Showing papers in "Southern Medical Journal in 1998"

The erythrocyte sedimentation rate: old and new clinical applications.

Abstract: Background.The erythrocyte sedimentation rate (ESR) is a simple and inexpensive laboratory test. It is commonly used to assess the acute phase response.Methods.A review of the recent literature was done to evaluate the role of the ESR and its importance in different clinical conditions both

Traditional and evidence-based acupuncture: history, mechanisms, and present status.

Abstract: Background.In 1983, the Southern Medical Journal advised its readers that a scientific basis might underlie the popular practice of ancient Chinese acupuncture. Recent studies have proven this to be correct, and a 1997 National Institutes of Health consensus panel recommended acupuncture as

Use of hospital services, religious attendance, and religious affiliation.

Abstract: Background We examined the relationship between religious attendance, religious affiliation, and use of acute hospital services by older medical patients. Methods Religious affiliation (n = 542) and church attendance (n = 455) were examined in a consecutive sample of medical patients aged 60 or older admitted to Duke University Medical Center. Information on use of acute hospital services during the year before admission and length of the current hospital stay was collected. Frequency of church attendance and religious affiliation were examined as predictors of hospital service use, controlling for age, sex, race, education, social support, depressive symptoms, physical functioning, and severity of medical illness as covariates using logistic regression. Results Patients who attended church weekly or more often were significantly less likely in the previous year to have been admitted to the hospital, had fewer hospital admissions, and spent fewer days in the hospital than those attending less often; these associations retained their significance after controlling for covariates. Patients unaffiliated with a religious community, while not using more acute hospital services in the year before admission, had significantly longer index hospital stays than those affiliated. Unaffiliated patients spent an average of 25 days in the hospital, compared with 11 days for affiliated patients; this association strengthened when physical health and other covariates were controlled. Conclusions Participation in and affiliation with a religious community is associated with lower use of hospital services by medically ill older adults, a population of high users of health care services. Possible reasons for this association and its implications are discussed.

Survival rates among children with severe neurologic disabilities.

Abstract: Background This study was done to determine survival rates in subpopulations of severely neurologically disabled children who reside in pediatric skilled nursing facilities and to compare these survival rates with those in previously published studies Methods Data were collected at three pediatric skilled nursing facilities over the 1986 to 1996 decade The total study population numbered 447 We studied in detail six groups of the most severely disabled children and correlated their survival rates with clinical parameters and the presence of other significant diseases Results The survival rates in our six groups of severely disabled children were significantly better than those previously reported In group 1, our 8-year survival rate was 66%, as compared with 5% in the previous study In group 2, our 8-year survival rate was 89%, versus 22% in the previous study We obtained better survival rates in all six groups studied, irrespective of the analysis including children less than 1 year old, between 1 year and 15 years old, or more than 15 years old The most significant determinant for reduced survival was the presence of other significant diseases Those with other significant diseases had a 10-year survival rate of 45%, whereas those who were relatively healthy had a survival rate of 90% Patients who received gastrostomy tube feedings had a better 10-year survival rate than those fed by nasogastric tube (78% vs 41%) This difference was independent of the presence of other significant medical diseases Conclusions Our results show substantially better survival rates than those previously reported These improved results are most likely related to much more intense medical management of severely disabled children in skilled nursing facilities than at home or in other residential settings Our study also showed a significantly better survival rate for those fed by gastrostomy tube as compared with nasogastric tube

Solid and papillary epithelial neoplasm of the pancreas, diagnosis by cytology.

Abstract: In this paper, I report a rare, low-grade malignant tumor, solid and papillary epithelial neoplasm of the pancreas (SPENP). I also discuss and review 157 previously reported cases. Unlike other malignant tumors of the pancreas, this neoplasm is typically found in young women, does not have metastases, and is amenable to cure after complete surgical resection. I discuss clinical features, diagnostic procedures, and differential diagnosis. Fine-needle aspiration can be effective in obtaining a preoperative diagnosis of SPENP, since the tumor has characteristic cytologic features. Also, use of clinical data, ultrasonography studies, computed tomography, magnetic resonance imaging, arteriography, and cytologic findings in the preoperative workup are important in obtaining an accurate diagnosis. Although potentially curable, late metastases and current inability to predict aggressive behavior by some tumors require lengthy follow-up.

