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Index to Articles: 2002

Wisconsin Medical Journal

Index of articles from 2002

Author Affiliations: Wisconsin Medical Journal

Corresponding Author: Please address correspondence to the Wisconsin Medical Journal at 608.442.3800

Editorials

Taking stock as another year ends

Thomas C. Meyer, MD Medical Editor, WMJ

As we reach the close of each year, I like to take the time to look back on what the WMJ has done over the past 12 months. This year we’ve covered a wide variety of topics, as can be seen by paging through the Index of Articles for 2002 (p. 61). But as I looked at everything we’d covered, I realized that there were still some very interesting pieces that we had not yet published that were worthy of attention. And so we’ve devoted this final issue of 2002 to this fine group of articles.


Author Affiliations: Medical Editor of Wisconsin Medical Journal

Corresponding Author: Please address correpondence to the Wisconsin Medical Society at 608.442.3800

A Genetic Approach to the Problem of Chronic Wasting Disease in Wisconsin

Deanna Cross, PhD, and James K. Burmester, PhD

Chronic wasting disease (CWD) of deer is a current public health concern. Recently $42 million was allocated to the detection and study of chronic wasting disease for the screening and eradication of the disease in the deer herd. However, one factor largely missing from public debate is a discussion regarding genetic predispositions in deer and humans to prion diseases. By focusing on what is known about the genetic factors involved in CWD and other known prion diseases, new methods for the population risk assessment and elimination of the disease from deer, and the prevention of human transmission may be developed.



Author Affiliations: Dr. Cross, postdoctoral fellow, and Dr.Burmester, senior scientist, are with theMarshfield Medical ResearchFoundation, Marshfield, Wis.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Original Research

Medical Costs—What’s Driving Them Up?

John D. Riesch, MD

Medical costs are spiraling upward at a dizzying pace and most people can’t understand why. Yet, four primary areas are held responsible for this frightening escalation—the pharmaceutical industry, market-dominating health organizations, hospital overconstruction, and physician income. A brief discussion is warranted.

Author Affiliations: Doctor Riesch is a general surgeon with Medical Associates Health Centers in Menomonee Falls. He served as president of the Wisconsin Medical Society from 1998 to 1999.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

The Effectiveness of a Follow-Up Program at Improving HIV Testing in a Pediatric Emergency Department

Kathleen R. Beckmann, DO; Marlene D. Melzer-Lange, MD; Barbara Cuene, RN; Mary Dietz, RN; Peter L. Havens, MD, MS

Background: HIV infection is on the rise in the adolescent population, with the most common risk for infection being sexual exposure for youth aged 15-24 years. Therefore screening for HIV infection should be performed on adolescent patients presenting to the emergency department (ED) with signs or symptoms of sexually transmitted disease (STD). Lack of opportunity for follow-up of HIV test results may prevent ED physicians from obtaining this test. Objective: Our objective was to compare the rate of HIV testing in patients evaluated in the ED for STDs before and after the implementation of a follow-up program. Methods: We conducted a retrospective chart review of all patients 12-18 years of age seen in the ED between April 1, 1993 and March 31, 1997 with ICD-9 codes for STD. The follow-up program started April 1, 1995. Rates of HIV testing were compared between the two years before and after the institution of the follow-up program to determine whether the follow-up program had an impact on the rate of HIV testing. Results: We reviewed 862 records. Before the follow-up program was in place, 86 (18%) of the patients tested for STD in the ED were also tested for HIV and only 7 (8.1%) were called back with their results. After the follow-up program was in place, 100 (27%) of the patients tested for STD in the ED were also tested for HIV. Attempts were made to notify 57 (57%) of these patients of their HIV test results. Coincident with the implementation of the follow-up program, both the rate of HIV testing and patient notification of HIV results increased (p< 0.05). Conclusions: Coincident with the institution of an appropriate follow-up system, HIV testing in the ED increased and follow-up of these patients improved. However, further steps should be taken to improve the HIV testing in the pediatric ED.



Author Affiliations: Doctors Beckmann and Melzer-Lange are Attending Physicians, Pediatric Emergency Medicine, Children’s Hospital of Wisconsin and affiliated with Medical College of Wisconsin. Doctor Beckmann is Assistant Professor of Pediatrics; Dr. Melzer-Lange is As

Corresponding Author: Please contact the Wisconsin Medical Society at 608.442.3800

Risperidone Induced Galactorrhea: A Case Analysis

Jaishree Hariharan, MD; Jamil Mohsin, MD

We report on the occurrence of galactorrhea and amenorrhea associated with prolactin elevation after 6 months of treatment with risperidone. The symptoms dramatically resolved with discontinuation of the drug. We discuss the possible mechanisms and clinical sequelae of elevated prolactin levels.



