Showing papers in "Southern Medical Journal in 1987"
TL;DR: Alkalemia-associated illnesses are common in hospitalized patients and are associated with high mortality in both medical and surgical patients, though the death rate is higher among medical patients, and mixed respiratory and metabolic alkalosis appears to be associated with a particularly poor prognosis.
Abstract: :The difference in death rate among medical and surgical inpatients having alkalemia is incompletely defined. This prospective study was done to identify the incidence, mortality, and clinical factors that resulted in a poor outcome in both groups of patients. We screened a total of 10,811 c
122 citations
TL;DR: The study emphasizes the importance of testing for the presence of HTLV-III antibody and assessing the immunologic status of all patients at risk for AIDS who have neurologic illness.
Abstract: :Neurologic disease was the harbinger of the acquired, immunodeficiency syndrome (AIDS) in 26 (20%) of 132 patients and ultimately developed in 83 (63%). The most common neurologic disorder heralding AIDS was toxoplasmic encephalitis (17 cases) followed by cryptococcal meningitis (six), reti
108 citations
TL;DR: The necessity for continuing intervention in the abused child's family to prevent further abuse is indicated and Serial CT was useful in managing the medical, legal, and social aspects of the cases and in predicting the neurologic outcome.
Abstract: We studied both the clinical features and CT findings in 24 children who had acute head trauma as a result of child abuse. Twenty-three of them were less than 1 year of age. The diagnosis of whiplash shaken infant syndrome was made in 17. Serial CT, done in 50% of the cases, was useful in managing the medical, legal, and social aspects of the cases and in predicting the neurologic outcome. Three children died and 12 others suffered serious neurologic sequelae. The other five children has lesser degrees of deficit; one was lost to follow-up. Three were neurologically normal on follow-up visits. Two siblings of these children died of child abuse, indicating the necessity for continuing intervention in the abused child's family to prevent further abuse. Language: en
77 citations
TL;DR: It is concluded that rather than attempting to predict compliance from sociodemographic characteristics, symptoms, or glucose values, the physician should directly inquire about medication taking in a nonthreatening manner.
Abstract: :Maintaining compliance with medications is important in the management of patients with non-insulin-dependent diabetes mellitus. We examined correlates of medication compliance in 77 patients followed up prospectively for 24 weeks. Of the demographic, socioeconomic, and clinical variables e
57 citations
TL;DR: Patients with acute pyelonephritis or acute prostatitis caused by E coli negative for P-fimbriae probably should be considered compromised; the compromising factor should be determined as a guide to subsequent treatment.
Abstract: We designed a retrospective study to determine the incidence of P-fimbriated Escherichia coli in patients with asymptomatic bacteriuria, acute urethral syndrome, bacterial cystitis, acute pyelonephritis, possible acute pyelonephritis, and acute and chronic prostatitis. In addition, we compared the incidence in uncompromised vs compromised hosts, inpatients vs outpatients, and children vs adults. P-fimbriated E coli were isolated in more than 80% of uncompromised patients with either acute pyelonephritis or acute prostatitis. In clinically compromised patients having these disorders, the incidence dropped to approximately 30% (P less than .025). Neither age nor inpatient/outpatient status was a significant factor. We stress the importance of P-fimbriation as a virulence factor in acute pyelonephritis and acute prostatitis caused by E coli, though these diseases may be caused by less virulent organisms in compromised patients. Thus, patients with acute pyelonephritis or acute prostatitis caused by E coli negative for P-fimbriae probably should be considered compromised; the compromising factor should be determined as a guide to subsequent treatment.
55 citations
TL;DR: Because hydroxyurea is safe and effective in the treatment of polycythemia vera, it should be considered as first-line therapy, particularly when the disease is not well controlled by phlebotomy alone.
Abstract: From 1963 to 1983, I treated 100 patients with polycythemia vera, using phlebotomy and the adjunctive agent hydroxyurea. These 78 male and 22 female patients ranged in age from 24 to 88 years (mean 55.7). Duration of therapy ranged from three to 216 months (mean 64.9). The mean daily dose was 0.72 gm, and the median dose was 0.64 gm. Hydroxyurea gave adequate control of red cells, platelets, and spleen size. Cytopenia was not observed. Phlebotomy requirements were markedly reduced. Leukocyte alkaline phosphatase scores were generally lowered and several blood chemistry values returned to normal. Side effects were minimal, and there were no drug-related deaths. Infections were not a problem. Hydroxyurea, a metabolic inhibitor of desoxyribonucleic acid, does not interfere with the synthesis of ribonucleic acid or protein and is thus probably less leukemogenic than radioactive phosphorus and alkylating agents. Acute myelogenous leukemia was seen in one patient after five years of continuous hydroxyurea therapy. He had received no other myelosuppressant agent. Because hydroxyurea is safe and effective in the treatment of polycythemia vera, it should be considered as first-line therapy. It probably offers practical and theoretic advantages over present therapy particularly when the disease is not well controlled by phlebotomy alone.
