Band 93, Heft 1

The following annotated bibliography has been developed for the purpose of providing to primary care physicians a handy source of review articles and major studies in the the field of nephrology, hypertension, and fluid and electrolyte disorders. Almost all of the articles are review articles of clinical topics that would be of interest to the practicing physician. JAOA will be publishing additional annotated bibliographies in various fields of internal medicine over the next several months. The second in this series will appear in a forthcoming issue of THE JOURNAL.

The authors retrospectively reviewed 15 cases of pelvic soft tissue sarcoma treated at the Children's Hospital of Philadelphia during a recent 6-year period. These patients were treated before the availability of magnetic resonance imaging. The authors compared ultrasonography, computed tomography, and excretory urography/voiding cystourethrography for establishing the diagnosis and following the progression/regression of the disease. Results were correlated with clinical, surgical, and pathologic findings. Although computed tomography and ultrasonography were both capable of characterizing the size and texture of the lesion, computed tomography was superior in defining disease arising from the pelvic sidewall. Both techniques effectively identified residual mass at the tumor site, but neither could differentiate active tumor from inactive tumor, posttherapy inflammation, or fibrosis. Excretory urography/voiding cystourethrography provided no information that could not be gleaned from either ultrasonography or computed tomography.

A new gram-negative bacterium, Helicobacter pylori, has been found in gastric secretions. In view of an almost 9% incidence of unidentified gram-negative bacteria in aspiration pneumonia, the authors set out to prove thatH pylori could be found in tracheal secretions. Eighteen sequential patients admitted to the intensive care unit who had endotracheal or nasogastric intubation for 24 hours or longer were studied. Of 20 sets of specimens from 18 patients, Helicobacter was recovered from 2 (10%) of the endotracheal specimens. The authors conclude that H pylori can gain access to the endobronchial tree and therefore may contribute to the origin of pneumonia due to unidentified gram-negative bacteria.

Current treatment for carpal tunnel syndrome may be ineffective or associated with complications or recurrence. In the case reported here, a myofascial release by the physician combined with the patient's self-stretch reduced pain and numbness and improved electromyographic results. The manipulative approach releases the transverse carpal ligament, and "opens"or dilates the canal. The patient stretches the wrist, digits, and thumb, including myofascial components. An aggressive, conservative approach lessens the need for surgery in mild to moderate cases. Studies with magnetic resonance imaging may be helpful to document canal size before and after treatment.

The rapid, accurate determination of the electrical axis of a patient's heart is very useful for diagnosis. This determination can be made readily by using six electrocardiographic leads. The procedure for interpreting the data from these leads and determining the electrical axis of. the heart is charted. This method uses key leads I and a VF to determine the quadrant where the axis is located and secondary leads II, III, a VR, and a VL to find the axial position within the quadrant. When either I or a VF is isoelectric, only one key lead is used.

The incidence of the autoimmunodeficiency syndrome (AIDS) is rising at an alarming rate. Usually, the first clue to human immunodeficiency virus (HIV) disease is an infection of the skin. The author describes a number of fungal, viral, and bacterial infections seen in myinfected patients and names the most effective therapies. Because my is immunosuppressive, the cutaneous conditions seen will be more difficult to treat than in nonimmunosuppressed patients, recurrence is more common, and permanent prophylactic therapy may be necessary. Part 2, to be published next month, will discuss noninfectious inflammatory diseases of the skin, malignant cutaneous neoplasms, and nonclassified skin changes found in my -infected individuals. These skin infections are manageable if patients are seen as early as possible, a diagnosis is confirmed promptly, and aggressive therapy is initiated.

We issue a call for an "osteopathic medical renaissance" in teaching osteopathic principles and osteopathic manipulative techniques. This article describes a seminar series in the postdoctoral training program at the College of Osteopathic Medicine of the Pacific. We ask osteopathic physicians to enhance their manual dexterity skills to better serve as role models for physicians-in-training. We challenge osteopathic physicians to stimulate a renewed emphasis in teaching distinctive osteopathic medical care.

Peduncular hallucinosis is characterized by vivid hallucinations associated with organic midbrain disease. In the case reported here, the computed tomography brain scan showed basilar arterial atherosclerotic disease with central and cortical atrophy. Carotid imaging revealed bilateral stenosis. The electroencephalogram and magnetic resonance imaging of the midbrain revealed no abnormalities. The patient's symptoms resolved completely in 48 hours. This is believed to be the first report of peduncular hallucinosis as the manifestation of a transient ischemic attack syndrome.