Public Health Commons^™

A Selective Approach To Bleeding Esophageal Varices, Glyn G. Jamieson, Irwin B. Faris, John Ludbrook

Henry Ford Hospital Medical Journal

It is possible that the best results of treatment for bleeding esophageal varices will come when a selective approach is used. In patients bleeding acutely and in patients with poor liver function shunt operations should be avoided, and a direct attack on the varices with either sclerosant therapy, percutaneous obliteration, or staple gun gastro-esophageal transsection should be carried out. In patients who have stopped bleeding, or those in whom elective treatment is being undertaken, the best operation at present appears to be selective distal splenorenal shunt.

Letters To The Editor

Henry Ford Hospital Medical Journal

No abstract provided.

Recurrent Klebsiella Meningitis Following Trans-Sphenoidal Hypophysectomy For Nelson's Syndrome: Chloramphenicol Resistance During Relapse, Tom Madhavan, Daria Kiani, Louis Saravolatz, Keith Burch, Raymond C. Mellinger

Henry Ford Hospital Medical Journal

Three episodes of meningitis due to Klebsiella pneumoniae occurred in a young man following cerebral surgery. The patient had the features of Nelson's syndrome, and a chromophobe adenoma was removed by trans-sphenoidal resection. Intravenous chloramphenicol was effective in producing a temporary clinical response during the first episode of meningitis, but the organism became resistant to chloramphenicol during the second episode. Combined parenteral and intralumbar administration of gentamicin resulted in temporary improvement only. Subsequently, the subcutaneous cerebrospinal fluid (CSF) reservoir of Ommaya provided a safe, convenient way to administer prolonged intraventricular therapy which, combined with a definitive procedure to correct the …

Occult Cushing's Syndrome Presenting With Osteoporosis, M. Kleerekoper, Sudhaker D. Rao, B. Frame, R. D. Larocque, T. Feigelman, V. Matkovic, L. V. Avioli

Henry Ford Hospital Medical Journal

Osteoporosis is a frequent complication both of endogenous hypercortisolism and of long-term treatment with corticosteroids, but only rarely is it the major clinical feature with the more characteristic features absent or minimally present. In the two patients presented, hypercortisolism was uncovered only during routine evaluation of osteoporosis. This presentation is probably due to slow progression of the disease and is often associated with so-called black adenoma of the adrenal gland. Secondary causes should be sought in all patients with seemingly "senile" or "postmenopausal" osteoporosis.

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Richmond W. Smith Jr., Raymond C. Mellinger

Henry Ford Hospital Medical Journal

No abstract provided.

The Presentation Of Thyroid Malignancy In The Geriatric Patient, Joel I. Hamburger

Henry Ford Hospital Medical Journal

Of 334 patients with thyroid carcinoma, 36 were age 65 or older. The sex distribution of the geriatric patients did not significantly differ from that of the younger patients. Older patients had significantly fewer papillary carcinomas and significantly more anaplastic and medullary carcinomas and lymphomas than younger patients. Papillary and follicular carcinomas of geriatric patients were large (4 cm or larger) significantly more often than those of the younger patients. Only one of 53 patients with very small (1 cm or less) papillary and follicular carcinomas was in the older group.

The Impact Of Needle Biopsy On The Preoperative Diagnosis Of Thyroid Nodules, J. Martin Miller, Joel I. Hamburger, Sudha R. Kini

Henry Ford Hospital Medical Journal

This study compares the noninvasive evaluation of 1,075 patients with "cold" thyroid nodules with the evaluation provided by needle biopsy. It also compares the treatment of this group with that of a similar group of 1,094 patients treated before biopsies were available. The results of these comparisons indicate that needle biopsy: 1) halved the number of surgical candidates; 2) doubled the percentage of cancers in the surgical specimens; 3) reduced the risk that a thyroid cancer would not be operated upon; and 4) accomplished all of the above with a substantial financial saving in overall patient management.