54 citations
TL;DR: With adherence to meticulous technique, tetracycline pleurodesis provides rapid, effective, and safe palliation of malignant pleural effusions.
Abstract: Because many patients with malignant pleural effusions could survive for months to years beyond its onset, definitive management must be safe and effective. Chemical pleurodesis with tetracycline has gained general acceptance as the therapy of choice, even though no large series confirming this viewpoint has appeared in the literature. We reviewed 108 procedures involving tube thoracostomy and tetracycline pleurodesis, and report a success rate of 94.4% without serious complications. Considering all patients, 49% were symptom-free at three months, and 13% were alive one year later. Several potentially important changes in technique have emerged since the initial description of this procedure. With adherence to meticulous technique, tetracycline pleurodesis provides rapid, effective, and safe palliation of malignant pleural effusions.
48 citations
TL;DR: Patients managed conservatively with vulvar and vaginal hematomas treated at three hospitals in Jacksonville, Florida, from March 1975 to March 1985 had more subsequent operative intervention and more complications requiring antibiotics and transfusion.
Abstract: We reviewed 32 cases of vulvar and vaginal hematomas treated at three hospitals in Jacksonville, Florida, from March 1975 to March 1985. Patients ranged in age from 14 to 37 years. In 29 patients the hematomas resulted from obstetric trauma and in three from other causes. We found that patients managed conservatively had more subsequent operative intervention and more complications requiring antibiotics and transfusion, and they required more days of hospitalization than patients managed operatively. We also found an increased risk of complications and increased hospitalization for patients with conservatively managed hematomas when the product of the longitudinal diameter and the transverse diameter was 15 or greater.
46 citations
TL;DR: The availability of organism-specific antibiotic agents has enabled us to use the in situ reconstruction method to successfully manage these patients without increased morbidity or mortality from recurrent infection.
Abstract: We report five cases of infected abdominal aortic aneurysm managed at the St. Thomas Hospital between 1975 and 1985. Two patients died, one before operation, and another during surgical repair of aneurysmal rupture. Three patients survived, all of whom had primary repair of the aorta or in situ Dacron graft reconstruction. One patient is still living nine years after operation. The availability of organism-specific antibiotic agents has enabled us to use the in situ reconstruction method to successfully manage these patients without increased morbidity or mortality from recurrent infection. A high index of suspicion, prompt surgical resection, and aggressive specific antibiotic therapy are necessary for patient survival.
45 citations
TL;DR: It is found that bacteremia is more likely to occur in infants less than 4 weeks of age (8%) than in the older infants (2.9%), and the initial clinical impression as important in assessing these febrile infants is supported.
Abstract: We evaluated fever in 342 hospitalized infants less than 8 weeks of age. Sixteen infants (5%) had bacteremia or bacterial meningitis. Fifty-two percent of the infants were admitted during the months of July through September. We found no significant relationship between season, sex, height of fever, or erythrocyte sedimentation rate and the recovery of bacteria from the blood or CSF. A WBC less than or equal to 5,000/cu mm or a ratio of immature to total neutrophils greater than or equal to 20% correlated significantly with bacteremia or bacterial meningitis, though the sensitivities of these tests were unacceptably low. Prospectively, of 61 infants whose clinical appearance did not suggest sepsis, none had bacterial pathogens in the blood or CSF, whereas four of 36 infants with a septic appearance did have pathogens. Recent investigations support the initial clinical impression as important in assessing these febrile infants. We found that bacteremia is more likely to occur in infants less than 4 weeks of age (8%) than in the older infants (2.9%).
45 citations
TL;DR: In July 1982, an outbreak of pharyngitis caused by adenovirus type 7a occurred among children in a small town in western Oklahoma, and swimmers who reported swallowing pool water were more likely to be ill than those who did not.
