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Nebraska Medical Journal PDF

746 Pages·1991·50.9 MB·English
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The New York Academy of Medicine By Exchange Digitized by the Internet Archive 2016 in https://archive.org/details/nebraskamedicalj76unse JANUARY, 1991 Nebraska Medical Journal With The Medical Protective Company, there’s no doubt. goal has been to provide physicians and surgeons with No doubt of our financial stability. No doubt about our worry-free protection of their financial future and their expertise. No doubt of our dedication to fighting non- professional reputation. Call your Medical Protective meritorious claims. Which is no less than what you'd general agent today and learn what we can do to insure expect from the company that invented professional your practice without a doubt. liability coverage nearly a century ago. Since then, our f88i)(tj;\t. iOjdt? !>’/9| , NO DOUIl GerrySmeader Suite114, CorporatePlaza, 11212Davenport, Omaha, NE68154 (402)334-9689 Another Methodist Innovation: Computerized Remote Afterioading Brachytherapy Methodist is proud to be the first hospital in the Midlands to offer Remote Afterloading Brachytherapy to treat cancer patients. This new, innovative outpatient treatment technique allows a higher dose of short range radiation (brachytherapy) to be concentrated on a cancerous tumor without harming healthy cells surrounding it. Its advantages include: • shorter treatment times/outpatient treatment • greater patient comfort • improved accuracy oftreatment • multicatheter implant possibilities 18 separate channels) ( • computerized dose optimization • endobronchial treatments possible Computerized Remote Afterloading Brachytherapy has appli- cations to palliative and curative cases. It can be safely combined with chemotherapy and allows for “on-site” radioactive isotopes, eliminating the need to order new radioactive sources for each new case. — Computerized Remote Afterloading Brachytherapy one of many reasons why people turn to Methodist Hospital for cancer treatment. METHODISr HOSPriAL 84th and Dodge We know over 175 specialists who would your join practice a minute. in Arrangingaconsultation isnowaspainlessaspickingupthephone.JustcallRSVP. You’ll have immediate access to physicians from Creighton University School of Medicine/Saint Joseph Hospital. Within 30 minutes, day or night, the specialist you requestwillcallyou backand sharethekind ofexpertiseyou’llonlyfind atateaching hospital. KeeptheRSVPnumbernearby. It’slikehaving 175specialistsonyourstaff. OUTSIDE NEBRASKA 1-800-228-RSVP; IN NEBRASKA 1-800-642-RSVP RSVP'REGIONAL SYSTEM FOR VISITING PHYSICIANS SaintJoseph Hospital _Creigliton University Medical Center_ Teaching, healing, leading. A The Nebraska Medical Journal EDITOR — VOL. 76 NO. 1 JANUARY, 1991 BENJAMIN R. GELBER, M.D. Neurological Surgery 2221 So. 17th Sl„ Suite 310 LETTER TO THE EDITOR Lincoln, NE 68502 "Drug Costs" 1 Scott P. Liggett, M.D. EDITORAL BOARD: James 0. Armitage, M.D., Omaha ORIGINAL ARTICLES Ronald L. Asher, M.D., North Platte Cardiac Transplantation — First Year Experience Rodney S.W. Basler, M.D. Lincoln Jehangir B. Bastani, M.D., Lincoln In A Community Hospital: A Three Year Follow-Up 2 John H. Casey, M.D., Lincoln Deepak M. Gangahar, M.D. Michael A. Breiner, M.D Sushil S. Lacy, M.D., Lincoln Scott P. Liggett, M.D. Giles S. Hedderich, M.D. Scott P. Liggett, M.D., Lincoln Stephen W. Carveth, M.D. George Papanicolaou, M.D. Hal K. Mardis, M.D., Omaha Richard A. Mortin, M.D., Lincoln Herbert E. Reese, M.D. Pradip K. Mistry, M.D., Norfolk Sinemet CR In Parkinson's Disease 8 TWailmtoetrhyJ.P.O'OD'oHonlolheurean,,MM..DD..,,ONmoarthhaPlatte Ronald F. Pfeiffer, M.D. Carolyn S. Glaeske, R.N. William F. Rayburn, M.D., Omaha Kathleen E. Wilken, M.D. Ruth Hofman, R.N. Michael A. Schmidt M.D., Lincoln A Medical Point of View: David L. Smith, M.D,, Lincoln An Answer To a Medical Student's Inquiry 11 Kenton L. Shaffer, M.D., Kearney Joseph M. Staves, M.D., Lincoln W. Riley Kovar, M.D. Jon S. Thompson, M.D., Omaha William L. Vosik, M.D., Kearney PERINATAL PAGE Arthur Weaver, M.D., Lincoln Amniotic Fluid Volume Assessment: Oligohydramnios 14 Stewart P. Wesiburg, M.D., Lincoln Carl V. Smith, M.D. Charles S. Wilson, M.D., Lincoln COVER PHOTO Stained glass designer hopes Bryan window offers patients comfort 16 — Jana Miller Lincoln Journal Writer PRESIDENT'S PAGE 1991: An "Intense" Year for the House of Medicine 17 SUBSCRIPTION RATE Paul E. Collicott, M.D. $20.00 PerYearU.S. $20.00 PerYear Foreign Country THE AUXILIARY Single Copies $1.75 Each Health Projects 20 Jeanette Schlichtemeier IN MEMORIAM 22 Copynght©1991NebraskaMedicalAssocia- tion. Informationconcerningreprintsofthe articlesinthisJournalandconcerningobtain- COMING MEETINGS 23 ing permission for the reproduction ofany portionofthisJournalmaybeobtainedfrom theEditor. TheNebraskaMedicalJournaldoesnotas- sumeresponsibilityforstatementsmadeor COVER PICTURE opinionsexpressedbytheauthors.Products andservicesadvertisedareneitherendorsed "STAINED GEASS WINDOW" norwarrantiedbytheNebraskaMedicalAs- sociation.TheNebraskaMedicalJournalre- Bryan Memorial Hospital Chapel, Lincoln, NE servestherighttoacceptorrejectadvertising Designed and Constructed by copy. Vernon F. Garwood, M.D. and hisfamily fhiblishedmonthlyandSecond-ClassPostage paidatLincoln,Nebraskaandatadditional (seecoverstoryon page 16) mailingoffices(ISSn0091-6730). Address all correspondence related to sub- PHOTOGRAPHERS & ARTISTS: scriptions,advertisingoraddresschangesto Pictures wanted for front cover of the Nebraska Medical Journal. Vertical William L. Schellpeper,Business Manager, 1512 FirsTier Bank Building, Lincoln, Ne- formatprintsofsubjectstypicalofNebraskapreferred,buthorizontalpictures bMMerAdaSisTckaaElR6:J8o5Su0re8n.nadlP,ahdo1dn5re1es2(s4Fc0i2hr)asnT4ig7ee4rs-B4to4a7nN2ekbPrBOuaiSslTkd-a- cLianncoblen,moNdEif6ie8d51as0necessary.MailtoStuartP,Westburg,M.D.,2756OStreet, ing,Lincoln,Nebraska68508. January 1991 Nebraska Medical Journal 5- REPRINTS OF YOUR Technical Articles ADVK'E TO AUTHORS addMraensuss;crBiepntjsasmhionulRd.bGeeslbuebrm,itMt.eDd.i.n2d2up2l1icSaot.et1o7,thSeuiEtdeit3o1r0a,ttLhiencfoollnl,owNinEg Are a direct presentation of research 6in8.5p0a2p.erT,hweitmhanguesncerrioputsmsahroguilndsboenteyapcehwrpiatgtee.n,Nudomubbeler-aslplapcaegde,soinntherxig1h1t and a valuable supplement upper comer with the author*s surname. to any doctor’s library. Reviewarticleswillbeconsidered,andshouldgenerallybelimitedtoless than 4,000 words and approximately 30 references. Manuscriptsdescribingoriginalclinicalorlaboratoryresearchshouldbe limited to 2,000 words and approximately 20 references. Acknowledgementsmustbegivenwhenmaterialfromotherpublications It costs very litt—le isincluded.Providenamesofauthors,titleofarticle,titleofjournalorbook, to run reprints volume number, pages, month and year, and publishers permission to write us for prices reprint. Always send a covering letter or letter of transmittal with each Norfolk Printing Co., Inc. manuscript, and refer to the manuscript by its title, in the letter and all correspondence. Donot senda manuscriptthatwaspublished elsewhere. P.O. Box 278 - 302 Philip Avenue Title page: each manuscript should have a title page, includingthe full NORFOLK, NEBRASKA 68702-0278 name,academicdegree,andhospitaloruniversityaffiliationofeachauthor. (402) 371-0620 A name and address for reprint requests should be included on the title page, including street address, city, state, and zip code. Letterheads - Statements Summar>'forarticle; ailmajorscientificarticlesshouldbeaccompanied Envelopes - Office Forms byasummaryattheendofthearticle,summarizingthekeyinformationand QUALITY PRINTING AT THE RIGHT PRICE recommendations presented. References: should be listed in the order in which they appear in the articleandshouldbetypeddouble-spaced.Authorsareresponsibleforthe completeness and accuracy of all cited references. Journal references shouldincludeauthors’namesandinitials,titleofarticle,abbreviatedname ofJournal(aslistedinIndexMedicus),volumenumber,inclusivepages,and year of publication. References to books should include authors, title, location and name of publisher, year of publication, edition, and page Since 1925 numbers. Tables and illustrations; should be typed double-spaced on separate sheets of8V^ x 11 in. paper. EachTableshould have a title. Illustrations should be prepared professionally and submitted as high-quality, glossy, unmounted black-and-whitephotographic prints, at least 5 x7 in. Donot sendoriginalartwork. Eachillustrationshouldbeconsecutivelynumbered Nebraska’s andcitedinthetext Eachphotographshouldhaveagummedlabelonthe back containing the figure number, name of senior author and an arrow Leading indicatingtop of figure. Legends should be typed double-space for each illustration.Permissiontoreproduceapictureofapatientisneeded,ifsuch a picture is included. Letters-to-the-Editon letters are encouraged by all readers and will be Physicians and publishedas space permitsand atthe discretionofthe Editor. Allletters should be accompained by the notation; For publication. Galley proofs generally will not be returned to the authors pre-publication. Surgical The Nebraska Medical Journal will accept cartoons for publication. Paymentwillbemadeonlyuponpublicationofthecartoons.TheJournal will make an effort to return unpublished cartoons, but this cannot be Supply House guaranteed. Thecopyrightforpublishedcartoonsmustbeassignedtothe Nebraska Medical Journal. Manuscripts will be published in the orderinwhichthey are received, particularly in the order in which galley proofs are returned from the authors.TheEditorofthisJournalassumesnoresponsibilityforopinionsand claims expressed in an article published in this Journal. Phone 474-3222 Reprintsshouldbeorderedfromtheprinter.NorfolkPrintingCompany. Inc., P.O. Box 278, Norfolk, Nebraska 68702-0278. SoNLEY MEDICAL SUPPLY COVIPAIVY P.O. Box 83108. Lincoln. NE 68501 AUTHORIZED CONTRACT AGENT 6-A Nebraska Medical Journal January 1991

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