Richmond Smith As A Clinical Investigator: His Work On Adult Periosteal Bone Expansion And Nutritional And Endocrine Aspects Of Osteoporosis In Light Of Current Concepts, A. M. Parfitt

Henry Ford Hospital Medical Journal

This paper discusses Richmond Smith's contributions to the field of metabolic bone disease from 1949 to 1969 in light of current concepts. He was the first to demonstrate continuing periosteal bone expansion in adults, a phenomenon of great biologic interest which is best explained if adult bone remodelling is qualitatively similar on all surfaces. He was the first to show that persons with less bone than normal have an increased risk of subsequent fracture, and so are more likely to benefit from preventive treatment. He found that blood vitamin D levels were lower in osteoporotic subjects than in controls, but …

Femoral Expansion In Aging Women: Implications For Osteoporosis And Fractures, Richmond W. Smith Jr., Richard R. Walker

Henry Ford Hospital Medical Journal

In femoral radiographs of 2030 aging women, the diameter of the midshaft periosteum increased as cortical thickness declined. Since the cortical area enlarged, periosteal accretion exceeded endosteal resorption. Since the section modulus increased more than did cortical area, the ratio of flexural failure resistance to crush resistance increased, in apparent contrast to the changes observed in the femoral neck.

Research In The Service-Oriented Institution, Richmond W. Smith Jr.

Henry Ford Hospital Medical Journal

No abstract provided.

Prospects For Clinical Research, G. Donald Whedon

Henry Ford Hospital Medical Journal

No abstract provided.

Transiliac Bone Biopsy: Complications And Diagnostic Value, Sudhaker D. Rao, Velimir Matkovic, Howard Duncan

Henry Ford Hospital Medical Journal

This article reviews the experience of 101 transiliac bone biopsies performed in one year at Henry Ford Hospital and discusses the possible diagnostic value ofthe procedure in evaluating generalized metabolic bone disease. In 50 of the 101 cases, we used a pain scoring method to evaluate the acceptability of the procedure to patients. Data from our study and 18 other clinical centers were then analyzed for: 1) demographic distribution of patients who had a bone biopsy; 2) its acceptability to patients; 3) quality of the specimen and its relationship to the physician performing the procedure; 4) diagnostic yield of bone …

Osteoporosis And Epidemiology Of Fractures In Croatia: An International Comparison, Velimir Matkovic, Marija Ciganovic, Cedomil Tominac, Krista Kostial

Henry Ford Hospital Medical Journal

We examined the epidemiology of osteoporotic fractures in Croatia and correlated the results with data from other countries. We analyzed annual rates of wrist fractures in the large urban community of Zagreb and hip fractures in the Republic of Croatia. In addition, we determined mortality data and measured metacarpal bone mass In patients with hip fractures. There were age and sex differences in the incidence of both types of fracture. The incidence of wrist fractures is the same as in some Northwestern European countries, but the incidence of hip fractures is much lower. The mortality after hip fractures is high …

The Acute Effect Of Piretanide Upon Serum And Urinary Calcium In Normal Subjects, Cristina Casco, Patricia Fainstein Day, Carlos Mautalen

Henry Ford Hospital Medical Journal

We gave piretanide, a new diuretic, at two dose levels to six normal subjects. Sodium excretion increased six to eightfold in the first two hours, and diuresis was completed within four hours. There was a simultaneous increase in the excretion of calcium which exceeded the amount present In the mobilized extracellular fluid. The resulting deficit of calcium produced a small but significant fall in serum calcium corrected for protein. After diuresis ended, calcium was retained but not sodium, when compared to basal values on the previous day. The fall in urinary calcium and the failure to correct the sodium deficit …

Cushing's Disease, A Pituitary Disorder: A Hypothesis, M. Saeed Zafar, Raymond C. Mellinger

Henry Ford Hospital Medical Journal

At present, Cushing's disease Is believed to be due to Inappropriate secretion of adrenocorticotropic hormone (ACTH). Associated abnormalities such as disturbed sleep pattern, growth hormone secretion, depressed thyroid hormone levels, and gonadal function are considered by some as manifestations of a generalized central nervous system disturbance, with abnormal ACTH secretion as one of the components. Recognition of microadenomata in Increasing numbers of patients with Cushing's disease, the reversal of hypothalamic abnormalities after adenomectomy, and correction of hypercortisolemia all suggest that the central nervous system disturbances result from Cortisol excess. We hypothesize that the basic abnormality in Cushing's disease is the …

