Showing papers in "California medicine in 1968"

Intussusception in Adults

Abstract: Three cases of intussusception in adults were observed within a period of six months in a small general hospital. All the patients were over 65 years old and all were admitted to hospital with intermittent cramping abdominal pains. None appeared to be in acute distress. In all three, body temperature, pulse rate and hemogram were within normal limits. Diagnosis was made preoperatively after barium enema studies. Bowel resection with end-to-end anastomosis was done in all three cases, in two because of gangrenous bowel. The site of intussusception was jejunojejunal in one case, ileocecal in another and colorectal in the third; and the cause in all cases was tumor, benign in two cases, malignant in one. The patients recovered uneventfully except for incisional abscess and diarrhea of seven days' duration in one. In a review of literature it was found that the clinical features in these three cases closely paralleled those of other cases of adult intussusception reported in this country.

Psychotherapeutic Drugs—Use Among Adults in California

Abstract: A cross-section survey of adults in California provides the following information about use of prescription and non-prescription stimulants, sedatives, and tranquilizers. • One person in two has used one or more of these drugs at one time or another. About three persons in ten have used them in the past 12 months. • Frequent use is reported by 17 percent of the adults sampled and occurs among almost twice as many women as men. • Relatively high proportions of frequent drug users are also found among persons who are divorced or separated, and among those with no religious affiliation. Relatively low proportions are found among persons in skilled, semi-skilled and unskilled occupations. • Contrary to expectation, neither income nor education is very highly related to frequent use of psychoactive drugs. Actual differences may be obscured, however, by the fact that questions in this preliminary investigation combined both prescription and non-prescription drugs. Early returns from a survey now going on in San Francisco indicate that use of ethical drugs is indeed more common in better educated and higher income groups. • Patterns of frequent drug use by age clearly reflect changing needs and stresses. Men, for example, are most likely to report use of stimulants in their 30s, tranquilizers in their 40s and 50s, and sedatives from age 60 on. • Data suggest that persons in low status socio-economic groups are less likely than others to have used psychoactive drugs (in particular, tranquilizers), but those who use them are more likely to have done so frequently. One explanation offered was that these persons do not have as ready access to such drugs as others do. Consequently, there is a selective factor operating: only those whose need for drugs is relatively great actually get them.

The carpal tunnel syndrome. A review of 100 patients treated surgically.

Abstract: The carpal tunnel syndrome, or compression neuropathy of the median nerve at the wrist, is a common cause of burning pain, numbness and tingling in the hand. The diagnosis is suggested by nocturnal paresthesias in the thumb, index and long fingers associated with signs of irritability of the median nerve in the carpal tunnel at the wrist. Surgical treatment in the form of incision of the transverse carpal ligament should be performed before irreversible motor and sensory changes occur.

The clinician's approach to drug interactions.

Abstract: Drug interactions are important causes of both unexpected toxic and therapeutic effects. Adverse reactions due to drug interaction are proportional to the number of drugs given and the duration of administration. Although drug interactions may be beneficial, they are most often recognized when they increase mortality or morbidity. The frequency of adverse drug interactions in clinical practice makes it mandatory for physicians to know the drugs and mechanisms involved.A drug may potentiate or antagonize the effects of another drug by direct chemical or physical combination, by altering gastrointestinal absorption, by influencing metabolism, transport, or renal clearance, by changing the activity of a drug at its receptor site, or by modifying the patient's response to the drug by a variety of means. This article stresses the importance of avoiding multible drug therapy. When such treatment is unavoidable, patients must be carefully observed for evidence of intensified or diminished drug effect. Only this permits the detection and prevention of untoward drug interactions.

A time to lead.

Abstract: Presenters from AHIMA's 2011 Leadership Academy share their perspectives on what it takes to lead in the current changing healthcare environment.

Failure to thrive-an analysis of 83 cases.

