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Biomedical subjects

D M Switz

Publications and source records attributed to D M Switz.

17 recordsLinked to original sources
PubMed1986

American Gastroenterological Association: results of a membership poll.

The Patient Care Committee of the American Gastroenterological Association determined that no data existed on the views or demographics of our rapidly growing membership. A 48-item questionnaire was developed and administered during 1982-1983. A random sample (232 of 2751 active members) was queried; 85% (196) replied and all returns were correctly completed. Respondents rate the American Gastroenterological Association as "somewhat responsive" to practitioners' needs but closer to "extremely responsive" to the needs of academic physicians. Full-time medical school faculty average 33% of their time in direct (digestive disease related) patient care, with 15% spent on endoscopy; non-faculty members spend 56% of their time on such care and 22% on endoscopy. Only 2% of the 22% of members who do some "bench research" are less than 35 yr old compared with 7% of the general membership. Most (97.9%) members have attended a Digestive Disease Week in the last 5 yr; they averaged 3.9 meetings and 2.5 courses. Members rank both Digestive Disease Week and GASTROENTEROLOGY a little toward the "research side" of a perfect balance.

Gastroenterology↗
PubMed1979

Clinical features and natural history of Crohn's disease.

Records of 1084 patients entered into the National Cooperative Crohn's Disease Study were analyzed to gather information concerning the natural history and clinical features of Crohn's disease. The age of onset reached a single peak between the second and fourth decade and was evenly distributed in both sexes. There was an average interval of 35 mo from onset of symptoms to diagnosis. Involvement of both colon and terminal ileum was the most frequent pattern and was present in 55% of patients. The disease was confined to the terminal ileum, other areas of the small intestine, or colon-only in 14%, 3%, and 15% of patients, respectively. Sigmoidoscopic abnormalities were seen in 34% of all patients and 51% of patients with Crohn's colitis. Diarrhea, abdominal pain, weight loss, and fever were present in the majority of the patients. Lower GI bleeding, fever, and perianal complications characterized patients with colon-only involvement. The frequency of extra intestinal manifestations was similar in all groups. Among patients who were randomized to placebo, 32% achieved a spontaneous remission by the end of 17 wk, and 53% of these were still in remission at the end of 24 mo. Clinical remission was associated with an improvement in barium x-rays in 18% of the patients. The predicted factors associated with favorable outcome in placebo-treated patients were: previous surgical removal of all observable disease, absence of perianal disease, and Crohn's Disease Activity Index value under 200.

Adult↗
PubMed1979

National Cooperative Crohn's Disease Study: results of drug treatment.

The response of active and quiescent Crohn's disease to prednisone, sulfasalazine, or azathioprine has been studied in 569 patients in a placebo-controlled, randomized, multicenter cooperative trial. The response of active symptomatic disease to prednisone or sulfasalazine was significantly better than to placebo. Response to azathioprine was better than to placebo, but the difference did not reach conventional levels of statistical significance. Patients with colonic involvement were especially responsive to sulfasalazine, and those with small bowel involvement were especially responsive to prednisone. Patients' drug therapy immediately before entry to the study significantly affected subsequent response. For patients with quiescent disease, none of the drugs was superior to placebo in prophylaxis against flare-up or recurrence. There is less than a 5% risk that a clinically significant prophylactic effect of any of the drug regimens was missed.

Adult↗
PubMed1976

Inadequate parathyroid response in acute pancreatitis.

We studied nine consecutive hypocalcemic patients with acute pancreatitis to elucidate the mechanism of hypocalcemia. Mean serum ionized calcium, 0.97 mM, was below the normal mean of 1.16 mM (P less than 0.001). Seven of eight patients tested had normal parathyroid hormone levels. All responded to parenteral parathyroid extract by increasing serum ionized calcium and urinary cyclic AMP, indicating parathyroid-hormone-responsive target organs. Calcitonin and glucagon concentrations were increased above normal in some patients, but there was no relation with serum ionized calcium. Parenteral glucagon had no significant effect on serum ionized calcium or calcitonin concentrations. These findings suggest that neither glucagon nor calcitonin was primarily responsible for the hypocalcemia, which did not produce expected increases in serum parathyroid hormone concentrations. Relative parathyroid insufficiency may account for the persistent hypocalcemia frequently observed in patients with acute pancreatitis.

Acute Disease↗
PubMed1976

Electrical malfunction at endoscopy. Possible cause of arrhythmia and death.

Gastroscopy-associated electrical shock occurred in two cases, with one death. An ACMI Wappler transformer-powered Hirschowitz flexible fiber-gastroscope was used. Ideally, endoscopes should not contain electrically conductive material or metals that might corrode. Electrical systems used at endoscopy should conform to the existing standards for "electrically sensitive patient" localtions, and should be subject to the routine maintenance procedure prescribed for equipment in such locations by the National Fire Protection Agency.

Aged↗
PubMed1976

The problem-oriented medical record: evaluation and management of anemia before and during use.

The problem-oriented medical record (POMR) is designed to rationalize and improve the structure of the medical record. This change might be expected to enhance the outcome of patient care. Therefore, I assessed the effect of the POMR on the care of the problem--anemia--in a Veterans Administration teaching hospital. The POMR concept was introduced by lectures and supported by chart audit. Four months later, the care described in 29 sequential records containing the discharge diagnosis--anemia--was compared with 31 records produced at the same period in the previous year by house officers not using the POMR. Records were graded for maintenance of the POMR format. Completeness of the "data base," as well as time to problem identification, therapy, and diagnostic description were compared. Introduction of the POMR had no observable beneficial effect on the thoroughness of data base accumulation or the process of patient care for the problem (anemia) or, in another study, on the ease or accuracy of chart audit.

Anemia↗
PubMed1976

What the gastroenterologist does all day. A survey of a state society's practice.

Members of a state society of gastroenterologist collected information about their pattern of practice. Twenty-two of the 41 members voluntarily kept a list of 25 sequential new patients seen during the spring of 1973. Five hundred and fory-nine diagnoses were accumulated; 369 (67%) of these diagnoses were gastroenterological. The five most common gastroenterological diagnoses were: functional disorder, duodenal ulcer, hiatus hernia, biliary tract disease, and esophagitis. The five most common over-all diagnostic areas were: functional disorder, cardiovascular disease, "other" nongastroenterological diagnoses (including obesity), duodenal ulcer, and endocrine malfunction. Geographically dispersed gastroenterologists in Virginia make more than one-half of their primary diagnoses in the area of their subspecialty interest. The primary gastroenterological problems seen are "upper gut" lesions and biliary tract disease. These observations may be of value in planning education, training, or research activities, especially if verified by a broader sample of gastroenterological practitioners.

Gastroenterology↗
PubMed1976

Bullets, joints, And lead intoxication. A remarkable and instructive case.

A retired teamster with abdominal pain and anemia was found to have lead intoxication presumably due to and old bullet in his ankle. Most lead particles within the body need not be removed. Lead solubility characteristics exemplified by this case cuase us to recommend that bullets and lead particles facing synovial spaces should be removed.

Ankle Injuries↗