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THE FRANCIS A. COUNTWAY LIBRARY OF MEDICINE Harvard Medical Library-Boston MedicalLibrary Digitized by the Internet Archive in 2017 with funding from The National Endowment for the Humanities and the Arcadia Fund https://archive.org/details/kansasmedicinejo9697kans KANSAS MEDICINE URNAL OF THE KANSAS MEDICAL SOCIETY J^b Spring 1995 Volume 96, Number 1 FRANCIS the B09TC AU6 1 First Quarterly Issue. See Our Readers,” page 4. KANSAS MEDICINE VOLUME 96 NUMBER SPRING 1995 • I • CONTENTS Scientific Article Complications of Laparoscopic Cholecystectomy Su^igestionsfor prevention, detectioyi and treatment ofbiliary problems. Michael S. Woods, M.D., Gilbert S. Santoscoy, M.D., John L. Shellito, M.D., and Eric A. Soder, M.D. Medical Milestones Neurology in Frontier America before Mitchell: Fort Scott Records Good medical records were rare in the 1850s, but not at Fort Scott. Saty Satya-Murti, M.D. Departments 2 Cover Story: Western Kansas in blown glass by Vernon Brejcha 4 Editorial Comment: The Pillars of Medicine, by a Pillar ofMedicine 8 Medicina et Lex: Legal Issues in Managed Care 10 A Personiail View: Emergency Medicine in Kansas: The Last Piece ofthe Puzzle 17 News from KDHE: Salmonella Outbreak at a Fligh School in Kansas, 1994 18 Physical Activity in Kansas, 1993 19 Preventive Medicine: The Value of Counseling Patients about Exercise 21 Radiology Vignette: An Unusual Case ofHydronephrosis 22 Case of the Month: Craniopharyngioma Presenting as Korsakoff Psychosis 24 Your Older Patient: The Impact ofVisual Impairment on Functional Independence 27 Geriatrics Journal Club 32 Book Reviews: A Medical School, a Medical Tool and Some Medical Jewels 35 Horse and Buggy Doctor: I Prepare to Study Medicine 36 Classified Advertisements 38 Cardiology Notes: Galloping Disagreements 40 Alliance News: To the Doctor in the House Miscellaneous 6 AMA Delegate’s Report: Interim Meeting 2 CME I Opportunities 37 Information for Authors Who can you call for objective investment advice and "fee- based” professional money Computerized "On-Line Tracking" of Tax and management experience? Performance Information George K. Baum & Company Professional Investment Advisors Division Independent Trustee Alternatives for P/S and The only one to callfor "Fee Based" 401(k)s Managed Accounts J m boston, David E. Black Senior Vice President 1-800-821-7195 George K. Baum & Company Investment Bankers Since 1928 Twelve Wyandotte Plaza Portfolio Strategies and 120 W. 12th Street MO Asset Allocation Kansas City, 64105 1-800-821-7195 816-474-1100 fax 816-283-5294 Member: New York Stock Exchange, Inc. STPC COVER STORY his issue brings not only a new' artist but a The Stone posts were an innovati\'e response new' medium to the cover of Kansas medicine. to the lack oftrees on the prairie. Early settlers, Vernon Brejcha is the former and blow'n glass the needing fences, quarried local limestone, cut it latter. Visitors to the KMS office late last fall had into 500-pound posts and drilled holes in them an opportunity to view' two of Brejcha’s glass forthewire. Exceptforan area between Ellsworth forms, which w'erc on display in the lobby. One and Hays called Post Rock Country', w'here many large piece (about 18” high), \'er\' similar to the still remain, the posts are disappearing from the cover subject, was placed in an east w'indow', Kansas landscape. v\'here the morningsun enlivened the manycolors Originally a painter,Vernon Brejcha fell in love embedded inside the clear exterior. with blown glass w'hen he saw some pieces at a The w'ork on the cover is part ofa series calleci show' in Wichita. After mastering the technique “Posts from the Memoix' Fenceline,” which echo himself, he found it the mostappropriate medium the stone fence posts and the colors found around to express his memories of the w'estern Kansas Holyrood (in central Kansas), w'here Vernon prairie. Just as a limestone post may evoke Brejcha spent his boyhood. He explains the posts thoughts of life on the plains, a glass post may thisw'ay: “I grew' up on a ranch w'here these posts depict different sorts of memories of the same traversed the landscape. To me they ha\'e always place: the color ofthe sky on a spring morning, been the ideal representation ofthe clash between perhaps, the green of new' grass sprouting from civilization and the natural world, between the the dead winter earth, or the clouds that w'ill Native and Western cultures. Fluid glass has been bring rain. the perfect medium for me in seeking new' forms Vernon Brejcha also makes two otherevocative to express the meaning of the posts: the