Southern medical journal
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Southern medical journal · Oct 1987
Comparative StudyComparison of hypertension prevalence and control in 5,237 rural and urban Alabama residents.
Selected urban and rural Alabama populations were compared by age, sex, and race on the prevalence of hypertension and uncontrolled hypertension and the percentage of treated hypertensives with controlled blood pressure. We found the following results: (1) Rural women had a significantly higher prevalence of hypertension than urban women. (2) The prevalence of uncontrolled hypertension was significantly higher for urban white men than for their rural counterparts. (3) The prevalence of uncontrolled hypertension was significantly higher for rural black women aged 30 to 39 than for the same age group of urban black women. (4) Rural dwellers generally had much better blood pressure control than urban, though this was not manifested evenly across groups. Statistically significant differences were found for white men and women of all ages combined and in three of four age groups. Reasons for the rural-urban differences are unclear, but the rural area surveyed was served by nurse practitioner clinics that strongly emphasized patient education.
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Retroperitoneal injury caused by penetrating trauma or associated with progressive shock following blunt trauma is usually recognized promptly and managed appropriately. Isolated retroperitoneal injury from blunt trauma, unless accompanied by major hemorrhage or gross hematuria, is often difficult to diagnose and needed treatment may be delayed. Although clinical examination remains the cornerstone of diagnosis, the high incidence of ethanol abuse and/or concurrent head injury in trauma patients has led to increased use of computed tomography in the diagnosis of abdominal trauma. ⋯ There were 90 pelvic fractures and 31 lumbar spine fractures, as well as 21 genitourinary, 12 gastrointestinal, five pancreatic, and eight major vascular injuries. Ten patients had isolated retroperitoneal hematomas. We conclude that (1) patients with retroperitoneal injuries and coexisting intraperitoneal injuries should have early operation; (2) isolated retroperitoneal trauma tends to lead to observation unless CT is used as part of the early assessment; and (3) routine use of CT in patients at risk accurately defines the extent of injury and enhances clinical management.
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Southern medical journal · Sep 1987
Biography Historical ArticleHenry Hill Hickman (1800-1830): country doctor and discoverer of inhalation anesthesia.
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The large numbers of medical graduates seeking residency training in anesthesiology have created a logistical problem for many programs. This difficulty and the recurrent phenomenon of the misplaced physician have prompted a search for better selection criteria and more efficient evaluation systems. The literature does not provide a concise description of the ideal resident candidate, but it does contain several approaches taken by a few individual teaching centers to improve applicant review procedures. ⋯ Based on faculty criteria, the entire process uses data management technology that provides automatic calculation of selection parameters, sorting on any data field or combination thereof, and maintenance of a concise information profile for each candidate. CARCS allows equitable consideration of all who apply, with significant cost savings to both program and applicants. This paper reviews traditional methods of selecting anesthesiology residents, describes the CARCS system, and previews the future of resident candidate selection.
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Southern medical journal · Jul 1987
Case ReportsAcute myocardial infarction associated with initial cocaine use.
We have described a young man who had acute myocardial infarction after his first use of cocaine. This case demonstrates that potentially lethal myocardial infarctions may be associated with such initial "experimentation" with cocaine even in relatively small doses. Cocaine intoxication should be considered in young patients with acute myocardial ischemia or necrosis. We recommend that cocaine metabolites be checked in the urine if a drug history is unreliable in such patients.