Issue - Southern Medical Association

Primary Article

Klebsiella Pneumonia in the Modern Era: Clinicoradiographic Correlations

ABSTRACTA classic clinical and radiographic picture of Klebsiella pneumonia has emerged in the literature. Patients are typically male, older than 48 years, and have a history of chronic alcoholism. The majority of these pneumonias are community acquired. Bulging interlobar fissures and cavitation are radiographic findings said to be distinctive for…

Primary Article

Cholesterol Screening in a Black Inner-City Pediatric Population

ABSTRACTA screening for total blood cholesterol levels was conducted by the University of Louisville Department of Family Practice in association with the National Youth Sports Program in Louisville, Kentucky. On May 30, 1987, 224 inner-city children between 10 and 16 years of age were tested; 109 (49%) were girls and…

Primary Article

Bupropion: Overview and Prescribing Guidelines in Depression

ABSTRACTBupropion is a new antidepressant medicine that is chemically distinct from previous agents. Clinical studies have shown it to be as effective as the standard antidepressant drugs currently used in the treatment of major depression. It is useful in patients resistant to other agents as well as in patients with…

Primary Article

Predictive Value of Historical and Physical Characteristics for the Diagnosis of Child Abuse

ABSTRACTChild abuse by burning may be difficult to recognize, especially since the injuries are often small. Historical and physical findings that can be elicited in the initial examination can be helpful in initiating a more in-depth investigation. An injury inconsistent with the history given or a delay in seeking medical…

Primary Article

Relationship Between Blood Groups and Behavior Patterns in Men Who Have Had Myocardial Infarction

ABSTRACTConsistent correlations have been found between physical dysfunctional states and blood factors. Some of these disorders have possible psychosomatic components (eg, duodenal ulcer, myocardial infarction). This study focused on the relationship between blood types and various indices of behavior patterns (eg, type A behavior scores, anger ratings) in young patients…

Primary Article

Attitude and Burden in Families of Depressed Elderly Patients: Strategies for Care

ABSTRACTFamily members and others who must care for depressed older adults have received relatively little clinical and research attention, despite their extensive special needs and burden. Attitudes and burden of caregivers affect the initial assessment and continuing treatment of depressed elderly patients. Clinicians can focus evaluation and therapeutic efforts to…

Review Article

Reactional States in Hansen’s Disease: Practical Aspects of Emergency Management

ABSTRACTHansen's disease (leprosy), though not a common condition in the United States, can be found in some localities among patients who come to the emergency room for treatment. Hansen's disease (HD) is a chronic systemic infectious granulomatous disease involving principally the skin, mucosa, nerves, and eyes. The causative organism, Mycobacterium…

Primary Article

Human Papillomavirus in Prostatic Cancer: No Evidence Found by In Situ DNA Hybridization

ABSTRACTHuman papillomavirus has been associated with benign squamous tumors, intraepithelial neoplasia, and invasive squamous cancer. The role of human papillomavirus as the most likely precursor of cervical dysplasia is well studied. We know of no available information as to the possible role of human papillomavirus in prostatic hyperplasia and cancer….

Primary Article

Endoscopy Versus X-ray Studies of the Gastrointestinal Tract: Future Health Care Implications

ABSTRACTI did esophagogastroduodenoscopy in 147 patients and colonoscopy in 59 patients who had had gastrointestinal x-ray studies. The endoscopic procedure was done within 7 days after the x-ray study and/or while the patient was still symptomatic. The barium swallow findings were confirmed in only 40%; in the other 60%, the…

Primary Article

Childhood Firearms Fatalities: The Metropolitan Dade County Experience

ABSTRACTI reviewed the cases of childhood firearms fatalities in the files of the Medical Examiner Department of Metropolitan Dade County, in Miami, Florida. Comparison of cases during the 5-year period from 1966 through 1970 to those during the 5-year period from 1984 through 1988, noting basic epidemiologic parameters, showed that…

