Showing papers in "Southern Medical Journal in 1978"
TL;DR: In this article, pathologic criteria are used to distinguish malignant melanoma of childhood from spindle and epithelioid nevus, among the patients reviewed, 110 cases (86%) occurred between ages 13 and 20 years, and 15 cases (14%) in children under 12.
Abstract: Since the entity of "juvenile melanoma" was first described, many pathologists have been reluctant to diagnose malignant melanoma in childhood by pathologic criteria alone. In this series of 125 cases, pathologic criteria are used to distinguish malignant melanoma of childhood from spindle and epithelioid nevus. Among the patients reviewed, 110 cases (86%) occurred between ages 13 and 20 years, and 15 cases (14%) in children under 12. There were 60 males (54%) and 50 females (46%) in the older age group, and six males (41%) and nine females (59%) in the childhood group. In the 13 to 20 age group, there were 24% head and neck primary melanomas, 38% truncal primaries, 30% limb primaries, and 7% indeterminate, as opposed to 35% head and neck, 23% truncal, and 41% limb in the group under 12. In the 13 to 20 year group, 66% were stage I, 11% stage II, 12% stage III, 2% stage IV and 7% indeterminate while in the 12 and under group, 76% were stage I, 12% stage III, and 12% stage IV. Mortality rates were 49% for the 13 to 20 year group and 60% for the 12 and under group.
88 citations
73 citations
TL;DR: Five patients with intercostobrachial nerve entrapment syndrome are reported and the distribution of the pain, its anatomic basis, and its treatment are discussed.
Abstract: Five patients with intercostobrachial nerve entrapment syndrome are reported. The pain in this syndrome has three aspects: somatic stimulus, perceptual surround, and behavioral response. Each must be dealt with appropriately. The distribution of the pain, its anatomic basis, and its treatment are discussed.
60 citations
TL;DR: Four metastatic tumors of the foot, of colonic, renal and humeral origin, are described, which involved three calcanei and two tali and all four patients died within a few months after the appearance of metastasis to the foot.
Abstract: Four metastatic tumors of the foot, of colonic, renal and humeral origin, are described. They involved three calcanei and two tali. All four patients died within a few months after the appearance of metastasis to the foot. Bony destruction, pain, and swelling can closely resemble the clinical signs and symptoms of osteomyelitis. Diagnostic roentgenograms must be obtained to rule out the possibility of metastatic disease, and biopsies are usually required for accurate diagnosis.
56 citations
TL;DR: The historical meanings of tactile communication to the doctor and to the patient and the importance of touching in the context of changing medical technology are reviewed.
Abstract: This paper reviews the historical meanings of tactile communication to the doctor (the diagnostic touch) and to the patient (the healing touch) and discusses the importance of touching in the context of changing medical technology. The quality of health care depends not only on how well physicians and other health professionals perform their tasks and the reliability of the technologies they use, but also on their ability to be human. To touch and be touched is part of the process of staying well or getting well.
55 citations
TL;DR: The validity and clinical acceptance of an alginic acid-containing agent, Gaviscon, which through a foaming action delivers a minimal dose of antacid directly at the site of acid irritation of the esophageal mucosa, has been confirmed in a multicentric, well-controlled randomized clinical trial.
Abstract: Gaviscon tablets and the standard antacid proved equally effective in reducing the number of heartburn attacks. Chi-square tests revealed no significant difference between the two treatment groups at the end of weeks 1, 2, 3, or 4. Heartburn score was arrived at by multiplying heartburn incidence by heartburn severity. This heartburn score also indicated no significant difference between the two treatment groups at the end of the four weeks. Tabulation of the mean number of tablets consumed by patients in the two groups was made. There was no significant difference between the two groups in tablet consumption, indicating equal demand as well as equal compliance in the two groups. Esophagoscopy done before and after 28 days of treatment showed that Gaviscon and the standard antacid tablets were equally effective in each group. There was significant, and equal, decrease in the severity in the specific signs of esophagitis, friability, erosion, and ulceration in both treatment groups, as well as in such nonspecific signs as hyperemia, edema, and exudate. The validity and clinical acceptance of an alginic acid-containing agent, Gaviscon, which through a foaming action delivers a minimal dose of antacid directly at the site of acid irritation of the esophageal mucosa, has been confirmed in a multicentric, well-controlled randomized clinical trial.
