Hawaii Medical Journal Articles For 1993

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Health care in the United States: the need for a new paradigm.
(1993-01) Gilbert, F I Jr
Breast-feeding versus formula: cost comparison.
(1993-01) Jarosz, L A
Peterkin and Walker published in 1976 a cost estimate of feeding a baby in the U.S. At that time, they found there was little difference in cost between breast-feeding and formula feeding. Since then, however, the cost of formula has risen drastically--more than 150% during the 1980s. One researcher estimated that food and feeding equipment cost $855 in the first year. Whereas the cost of formula is quite apparent when a family buys it, the cost of breast-feeding is hidden.
Health care and more health care.
(1993-01) Reppun, J I
"Buy right".
(1993-01) Reppun, J I
Cross-cultural dream use in Hawaii.
(1993-02) Pagel, J F; Vann, B H
Cultural variations in the narrative content of dreams have been reported in many studies. This basic cultural difference in dream language and representations has been used to support psychoanalytic theories of dreaming, especially that of the Jungian-based schools. Others have postulated that such variations reflect the cultural differences that each individual experiences during waking life. This "continuity" hypothesis proposes that a high correlation exists between an individual's waking life and his or her dream content. The biologic framework of dreams, sleep/dream-state physiology, is cross-culturally consistent, and the incidence of dream related pathology also is remarkedly similar between differing cultures.
Vaginal birth after cesarean section in Hawaii. Experience at Kapiolani Medical Center for Women and Children.
(1993-02) Brody, C Z; Kosasa, T S; Nakayama, R T; Hale, R W
Medical records at Kapiolani Medical Center for Women and Children were reviewed for cases that had a trial of labor subsequent to prior cesarean section during the period January 1990 to July 1991. All cases were > or = delivered 36 weeks' gestation. During the 19-month period, 356/483 or 73.5% cases with a trial of labor had successful vaginal births after previous cesarean sections (VBAC). The majority of the others that did not were due to failure of progression in labor. The incidence of scar separation was 5/483 (1.04%). There were 5/483 neonates with Apgar scores of < or = 6 at 5 minutes, giving a perinatal morbidity rate of 1.04%. There were no maternal deaths. Oxytocin induction resulted in successful VBAC in 30/47 (63.8%) cases. This study concludes that a trial of labor for vaginal birth after cesarean section is well established at our institution. In addition, the rates of successful VBAC, its complications and outcomes, are comparable to national averages.
Quality improvement: how does it differ from quality assurance?
(1993-02) Hawk, A B; Miyamura, J B
Quality improvement? How does it differ from Quality assurance? The "Total Quality Management" movement which has been so successful in improving the quality of manufactured products in Japan and more recently in the United States has arrived in American service industries, including health care. Although a minority of health care institutions has adopted the Continuous Quality Improvement (CQI) or Total Quality Management (TQM) philosophy and techniques on their own, the new Joint Commission on Accreditation of Health Care Organizations (JCAHO) standards to be phased in over the next 3 years require all accredited hospitals to "adopt the new philosophy".
Pulmonary balloon dilation for valvular and arterial stenosis.
(1993-02) Ho, E C
The use of balloon catheters to dilate obstructed vascular lesions represents one of the major advances in cardiology and dates back to 1964 when Dotter and Judkins reported their experience in dilating arteriosclerotic obstructive lesions. Since that time, the technique of balloon dilation has been used extensively for coronary and peripheral vascular lesions but also has been applied to such diverse cardiac lesions as pulmonic stenosis, mitral stenosis, aortic stenosis, aortic coarctation, superior vena caval and pulmonary venous obstructions. Balloon dilation has been used for both valvular and arterial pulmonary stenosis. The purpose of this study is to report on our initial experience in Hawaii with balloon dilation of valvular pulmonic stenosis and also with dilation of peripheral pulmonary artery stenosis due to congenital causes and as a residual postoperative lesion.
Do we need second generation lithotripters in Hawaii?
(1993-03) Crocco, N B; Stenson, R V
The Kidney Stone Center of the Pacific (KSCoP) currently provides statewide services for kidney lithotripsy. The non-invasive technique uses shock waves to disintegrate kidney stones. Extracorporeal shock wave lithotripsy (ESWL) can be used successfully in 85% to 90% of kidney stone patients when surgery is indicated.
A rare case of cholera in Hawaii.
(1993-03) Yamada, G M
Cholera is the most fatal of the infectious diarrheas but only rarely encountered in Hawaii. Two cases previously have been documented in the Islands. We describe an elderly patient, without obvious risk factors, who contracted cholera. Early consideration of cholera as a diagnostic possibility is recommended in patients with unexplained, profuse diarrhea. The unique features of this case are discussed in this report.
