Southern medical journal
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Southern medical journal · Jul 1985
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of ranitidine as an oral antacid in outpatient anesthesia.
We studied the effects of preanesthetic ranitidine on gastric contents in 60 outpatients scheduled for elective surgery, with random allocation into three groups of 20 patients each. Patients in group 1 did not receive ranitidine and served as controls. Patients in groups 2 and 3 received ranitidine orally, 150 and 300 mg, respectively, one to five hours before induction of anesthesia. ⋯ Mean gastric volume and proportion of patients with volume greater than or equal to 20 ml were significantly reduced in both treatment groups. Proportions of patients with combination of pH less than or equal to 2.5 and volume greater than or equal to 20 ml were significantly low in both treatment groups, as there was only one patient in group 2 and none in group 3 with both low pH and high volume. With respect to reduction of gastric acidity and volume, 300 mg of ranitidine had no advantage over 150 mg.
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Southern medical journal · Jun 1985
Vital statistics data as a measurement of perinatal regionalization in Alabama, 1970 and 1980.
Although regionalization of perinatal health care services has received credit for much of the recent improvement in neonatal mortality, until now no measurement of regionalization has been proposed. The measurement presented in this paper--the average of the percentage of infants of very low birthweight and neonatal deaths occurring among residents of a geographic area at a perinatal center--provides a means of comparing the extent of perinatal regionalization in various geographic areas and time periods. Despite continued disparities in the degree of regionalization from one perinatal district to another, Alabama's perinatal system became substantially regionalized from 1970 to 1980. The lower mortality for infants of very low birthweight born at a perinatal center suggests that if Alabama were more completely regionalized, its neonatal mortality would be improved.
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Eight patients had air-fluid levels in the lung as a result of fluid accumulation in preexisting bullae. In four cases the cause was peribullous pneumonitis; in the other four cases the cause could not be determined. ⋯ The initial interpretation of air-fluid levels was correct in only two instances. Differentiation of fluid-containing bullae from other causes of air-fluid levels is important so that unnecessary diagnostic and therapeutic maneuvers can be avoided.
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Southern medical journal · Apr 1985
Case ReportsPatient-physician communication and interaction: a unifying approach to the difficult patient.
Many difficult patients encountered by the primary care physician may be understood in terms of severe unmet dependency needs. These patients often evoke negative feelings on the part of physicians. A mutual participation approach to the patient-physician relationship is a means of providing effective care for these patients, at the same time preventing frustration and burnout in the physician by preserving his energies.
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Southern medical journal · Apr 1985
Intracranial complications of ear disease in a pediatric population with special emphasis on subdural effusion and empyema.
Between the years 1963 to 1982, 84 consecutive cases of intracranial complications of ear disease in pediatric patients were diagnosed and treated at the North Carolina Baptist Hospital. This group consisted of 65 patients with otitic meningitis, four with otitic brain abscess, four with otitic hydrocephalus, three with lateral sinus thrombosis, three with otitic subdural empyemas, and five with an otitic subdural effusion of fluid. The advent of antibiotics has drastically altered the natural history of middle ear infections. We present these 84 cases to review diagnostic problems and therapeutic options, and to offer a plea for continued awareness of the middle ear as a potential source of central nervous system complications.