52 citations
TL;DR: The incidence of symptoms is probably greater than usually appreciated, but that few patients require treatment, and Steroid injection may occassionally be necessary, but the need for surgical intervention is rare.
Abstract: Occurrence of the carpal tunnel syndrome in pregnancy was studied by examining 100 consecutive obstetric admissions. Twenty-one patients reported paresthesias or hypesthesia in the median nerve sensory distribution of the hand during the pregnancy; eight of these had decreased sensation subjectively at the time of examination one to three days after delivery; two had trophic changes, loss of sudomotor function, thenar atrophy, and decreased two-point discrimination; and one had a delay in motor conduction time across the carpal tunnel. Of the 21 patients, 18 became asymptomatic before or shortly after delivery. The remaining three were asymptomatic three months after delivery. We conclude that the incidence of symptoms is probably greater than usually appreciated, but that few patients require treatment. Steroid injection may occassionally be necessary, but the need for surgical intervention is rare.
51 citations
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TL;DR: The vagina was found to be a curved organ with a distinct upper portion that has an axis between the third and fourth sacral vertebrae that is important for pelvic organ prolapse repair.
Abstract: Vaginograms were done on 20 normal women to determine the exact axis, length, and direction of the normal vagina. The vagina was found to be a curved organ with a distinct upper portion that has an axis between the third and fourth sacral vetebrae. The importance of restoring this axis in pelvic surgery, especially for vault prolapse, is discussed.
49 citations
48 citations
TL;DR: A series of patients with 3,817 cutaneous carcinomas of different types observed in a private practice setting is reported and preliminary computerized analyses indicate that 88% of these squamous cell and basal cell carcinomas were < 25 mm.
Abstract: A series of patients with 3,817 cutaneous carcinomas of different types observed in a private practice setting is reported. Preliminary computerized analyses indicate that 88% of these squamous cell and basal cell carcinomas were less than 25 mm. Scalpel surgery, curettage and desiccation, or radiation therapy was used for most tumors and an overall cure rate of greater than 98% was obtained. A pretreatment biopsy allowed for selection of the most appropriate management and authoritative instructions for long-term follow-up visits and prophylaxis.
48 citations
TL;DR: A group of 61 patients with problems of chronic pain were managed through a rehabilitation program based on the principles of operant conditioning, where 69% made significant increases in their functional performances, while only 43% of the compensation group made similar increases.
Abstract: A group of 61 patients with problems of chronic pain were managed though a rehabilitation program based on the principles of operant conditioning. Of these patients, 35 were receiving compensation for work-related accidents, and 26 were receiving no financial compensation for their chronic pain. Of the patients not receiving compensation, 69% (18) made significant increases in their functional performances, while only 43% (15) of the compensation group made similar increases.
TL;DR: A carbon dioxide laser was used to treat congenital hemangioma, verruca vulgaris, and condyloma acuminatum, and to remove tattoos, and the four types of lesions treated responded best.
Abstract: Each of the four general classes of laser (gas, solid, liquid, and semiconductor) emits a particular wavelength of light. This beam of light can be focused to a minutely accurate diameter and the depth of penetration can be controlled by the power input. Thus, there is minimal damage to surrounding tissue. A carbon dioxide laser was used to treat congenital hemangioma, verruca vulgaris, and condyloma acuminatum, and to remove tattoos. Of the four types of lesions treated, verruca vulgaris, condyloma acuminatum, and tattoos responded best.
TL;DR: A 62-year-old woman developed a fatal Aeromonas hydrophila infection of the skin after dropping a crab trap on her leg and died three months after injury.
Abstract: A 62-year-old woman developed a fatal Aeromonas hydrophila infection of the skin after dropping a crab trap on her leg. The area surrounding the punctures was erythematous and had several flaccid bullae. A biopsy specimen of the involved skin showed necrosis and suppuration in the dermis and subcutaneous fat. The A hydrophila sepsis resolved after treatment with gentamicin, but the patient developed secondary wound infections and died three months after injury.
TL;DR: Prophylactic antibiotics reduced febrile morbidity from 74.4% to 20.8% in the vagina and cefazolin and cephalexin reduced infection and morbidity in private patients undergoing vaginal and abdominal hysterectomy.
Abstract: A double-blind, prospective study over a 12-month period evaluated the effectiveness of cefazolin and cephalexin in reducing infection and morbidity in private patients undergoing vaginal and abdominal hysterectomy. Prophylactic antibiotics reduced febrile morbidity from 74.4% to 20.8% in the vagina
TL;DR: The mean number of natural bowel movements among the DCS group increased approximately 62% over the placebo period, more than twice the 30% increase seen with DSS administered either b.i.d. or q.d, regardless of whether it was administered once or twice a day.
