Southern medical journal
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Southern medical journal · Jun 1988
Review Case Reports Comparative StudyTrachea-innominate artery fistula: retrospective comparison of treatment methods.
A fistula between the trachea and the innominate artery, a potentially fatal complication of tracheostomy, can be managed successfully. We have derived several guidelines from our experience with one such case and from a review of the 36 cases reported in the literature over the last decade. Diagnosis must be established before exsanguination occurs. ⋯ Interruption of the innominate artery is the definitive treatment, with a low rebleeding rate (7%, 1/14 cases) and good long-term survival (64%, 9/14 cases). Maintenance of continuity of the innominate artery is contraindicated, because of a high rebleeding rate (60%, 6/10 cases) and poor long-term survival (10%, 1/10 cases). There is no convincing evidence that interruption of the innominate artery causes significant neurologic or vascular compromise.
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Southern medical journal · May 1988
Case ReportsKorsakoff's psychosis due to massive beer intake provoked by diabetes insipidus.
Posttraumatic diabetes insipidus, acute pancreatitis, and Wernicke's encephalopathy and Korsakoff's psychosis in a 33-year-old white male alcohol abuser resulted in near-fatal cardiovascular collapse. The Wernicke's encephalopathy and Korsakoff's psychosis resulted from drinking massive quantities of beer to satisfy the thirst induced by diabetes insipidus. Although the diabetes insipidus was controlled with vasopressin, and the need for vasopressin resolved two months after diagnosis, the Wernicke-Korsakoff syndrome had not resolved by six months.
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Lactic acidosis, a rare and usually fatal complication of malignancy, is defined as a clinical condition in which the pH is less than or equal to 7.35 and the serum lactate level greater than or equal to 5 mEq/L. We have described the clinical aspects of four cases of lactic acidosis associated with malignancy, and have reviewed all reported cases of lactic acidosis in malignancy meeting the criteria. Rapid recognition of the condition and prompt institution of chemotherapy led to reversal of lactic acidosis in three of our four patients, but long-term survival is related to the responsiveness of the underlying tumor.
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Southern medical journal · Apr 1988
Brooks fusion for atlantoaxial instability in rheumatoid arthritis.
Atlantoaxial instability in rheumatoid arthritis has been recognized in the natural history of rheumatoid arthritis, but successful surgical stabilization has proven to be elusive. We review our experience using the Brooks technique of wedge compression arthrodesis combined with halo immobilization in five women with rheumatoid arthritis with symptomatic C1-2 subluxation. ⋯ Follow-up ranges from 18 to 56 months. One major complication occurred in a patient who had significant postoperative quadriparesis in spite of normal intraoperative sensory evoked potentials; it has since slowly resolved.
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Southern medical journal · Apr 1988
Initial resuscitation and assessment of patients with multisystem blunt trauma.
In the vast majority of blunt trauma victims, shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clear-cut, the rapid identification and control of the bleeding source may not be. Such patients often have injuries to several body systems and thus have numerous possible sources of hemorrhage. ⋯ In concert with respiratory management, other members of the trauma team should secure adequate vascular access, resuscitate the patient, and perform a physical examination. Physical findings dictate the order of further diagnostic and therapeutic maneuvers. Patients in unstable condition may need emergency surgery.