Painless Thyroiditis With Hyperthyroidism Following External Irradiation To The Neck, J. David Fachnie, Sudhaker D. Rao

Henry Ford Hospital Medical Journal

Two months after finishing 60Co external irradiation to treat squamous cell carcinoma of the larynx, a 47-year-old man became hyperthyrold. Although the thyroid gland was not tender, the radioactive iodine uptake was diminished. After subsequent periods of euthyroidism and hypothyroidism, the patient's thyroid function spontaneously returned to normal. The features of this case mimic the syndrome of painless granulomatous thyroiditis. Although hypothyroidism is frequently observed following radiation thyroiditis, hyperthyroidism from external radiation has not been reported. Despite this low frequency, diagnosis is important to permit prompt, symptomatic treatment of the thyrotoxic phase.

Graves' Disease Following The Occurrence Of Hypothyroidism, A. R. Guansing, D. D. Klink, N. Engbring, Y. Leung, J. Chakravarty, S. Wilson

Henry Ford Hospital Medical Journal

Three patients with hypothyroidism of 15-48 months' duration developed Graves' disease while on thyroid hormone replacement therapy. In one patient, the hyperthyrold phase was preceded by ophthalmopathy and nonsuppresslble 24-hour radioactive iodine uptake (RAIU). Eventually, all had hyperthyrold findings with elevated thyroid hormone levels, high 24-hour RAIU, and a diffuse uniform uptake of RAI by the enlarged thyroid. All subjects had negative antithyroglobulin and antimicrosomal antibody titers. Two had demonstrable long-acting thyroid stimulator (LATS) in their sera. All three were followed for 5-36 months while on propylthiouracil therapy prior to surgery or RAI administration. Both LATS-positive patients underwent bilateral subtotal …

Insulin-Resistant Diabetes Mellitus And Insulin Receptor Antibodies: Variable Association With Acanthosis Nigricans, José Goldman

Henry Ford Hospital Medical Journal

Two patients with severe insulin-resistant diabetes mellitus and anti-insulin receptor autoantibodies are reported here. A marked decrease in the number of accessible insulin receptors was found in the monocytes of one patient. Otherwise, the Insulin receptors were of normal affinity compared to those of normal controls. Acanthosis nigricans was not present in one patient, and in the other patient it preceded the diagnosis of diabetes by ten years. We conclude that although acanthosis nigricans and insulin resistance are frequently associated, they probably do not bear a pathogenetic relationship to each other. Therefore, the investigation of anti-insulin receptor antibodies Is advisable …

Dietary And Hormonal Factors In Bone Loss, Richmond W. Smith Jr.

Henry Ford Hospital Medical Journal

No abstract provided.

Back Matter

Henry Ford Hospital Medical Journal

No abstract provided.

Body Adiposity Measurement By Differential Absorptiometry, Luther E. Preuss, Frank P. Bolin

Henry Ford Hospital Medical Journal

A scanning principle utilizing a dual beam of penetrating radiation and a new instrument designed to measure the fat to fat-free ratio of the soft tissue of the upper arm by differential absorptiometry were tested in 24 volunteers for short and long-term precision. Reproducibility of the adiposity measurements was generally good, and positive correlations were obtained with other variables such as weight and skinfold. Regional adiposity measurement by absorptiometry shows promise for clinical application.

The Pulmonary Component Of The Second Sound In Right Ventricular Failure, Paul D. Stein, Hani N. Sabbah, Daniel T. Anbe, Mario Marzilli