land- glass forms suggesti\'e ofKansas histor\': brightly scapes and atmosphere I infuse into them, and colored peace pipes and highly stylized dippers. the stories of heritage that I tell through them, Ofthe pipes he states, “As w'e are about to enter for each ofthem tells a talc.” y a new' centuty, the idea ofa ceremonial pipe in- trigues and inspires me. The concepts of peace PRIMARY CARE and f—reedom must be kept alive, as much now' as PHYSICIANS ever ifnot more so.” The glass dippers recall a time when “on the ranch we drank from the dHeesairrtelatnodjPorinimaarpyroCgarreessiisvsee,ekhionsgpBitEa/l-BeCmpPlroiymeadrygrCoaurpeprpahcytsiciec.iaYnous'lwlhboe well with a dipper; a dipper banged on a pan involvedinallaspectsoffamilymedicineexceptobstetrics,providingclinical brought us to our meals from the fields; a dipper cofofviecreasgienSatlJaosneepwhahnodspniteaalr-bbyasceodmmaumnbiutliaetso.rTyocaalrleowcefnlteexirbialintdyfsoarteyloliutre was used to breakthe iceon the kitchen bucketon personal life, you'll sharecall with other membersofthe Heartland the bitter winter mornings. Glass has allow'ed HealthSystemDepartmentofPrimaryCart me to explore this basic obj.e.c.t and turn it into cHeenaterrt,lasnerdviHngea2l9thcoSunytsiteesminisNoart6h0w0e-sbtedMisbsio-ucraimapnudsardejgaicoennatlarreefaesrroalf something both fluid and organic; into a thing Kansas,IowaandNebraska. ofw'ontfer.” • Guaranteedsalaryof$135,000peryear The glass creations ofVernon Brejcha are just • Medicalstudentloanrepaymentoptions that: things ofwonder. They may be seen in Kan- • MalpracticeinsuratKe sas City, Missouri, at Leopold International gal- • Healthandlifeinsurance lety in the Savoy Hotel. • Vaation • Relocationexpensesareprovided FormoreinformationcallRhonda,800-455-2480orHeidi,800-455- 2485.SendCVtoHeartlandHealthSystem,MedicalStaffDevelop- ment,5325Faraon,St.Joseph,MO64506orFaxto816-271-6146. HAVE YOU MOVED RECENTLY? Don’t forget to let IvMS know'! Please complete and return the change-of-address form on page 26. ©1995 NAS Media: pleasedeletecopyright Kansas Med. JRNLofthe Mississippi Med. Assoc. 2 • Kansas Meciicinc • Spring 1995 MEDICAL SUPPLIES EDITORIAL BOARD AT WHOLESALE COST! Warren E. Meyer, M.D., Acting Editor M. Martin Halley, M.D. David S. Jacobs, M.D. MedVentures M HariA' G. Kroll, I"). Donald R. I’ierce, M.!"). buys manufacturer overruns James H. Ransom, M.I^. and overstocks. William J. Reals, M.D. Donald L. Vine, M.D. M Anne I'). Walling, l"). We sell at wholesale or below : STAFF • Case lots only. Susan Ward • Minimum orders of $200. MayiagingEditor • Stocking 5,000 line items daily. Jeremy Slaughter BusinessManager Call MedVentures, Inc., Topeka, Ks. 1-800-774-4633 or 1-913-272-2300 KANSASMEDICINE(ISSN8755-0059)ispublishedquarterlyby for more information. the ICansas Medical Society, 623 W. 10th Avenue, Topeka KS 66612.KMSmembershipincludesaone-yearsubscriptionforwhich $15 is allocated from each member’s dues. Rates to others: $65/ A Munns Company yrdomestic; S80/yr foreign. Printed byThe Ovid Bell Press, Inc., Fulton MO. Second class postage paid at Topeka KS and at addi- tional mailing offices. POSTMASTER: Send address changes to KANSAS MEDICINE, 623 W. 10th Avenue, Topeka KS 66612. IndexedinHospitalLiteratureIndex^ndIndexMedicus.Available through Universits' Microfilms. Listed in CC/CJinical Practice. PRINCIPAL CLINICAL COORDINATOR Search Resource for Institute for Medical Information, Inc., and Medical Search, Inc. Copyright 1995 by the Kansas Medical Society’. Permission to The Kansas Foundation for Medical Care is reproducematerialspublishedhereinmustbeobtainedfrom KAN- seeking a physician to assume the overall SpuAbSlisMhEoDnIlyCIacNcuEraatendarttihceleasuatnhcoJr(lse)g.itAilmattheouadgvheretfifsoertmeinstsm,aKdeANt-o responsibilities for Health Care Quality SASMEDICINEdenieslegalresponsibility'forstatements,opinions Improvement Program activities. The individual or advertisements appearing under the names ofcontributors or will serve as a focus for change within the c6o2n3ceWr.ns.10AtdhdrAevsesnuael,l cToorpreeksapoKnSde6n6c6e12to.: KANSAS MEDICINE, organization and in the provider and practitioner community. The candidate must be board certified in an allopathic or osteopathic specialty and possess strong interpersonal and communications skills. Preference will be given to candidates holding credentials in Epidemiology or Public Health. Candidates should be licensed to practice medicine or surgery in Kansas; or capable of acquiring a ABOUT OUR LOGO Kansas license. In January' 1935,aneyvlogoappearedonthecoverofK.;yNSAS The Kansas Foundation for Medical Care is a MEDICINE