Abstract: The case histories of 83 children admitted to the hospital with a diagnosis only of failure to thrive were examined. In twenty-six cases there was evidence of maternal deprivation as a factor. Forty patients were found to have significant organic diseases as a possible or probable cause or contributing influence.Twenty-six were found to have some degree of mental retardation, either documented or suspected, but in nearly all of them there were associated factors presumably responsible, at least in part, for failure to thrive.Several children had birth weight less than 2,500 grams, but no child was thought to grow poorly because of prematurity alone. Congenital anomalies such as cleft palate and other problems leading to feeding difficulties were not unusual.In any case of persistent failure of an infant to gain adequately in weight and length, in which the cause is not evident, the child should be admitted to a hospital to determine response in a new environment. Also an adequate social history should be sought and siblings more closely evaluated; and careful study should be made of the renal, gastro-intestinal, cardiac, pulmonary and central nervous systems, even if there are no symptoms or signs referable to these systems.

Osteoarthritis of the first carpometacarpal joint

Abstract: The first carpometacarpal (trapeziometacarpal) joints are a frequent site of osteoarthritis in postmenopausal women. This osteoarthritis, which is typically bilateral both clinically and roentgenographically, may be mistaken for tenosynovitis unless its characteristic features are recognized. These features include tenderness, stiffness, crepitus, swelling, and pain on wringing movements or other motions that cause abduction of the thumb. The swelling, radial subluxation of the metacarpal and atrophy of the thenar muscles give the hand a squared appearance.In severe cases, conservative medical therapy is generally unsatisfactory. Intra-articular corticosteroids and local anesthetic give only transient relief. Results of surgical therapy, including excision of the trapezium or arthrodesis of the trapeziometacarpal joint, were in general good. Distinct indications exist for each type of operation.

Salivary Gland Tumors and Sialadenitis in Children—Experience at Childrens Hospital of Los Angeles

Abstract: Parotitis, hemangio-endothelioma and mixed tumors are the most common salivary gland lesions in the pediatric age group. Carcinoma and sarcoma are uncommon. Rapid growth of a tumor and pain suggest malignant change.A conservative non-operative approach is stressed for most cases of chronic parotitis. Scout x-ray films and sialangiographic examination are useful in differentiating an inflammatory lesion from a neoplastic growth. Total parotidectomy is advised if operation is indicated.A case of spontaneous resolution of a hemangioma of the parotid gland is presented. A less aggressive temporizing plan should be considered with these lesions, as the risk of seventh nerve injury in children is considerable. The treatment of choice for a non-inflammatory tumor is surgical excision, for most parotid tumors are radioresistant. Small masses should be completely excised for pathological evaluation. Incisional biopsy may occasionally be indicated in the case of a large diffuse lesion, for it may be inflammatory and total excision unnecessary. Most patients with chronic parotitis came to medical attention because of a non-tender asymptomatic parotid lump or diffuse swelling.

The LSD syndrome. A review.

Abstract: lsd (lysergic acid diethylamide) is a powerful bio-active substance related to serotonin in structure. Its actions generally affect autonomic, sensory and psychological functions. Autonomic stimulation is varied. Sensory responses are usually visual, involving heightened and distorted color perception and fusion of sensory impressions. Psychological responses include a feeling that a unique experience is occurring; feelings of depersonalization; pronounced fluctuation of mood; time and space distortions; autistic phenomena; fluctuation of aggressive drives (usually reduction); and spontaneous reoccurrence of the lsd experience. THE SUBJECTIVE RESPONSES CAN BE RELATED TO THREE BASIC PHENOMENA: (1) expectation; (2) loss of characteristic modes of perceptual and cognitive patterning; and (3) hypersuggestibility. THE MAJOR ADVERSE REACTIONS ARE: (1) chronic drug dependence including subsequent personality changes and depressive reactions; and (2) acute ego dissolution. These reactions usually occur in already emotionally ill people. Most of these users fall into two groups, those with unresolved identity problems and those with severe ego abnormality. The majority of adverse reactions are of the chronic drug dependence type and are usually seen in adolescents and young adults who have not negotiated the age-appropriate tasks of forming and integrating the various identities that are the composite of their life experiences.lsd helps alleviate these stresses via some of its psychological properties as discussed. It also provides a nidus for the formation of a subculture where goals for social, sexual and vocational achievement are lower and idiosyncratic modes of adaptation are better tolerated. A smaller group of users who have serious reactions such as psychosis, rage reactions, homicidal and suicidal ideation are usually found to have preexisting ego abnormality such as ambulatory schizophrenia, chronic impulse disorders and borderline states. Although adverse reactions most often appear to be related to pre-morbid psychopathology, this is not invariably so. Further, there is as yet no reliable method to determine who will have an adverse reaction and what the nature of that reaction will be.