Author Affiliations: Authors are from the Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wis. Doctor Hariharan is assistant professor of medicine; Dr. Mohsin was Internal Medicine Resident.


Corresponding Author: Please address the Wisconsin Medical Society at 608.442.3800

Proceedings from the 2002 Annual Meeting of the American College of Physicians-American Society of Internal Medicine, Wisconsin Chapter

Edited by Kesavan Kutty, MD, FACP, Chapter Governor

The Wisconsin Chapter of the American College of Physicians-American Society of Internal Medicine held its annual meeting in Madison, Wis, September 5-7. Internal Medicine residents from each of the five residency programs in the state (Gundersen Clinic, Marshfield Clinic, The Medical College of Wisconsin, University of Wisconsin Hospital and Clinics, and University of Wisconsin Milwaukee Clinical Campus [Aurora Sinai Medical Center]) presented via posters and vignettes their research and/or unusual clinical experiences. On behalf of the Chapter, it is my pleasure to provide below the text versions of their presentations, in an attempt to showcase the scholarly work of these physicians in training and to provide the WMJ reader an overview of the quality of care given by them in the fine residency programs in our state.


Author Affiliations: Annual Meeting of the American College of Physicians

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Chiari Type I Malformation: Overview of Diagnosis and Treatment

John Nash, BS; Joseph S. Cheng, MD; Glenn A. Meyer, MD; Bernd F. Remler, MD

Chiari Type I malformation (Chiari I) is a congenital hindbrain anomaly characterized by downward displacement of the cerebellar tonsils through the foramen magnum. This can lead to compression of cerebellar components, the lower brainstem, and the upper cervical spinal cord. In turn, a variety of neurological deficits and permanent nervous system damage may evolve. This review article discusses the etiology, diagnosis, and treatment of patients with Chiari I malformation. Its protean manifestations cause significant overlap with multiple sclerosis, chronic fatigue syndrome, and numerous other conditions. Accordingly, the diagnosis of Chiari I is difficult to establish by clinical evaluation alone. Demonstration of the characteristic hindbrain abnormalities, however, is easily accomplished with magnetic resonance imaging. Neuroimaging should therefore be considered in patients with cerebellar, brainstem, and cervical cord dysfunction. Surgical treatment is indicated in symptomatic patients with radiographic evidence of hindbrain abnormalities. Posterior fossa decompression has also been performed in patients with fibromyalgia and chronic fatigue syndrome based solely on overlapping symptoms with Chiari I. This practice remains controversial. Appraisal of surgical outcome requires postoperative neuroimaging and long-term patient follow-up to assess the permanency of improvement. Preliminary study results of the impact of surgical technique on patient outcome are reported. Ongoing research is devoted to a better understanding of the pathophysiology of Chiari I malformation and the development of more effective medical and surgical treatments.



Author Affiliations: Mr. Nash and Drs. Meyer and Remler are with the Medical College of Wisconsin, Milwaukee, Wis. Mr. Nash is a research coordinator with the Department of Neurosurgery; Dr. Meyer is a Professor with the Department of Neurosurgery; Dr. Remler is an Associate

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Review Articles

A Physician’s Guide to Health Care Management

Reviewed by Charles C. Lobeck, MD

It is probably not proper for a book contributor to review it. However, it does not diminish the importance of the subject. This small paperback volume is a primer of health care manage-ment, an oft-maligned subject in medicine. Like teaching, we physicians do it, but are not thrilled about learning how to do it. This little book will help the beginner, whether a student just beginning a career in medicine or a physician who has just assumed a management role and feels “at sea.”



Author Affiliations: Doctor Lobeck is Emeritus Professor of Pediatrics at the University of Wisconsin-Madison Medical School.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Your Profession

From DNA to Molecular Medicine

Philip M. Farrell, MD, PhD

James Watson and Francis Crick made history in April 1953, when their famous work describing the structure of DNA—double helical strands consisting of pairs of base units—was published in the journal Nature.

Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Other

A Week in Ethiopia...

William E. Cayley Jr, MD

In the fall of 2002, I spent two weeks in Ethiopian prisons on an outreach with Prison Fellowship International and the Christian Medical Association. Our team of 15 provided primary medical and dental care to inmates in three Ethiopian prisons, and worked to encourage local physicians and local churches to become more involved in caring for prisoners. This “diary” illustrates some highlights of our first week in Ethiopia.



Author Affiliations: Doctor Cayley works at the Augusta Family Medicine Clinic, a rural training site for the Eau Claire Family Medicine Residency. He is an Eau Claire native and has also worked in Kenya, Tanzania, and Guatemala.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800