Showing papers in "Southern Medical Journal in 1977"

Acetabular labrum tears: a cause of hip pain and degenerative arthritis.

Abstract: A torn acetabular labrum causing disabling hip pain has been noted in two patients. One patient had obvious erosion of the articular surfaces of the femoral head and acetabulum corresponding to the location of the displaced torn labrum. Excision of the torn labrum fragments afforded relief of the symptoms. In addition, a torn labrum was found in two surgical procedures for degenerative arthritis of the hip. A torn labrum could be a cause of degenerative hip disease where no preexisting condition is present, ie, slipped epiphysis or infection.

Morbidity/mortality and economics of hospital-acquired blood stream infections: a controlled study.

Abstract: A controlled study of mortality, length of hospital stay, and cost of hospitalization in 40 patients with hospital-acquired blood stream infections and 40 similarly ill patients without blood stream infections was done. Patients with septicemia were identified by ongoing routine surveillance, while controls were selected from computer surveys of similarly aged patients matched for primary diagnosis of operation or both. Bacteremic cases for which no matched controls could be obtained and 109 additional cases of blood stream infection occurring after the study period were also characterized to determine any gross bias in the process of case selection. Mortality in bacteremic patients was 38% compared to 10% in controls; median hospital stay was 33 days for bacteremic patients and cost was $6,692, compared to 14 days' hospitalization and $2,322 cost for controls. Mortality among the unmatched cases as well as the 109 additional cases was 34%. The excess morbidity, mortality, and hospitalization costs offer a better estimate of the direct effects of the hospital-acquired blood stream infection.

Reconsideration of orchiectomy in the treatment of advanced prostatic carcinoma.

Abstract: The results of a large randomized prospective clinical trial conducted by the Veterans Administration Co-operative Urological Research Group (VACURG) in 1968 are updated and reevaluated. In this study, placebo, diethylstilbestrol (DES, 5 mg/day), orchiectomy plus placebo, and orchiectomy plus DES were compared in patients whose conditions were initially diagnosed as stage III and IV carcinoma of the prostate. Results showed that orchiectomy alone or in combination with estrogen did not improve overall survival rates in stage III and IV carcinoma of the prostate. In the two treatment groups receiving estrogen, however, there were fewer deaths due to cancer of the prostate, but this effect tended to be offset by an increased number of deaths due to cardiovascular causes. Deaths from other causes showed no particular pattern with respect to treatment. These studies showed that estrogen is more effective than orchiectomy in preventing deaths from cancer and that the addition of orchiectomy to estrogen does not offer any clear-cut advantage over estrogen therapy alone. If cancer symptoms necessitate treatment, initial therapy with estrogen is preferred. Orchiectomy should be reserved for those circumstances in which a patient is not reliable, cannot tolerate estrogens, or has severe cardiovascular disease.

Dislocation of the elbow: a retrospective study of 115 patients.

Abstract: Of the 115 elbow dislocations treated at two New Orleans hospitals between 1959 and 1969, 78% were posterior. Sixty-one percent of the patients were 21 years of age or younger, and the male-female ratio was 1.7:1.0. The most common associated injuries were fractures of the medial condyle or epicondyle. All uncomplicated dislocations were treated by closed reduction and plaster immobilization. Of the 35 cases complicated by medial condylar or epicondylar fractures, 29 required open reduction and internal fixation. Results were excellent or good in 91% of the cases. The three patients (2.6%) with poor results all had mental impairment. This study suggests a generally favorable prognosis for these injuries.

Minoxidil-induced hypertrichosis: treatment with calcium thioglycolate depilatory.

Abstract: Minoxidil is a new, effective, investigational antihypertensive drug. A serious, cosmetic side effect in women is hypertrichosis. Five female patients with this complication had successful removal of the excessive hair with a calcium thioglycolate depilatory agent.

Sickle cell hepatopathy.