Abstract: The difficulties of adequately managing constipation, particulary in patients with impaired or limited mobility as a result of surgery, cardiovascular or cerebral disease, or advanced age, led us to evaluate the use of stool softeners in a homogeneous group of institutionalized patients. Comparison was made between dioctyl sodium sulfosuccinate (DSS) (Colace), q.d. and b.i.d., and dioctyl calcium sulfosuccinate (DCS) (Surfak), q.d. Analysis of results showed 81% of the patients receiving DCS improved, a significant result (P is less than .02) when assessed by the sign test. By contrast, DSS caused no significant improvement over placebo, regardless of whether it was administered once or twice a day. The mean number of natural bowel movements among the DCS group increased approximately 62% over the placebo period, more than twice the 30% increase seen with DSS administered either b.i.d. or q.d. No adverse reactions were reported in any of the groups, and no significant study-induced changes occurred in laboratory measurements.
TL;DR: The apparent predilection of S aureus for the right side of the heart and infrequent left-sided involvement may explain why addicts with endocarditis have a favorable response to antibiotic therapy.
Abstract: We retrospectively reviewed 55 episodes that fulfilled criteria for Staphylococcus aureus endocarditis in 50 drug addicts. The most common presenting symptoms were fever(90%), chest pain(58%), and cough(43%). All patients had evidence of right-sided heart involvement, and a murmur of tricuspid insufficiency was noted in 42%. Evidence of left-sided heart involvement was present in only 5%. The most helpful laboratory aid in facilitating an early clinical diagnosis of endocarditis was the chest x-ray film. Roentgenographic evidence of septic pulmonary emboli was present in 67% of initial chest films and eventually in 87% of all cases. All but five patients completed at least four weeks of intravenous antibiotic therapy. No patients required cardiac surgery and there were no deaths. The apparent predilection of S aureus for the right side of the heart and infrequent left-sided involvement may explain why addicts with endocarditis have a favorable response to antibiotic therapy.
TL;DR: It is believed that infants, patients undergoing extracorporeal circulation, major abdominal, vascular, or neurosurgical procedures, or patients with a history of temperature regulatory problem are probably best monitored by a method which more exactly reflects core temperature.
Abstract: Forehead skin temperature measured by a stip of liquid-crystal material was compared to esophageal, rectal, and axillary temperatures measured by thermistor probes in patients having general anesthesia for coronary artery bypass grafting. Before extracorporeal circulation, forehead skin temperature was lower than axillary, rectal, and esophageal temperatures by approximately 2.2 C (4.0 F). During rapid warming, forehead skin temperature rose concurrently with the other temperatures measured but remained significantly different. The liquid-crystal strip may be useful as a safe, convenient method for routine monitoring of temperature trends during general anesthesia in patients whose exact core temperature need not be continuously monitored. We believe that infants, patients undergoing extracorporeal circulation, major abdominal, vascular, or neurosurgical procedures, or patients with a history of temperature regulatory problem are probably best monitored by a method which more exactly reflects core temperature.
TL;DR: Fiberoptic gastrointestinal endoscopy was particularly helpful in localizing the site of upper gastrointestinal hemorrhage, in retrieving foreign objects, and in removing colonic polyps, in children with recurrent abdominal pain or vomiting, in whom fiberopticendoscopy is not indicated unless the symptoms or history appear inconsistent with the diagnosis of functional bowel disease.
Abstract: Fiberoptic gastrointestinal endoscopy was performed on 52 patients between the ages of 2 months and 16 years. The procedures were safely and easily done with premedications consisting of meperidine, promethazine, and chlorpromazine, and atropine, with diazepam given at the time of the procedure. Fiberoptic endoscopy was particularly helpful in localizing the site of upper gastrointestinal hemorrhage, in retrieving foreign objects, and in removing colonic polyps. In contrast, endoscopy added little to the clinical history and roentgenographic studies in children with recurrent abdominal pain or vomiting, in whom we believe fiberoptic endoscopy is not indicated unless the symptoms or history appear inconsistent with the diagnosis of functional bowel disease.
TL;DR: A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) is described in a patient with chronic myelogenous leukemia, with a review of all published reports in the English literature.