Abstract: In July 1982, an outbreak of pharyngitis caused by adenovirus type 7a occurred among children in a small town in western Oklahoma. Predominant symptoms were fever and sore throat (by case definition), headache (83%), abdominal pain (64%), and conjunctivitis (51%). At least 77 persons were identified whose symptoms met the case definition for illness. Onsets of illness peaked during the week of July 5 to 12, and the outbreak resolved within three weeks. A systematic telephone survey of the town revealed that persons who had swum at the community swimming pool were more likely to be ill than those who had not (P less than .001). A second survey of families with season passes to the pool showed that among swimmers, illness was directly related to average number of hours of exposure to the pool each week (P less than .001 by chi-square for trend). In addition, swimmers who reported swallowing pool water were more likely to be ill (29 of 56, 52%) than persons who did not (ten of 41, 24%) (P = .01). Throat-swab specimens from five of seven ill persons (71%) grew adenovirus 7a compared with one of 12 well persons (8%) (P = .01). The pool chlorinator had reportedly malfunctioned during early July. The outbreak resolved with proper operation of the chlorination system. Swimming pools continue to be a potential source of community-wide outbreaks of adenovirus infections.
TL;DR: It is concluded that the major discernible effect of call is a deterioration of interns' feelings of well-being.
Abstract: We assessed the effect of in-hospital call on clinical performance and emotional state in seven medical interns. Clinical performance was evaluated through the use of actors who were trained to pose as patients seeking consultation because of specific medical complaints. The physician-patient interaction was scored according to predetermined criteria. There was no significant difference in interns' performance whether or not the preceding 24 hours had been spent on call. On a standardized questionnaire, interns reported significantly more fatigue and depression after call. We conclude that the major discernible effect of call is a deterioration of interns' feelings of well-being.
TL;DR: The worst visual prognosis was among those patients suffering blunt eyeball rupture, of whom 40% had no light perception and 25% regained vision of 20/ 100 or better.
Abstract: Each year an estimated 1.3 million Americans suffer eye injuries. There is little information in the literature regarding the prevalence, demographic characteristics, and prognosis of these patients. The Eye Injury Registry of Alabama (EIRA) serves as the first and only statewide system of its kind for the collection of information on serious eye injuries. We have analyzed 736 cases of serious eye injury (injury involving permanent structural or functional change) accumulated by the EIRA between August 1982 and May 1986. Prognosis was found to be related to early diagnosis and initial vision. Individuals with follow-up vision of 20/40 or better were found in all early diagnostic groups, and 13% of patients with no light perception on initial examination had some improvement on follow-up. The worst visual prognosis was among those patients suffering blunt eyeball rupture, of whom 40% had no light perception and 25% regained vision of 20/100 or better.
TL;DR: One patient died and three of the other four had residual neurologic deficits or back pain, while clinical examination, CT scanning, and myelography were useful in diagnosing SEA; SSE was not suspected preoperatively.
Abstract: We treated 31 cases of localized central nervous system infection over a seven-year period in our community hospital. The causes included brain abscess in 18 cases (58%); cranial subdural empyema (CSE) in six cases (20%); spinal epidural abscess (SEA) in four cases (13%); cranial epidural abscess (CEA) in two cases (6%); and spinal subdural empyema (SSE) in one case (3%). Both CSE and CEA were often caused by sinusitis and manifested by fever, headache, altered sensorium, and focal neurologic signs. Treatment consisted of drainage by burr holes or craniotomy followed by long-term administration of parenteral antibiotics. Though all patients with CSE and CEA survived, half had severe residual neurologic deficits. Both SEA and SSE were manifested by fever, spinal pain, and loss of motor function, and both were treated by laminectomy drainage and antibiotic administration. One patient died and three of the other four had residual neurologic deficits or back pain. Diagnosis of CSE and CEA was facilitated by CT scanning, while clinical examination, CT scanning, and myelography were useful in diagnosing SEA; SSE was not suspected preoperatively.
TL;DR: It is suggested that weight training can be used to increase strength, alter body composition, improve plasma lipids, and enhance cardiovascular function.