Abstract: Hepatic dysfunction is a common finding in patients with sickle cell disease but viral hepatitis appears to be an unusual complication in the adult SS patient. Only five cases of viral hepatitis were recorded in 378 admissions for SS crisis. In contrast, hepatic crisis occurred as a distinct event in 9% of 88 patients with sickle cell anemia. This entity must be differentiated from acute cholecystitis or viral hepatitis. Transiently abnormal results of hepatitic function tests were observed in another 26 patients with extrahepatic crisis. Cirrhosis is relatively common and often the terminal event in SS disease. Choledocholithiasis and cholecystitis are infrequent complications despite the prevalence of gallstones in SS anemia.

Carpal tunnel syndrome: report of 430 operations.

Abstract: Analyzed are data on 430 operations in 326 patients for median nerve compression at the wrist. Follow-up data from a patient self-evaluation questionnaire were available for 71% of patients. Incidence was highest in the fifth and sixth decades of life, and 65% of patients were female. For most patie

Prevention of prematurity.

Abstract: Although only about 8 per cent of pregnancies end prematurely, as much as 75 per cent of perinatal deaths are due to prematurity. Since it is difficult to identify the predisposing factors in individual cases and to prevent the premature onset of labor, it is necessary to try to arrest such labor when it occurs. A theoretical scheme for the mechanism of labor in the human subject is presented. This permits the identification of four possible points of attack: (1) replacement of progesterone to reduce the myometrial sensitivity to oxytocin, (2) administration of beta-mimetic agents to relax the uterus and make it unresponsive to stimuli, (3) administration of ethanol to block oxytocin secretion, and (4) administration of anti-inflammatory drugs to inhibit prostaglandin synthesis. Results obtained with ritodrine, a beta-mimetic agent, and with ethanol are presented as illustration. Ritodrine gave somewhat better results than ethanol, possibly because the treatment was continued after discharge of the patients.

Avoiding a pitfall in resuscitation: the painless cervical fracture.

Abstract: For the physician treating an injured patient, it is important to recognize fracture of the cervical spine without neck pain. Films of the cervical spine in patients with head or facial trauma, or patients who are unconscious, inebriated, or have multiple injuries, should be routine and are best obtained by portable technic in the emergency room before procedures requiring or resulting in cervical manipulation. The cost of cervical spine injury may be great for the patient, society, and the physician who fails to recognize it.

Posterior fracture dislocation of the hip.

Abstract: We have reviewed 46 posterior fracture dislocations of the hip treated at the University of Alabama in Birmingham Hospitals and the Birmingham Veterans Administration Hospital from 1963 to 1973. Of the 13 injuries which were followed up for at least one year, there were two good, five fair, and six poor clinical results. One instance of aseptic necrosis was documented. There was no obvious correlation between fracture type or treatment and clinical result in this preliminary series.

Acute corneal injury by mustard gas

Abstract: Described is an acute ocular injury caused by mustard gas. The clinical course was similar to what has been established by laboratory research. Some of the histopathologic events have been discussed in theory since no tissue sample from this reported case was available for examination.

Prophylactic antibiotics in elective orthopedic surgery: a prospective study of 1,591 cases.

Abstract: A double-blind prospective study involving 1,591 clean orthopedic surgical procedures was done to test the effectiveness of preoperative and intraoperative antibiotics in reducing the postoperative infection rate. The antibiotic and placebo groups were analyzed carefully for factors known to predispose to infection. Several minor exceptions were noted, but generally the antibiotic and placebo groups were comparable with regard to these factors. A decrease in overall postoperative infection rate from 5.0% in the placebo group to 2.8% in the antibiotic group was found. In specific areas such as the hip and spine a much greater reduction in postoperative wound infections occurred than in the group as a whole.