Abstract: :A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) is described in a patient with chronic myelogenous leukemia, with a review of all published reports in the English literature. The disease is characterized by an acute febrile illness with painful plaques involving the extre
TL;DR: The efficacy of a three-dose, perioperative regimen of cefazolin or placebo in reducing postoperative infectious morbidity was evaluated in 206 patients undergoing elective vaginal or abdominal hysterectomy.
Abstract: The efficacy of a three-dose, perioperative regimen of cefazolin or placebo in reducing postoperative infectious morbidity was evaluated in a double-blind study in 206 patients undergoing elective vaginal or abdominal hysterectomy. Postoperative infectious morbidity was defined as: an oral temperature of 100.4 F (38 C) or greater on any two postoperative days (excluding the first day), positive bacteriologic cultures, or pus from a wound. In premenopausal patients, cefazolin significantly reduced the incidence of postoperative infectious morbidity; 19% of the cefazolin group who had abdominal hysterectomy had evidence of infection compared to 71% of the placebo group, and 10% of the cefazolin group who had vaginal hysterectomies had evidence of infection compared to 37% of the placebo group. In postmenopausal patients undergoing abdominal hysterectomy, cefazolin also reduced the incidence of postoperative infection compared to placebo, but the difference was not significant (20% compared to 37%).
TL;DR: Four patients with previously untreated stage D carcinoma of the prostate are still being followed up at 13, 15, 20 and 24 months, demonstrating that flutamide can give positive results to some patients whose condition is deteriorating despite diethylstilbestrol therapy.
Abstract: In our three-year experience with the use of flutamide for the treatment of carcinoma of the prostate, 20 patients with previously untreated stage D carcinoma of the prostate were enrolled in a 12-week double-blind study. Seven patients received 1.5 gm of flutamide daily, seven patients received 0.75 gm of flutamide daily, and six patients received 1.0 mg of diethylstilbestrol daily. Two patients receiving flutamide did not complete the 12-week study. Six patients receiving flutamide and three patients receiving diethylstilbestrol had objective evidence of improvement. Of the patients receiving flutamide, 50% were alive at one year, and 43% were alive at two years. Three of the original 14 patients started on flutamide are alive at 36, 33, and 24 months. In addition, we continued clinical evaluation of flutamide as an open study, enrolling six other patients (four with stage D and two with stage C carcinoma of the prostate). All except one of these patients had received previous hormonal therapy. At present, four are still being followed up at 13, 15, 20 and 24 months, demonstrating that flutamide can give positive results to some patients whose condition is deteriorating despite diethylstilbestrol therapy.
TL;DR: A patient with ulcerative colitis in whom hepatic granulomatosis was associated with salicylazosulfapyridine (Azulfidine) is reported, which should be considered a possible cause of hepatotoxicity when used therapeutically in inflammatory bowel disease.
Abstract: Granulomatous hepatitis has been associated with many conditions, including chronic ulcerative colitis and sulfonamide therapy. We report a patient with ulcerative colitis in whom hepatic granulomatosis was associated with salicylazosulfapyridine (Azulfidine). Sulfonamides should be considered a possible cause of hepatotoxicity when used therapeutically in inflammatory bowel disease.
TL;DR: Acute rhabdomyolysis and renal failure occurred in a 16-year-old boy with infectious mononucleosis; recovery was complete.
Abstract: Acute rhabdomyolysis and renal failure occurred in a 16-year-old boy with infectious mononucleosis; recovery was complete. Renal failure is a rare complication of infectious mononucleosis. Rhabdomyolysis has been reported only once in association with the Epstein-Barr virus, but has frequently been associated with influenza virus infections. Prospective studies measuring creatine phosphokinase enzymes should establish the frequency of rhabdomyolysis in viral infections.
TL;DR: A nursery supervisor with smearand culture‐positive pulmonary tuberculosis and a productive cough exposed 528 newborns over a three‐month period before her disease was diagnosed, and periodic tuberculin testing of hospital personnel with preventive treatment of reactors presumably would have prevented this exposure.