Henry Ford Hospital Medical Journal

Sound within the pulmonary artery was measured in 24 patients to determine if right ventricular failure modifies the amplitude of the pulmonary component of the second sound (P2). The amplitude of P2 in eight patients with right ventricular failure secondary to pulmonary hypertension (2610 ± 370 dynes/cm2) did not differ from P2 in eight patients with pulmonary hypertension not accompanied by right ventricular failure (3120 ± 710 dynes/cm2). In both groups, the amplitude of P2 exceeded control subjects (520 ± 70 dynes/cm2) (P < .001 and P < .01, respectively). The maximal rate of development of the pressure gradient across the closed pulmonary valve was higher in patients with right ventricular failure (580 ± 100 mm Hg/sec) than in control subjects (150 ± 30 mm Hg/sec) (P < .001) and maximal negative dp/dt was also higher in patients with failure (750 ± 70 mm Hg/sec vs 190 ± 20 mm Hg/sec) (P < .001). The maximal rate of change of the diastolic pressure gradient correlated linearly with maximal negative dp/dt (r=.89). These observations indicate that P2 is accentuated in patients with right ventricular failure secondary to pulmonary hypertension. The accentuation results from the augmented rate of development of the diastolic pressure gradient, which reflects an augmented right ventricular negative dp/dt. Therefore, an accentuated P2 remains valid as a clinical sign of pulmonary hypertension whether or not right ventricular failure occurs.

Persistent Obstructive Jaundice Associated With Chronic Pancreatitis, C. Grodsinsky, M. A. Block

Henry Ford Hospital Medical Journal

Persistent obstructive jaundice due to stenosis of the distal common bile duct by chronic pancreatitis has been documented in 13 patients of 253 for whom the diagnosis of chronic pancreatitis has been established. All 13 cases required operation; obstructive jaundice was present at surgery in nine; four had recurring jaundice for prolonged periods. None had associated biliary lithiasis. All cases showed evidence of excess alcohol intake. The jaundice, often associated with mild to moderate pain, was disabling and life-endangering and was relieved by operation. In these patients carcinoma must always be ruled out by diagnostic studies, operation, and the elapse …

Intrahepatic-Cutaneous Biliary Fistulas Secondary To Trauma, Farouq Samhouri, James C. Gruenberg, Robert S. Brown

Henry Ford Hospital Medical Journal

Biliary fistula is an unusual complication after operations for hepatic trauma, but only scant information is available concerning its management. This report describes biliary fistulas and presents two cases of their successful resolution, by external drainage in one case and internal drainage in the other. These cases illustrate aspects of fistula management and prevention described in the literature and suggest individualized approaches.

Herpes Zoster Encephalitis: Successful Therapy With Vidarabine, Steve J. Wees, Tom Madhavan

Henry Ford Hospital Medical Journal

A 77-year-old woman was seen who had encephalitis complicating trigeminal herpes zoster. Diagnosis was made by clinical and cerebrospinal fluid findings and electroencephalogram. As a result of parenteral vidarabine therapy, the patient recovered.

Ards And Cerebral Infarction Complicating Mycoplasma Pneumonia In Sickle Cell Trait, Mark I. Pensler, Jan R. Radke

Henry Ford Hospital Medical Journal

A patient with Down's syndrome and sickle cell trait developed the adult respiratory distress syndrome and cerebral infarction during infection with Mycoplasma pneumoniae. The slow recovery of pulmonary function was unrelated to antimicrobial therapy. Sickle cell trait may be a risk factor for severe M. pneumoniae infection. The possible underlying mechanism for this relationship is explored, and the relationship between sickle cell trait, cold agglutinins, and the cerebral infarction is discussed.

Front Matter

Henry Ford Hospital Medical Journal

No abstract provided.

1980 Beaumont Lecture: Restriction Enzymes As Tools For Genetic Research, Hamilton O. Smith

Henry Ford Hospital Medical Journal

No abstract provided.

Systematic Treatment Of Chronic Pain With Antidepressants, Dietrich Blumer, Mary Heilbronn, Edgard Pedraza, Gerald Pope

Henry Ford Hospital Medical Journal

Patients with chronic pain who do not have significant physical symptoms present a characteristic clinical-psychological profile and show a high incidence of depressive traits (inactivity, depressive mood, anhedonia, and insomnia). This syndrome is termed pain-prone disorder and represents a form of masked depression par excellence. A series of 129 patients with pain of 6.9 years' duration was divided into three treatment groups. Two psychiatrists prescribed antidepressants systematically by promptly increasing doses and by alternating antidepressants if indicated. Significant improvement or freedom from pain was achieved in most patients who complied with treatment.

The third psychiatrist did not follow the systematic …