Strongyloides infection in Hawaii: an imported case.
(1993-03) Yoshimoto, C M
Tropical diseases may present anywhere in the world. A case of strongyloidiasis in Hawaii, identified by a characteristic manifestation, larva currens, is described. Strongyloides infection may persist long after leaving an endemic area through the mechanism of autoinfection and, especially under circumstances of immunosuppression, may become overwhelming (the hyperinfection syndrome), with a likelihood of being fatal. Each case of Strongyloides infection should be treated aggressively in order to prevent this dangerous outcome; in addition, the parasite should be eliminated before immunosuppressive therapy is begun.
Tamoxifen: a caveat on the pro side of the debate.
(1993-04) Pressler, V M
Tamoxifen: a caveat on the con side of the debate.
(1993-04) Moser, S M
Extraction of lipomas: a simple technique.
(1993-04) Reinking, G F; Parsa, F D
Benign lipomas are among the most common subcutaneous fatty tumors. They are often solitary, more common in women and occur frequently during the fourth and fifth decades. They usually involve the posterior neck, back and thighs, and the great majority are less than 2 cm in diameter. Malignant transformation is extremely rare, and they usually do not require treatment. However if removal is desired, surgical excision is curative. In this article we present a simple method of resecting large lipomas measuring 4 cm to 10 cm in diameter.
Learning to save our skin.
(1993-05) Berry, P
With serious depletion occurring in the stratospheric ozone layer, we face a public health problem that poses an educational challenge as well. How do we teach our children about the hazard and how to respond to it? Although we have the science to demonstrate the problem, changing young people's behavior on a large scale is at best a slow and uncertain process, especially when the behavior involves something most of them perceive as a familiar pleasure and a reward: The Hawaii sun.
The Kauai Skin Cancer Study--1983 to 1992.
(1993-05) Reizner, G T
The Kauai Skin Cancer Study began as a modest effort in 1983 to look at this island's skin cancer incidence. David Elpern MD, Kauai's only dermatologist at the time, was interested in the large number of these tumors in his practice. He first enlisted his office staff to help keep track of the numbers and type of these skin cancers. Along with this information, the basic demographic data on each patient was collected. These records became the first entries into what has become a decade-long project.
Mohs micrographic surgery: a synopsis.
(1993-05) Stone, J L
Mohs micrographic surgery is a method for removal of non-melanoma skin cancer in thin layers, allowing frozen-section examination of all peripheral and deep margins. Subsequent tissue layers are removed as dictated by microscopic examination, allowing for maximal sparing of normal tissue. This method offers cure rates significantly higher than excision or other modalities. Mohs micrographic surgery is the method of choice for removal of large, recurrent or incompletely excised skin cancers or for tumors located in regions of high recurrence.
Surgical treatment of melanoma.
(1993-05) Hundahl, S
"Malignant melanoma writes its message in the skin with its own ink ... some see, but do not comprehend." Effective treatment of melanoma begins with early recognition. Paranoid suspicion of any irregular, pigmented, nodular or ulcerated dermal lesion, when coupled with excisional biopsy, merits approbation even though many such lesions prove benign.
Skin cancers in Hawaii (1993).
(1993-05) Goldstein, N
Basal cell cancers are the most common of all cancers. They rarely metastasize and very rarely kill. Melanomas, however, do kill! An estimated 20 people in Hawaii will die this year from malignant melanoma. Early diagnosis and treatment can save much morbidity--surgery, scars and other defects--and can save lives. This manuscript reviews melanoma data from several agencies in Hawaii and from the experience of the author's private practice. In his private practice, he has seen the incidence of melanomas jump from an average of one a year in 1970 to 1975 to 7.4 each year between 1986 and 1990. While basal cell cancers and melanomas occur more in Caucasians, they are seen in all races. Everyone can get skin cancer and melanoma. Physicians must teach their patients to Practice Safe Sun--Hawaii.
The gender-related issues in malignant melanoma.
(1993-05) Rigel, D S
The problem of malignant melanoma is important in the United States, in the world as a whole, and particularly in Hawaii with its high levels of ultraviolet radiation. It is estimated that 32,000 Americans will develop melanoma and 6,800 will die of this tumor in 1993. Melanoma is now the seventh most frequent cancer in the United States. It is more common than ovarian, cervical, CNS cancer and leukemia. Both incidence and mortality from melanoma are rapidly increasing. The incidence of melanoma has consistently increased 6% a year and the death rate has increased 2% a year since 1950. At current rates, one in 400 will die of this tumor. Should this rate of increase continue, by the year 2000, it is estimated that one in 75 Americans will develop melanoma during a lifetime. The highest melanoma incidence in the U.S. is found in Hawaii. Melanoma is increasing faster than any other cancer in the United States and all over the world.

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