Hawaii Medical Journal Articles For 1992
Permanent URI for this collection
Browse
Recent Submissions
Item Hereditary anemias in Hawaii: an update.(1992-01) Hsia, Y EItem Comparison of health expenditures in U.S. and Hawaii economies.(1992-01) Stenson, R VItem Maintaining the supply and monitoring the quality of the blood bank.(1992-01) Henry, G WItem The right to die as an ethical dilemma for new physicians in Hawaii.(1992-02) McDermott, J F Jr; Waldron, J A; Ponce, D EIn 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.Item Radio-frequency catheter cure of re-entrant supraventricular tachycardias: report of the first experience in Hawaii.(1992-02) Shen, E NOther 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.Item Prescriptive privilege by permit.(1992-02) Reppun, J IItem The patient's right to die.(1992-02) Reppun, J IItem Heterotopic bone formation in abdominal incisions.(1992-03) Charles, J; Hunt, J AHeterotopic 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).Item Medical care in Hawaii.(1992-03) Houk, J HItem Ciguatera: a review.(1992-04) Gollop, J H; Pon, E WHawaii State Department of Health epidemiological records were reviewed for cases of ciguatera poisoning for the entire state, from January 1984 through December 1988. During the 5 year interval, the numbers of ciguatera poisoning incidents, number of cases, and date of onset were recorded, as well as age and sex of individuals involved. The place of catch of each fish was noted as well as whether or not the fish was obtained commercially. The parts of the fish consumed were also recorded. A total of 150 ciguatera incidents occurred during this period, involving 462 individuals for an average annual incidence rate of 8.7/100,000 population. The 3 most frequently implicated species of fish were the Carangoides species (jack or papio or ulua), Ctenochaetus strigosus (surgeon fish or kole), and Aphareus furcatus (fork-tailed snapper or waha nui); however, more than 50 species of fish had caused one or more outbreaks. The most frequently implicated areas of the toxic fish were the Kona coast as well as the South Point of the island of Hawaii, and the Napali coast of the island of Kauai. Of the 150 outbreaks, 32 (21%) were related to commercial fish. The rest were related to sportfishing.Item Providing health care to Hawaii's elderly.(1992-04) Hayashida, C T; Wong, WHawaii's rapidly aging population is a challenge for Hawaii's health care providers. What with the high cost of care, limited health care resources, and a rapidly increasing population of frail elderly patients living in the community, will our medical practices be able to adapt to the care of patients who require more time and who will have not only multiple medical illnesses but complicated psychosocial conditions as well? Will our health care facilities be prepared for the typically longer stay and more expensive older patient? Will the cost of care in Hawaii keep on rising? Who will pay? Will this challenge turn into a crisis?Item Ciguatera, once again.(1992-04) Reppun, J JItem Human hematopoietic growth factors.(1992-05) Matayoshi, A H; Nakamura, J MItem Massive pulmonary embolism presenting as disseminated intravascular coagulation.(1992-05) Hart, W T; Hallenborg, C PDisseminated intravascular coagulation (DIC) can be defined as evidence of activation of the coagulation mechanism resulting in proteolysis of fibrinogen by thrombin and plasmin and an acute thrombocytopenia. The association of pulmonary embolism (PE) with DIC has recently been reported but in reviewing recent textbooks of hematology, there is no mention of PE as a cause of DIC. Clinicians need to be made aware of this association since it affects the patient who is thought to be autoanticoagulated as well as the patient who has DIC of unknown cause. PE needs to be included in the differential diagnosis of an autoanticoagulated state and in DIC of unknown etiology. In both instances the recommended treatment is full-dose intravenous heparin therapy.Item Medicaid recipients and psychiatric treatment.(1992-06) Chun, W KItem Elimination of preventable blindness from diabetes by the year 2000.(1992-07) Plechaty, G; Smith, R E; Patz, A"Diabetes 2000" will parallel a major diabetic retinopathy public information campaign recently announced by the National Eye Institute. The NEI's National Eye Health Education Program (NEHEP), which targets both diabetic retinopathy and glaucoma, is fashioned along the lines of earlier federal initiatives against smoking and high blood pressure. By continuously updating our medical knowledge and skills related to this multisystem disorder, and by forging partnerships between physicians in the effective and efficient management of diabetic patients, we have a unique and important opportunity--we can reduce preventable blindness from diabetes by the year 2000.Item Rabid bat diagnosed in Hawaii.(1992-07) Sasaki, D M; Middleton, C R; Sawa, T R; Christensen, C C; Kobayashi, G YSince 1966, the Hawaii State Government has been conducting Fluorescent Rabies Antibody (FRA) testing on animal brains as part of a statewide rabies-surveillance program. On April 3, 1991, the Department of Health (DoH) laboratory diagnosed the first case of rabies detected in the State. A large brown bat, Eptesicus fuscus fuscus, captured in a transport container that had just been off-loaded from a ship at Honolulu harbor, was caught. It's brain was examined and showed typical fluorescent staining patterns for rabies virus. The USPHS Centers For Disease Control (CDC) rabies laboratory confirmed the diagnosis 2 days later. The successful interception of this rabid animal was the result of close cooperation between the private sector (Sea Land Service, Hawaiian Stevedores) and the Hawaii State Government Departments of Health and of Agriculture.Item Starting from the bottom up.(1992-07) Dillon, J BItem Tuberculosis: a personal commentary.(1992-08) Fryer, G CTuberculosis is another of those diseases from which our attention has been diverted in recent decades, and which may now come back to plague us. I refer to the timely warning in Dr Frankel's report and Dr Reppun's editorial comment in the Hawaii Medical Journal of December 1991.