Prevalence of hot flushes during and after neoadjuvant hormonal therapy for localized prostate cancer

Abstract: Objectives We sought to determine the prevalence of hot flushes after neoadjuvant hormonal therapy. Methods Forty-three patients who received neoadjuvant hormonal therapy before radical prostatectomy were asked to complete a questionnaire regarding hot flushes. Results Complete information was available for 35 of the 43 patients. No hot flushes were noted in 20%; in 69%, hot flushes were noted during treatment but resolved after termination of treatment; and in 11%, hot flushes continued for at least 3 months after cessation of hormonal therapy. Analyzing the data with respect to duration of hormonal therapy showed that patients receiving neoadjuvant hormonal therapy for more than 4 months had the highest incidence of persistent hot flushes. Conclusions Hot flushes will be noted in 80% of patients who receive neoadjuvant hormonal therapy. In approximately 10%, hot flushes will continue for a significant period after hormonal therapy is terminated. Patients should be apprised of this potential side effect.

Fatal and near-fatal complications of liposuction

Abstract: :Cosmetic liposuction is considered to be safe and effective in properly selected patients and is widely done as an outpatient or office procedure. When major complications occur, office-based practitioners may refer patients to a hospital emergency department, where medical personnel unfami

Gabapentin for treatment of pain and tremor: a large case series.

Abstract: Background Several anticonvulsant agents, including carbamazepine, phenytoin, and valproate, are effective in some patients for the treatment of pain and tremor. This study reports on a trial of the newly introduced anticonvulsant, gabapentin, for pain and tremor control. Methods A large case series of patients with centrally mediated pain, peripherally mediated pain, migraine, and tremor were treated in an open-label study with gabapentin (maximum of 2,700 mg/day). Results Thirty-nine patients (65%) had moderate-to-excellent improvement in symptoms, with the best responses occurring in patients with peripherally mediated neuropathic pain. The other conditions treated that showed some improvement were benign essential/familial tremor, restless legs syndrome, centrally mediated pain, and periodic nighttime leg movements. Conclusions Gabapentin offers an effective, safe alternative therapy or co-therapy for the listed painful conditions and tremor; it does not affect the metabolism of other medications and is well tolerated.

Acupuncture : A review of its history, theories, and indications

Abstract: Background The National Institutes of Health recently recommended acupuncture as an effective tool for the treatment of various health problems. Acupuncture is an old technique but has been popular in the United States only since 1972. Its history, theories, and indications are not well known to the medical community. Methods We reviewed the literature to gather information on the history, techniques, physiology, indications, adverse effects, and opposing views to acupuncture. Results The mechanism by which acupuncture works involves neurotransmitters and adrenocorticotropic hormones. It appears to be effective in the treatment of pain, nausea, and drug detoxification and in stroke victims. Studies suggest acupuncture is no more effective than placebo. Acupuncture side effects have rarely been reported. Conclusions Acupuncture appears to be a safe and effective alternative medical therapy for certain health problems. More controlled research is necessary to better understand the range of its clinical application.

Unreliability of the infrared tympanic thermometer in clinical practice: a comparative study with oral mercury and oral electronic thermometers

Abstract: BACKGROUND This study was designed to determine the magnitude and frequency of measurement errors with infrared tympanic thermometers in the clinical setting. METHODS In a convenience sample of 137 adult inpatients, we compared body temperatures measured by a Diatek 9000 Infrared Aural Thermometer and an IVAC 2090 CoreCheck Tympanic Thermometer between themselves, in right versus left ears, and against concurrently measured oral temperatures using both an electronic thermoprobe and conventional glass mercury thermometer. RESULTS There was a significant between-brand difference of 0.6 degrees C (IVAC

Bishop score : A poor diagnostic test to predict failed induction versus vaginal delivery

Abstract: BACKGROUND We evaluated the accuracy of the Bishop score in predicting the likelihood of successful labor induction (entry into active phase) in nulliparous and multiparous women. METHODS During an index year, all patients having induction of labor and a preinduction Bishop score were included in a standard protocol for cervical ripening and use of oxytocin. Receiver-operating characteristic (ROC) curves were constructed for Bishop scores (0 to 11) to predict abdominal delivery for failed induction (final cervical dilation <4 cm) versus vaginal delivery. RESULTS Parturients who had vaginal delivery (n = 253) and those in whom attempted induction failed (n = 38) did not differ significantly with respect to maternal demographics, length of gestation, Bishop score and its distribution, and infant birth weight. The area under the ROC curve did not differ significantly from the area under the nondiagnostic line. CONCLUSION The Bishop score appears to be a poor predictor of the outcome of labor induction.