The incidence of “Silent” Coronary Heart Disease

Abstract: In a group of clinically normal male executives subjected to maximal treadmill stress testing, the occurrence of ischemic st segment responses was in all cases unaccompanied by pain, while in a clinically suspect group a large proportion of those having ischemic st segment responses did not have chest pain. While a significant number of persons have no subjective sensation of pain while having ischemic st segment changes on the electrocardiograph during or after maximal treadmill exercise, occasionally atypical pain may occur during or following exercise. Maximal treadmill stress testing is useful in discovering “silent” coronary artery disease.

Leukemia in animals and man.

Abstract: General comparative aspects of leukemia were reviewed. Leukemia in adult cattle occurs frequently within certain multiple case herds. Cattle in these herds often have persistent lymphocytosis and increased numbers of atypical lymphocytes in blood. Attempts are being made to demonstrate the frequency in which this is a “pre-leukemic” or “perileukemic” condition. With the recognition of viral causative agent(s) in chickens, laboratory rodents and cats, there is increased interest in the leukemia of dogs, cattle and other animals, for the disease in these animals may serve as valuable models in the study and isolation of human leukemogenic agents. Epidemiologic and clinicopathologic aspects of animal leukemias share comparative similarities with themselves and with lymphoreticular neoplasms of man. Causative factor(s) probably act on the host, regardless of species, in a similar fashion. It is not likely, but neither improbable, that leukemia in domesticated animals and leukemia in man share common causal relationships.

Mycosis Fungoides—Topical Use of Nitrogen Mustard in Recurrent Cases

Abstract: The management of the patient with mycosis fungoides requires a variety of therapeutic modalities depending on the stage of the disease. Topically applied nitrogen mustard in the early stages of the disease has a beneficital palliative effect. The effects of nitrogen mustard paintings in the later course of the disease have not been previously reported. In the present study, topically applied nitrogen mustard solution was used to control recurrences of mycosis fungoides following electron beam therapy in 11 patients. Each patient received whole body applications of freshly prepared 10 mg per 50 ml solution of mechlorethamine hydrochloride (a nitrogen mustard) in water daily for seven days. In all patients pruritus disappeared within the first week and ulcers and plaques improved or disappeared in two to four weeks. The seven-day courses of mechlorethamine paintings were repeated as recurrences were noted. Mycosis fungoides was controlled by this therapy for periods ranging up to 15 months. Absence of systemic toxicity, a low incidence of cutaneous irritation and application of the treatments at home make topical nitrogen mustard a useful adjunct in the management of the late stages of mycosis fungoides.

Complications of Heart Valve Replacement—Embolism, Bleeding and Hemolysis

Abstract: Fifty-two patients surviving single heart valve replacement since September 1962 were reviewed in order to detail the incidence of post-operative embolism, bleeding and hemolysis. A substantial decrease in the occurrence of embolism has been seen with newer prosthetic devices paralleling the improvement in cardiac catheterization dynamics. The frequency of embolism appears also to be affected by the degree and adequacy of anticoagulant control although a higher morbidity from bleeding must be accepted. The tendency to deformation and destruction of red cells by rigid prosthetic valves is apparent since shortened red cell survival indicative of hemolysis was found in all patients studied. Hemolytic anemia of importance was uncommon.