Abstract: Weight training regimens are generally thought not to improve cardiovascular function or lipid parameters. To evaluate this further, we studied 25 men before and after supervised weight training three times each week for eight weeks. Mean plasma HDL-cholesterol level increased significantly with training, from 38.8 to 44.1 plasma HDL-cholesterol level increased significantly with training, from 38.8 to 44.1 mg/dl, while calculated LDL-cholesterol decreased from 132 to 121 mg/dl. Triglyceride values were unchanged. Percent fat decreased from 14% to 12.7% (P less than .05), and muscle mass increased from 32.4 kg before training to 37 kg after training (P less than .05). Maximal oxygen consumption (VO2max) increased significantly (from 45.2 to 49.2 ml/kg X min) during the eight-week period. LDL-cholesterol and triglycerides were negatively correlated with VO2max but changes in HDL-cholesterol were not accounted for by alterations in VO2max, muscle mass, or percent fat. This study suggests that weight training can be used to increase strength, alter body composition, improve plasma lipids, and enhance cardiovascular function.
TL;DR: Since preeclampsia in the authors' culture is frequently associated with unrestrained consumption of “fast foods” (foods having high levels of saturated fat) and rapid weight gain, it is possible that a vegan diet could alleviate most, if not all, of the signs and symptoms of preeclamping.
Abstract: Studies at "the Farm," a community of spiritually gathered young people in Summertown, Tenn, have shown that it is possible to sustain a normal pregnancy on a vegan diet. The source of dietary protein (ie, animal or vegetable) does not seem to affect birth weight, as long as vegans are health conscious, receive continuous prenatal care, supplement their diets with prenatal vitamins, calcium, and iron, and apply protein-complementing nutritional principles. Preeclampsia may be caused by a relative prostacyclin deficiency in the face of excessive production of thromboxane A2. A vegan diet (one low in arachidonic acid) might provide protection against this condition, especially if the conversion of linoleic acid to arachidonic acid is inhibited by decreased activity of the enzyme delta-6-desaturase. We examined the maternity care records of 775 vegan mothers for symptoms of preeclampsia, and only one case met the clinical criteria. Since preeclampsia in our culture is frequently associated with unrestrained consumption of "fast foods" (foods having high levels of saturated fat) and rapid weight gain, it is possible that a vegan diet could alleviate most, if not all, of the signs and symptoms of preeclampsia.
TL;DR: A review of cases of 56 children treated at the University of Florida from 1973 to 1984 suggests that the character of the ingested caustic material is the most important determinant of the severity of esophageal injury, with preparations containing lye being the most injurious.
Abstract: Management of caustic ingestion in children remains a difficult challenge, with the outcome ranging from an asymptomatic state to intractable esophageal strictures. We reviewed the cases of 56 children ranging in age from 10 months to 5 years treated from 1973 to 1984 at the University of Florida. For children seen primarily at our institution, initial management consisted of prompt endoscopy and early institution of steroids and antibiotics. Esophageal burns were confirmed in 37 patients, 21 (56.75%) of whom subsequently had esophageal strictures of varying severity. In seven patients, limited esophageal strictures were managed successfully by dilation, but 14 children with multiple strictures required eventual esophageal replacement. Substernal right colonic interposition was tolerated well by these patients, with few complications, and their growth and development have been satisfactory over follow-up periods ranging from nine months to 13 years. A review of these cases suggests that the character of the ingested caustic material is the most important determinant of the severity of esophageal injury, with preparations containing lye being the most injurious; that in the presence of full-thickness esophageal injury, there is a high potential for stricture formation, regardless of the type of initial management, including early use of steroids; and that multiple esophageal strictures are refractory to dilation, and esophageal replacement should be an early consideration.
TL;DR: Since salpeditis during pregnancy, like salpingitis generally, is amenable to antibiotic therapy, surgery may be avoided if appropriate antibiotic therapy is quickly instituted and the pregnant patient and her fetus may be spared general anesthesia and the attendant risks of abdominal surgery.
Abstract: Pelvic inflammatory disease associated with pregnancy is not commonly reported. We present three illustrative cases at ten, 13, and 26 weeks of gestation. Unlike pelvic abscess, which may be discovered at any stage of gestation, acute salpingitis during pregnancy occurs more commonly in the first trimester. Both processes are associated with substantial fetal wastage. Diagnosis may be difficult if the obstetrician is not aware that these infections can occur during pregnancy. The diagnosis is often made at laparotomy by a physician expecting appendicitis or another inflammatory condition. Since salpingitis during pregnancy, like salpingitis generally, is amenable to antibiotic therapy, surgery may be avoided if appropriate antibiotic therapy is quickly instituted. The pregnant patient and her fetus may be spared general anesthesia and the attendant risks of abdominal surgery.
TL;DR: This work has used a variety of therapeutic agents to treat 44 patients with leukocytoclastic vasculitis who had chronic or recurrent disease of more than three months' duration and found systemic corticosteroids, azathioprine, and colchicine appeared to be effective in most patients.