Lifetime use of alternative therapy: a study of Florida residents.

Abstract: Background.Clinically relevant questions remain about who uses alternative medicine, which treatments they use and whyMethods.The random digit dialing survey method was used to ask Florida residents about their lifetime use of 11 different alternative therapies. The response rate was 54% (n

Chromobacterium violaceum infection.

Abstract: :Chromobacterium violaceum infection is confined to the tropical and subtropical areas, with almost all reported cases occurring in the Southeast. The most common feature of this infection is sepsis, followed by cutaneous involvement and liver abscesses. Treatment consists of surgical draina

Low Postoperative Infection Rates With Instrumented Lumbar Fusion

Abstract: BACKGROUND Studies have shown postoperative infection rates increase with the use of internal instrumentation. It is believed that longer operative times, prolonged retraction, instrumentation, and bone grafting lead to a higher risk of infection. METHODS We retrospectively reviewed 126 consecutive instrumented lumbar fusions. All had bone graft. The infection rate was statistically compared with previously reported values. RESULTS Our infection rate (0.8%) was lower than the combined data from the literature (2.8%), though not significantly different. No significant differences were noted regarding patient or surgical factors. CONCLUSIONS This review showed that low rates of postoperative infection can be achieved despite patient or surgical factors. We believe that conforming to strict techniques, including copious irrigation and debridement, and having experienced operating room personnel and short operating times will reduce the incidence of postoperative infections.

Traumatic vulvar hematomas: conservative versus surgical management.

Abstract: Background Vulvar hematomas are relatively uncommon and usually result from blunt trauma. They are more commonly diagnosed in postpartum patients, but hematomas after straddle-type injuries, coitus, or physical assault have been reported. Conservative and surgical management have both been advocated as the appropriate initial treatment. Methods In this study, we have done a retrospective review to obtain data that might indicate a clinical benefit for either conservative or surgical management. We reviewed the charts of patients treated for vulvar hematomas at the University of North Carolina Hospitals between 1975 and 1991. Cases were separated into obstetric and nonobstetric and conservatively and surgically managed groups. Results Of the 29 cases reviewed, 19 were classified as obstetric and 10 were nonobstetric. All 13 obstetric hematomas and 3 of 7 nonobstetric hematomas managed conservatively resolved without subsequent surgical intervention. Conclusion In the absence of acute hematoma expansion, conservative management was often successful.

Sociodemographic characteristics and individual health behaviors

Abstract: Background We examined individual demographics and socioeconomic status to learn how they were related to major health behavior (ie, exercise, smoking, and diet), and the sociodemographic predictors of healthy versus unhealthy behavior. Methods The study was based on data collected through the 1994 Behavioral Risk Factor Surveillance System (BRFSS) of South Carolina. More than 2,000 South Carolina adults who lived in households with telephones were randomly selected and interviewed by telephone to obtain the data. Results The current report confirms much of the literature on the relationship between sociodemographic characteristics and health behavior. It also shows that controlling for sociodemographic influences, women, individuals with a college education, and the 18 to 24 and 65+ age groups were more likely to practice a cluster of healthy behaviors than men, individuals with less or no education, and the 25 to 44 age group. Race and marital status were not significantly associated with healthy behavior patterns. Conclusions An important policy implication of the study is the need for targeted health promotion activities on the risk groups identified, namely men, individuals with little education, and the 25 to 44 age group.

