Hawaii Medical Journal Articles For 1992

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Now showing 1 - 10 of 37
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    The right to die as an ethical dilemma for new physicians in Hawaii.
    ( 1992-02) McDermott, J F Jr ; Waldron, J A ; Ponce, D E
    In the Cruzan case, the U.S. Supreme Court acknowledged the patient's right to refuse treatment but limited the decision-making involvement of the family when the patient's wishes are unknown. A study of 118 graduating physicians at the John A. Burns School of Medicine revealed their most significant clinical experience involving an ethical dilemma during their 3rd and 4th years was their involvement with families in the decision to discontinue treatment for terminal patients. These findings underscore the need for a focus on this issue in the curriculum.
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    Radio-frequency catheter cure of re-entrant supraventricular tachycardias: report of the first experience in Hawaii.
    ( 1992-02) Shen, E N
    Other than atrial fibrillation-flutter, the majority of supraventricular tachyarrhythmias involve either a macro-re-entry circuit utilizing an atrioventricular (AV) accessory pathway or a micro-re-entry circuit inside or around the AV node. The traditional form of therapy has been medical, with suppression by antiarrhythmic agents, most of which carry a heavy side-effect profile. The established alternative for medical therapy has been surgery, with open-chest excisional ablation of the accessory pathway or cryo-modification of the AV node. Even though, as opposed to medical therapy, surgery promises cure, it requires thoracotomy and cardiopulmonary bypass with significant associated morbidity and even mortality, as well as high cost. Ten years ago, the technique of "fulguration" was first introduced, which involved the delivery of an electrical charge through specialized catheters. Our first experience with this technique was reported in this Journal. Unfortunately, despite being a much better tolerated curative procedure involving a very brief hospitalization, the use of high-energy direct current (DC) shocks is associated with a low but significant incidence of serious complications including cardiac perforation, hypotension, coronary artery spasm, and late occurrence of ventricular fibrillation. Concerns about these potential complications have markedly limited the application of the catheter technique. In the past 2 years, adoption of radio-frequency (RF) current as the energy source has allowed the ablation to be performed in a very efficacious and much safer fashion. We would like to report the first experience with this technique in Hawaii.
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    Prescriptive privilege by permit.
    ( 1992-02) Reppun, J I
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    The patient's right to die.
    ( 1992-02) Reppun, J I
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    Heterotopic bone formation in abdominal incisions.
    ( 1992-03) Charles, J ; Hunt, J A
    Heterotopic bone formation in vertical abdominal wounds is a not infrequent and sometimes disabling complication of abdominal surgery, occurring predominantly in males. Excision of the bone is indicated only for marked discomfort or pain, usually produced by an active lifestyle. Under these circumstances, recurrence of bone following excision, would be highly undesirable and the prophylactic use of etidronate disodium may well be indicated to prevent new bone formation, as demonstrated by one of our cases (Case 8).
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    Medical care in Hawaii.
    ( 1992-03) Houk, J H