Unusual Cutaneous Manifestations of Sarcoidosis

Abstract: The diagnosis of sarcoidosis is best established when there is evidence of granulomatous involvement in two or more organs. Three patients with unusual cutaneous manifestations of sarcoidosis, including palmar and follicular lesions, nonscarring alopecia, and widespread plaque or erythrodermic sarco

Treatment of patellar fractures by partial patellectomy.

Abstract: Results of treating 238 transverse, longitudinal, and osteochondral fractures of the patella are reviewed. Of these, 89 patients had partial patellectomy and extensor mechanism reconstruction. After an average follow-up of four years, functional results have been excellent; there have been no late patellectomies and traumatic arthritis has not developed. Total patellectomy is recommended only when the entire patella is so severely comminuted that none of it can be used as part of the extensor mechanism of the knee.

Infection Surveillance: Identifying the Problems and the High-Risk Patient

Abstract: A prospective wound surveillance program (47,917 wounds studied) proved valuable in determining the factors responsible for infection, the operations at risk, and the influence of variables. Because the rate of infection in clean wounds is the most sensitive indicator of surgical technic, it

Acinar cell carcinoma of the pancreas in a 9-year-old child: case report with electron microscopic observations.

Abstract: A case of acinar cell carcinoma of the pancreas in a 9-year-old boy is presented, in which the diagnosis was established by electron microscopy. Treatment was by combination chemotherapy and the survival time was two years.

Squamous carcinoma of the lower lip in patients under 40 years of age.

Abstract: In a series of 1,308 squamous carcinomas of the lower lip, 97 (7%) occurred in patients under 40. Among the 56 followed up for at least five years, there were 12 deaths due to disease for a determinate mortality of 21%. In five of these patients (41%) the tumor persisted more than three years from the time of initial treatment and in four others (33%), for more than five years. Of all 97 patients, 15 (15%) developed additional primary tumors. Most second lesions were squamous or basal cell carcinomas of the skin; however, four patients developed second primary lesions with considerable malignant potential (one melanoma and three visceral cancers). Three of these patients died of their second tumors, raising the overall mortality to 26%. Squamous carcinoma of the lower lip appears to have a worse prognosis in younger patients. A significant fraction of these patients succumb to their disease more than five years after initial treatment. This, coupled with a tendency to develop significant second primaries, suggests that a protracted period of close clinical follow-up is essential.

Acute glomerulonephritis in children: a review of 153 cases.

Abstract: Clinical experience with 153 cases of acute glomerulonephritis is recorded. Streptococcal impetigo was the major causative factor in this series. The acute fatality rate was 1.3% (two patients). Of the 151 survivors, 103 patients have been followed up for periods of six months to 11 years. None of these patients have shown any evidence of progression to chronic glomerulonephritis. In this series, as in others previously reported, acute glomerulonephritis in children appears to be self-limited in contrast to the illness in adults, where 25% to 40% of the cases progress to chronic glomerulonephritis. Unusual findings in this survey were ten patients with minimal or no urine abnormalities. Ten patients had normal serum complement values and three patients had well documented second attacks of poststreptococcal glomerulonephritis.

Mesenteric venous thrombosis and oral contraceptives.

Abstract: A case of a 46-year-old white female admitted with a preoperative diagnosis of appendicitis was found to have a 30 cm portion of the ileum infarcted at operation. Clots were present in mesenteric veins. The patient had a recurrenc of infarction and another 30 cm segment of ileum was removed later that day. Th patient had been taking norethindrone with mestranol for 6 years. 17 cases of mesenteric venous thrombosis have been reported in young women taking oral contraceptives. An association is suggested.

Kaposi's sarcoma after long-term alkylating agent therapy for multiple myeloma.

Abstract: Described is a patient with multiple myeloma who, during long-term treatment with alkylating agents, developed cutaneous Kaposi's sarcoma. Patients with multiple myeloma, unlike those with malignant lymphoma, do not usually develop Kaposi's sarcoma during the natural course of the disease. It is suggested that the immunosuppression resulting from the long-term alkylating agent therapy for multiple myeloma may have prediposed this individual to the development of Kaposi's sarcoma.

