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The purpose of this paper is to assess career satisfaction of surgeons in the era of managed care. The method of this assessment is by membership survey of the Southeastern Surgical Congress and the Western Surgical Association. Members were queried about their demographic characteristics, some aspects of the business of their practices, their attitudes toward retirement, their perception of the effectiveness of organized medicine as a socioeconomic advocate, and a comparison of each surgeon's career satisfaction before and during the era of managed care. Three hundred seventy-three usable surveys were returned, computerized, and analyzed statistically. Summaries of categorical variables are presented as percentages for various groupings of the categorical set. Results reveal a broad-based career disaffection in all areas queried, most notably in the business of surgical practice, attitude toward retirement and retirement alternatives, and the advocacy role of organized medicine for their issues. There is an almost unanimous desire for the American College of Surgeons to become their aggressive socioeconomic advocate. The data support a conclusion that surgeons perceive they are not represented in a realistic manner with the insurance companies and the government when their core issues are decided.

The administration of magnesium is an effective therapeutic option in such conditions as preeclampsia, ischemic heart disease, cardiac arrhythmia, and asthma. It has also been used as a cathartic in the treatment of constipation. As a medical therapy, magnesium enjoys an acceptable safety record. Because magnesium is almost exclusively excreted in the urine, significantly elevated levels of magnesium are typically anticipated only in patients with renal dysfunction. With wider application, emerging reports suggest that additional factors such as intestinal hypomotility and chronic constipation should be considered before using magnesium to avoid toxicity.

Simvastatin, a hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, is a commonly used cholesterol-lowering agent. The long-term safety profile of simvastatin, established over 10 years of clinical use, is excellent. HMG-CoA reductase inhibitors block 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme in cholesterol synthesis. However, other important nonsterol compounds, such as coenzyme Q10 (CoQ10), are also derived from the same synthetic pathway. CoQ10 is an essential carrier in the mitochondrial respiratory chain that participates in oxidative phosphorylation. Simvastatin and other HMG-CoA reductase inhibitors have been documented to lower serum concentrations of CoQ10. It has been suggested that the adverse effect of myopathy caused by HMG-CoA reductase inhibitors is due to CoQ10 deficiency in the tissue mitochondria. Documentation of this cause-and-effect phenomenon, however, has been lacking. We offer evidence that lactic acidosis may develop as a complication of simvastatin therapy. Our patient also manifested the well-known HMG-CoA reductase inhibitor drug toxicities of rhabdomyolysis and hepatitis. The occurrence of these known adverse events with lactic acidosis in our patient suggests that interference of the mitochondrial respiratory chain may play a role in the toxicity of this class of drugs.

Blastomycosis is a chronic fungal disease that primarily affects the lower respiratory tract. The acute inflammatory phase of the primary pulmonary infection is characterized by a lymphohematogenous spread to extrapulmonary sites, especially the skin. The presence of disseminated infection with Blastomyces dermatitidis in the larynx is unusual. In areas of the United States where this fungus is endemic, failure to consider laryngeal involvement might lead to inappropriate therapy and thus worsening inflammation and airway compromise.

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Although central measurement of bone mass by dual X-ray absorptiometry (DXA) is viewed by many as the "gold standard" for the diagnosis of osteoporosis in patients without previous fragility fracture, controversy remains on how best to use central DXA as a tool for diagnosis. Questions concerning the measurement of bone mass of the central skeleton were addressed at the International Society for Clinical Densitometry Position Development Conference. An expert panel agreed on the following positions: First, the diagnosis of osteoporosis should be based on the lowest T-score of either the PA spine or hip. Second, both the PA spine and hip should be measured. Third, whenever possible, bone mineral density (BMD) of the first four lumbar vertebrae should be measured. Fourth, DXA manufacturers should use L1-L4 as the default region of interest for their printouts. Fifth, BMD of either hip may be measured. Sixth, the lowest T-score of the three sites - total hip, femoral neck, or trochanter - should be considered. Seventh, Ward's area should not be used for diagnostic purposes; DXA manufacturers should not include this region in the default printout. Eighth, BMD of the forearm should be measured if the hip or spine cannot be accurately measured. Finally, lateral spine BMD should not be used to diagnose osteoporosis.

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No description available.