Abstract: Chronic or recurrent cutaneous leukocytoclastic vasculitis is one of the more difficult therapeutic challenges to the practicing dermatologist We have used a variety of therapeutic agents to treat 44 patients with leukocytoclastic vasculitis who had chronic or recurrent disease of more than three months' duration Sixteen cases were classified as urticarial vasculitis based on the major clinical manifestations, while the remaining 28 cases represented various patterns Effectiveness of treatment was graded according to resolution of lesions, return to normal of abnormal laboratory findings, or the ability to lower the dosage of a second therapeutic agent (usually a corticosteroid) Systemic corticosteroids, azathioprine, and colchicine appeared to be effective in most patients Nonsteroidal anti-inflammatory agents, sulfones, antihistamines, and antimalarials were effective only in sporadic cases We present an approach to the treatment of this type of disorder
TL;DR: A young man with unilateral renal artery thrombosis and embolization temporally related to the intravenous injection of cocaine is described.
Abstract: I have described a young man with unilateral renal artery thrombosis and embolization temporally related to the intravenous injection of cocaine. Patients with underlying vascular disease may be risking cardiovascular complications from recreational or medical use of cocaine.
TL;DR: A case of malignant melanoma of the esophagus, which appeared to be a primary neoplasm, is presented, which should be suspected clinically when a polypoid mass is found in the esphagus, even in the absence of pigmentation.
Abstract: We have presented a case of malignant melanoma of the esophagus, which appeared to be a primary neoplasm. Characteristic clinical, histologic, and ultrastructural features are described. This lesion should be suspected clinically when a polypoid mass is found in the esophagus, even in the absence of pigmentation.
TL;DR: At least four different species of the toxic dinoflagellates cause shellfish and fish poisoning in the United States: Ptychodiscus brevis, neurotoxic shellfish poisoning; Protogonyaulax catenella and P tamarensis, paralytic shell fish poisoning; and Gambierdiscus toxicus, ciguatera fish poisoning.
Abstract: At least four different species of the toxic dinoflagellates cause shellfish and fish poisoning in the United States: Ptychodiscus brevis, neurotoxic shellfish poisoning; Protogonyaulax catenella and P tamarensis, paralytic shellfish poisoning; and Gambierdiscus toxicus, ciguatera fish poisoning. These three disorders have similar clinical manifestations, primarily neurologic and alimentary. A complete history is essential; confirmation, while dependent on specific laboratory analysis, is usually based on a history of ingestion of fish or shellfish previously associated with these types of poisonings. The principal toxins affect sodium channels; Ptychodiscus brevis toxins and ciguatoxin by stimulating these channels and saxitoxin by blocking them. Since no antidote is known, treatment is symptomatic. Public health measures and public education are necessary to prevent this form of poisoning.
TL;DR: In general, the patients were normophosphatemic at the time of hospitalization, and SH occurred early in the hospital course, and the course of SH was typically short and without sequelae.
Abstract: We reviewed 16,621 blood chemistry samples taken over a 12-week period; 34 patients with severe hypophosphatemia (serum phosphate level less than or equal to 1.0 mg/dl) were identified, for an incidence of 0.24%. The most common causes of severe hypophosphatemia (SH) in this population were infusion of dextrose solutions (73%), nutritional recovery syndrome (50%), phosphate-binding antacids (50%), and alcohol withdrawal (32%). In general, the patients were normophosphatemic at the time of hospitalization, and SH occurred early in the hospital course. All of the patients responded to the drop in serum phosphate by renal conservation of phosphate (Tm PO4/GFR less than 1.0 mg/dl GFR). Patients required small doses of phosphate to achieve a serum level above 2.0 mg/dl, with 50% of the population receiving less than 25 mmol of replacement therapy. Regardless of the route or amount of replacement therapy given, the course of SH was typically short and without sequelae.
TL;DR: The frequency of significant renovascular hypertension does not justify the routine search for this problem during catheterization procedures, though it may be worthwhile if the patients are hypertensive.
Abstract: Patients with renovascular hypertension comprise only a small percentage of those with hypertension. In our study 102 consecutive patients who had cardiac catheterization were screened at the time of the procedure for renal artery stenosis. Only 65 (64%) of the 102 patients were hypertensive, and 14 of the total population (13.7%) had renal artery stenosis. Of these 14 patients, only five had more than 50% narrowing of the arterial lumen. By renal vein renin determination, only four of the five patients with significant renal artery stenosis had lateralizing renins. The frequency of significant renovascular hypertension does not justify the routine search for this problem during catheterization procedures, though it may be worthwhile if the patients are hypertensive. This area deserves further evaluation.