Injuries from sea urchins.

Abstract: Injuries from sea urchins result from penetration of the calcareous spines into the skin. Local pain of several days' duration is the most common symptom, but systemic reaction from toxins found in certain species can occur. There is no uniformly accepted successful treatment other than cleansing the wound. Attempts to remove the imbedded spines can increase the severity of the reaction. Language: en

Richter's syndrome.

Abstract: A 56-year-old man with chronic lymphocytic leukemia who developed Richter's syndrome is described. The criteria for diagnosis are given and the histology is discussed. We agree that Richter's syndrome represents a peculiar complication of chronic lymphocytic leukemia and not a separate disease entity. As such, Richter's syndrome must be known and recognized by those evaluating patients with lymphadenopathy whose basic diagnosis may be confused with Hodgkin's disease or "histiocytic" lymphoma.

Scar carcinoma: prognosis and treatment.

Abstract: A 30-year experience with 31 cases of squamous cell carcinoma arising in scars is reviewed. Mean age of the patients was 58 years. Average time from injury to diagnosis was 23 years. The male to female ratio was 4:1. Tumors were well differentiated in 23 cases and poorly differentiated in eight cases. Three-year survival rate was 94% for patients with well-differentiated lesions, but only 38% for those with poorly differentiated ones which were more likely to metastasize. Implications of these findings are discussed in relation to therapy.

Grossly bloody urine of runners.

Abstract: A study of 13 men with grossly bloody urine induced by running incriminated the urinary bladder neck or posterior urethra as the site of blood loss. Our evidence also showed that diet lacking in animal protein can play a causative role. The ailment seems to have no long-term sequelae and may

Intracranial meningioma containing metastatic foci.

Abstract: A case of a woman with carcinoma of the lung who died as the result of an expanding fluid mass over the right cerebral hemisphere is presented. Adjacent to this fluid mass was a small meningioma containing a metastatic focus. This was one of many metastases from the primary bronchiolar carcinoma. Photomicrographs are presented and comments regarding tumor collison are given.

Zinc sulfate supplementation for treatment of recurring oral ulcers.

Abstract: Use of zinc sulfate in promotion of wound healing and in maintenance of epithelial integrity suggested its possible use in the treatment or prevention of recurrent oral ulcers. In a series of 32 patients with recurrent aphthous ulcers (RAU), serum zinc levels were observed. Seventeen patients, eight with initial serum zinc levels above 110microng/dl and nine with serum zinc levels below 110microng/dl, were provided zinc sulfate supplementation up to a total of 660 mg/day. All patients with initial serum zinc levels less than or equal to 110 microng/dl showed improvement; three of the eight patients with initial serum zinc levels above 110 microng/dl improved, five did not. Improvement consisted of 50% to 100% reduction in frequency of episodes. This suggests a combination of causes of RAU, one of which may be a local or general deficiency of zinc or a defect in metabolism, perhaps at the cellular level, related to zinc.

Importance of the external carotid artery in extracranial cerebrovascular occlusive disease.

Abstract: We have encountered 12 patients whose symptoms of transient ischemic attacks were due to total occlusion of the internal carotid artery with patency of the intracranial circulation being maintained by collateral circulation from the external carotid artery. In each case there was either tight stenosis or total occlusion at the origin of the external carotid artery. Eleven of the 12 patients were operated upon, receiving either thromboendarterectomy of the external carotid artery or a saphenous vein bypass to the patent distal portion of this artery. Ten of these 11 had complete or significant relief of symptoms. Although this condition represents only a small percentage of the total number of clinically significant extracranial occlusive lesions, studies suggest that the external carotid artery may be involved more commonly than previously suspected. Adequate radiographic visualization of the cerebral circulation is essential to evaluate the collateral pathways.