Primary Article

Laparoscopic Cholecystectomy: Report of 82 Cases

ABSTRACTIn our initial experience with 82 patients, laparoscopic cholecystectomy has shown numerous advantages over open cholecystectomy. Both intraoperative blood loss and postoperative need for pain medication have been minimal. Most patients were discharged within 24 to 36 hours and resumed normal activities within 3 to 5 days. The aesthetic aspect…

Primary Article

Assessment of Risk for HIV-1 Infection for Missionaries in Sub-Saharan Africa

ABSTRACTNorth American mission boards (N = 82) with programs in sub-Saharan Africa were surveyed to identify practices affecting risk of human immunodeficiency virus type 1 (HIV-1) infection among international staff. Thirty-four percent of participating boards thought risk for HIV-1 infection in missionaries in Africa was greater than it was for…

Primary Article

Voluntary Human Immunodeficiency Virus Testing: Acceptance Levels and Identification of Seropositive Individuals

ABSTRACTOf 4340 clients of a clinic for those with sexually transmitted diseases who were eligible for voluntary, confidential, serologic testing for the human immunodeficiency virus, 4246 (97.8%) consented to testing; 23 (0.5%) were seropositive. Of 94 persons who declined voluntary testing but who were tested in a blinded study, nine…

Primary Article

A Simple Height-Specific and Rate-Specific Step Test for Children

ABSTRACTRecently an anatomic model was reported for adults that standardized the platform height for step tests using an individual's stature and a specified hip angle. In order to determine if the model could be used to predict the platform height for children, platform heights were calculated and hip angles were…

Primary Article

Literacy and Laryngectomy: How Should One Treat Head and Neck Cancer in Patients Who Cannot Read or Write?

ABSTRACTThe entire population of otolaryngologists and radiation oncologists (N = 192) in active practice in the state of North Carolina were surveyed to assess their level of awareness of illiteracy among adults in the United States and to determine whether these physicians consider illiteracy in the treatment decision process for…

Medical Education

Contemporary Use of the Disease Concept: III. A Pedantic Failure to Change Behavior Regarding the Problem of Anemia

ABSTRACTThe frequency with which house staff noticed their patients to be anemic, the frequency with which they tried to find out why the patients were anemic, and the diagnostic accuracy of such endeavors were measured. Next, an intervention was conducted in which the teams were lectured on the subject of…

Primary Article

Adenotonsillectomy in Children With Sickle Cell Disease

ABSTRACTThe pediatric patient with sickle cell disease risks having a vasoocclusive episode during adenotonsillectomy under general anesthesia. With proper patient selection and appropriate perioperative management, adenotonsillectomy can be accomplished safely in children with sickle cell disease. We review the management of 10 children with sickle hemoglobinopathies who had adenotonsillectomy. Indications…

Primary Article

Continuous Intravenous Infusion of Morphine for Severe Dyspnea

ABSTRACTWe describe eight patients who had terminal lung cancer causing severe dyspnea unrelieved by oxygen, nonnarcotic drugs, or intermittent bolus narcotics. We treated these patients with continuous intravenous infusion of morphine, beginning with bolus IV injections of 1 or 2 mg of morphine every 5 to 10 minutes until the…

Primary Article

Infrainguinal Revascularization for Limb Salvage in Patients With End-Stage Renal Disease

ABSTRACTWe studied the efficacy of infrainguinal bypass for limb salvage in patients with end-stage renal disease. The patency of 42 femoropopliteal and femorodistal bypasses, performed for limb salvage in 37 patients with end-stage renal disease, was assessed with Doppler ultrasonography and dye tests. Patency rates and limb salvage were determined…

Case Report

Recurrent Rhabdomyolysis in Association With Cocaine Use

SUMMARYAs the popularity of cocaine increases in our society, so does the frequency and variety of medical complications associated with its use. A growing number of cases have implicated cocaine use in the development of rhabdomyolysis and its complication, acute renal failure. We have reported the first case of recurrent…