Pulmonary Contusion in Children: Diagnosis and Management

Abstract: Background.Pulmonary contusion (PC) is the most common injury identified in pediatric blunt chest trauma. The disagreement over management principles of children with PC may complicate care of these patientsMethods.We reviewed the literature and our institutional experienceResults.Pulmonary

Profile of Pediatric Bicycle Injuries

Abstract: BACKGROUND: Bicycle injury data from local communities are important for developing injury prevention and control programs. This study represents the efforts of one community trauma center to describe bicycle injuries. METHODS: We conducted a retrospective analysis of bicycle injury data from hospital charts, emergency medical services reports, and medical examiner reports. The review encompassed a 4-year period. The study sample included 211 trauma alert patients, ages 1 through 15 years, who were treated for bicycle-related injuries at our level II pediatric trauma center. RESULTS: Bicycle injuries accounted for 18% of all pediatric trauma alert patients. The mean age of injured children was 10 years, and 79% were males. Bicycle-motor vehicle collisions caused 84% of injuries. Only 3 children (1.4%) wore bicycle helmets. Resulting injuries included external wounds (86%), head injuries (47%), fractures (29%), and internal organs (9%). Six children died. CONCLUSIONS: Bicycle injuries are a significant cause of mortality and morbidity for children in our community. Use of safety helmets by child bicyclists is inadequate. The data from this study can be used as a baseline in testing the effectiveness of local and state interventions, including new legislation mandating helmet use by children in our state.

Clenbuterol and anabolic steroids: a previously unreported cause of myocardial infarction with normal coronary arteriograms.

Abstract: During the last 10 years, several cases of myocardial infarction associated with anabolic steroid use have been reported. Postulated mechanisms to explain this association have included changes in lipid levels, the fibrinolytic system, and platelet aggregation. Clenbuterol is a beta 2-agonist with anabolic properties that has not been seen previously with myocardial infarction. We report a case of myocardial infarction in an otherwise healthy 26-year-old body-builder who recently used clenbuterol and anabolic steroids. In this case, synergistic effects of the two agents seem likely to have played a role in the infarct. The normal coronary arteriograms before any anticoagulant or thrombolytic therapy strongly suggest coronary spasm as the mechanism of the infarct.

Visceral larva migrans and the hypereosinophilia syndrome.

Abstract: :This is a case of visceral larva migrans and hypereosinophilia syndrome with persistently elevated white blood cell count despite adequate medical therapy in a 4-year-old boy with leukocytosis and splenomegaly. Medical history included reactive airway disease and geophagia (pica). Serology

Disorders associated with clinically severe obesity: significant improvement after surgical weight reduction.

Abstract: Background.Surgical treatment for patients with clinically severe obesity mainly aims to reduce morbidityMethods.Sixty-two patients were examined for disorders associated with morbid obesity before and after surgical weight reduction by vertical banded gastroplasty. All patients were followe

Pertussis infection in adults.

Abstract: Background Pertussis is a potentially serious vaccine-preventable disease. Many clinicians are unaware that pertussis is common in adults, and that adults are a major reservoir of the disease in the United States. Methods A MEDLINE search was conducted of all English-language articles pertinent to pertussis infections in adults. Results of relevant articles were compiled into a narrative review. Results Studies have shown that sporadic cases of pertussis in adults are common in a variety of clinical settings. Patients typically present with a prolonged cough illness preceded by upper respiratory symptoms. Widespread outbreaks of pertussis occasionally occur in high schools, college campuses, and healthcare settings. The diagnosis and treatment of adults with pertussis are reviewed. Conclusions Pertussis infection, because of waning immunity, is common in adults. Routine booster immunization of adults with the newer acellular vaccine may lead to the elimination of the disease in both children and adults.

Transudative malignant pleural effusions: prevalence and mechanisms.

Abstract: Background.Malignant pleural effusions are classically exudative, though occasionally they can be transudative. We attempted to determine the prevalence of transudative malignant pleural effusions and to describe their clinical and radiographic characteristicsMethods.We studied the medical r

Multiple organ toxicity from addition of erythromycin to long-term lovastatin therapy.

Abstract: A patient who had taken lovastatin for 7 years received erythromycin before dental procedures. Multiple organ toxicity developed, manifested as rhabdomyolysis, acute renal failure, pancreatitis, ileus, livedo reticularis, and elevated aminotransferase values, without liver injury. No previou

Solitary Choroid Plexus Metastasis From a Renal Cell Carcinoma

Abstract: :Metastatic tumors to the choroid plexus are rare We report a case of renal cell carcinoma metastasizing to the choroid plexus of the lateral ventricular atrium This tumor was shown by magnetic resonance imaging, followed by craniotomy and histologic confirmation Computed tomography of th

Continuous non-seasonal epidemic of respiratory syncytial virus infection in the southeast United States.

