymph Node Only

Article

Horace Smithy: Pioneer Heart Surgeon

Letter to the Editor

Hyperpyrexia as the Sole Symptom of Thyrotoxicosis

Letter to the Editor

Imipramine-Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion

Case Report

Mycobacterium kansasii Infection in a Patient With AIDS

Letter to the Editor

Periactin for Headache

Evagations

PLATO’S CAVAGRAM: SHADOWS ON THE WALL OF THE READING ROOM

Editorial

THE LOST ART

Our Medical Heritage

William Harvey and the Circulation of the Blood