Case Report

Cerebrospinal Fluid Losses Through Ventricular Catheters Leading to Hyponatremia in Two Children

SUMMARYI have presented two cases of patients with hyponatremia due to excessive cerebrospinal fluid losses from ventricular drains. The possibility of such losses exists whether the drain is used to treat hydroccphalus or to monitor intracranial pressure. I find normal saline (sodium concentration = 154 mEq/L) to be an appropriate…

Case Report

Wernicke-Korsakoff Syndrome Complicating T-Cell Lymphoma: Unusual or Unrecognized

SUMMARYMalnutrition rather than alcohol abuse is the common element in most cases of WKS. Our report may be the first to identify both the clinical and neuropathologic features of the syndrome in a patient with T-cell lymphoma. The coincidence of these two illnesses underscores a need to consider Wernicke's encephalopathy…

Case Report

Successful Pregnancy in a Patient Receiving Hemodialysis

SUMMARYPregnancy is an unusual occurrence in women with ESRD. We report a successful pregnancy in a patient with ESRD who was receiving hemodialysis; she gave birth to a healthy female infant at 34 weeks' gestational age. We discuss possible physiologic causes of gonadal dysfunction in patients with ESRD.

Case Report

High Mortality Among Patients With the Leukemoid Reaction and Alcoholic Hepatitis

SUMMARYWe describe a patient with severe alcoholic hepatitis, markedly elevated white blood cell count, and high fever. After review of the English literature, we discovered reports of other cases similar to our case. The striking feature in all of these cases was a high short-term mortality rate, despite predictions of…

Case Report

Deep Venous Thrombosis in Intravenous Cocaine Abuse Mimicking Septic Arthritis of the Shoulder

SUMMARYWe describe two patients with deep venous thrombosis of the upper extremity who initially were thought to have septic arthritis of the shoulder. These patients had a history of recent intravenous cocaine abuse. The diagnosis of deep venous thrombosis should be considered when a patient with a swollen shoulder has…

Case Report

Cavitary Pneumocystis carinii Pneumonia in Patients Receiving Aerosol Pentamidine Prophylaxis

SUMMARYWe have described two patients with AIDS who had cavitary Pneumocystis carinii pneumonia while receiving aerosolized pentamidine prophylaxis. This is the first report of this complication. Neither patient showed a clinical response to subsequent use of pentamidine either intravenously or by aerosol followed by intravenous use. Clinicians should be aware…

Case Report

Paratesticular Myxoma An Unusual Benign Intrascrotal Neoplasm

SUMMARYWe have presented a case of paratesticular myxoma and have described the clinical history, findings on light microscopy and immunohistochemistry, and possible pathogenesis. Although primary paratesticular myxoma is a rare lesion, it should be considered in the differential diagnosis of intrascrotal mesenchymal tumors.

Case Report

Mesenteric Volvulus in a Patient With Anorexia Nervosa

SUMMARYWe report a case in which CT examination led to the diagnosis of gangrenous small bowel in a patient with anorexia nervosa, who on autopsy was shown to have mesenteric volvulus of the small intestine.

Editorial

A NEW AND NOVEL APPROACH

Letter to the Editor

Ampicillin Remains Inadequate Therapy for Enterococcal Endocarditis

Editorial

AND THEY GOES

Case Report

Anterolateral Ankle Dislocation Without Fracture

Case Report

Colitis Due to Antituberculous Chemotherapy

Letter to the Editor

Correction

Letter to the Editor

Corrigendum

Letter to the Editor

Finnegans Wake

Case Report

Giant Cell Interstitial Pneumonia

Letter to the Editor

Metoclopramide-Induced Acute Congestive Heart Failure

Case Report

Necrotizing Tracheobronchitis Complication of Mechanical Ventilation in an Adult

Case Report

Pregnancy Complicated by Antiphospholipid Antibodies

Case Report

Solid and Papillary Epithelial Neoplasm of the Pancreas

Editorial

THEY COMES