respect

to

indications, drugs, dosages,

and regimen. Students are also taught to consult with the attending physician to confirm their treatment plans. Diffi¬ culty may arise from the large number of dental operations with which the physician may be unfamiliar and perhaps even uncertain as to whether prophylaxis is necessary. All of this reinforces dentistry's commitment to increase the opportunities for advanced education in hospital training pro¬ grams. From such interfaces physi¬ cians learn what dentists do, and dentists learn what physicians need to learn for better understanding of dental procedures. Eugene Friedman, DDS School of Dental Medicine Health Sciences Center State University of New York at Stony Brook

Stony

pyurias are associated with regular drinking of soda pop. Recently I saw a 10-year-old girl with gross hematuria; she admits to drinking two or three cans of soda pop daily. She will be rechecked in a few days for complete clearing after stop¬ ping consumption of pop. I fully expect to find no microscopic hematuria on

her return in about one week. This probably is due to metabolic acidosis; however, I would appreciate other comments as to the cause. Our heavy pop-drinking society of adults and children cannot eat because their stomachs hurt, cannot sleep because of the excessive caffeine, and cannot urinate because of the burning. A pop-drinking history should be included for every patient.

Neither Dr Fellner nor Dr Culp includes in his published correspondence any thought of the patient's obligation to follow up his own disease. It may be that the unknown urologist who cared for him so inadequately instructed the patient firmly that he must return for follow up, and the patient did not do so. The experience of 30 years with patients' failure to participate in their own care has taught me that one can never jump to the conclusion that the previous physician was always a careless dummy. Perhaps our biggest mistake in caring for patients is not emphasizing the importance of their own obligations to their health. C. Balcom Moore, MD Walla Walla, Wash

Daniel M. Thompson, MD Wichita, Kan

Brook

Treatment of Hematuria Associated With Soda Pop Drinking

Synovial

To the Editor.\p=m-\The summer of 1963 was hot in Kansas and everyone was thirsty. In July 1963 a 63-year-old man was seen with hematuria. Initially, no cultures were taken, and he was treated with a sulfa preparation. He made no improvement, and gross hematuria continued for the next ten

days. He was hospitalized, and a complete urological workup was done, including urine culture, cystoscopy with retrograde pyelogram, and individual cultures from each ureter. Workup results were completely normal. On the third day of his hospitalization, the hematuria stopped, and there was no further hematuria for the next several days. A few days later an 18-year-old was seen with gross hematuria. He was not treated but was immediately hospitalized for the

complete urological workup, the results were also within normal limits. Hematuria stopped on the third day of hospitalization. Both of these patients were released to return to work on the same day. They both returned within the week with gross hematuria. They both had identical jobs at soft-drink bottling plants checking bottles for foreign material. When they were thirsty, they

would take a bottle of carbonated beverage off the line and drink it. They rarely drank water. They were both advised to drink no more soda pop, and neither had hematuria again that summer.

Since these two episodes, I have seen many cases of hematuria in those people who are heavy drinkers of soda pop. In my practice a considerable

number of recurrent

urinary

tract

Fluid Glucose

To the Editor.\p=m-\Iread with interest the article "Leukocytosis and Artifactual Hypoglycemia" (237:1961-1962, 1977). An analogous situation occurs in synovial fluid and needs to be emphasized. For example, on occasion synovial fluids from patients with rheumatoid arthritis and gout have leukocyte counts greater than 50,000 cells/cu mm. If the glucose determination is not done within an hour, the glycolytic action of the leukocytes can produce a value of 30 mg/dl or less, and the inexperienced clinician may make an erroneous diagnosis of septic arthritis. To avoid confusion and errors, we recommend that the synovial fluids to be used for glucose determinations be placed in a tube containing sodium fluoride.1,2 Tubes containing sodium fluoride are commercially available. Duncan S. Owen, Jr, MD

Neuralgia

Postherpetic

To the Editor.\p=m-\This letter is written in response to the treatment that was recommended for postherpetic neuralgia in a recent issue of The Journal. Ervin Epstein, MD, suggested repeated injections of triamcinolone acetonide into the symptomatic areas (238:517\x=req-\

518, 1977).

Two alternative methods that I have used successfully in treating postherpetic neuralgia are intercostal nerve block and sympathetic ganglion block. The blocks may be repeated daily until the symptoms subside. The reader is referred to Moore's textbook on Regional Block1 for descriptions of the

techniques.

Robert H. Libman, MD Illinois Masonic Medical Center University of Illinois Abraham Lincoln School of Medicine

Chicago Regional Block. Springfield, Ill, Charles C Thomas Publisher, 1975. 1. Moore DC:

Medical College of Virginia Virginia Commonwealth University Richmond

Jr, Cooke CL, Toone E: Practical synovial fluid examination. Va Med Mon 97:88-94, 1972. 2. Owen DS Jr: Recent advances in synovial fluid analysis. MCV Q 10:13-17, 1974. 1. Owen DS

Patients'

Responsibility

To the Editor.\p=m-\In regard to the discussion of management of prostatic carcinoma in QUESTIONS AND ANSWERS (238:254, 1977), I would like to compliment David A. Culp, MD, on his restraint in saying that "the postoperative management of the patient was rather inadequate." It was completely inadequate, and Donald W. Fellner, MD, is certainly very correct in his implication that this was the case.

Restraints in Use of Statistics To the Editor.\p=m-\The BRIEF REPORT, "Amebiasis: An Increasing Problem Among Homosexuals in New York

City" (238:1386, 1977), was a shrewd piece of research that will undoubtedly be of value to many physicians. In an era in which research physicians use statistically significant associations

as

conclusive evidence of

etiologic relations, it is gratifying that the authors did not conclude, as they had every right to do, that overseas travel to areas in which amebiasis is endemic is less frequently undertaken by homosexual men than by heterosexual men.

Downloaded From: http://jama.jamanetwork.com/ by a UNIVERSITY OF SYDNEY LIBRARY User on 01/19/2016

Jack R.

Harnes, MD

New York

Synovial fluid glucose.

respect to indications, drugs, dosages, and regimen. Students are also taught to consult with the attending physician to confirm their treatment pl...
173KB Sizes 0 Downloads 0 Views