Abstract: Newborn infants are thought to be particularly susceptible to infection with Mycobacterium tuberculosis, and the possibility of exposure to unrecognized clinical tuberculosis in nursery and hospital personnel is ever present. To reduce this possibility, periodic skin testing of hospital personnel is often carried out, and tuberculin-positive personnel are given preventive treatment with isoniazid (INH). Also, environmental controls, such as ultraviolet light and periodic air exchange, are used. The efficacy of these measures has not been fully established. A nursery supervisor with smear- and culture-positive pulmonary tuberculosis and a productive cough exposed 528 newborns over a three-month period before her disease was diagnosed. All 514 infants available for skin testing at approximately 3 months of age had negative skin tests. None received isoniazid preventive treatment. The nursery rooms all had ultraviolet lighting mounted above eye level. Calculated air changes per hour with positive pressure ventilation of fresh air ranged from 12 to 18. The hospital did not regularly test employees for tuberculosis. Periodic tuberculin testing of hospital personnel with preventive treatment of reactors presumably would have prevented this exposure.
TL;DR: A useful clinical rule seems to be that serum ferritin of greater than 100 ng/ml tends to exclude iron deficiency, and a level of less than 30 ng/ ml tends to confirm decreased iron stores.
Abstract: We examined the relationship of serum ferritin to bone marrow iron stores in 73 anemic male medical inpatients with liver disease, alcoholism, chronic inflammatory disease, and malignancies. A correlation of r = 0.75 (P less than .00005) was found between serum ferritin and bone marrow iron stores (BMIS) for the entire group. Liver disease as manifested clinically or by increased levels of serum glutamic-oxaloacetic transaminase did not appear to significantly affect this relationship. Patients with folic acid deficiency did tend to have a disproportionate increase in ferritin in relation to BMIS, but this did not seem to destroy the usefulness of ferritin levels. A useful clinical rule seems to be that serum ferritin of greater than 100 ng/ml tends to exclude iron deficiency, and a level of less than 30 ng/ml tends to confirm decreased iron stores.
TL;DR: Erythema multiforme (EM) is clinically characterized by a “minor” form and a ‘major’ form, the latter of which is known as the Stevens-Johnson syndrome.
Abstract: Erythema multiforme (EM) is clinically characterized by a "minor" form and a "major" form. The latter is known as the Stevens-Johnson syndrome. Infections (particularly herpes simplex and Mycoplasma pneumoniae) and drugs seem to predispose toward the development of EM. The pathogenesis is poorly understood. The treatment is supportive. Prognosis varies with the severity of the eruption. Recurrences are commonly seen.
TL;DR: The case appears to be an example of radiation recall injury involving the small bowel and the decision to use actinomycin-D or adriamycin must be weighed against the risk of tissue injury when a predisposition to radiation damage is present.
Abstract: A 22-year-old man developed four episodes of bowel obstruction after radiation therapy for a testicular tumor metastatic to retroperitoneal nodes. Each episode followed a course of chemotherapy with actinomycin-D or adriamycin. On one occasion bowel resection was required and revealed vascular changes compatible with radiation injury. The case appears to be an example of radiation recall injury involving the small bowel. The decision to use actinomycin-D or adriamycin must be weighed against the risk of tissue injury when a predisposition to radiation damage is present.
TL;DR: A patient with an anomalous intramyocardial course of the LAD coronary artery, causing angina pectoris, is described and surgical correction of the anomaly may give symptomatic improvement and improved exercise tolerance.
Abstract: A patient with an anomalous intramyocardial course of the LAD coronary artery, causing angina pectoris, is described. The patient had symptomatic relief after an aortocoronary artery bypass operation. Intramural coronary arteries may be clinically significant. In cases where medical management does not provide relief, surgical correction of the anomaly may give symptomatic improvement and improved exercise tolerance.
TL;DR: A review of 31 patients with adenocarcinoma of the ampulla of Vater treated at this institution reveals that the classical history of fluctuating jaundice and the well known findings of a palpable gallbladder and occult blood in the stool may not be present.
Abstract: Adenocarcinoma of the ampulla of Vater represents about 10% of periampullary neoplasms. This tumor is slow-growing, often amenable to radical surgical resection, and associated with a better prognosis than the other neoplasms which arise in the periampullary area. Correct identification of ampullary carcinoma may be difficult but is essential because of its better prognosis. A review of 31 patients with adenocarcinoma of the ampulla of Vater treated at our institution reveals that the classical history of fluctuating jaundice and the well known findings of a palpable gallbladder and occult blood in the stool may not be present. The treatment of choice for ampullary carcinoma in the absence of hepatic or distant metastases is pancreaticoduodenectomy. Our operative mortality for pancreaticoduodenectomy is 16%, and the five-year survival rate is 32%. The role of palliative procedures, the operative complications, and the survival rates are discussed.