Abstract: BACKGROUND This study was done to define the seasonality of respiratory syncytial virus (RSV) epidemics in the southeastern United States. METHODS We tested 5,092 fresh nasal aspirates or washings, using the Kallestad Pathfinder enzyme immunoassay (EIA) or the Directigen RSV membrane EIA according to manufacturers' directions. RESULTS A total of 1,419 (27.9%) respiratory specimens, collected from pediatric patients between May 1993 and December 1996 at two large southeastern medical centers, were positive for RSV antigen by enzyme immunoassay. A persistent RSV epidemic was documented between July 1993 and December 1996. We defined an epidemic as 2 consecutive months in each of which > or = 10% of the specimens were positive and > or = 2 positive specimens detected. The highest percentages of positive specimens were detected in December of 1993, 1994, and 1996, to date, and November 1995. CONCLUSION On the basis of our findings, we recommend health care workers consider RSV in the differential diagnosis of acute respiratory illness throughout the year in pediatric patients from the southeast United States.

Hepatic amebiasis among patients in a public teaching hospital

Abstract: The increase in immigration to the United States is associated with diseases, such as amebiasis, that are endemic to developing countries. We retrospectively reviewed 49 public-hospital patients with hepatic amebiasis occurring between 1985 and 1995. Most patients were immigrants (47) from Latin America (43), male (43), and young (mean age, 39.8 years). Symptoms noted by more than half were abdominal pain and fever. Ultrasonography showed single lesions in 70% and right-sided involvement in 85%. Serologies against Entamoeba histolytica were noted in 86%. After treatment, the median interval from admission to defervescence was 2 days, to normalization of white cell count 3 days, and to resolution of abdominal pain 4 days. Morbidity (one case of pericarditis) and mortality (one death in a cirrhotic man) were low. Hepatic amebiasis continues to be diagnosed in the United States, primarily among Hispanic and Asian immigrants. When appropriately considered, current diagnostic and therapeutic modalities result in rapid improvement and excellent outcome.

Fire in the operating room during tracheostomy

Abstract: Background.Fire in the modern operating room is still a constant danger today despite the usual absence of the historically explosive anesthetic gases, cyclopropane, and ether. During a tracheostomy, three conditions are present that will support an explosive or combustive event: heat, fuel

Peripheral Neuropathy and Lipid-Lowering Therapy

Abstract: We report a case of a peripheral neuropathy induced and exacerbated by several commonly used HMG-CoA reductase inhibitors including lovastatin, simvastatin, pravastatin, and atorvastatin, and the vitamin niacin. A review of the literature shows similar cases with individual lipid-lowering drugs, but this case shows the cross-reactivity of the neuropathic process to different HMG-CoA reductase inhibitors, and it is the first reported case of a peripheral neuropathy exacerbated by the use of niacin.

Invasive Disease Due to Group A β-Hemolytic Streptococci: Continued Occurrence in Children in North Carolina

Abstract: BACKGROUND We have previously reported a significant increase beginning in the late 1980s in the incidence of invasive disease due to group A beta-hemolytic streptococci (GABS) in children admitted to our hospital. To determine subsequent trends in epidemiology, we have continued to monitor cases. METHODS We prospectively monitored cases of invasive disease due to GABS at Brenner Children's Hospital during the 5 1/2 years (July 1, 1990, to December 31, 1995) since our last report. RESULTS Twenty-five patients had GABS isolated from normally sterile sites. Their presentations were varied. One patient had necrotizing fasciitis and one had toxic shock-like syndrome. The one death was that of a newborn infant with sepsis and meningitis. The proportion of GABS infections associated with varicella was significantly greater during this period (7/25, 28%) than during the period 1983 to 1990 (1/22, 5%). Isolates were available tor study from 24 patients. Serotypes were M1 (4), M3 (4), M6 (2), M12 (3), M22 (3), M75 (1) and M-nontypeable (7). The number of cases of invasive disease seen annually from 1983 through 1995 also is reviewed. CONCLUSIONS The resurgence of invasive disease due to GABS in children noted in the late 1980s continues through the first half of the 1990s. The clinical manifestations are varied as are the causative M-types. As almost one third of cases in this series were associated with varicella infection, widespread use of the varicella vaccine may lead to a decrease in the incidence of invasive GABS disease.