for the first time. This device represents two physician sponsored organization dedicated to stethoscopes:theoriginal monauralty'peasusedbyLiicnnec, improving the quality of patient care. and the modern binaural variety. The logo was designed expresslyforKANSASmedicinebyrenownedgraphicdesigner Bradbury' Thompson, a native ofTopeka and friend ofuvo Qualified candidates, please submit CVs to: formereditorsofthejournal.Dr.W.M. Millsand Dr. Lucien Evelyn Headley, Manager, Human Resources, Pyle. As another former editor. Dr. Orville R. Clark, yvrote Kansas Foundation For Medical Care, 2947 SW in January' 1955, the logo “has become as much a part of Wanamaker Drive, Topeka KS 66614, EOE the journal as any ofthe features on the inside and is something yvhich is ours alone.” Kansas Medicine • Spring 1995 3 EDITORIAL COMMENT The of Medicine, Pillars by a of Medicine Pillar ^liilippusAurcokisTheophrastus ofLatin and admitted barber surgeons to his lec- Bombastus \'on Hohenheim, tures. To the dismay ofthe business community, 1493?-1541, was a physician bom he refused to prescribe the medicines ofthe local in Einsicdeln, Sw'itzcrland. As a apothecaries. As ifthis w’ere not enough, he w'as a young man, he gave himself the Catholic with tendencies tow'ard the occult, w'hile name by which we ha\'e come to the rest ofnorthern Europe embraced the Refor- know him: Paracelsus. He re- mation. ceived his early education from Not surprisingly, his views w'ere greeted wath his lather, also a physician and opposition by the medical establishment of the chemist. Paracelsus pioneered the application of da\y and he was forced to flee Basel to avoid chemistry to medicine and introduced many imprisonment. Still, he—did have some remarkable drugs, the best known of which was laudanum, successes as a healer w’hich led the populace the tincture ofopium, used in the reliefofpain. to suspect that he w'as the infamous Dr. Faustus. An outspoken independent thinker ^\’ith a But perhaps what accounted for his success w'as healthy ego, Paracelsus brought controversy with his inclination to reject rote learning, question him as he traveled through Europe. During astint the reasoning that “w'e’\'e ahvays done it that in 1526-28 as town physician in Basel, which also w'ay,” andtoobserve thesymptomsofhispatients required him to teach, he sharply attacked the and the properties of the herbs he used to treat foundations of ancient and medieval medicine, them. burning the works of Galen and criticizing the So, W'hile we pride ourselves on having out- traditional teaching ofmedicine by textual analy- grown the simpleminded adherence to the magic sis. “The patients are your textbook,” he told his and sorccty of Paracelsus’ time, an examination students, “the sickbed is your study.” In another of his principles is still w'orthw'hile. Considering breakwith tradition, he taught in German instead the general ignorance of science and medicine that prevailed in the sixteenth centuty, the depth TO OUR READERS of his knowledge and the soundness of his wis- dom are surprising. This Spring issue oficxnsas medicine is the Some of Paracelsus’ theories foreshadowed first published as a quarterly. It is also the modern medical practice. He was the first to note firstpublished in 1995, andyou maywonder the relationship of endemic goiter in the parent w'hy. As w'e planned changes to the journal, and the existence of cretinism in the child. His we also made the decision to rework the monograph on miners’ diseases contains descrip- KMS Membership Directory, and to mail it tions of miners’ phthisis anti the effects of coal as a companion to the Spring 1995 journal gas. Many ofhis observations, iar from reflecting so that it w'ould qualib' under our 2nd class the superstitions ofhis era, w’ere original and tar bulk mail permit. Unfortunately, it hastaken ahead ofhis time. longer than we expected to complete work The Pillars ofMedicine are statements by Para- on the new’ directon'. We now anticipate celsus that illustrate his feelings about the practice mailing it later in the yearw’ith another issue ofmedicine. Althoughw’ritten centuriesago, they ofKANSAS MEDICINE. have validit)’ today and can still be of \'alue to The Summer journal will be published in those ofus w’ho carry' the mantle ofresponsibility late August, and the Fall issue w'ill appear, for the care ofthe sick. as scheduled, at the end ofSeptember. Our THE PILLARS OF MEDICINE Winter publication date is set for the end of December. Thank you for your patience • He who wants to know' a man must look during our “remodeling.” (Continued on page 7.) 4 • Kansas Medicine • Spring 1995