TL;DR: Transsphincteric posterior resection of villous adenomas and small carcinomas restored gastrointestinal continuity and preserved continence in 25 of 26 patients in this study.
Abstract: Transsphincteric posterior resection of villous adenomas and small carcinomas restored gastrointestinal continuity and preserved continence in 25 of 26 patients in this study. No patient had local recurrence. This procedure is suitable for villous tumors that are too high for transanal or too low for transabdominal resection, and for small mobile malignancies of the lower 5 cm of the rectum.
TL;DR: Temperature elevations generated during intramedullary reaming are sufficient to cause thermal necrosis, and may cause delayed healing in vivo, and there was a direct correlation between temperature increase and reamer size.
Abstract: Cortical ischemia and necrosis after intramedullary reaming are well documented. Numerous authors have described ischemic changes attributed to mechanical disruption of the arterial system of the intramedullary canal. Few have investigated the potential thermal injury during extreme temperatures generated during intramedullary reaming. We reamed the medullary canal of cadaveric tibial and femoral diaphyses using a flexible shaft reaming device and stainless steel intramedullary reamer. The temperatures generated by reaming from 11 mm through 15 mm in 1 mm increments were measured after each pass. In the 17 specimens tested, we observed an incremental rise in temperature with reaming. The mean intramedullary temperature after reaming was 52 C ( +/- 8.3) with a range of 42 to 67 C. The mean extramedullary temperature was 46 C ( +/- 8.3) with a range of 36 to 59 C. There was a direct correlation between temperature increase and reamer size. Our results indicate that temperature elevations generated during intramedullary reaming are sufficient to cause thermal necrosis, and may cause delayed healing in vivo.
TL;DR: Patients with diarrhea and increased bile acids in their stools had prompt improvement when given cholestyramine and returned to a more normal life-style.
Abstract: Radiation-induced bowel disease manifested by debilitating diarrhea is an unfortunate consequence of therapeutic irradiation for pelvic malignancies. Although the mechanism for this diarrhea is not well understood, many believe it is the result of damage to small bowel mucosa and subsequent bile acid malabsorption. Excess amounts of bile acids, especially the dihydroxy components, are known to induce water and electrolyte secretion and increase bowel motility. We have directly measured individual and total bile acids in the stool samples of 11 patients with radiation-induced diarrhea and have found bile acids elevated two to six times normal in eight of them. Our patients with diarrhea and increased bile acids in their stools had prompt improvement when given cholestyramine. They had fewer stools and returned to a more normal life-style.
TL;DR: This report of a plasma cell granuloma recurring 11 years after the initial resection emphasizes that complete surgical resection should be done whenever possible.
Abstract: From the Division of Pulmonary Diseases, Departments of Medicine and Pathology, North Carolina Memorial Hospital, University of North Carolina at Chapel Hill
TL;DR: Eating behavior was studied in two non-overlapping cohorts of consecutive patients electing gastric bypass surgery for obesity: 100 patients one year after operation and 60 patients three years afterward, finding little evidence of disturbed eating patterns.
Abstract: We studied eating behavior in two non-overlapping cohorts of consecutive patients electing gastric bypass surgery for obesity: 100 patients one year after operation and 60 patients three years afterward. Information was obtained through structured interviews and from office charts. Eating behavior was compared with previously collected data on 232 morbidly obese adults and 174 adults of normal weight. Despite an average weight loss of 100 lb (45 kg), there was little evidence of disturbed eating patterns among gastric bypass patients. Significantly fewer gastric bypass patients than morbidly obese comparison subjects reported frequent hunger, overeating, guilt about eating, or food preoccupation. Gastric bypass patients reported less preoccupation with food than did the normal-weight comparison subjects.
TL;DR: The spring and summer months had the highest incidence and the fall and winter the lowest, using analysis of variance, however, there was no statistically significant variation in incidence.
Abstract: Over a period of 56 years, 12,686 appendectomies were done for acute appendicitis at the Jersey City Medical Center in Jersey City, New Jersey. We tabulated each appendectomy by the month and season of its occurrence. The spring and summer months had the highest incidence and the fall and winter the lowest. Using analysis of variance, however, we found no statistically significant variation in incidence.