Snowmobile trauma: an eleven-year experience.

Records of 88 patients with snowmobile injuries from 1977 to 1987 were reviewed to identify the types of trauma. Data collected included age, sex, method and degree of injury, use of safety attire, and risk factors. There were 77 males and 11 females. Seventeen (19.3%) were children under the age of 16. Poor driving judgment involved in the hitting of obstacles led to the majority of injuries. There were 106 fractures in 71 patients. Eighteen patients (25%) had more than one fracture. Eleven patients had loss of consciousness. Eighty-eight other injuries resulted for a total of 205 injuries. There were three fatalities. Results indicate that inexperience, prior use of alcohol, driver carelessness, excessive speed, and poor adherence to manufacturer recommendations were the leading contributors to the accidents.

Further experience with division of the left renal vein.

The left renal vein (LRV) has numerous tributaries including, but not limited to, the inferior phrenic, suprarenal, and gonadal veins. The resultant potential for collateral LRV outflow through these tributaries in instances of LRV division is obvious. One of us has previously reported 10 such cases of LRV division (close to its confluence with the inferior vena cava and without reanastomosis) for the purpose of facilitating proximal abdominal aortic exposure for reconstructive procedures. One of the 10 patients had moderate renal insufficiency at follow-up. We present herein an additional 19 patients who underwent LRV division predominantly for aneurysmal disease of the abdominal aorta. Sixteen patients were available for follow-up. Three patients died in the intraoperative and early postoperative periods. Multivariate analysis of variance of preoperative, postoperative, and follow-up laboratory data--serum creatinine and BUN--showed no significant change in renal function as assessed.

Using the 1983 norms for the MMPI: code type frequencies in four clinical samples.

MMPI responses obtained from a large random sample of midwestern adults who were 18 through 99 years old and had no physically or mentally handicapping condition yielded a pattern significantly different from the pattern of the original norms. From these data, two new kinds of normative tables have been developed: Norms that reflect, for each sex, the response pattern of the general adult population, and a set of tables, separate for each sex, that allow comparisons to be based on age. In addition, the traditional scoring procedures based on a linear transformation that maintains any underlying skewness of the raw score distribution has been replaced by procedures that yield normalized T scores. The changes that are apparent at the item and scale level are also evident in the frequency with which certain 1- and 2-point codes occur in normal and clinical samples. These changes are apt to make our interpretive statements more meaningful because they are based on contemporary norms.

The aging MMPI: development of contemporary norms.

Twenty-five years of experience with the Mayo Clinic computerized system for the Minnesota Multiphasic Personality Inventory (MMPI) have accrued since Swenson , Rome, and their colleagues proposed this innovation in 1959. Although it is the most respected, widely used, and thoroughly researched objective personality-assessment instrument that has been developed to date, the MMPI is aging. Work on the MMPI began in 1937, and the original normative base was established in the late 1930s and early 1940s . To develop new norms, we selected a random sample of 1,408 subjects, not under care for any physically or mentally handicapping condition and ranging in age from 18 through 99 years, from parts of Iowa, Wisconsin, and Minnesota in a 50-mile radius surrounding Rochester, Minnesota. MMPI responses obtained from this sample were used to develop normalized T-score tables for specific age ranges, and for adults in general, for the 13 basic scales of the MMPI.

Prognosis of physicians treated for alcoholism and drug dependence.

Data on 73 physicians are compared with data on 185 middle-class patients similarly treated for alcoholism or drug dependence in a hospital-based inpatient program. General patients were contacted on year after treatment and physicians, one to five years later. The prognosis was more favorable for physicians than for general patients. When the groups were selected for study on the basis of completion of inpatient treatment, availability at time of contact, and not having died, 83% of physicians and 62% of the general group were noted to have favorable outcomes. Close monitoring may account, in part, for the better prognosis for physicians.

Alcoholism in physicians.

The Self-Administered Alcoholism Screening Test was completed by physicians attending an annual continuing medical education meeting. Of the responding physicians, 12% were identified as abstainers, 81% were classified as not alcohol-dependent drinkers, 5% were classified as possibly alcoholic, and 2% were classified as probably alcoholic. These results were similar to those obtained in a nonphysician general medical patient population previously given the same questionnaire. The data show that the prevalence of alcoholism among a group of physicians is not substantially different from that in a general medical population.

The MMPI: development of contemporary norms.

The original standardization of the MMPI was completed approximately 40 years ago. These norms were refined in 1957, but no attempt has been made to develop new standards. Therefore, a contemporary random sample of 1,408 persons living in the midwestern states who were similar to the original sample in area of residence and in the absence of significant medical problems were asked to complete the MMPI. The resulting MMPI data by age and sex are presented. In general, responses from this contemporary sample yielded higher mean scores than appeared in the original standardization group. These data suggest a somewhat more conservative approach to profile interpretation, with more careful consideration of the impact of age and sex on profile configurations.

Diagnosis of alcoholism with a self-administered alcoholism screening test: results with 1,002 consecutive patients receiving general examinations.

Since 1972 we have used the Self-Administered Alcoholism Screening Test (SAAST) in impatient alcoholics and their spouses and in patients from a general medical population. The SAAST, a 35-item test with a yes/no format, was administered to 1,002 consecutive Mayo Clinic patients who generally were not acutely ill and were requesting an annual examination or a general reexamination for chornic but stable problems. Of the 1,002 patients, 5.4% gave responses to the SAAST that would indicate the presence of possible or probable alcoholism. The medical record review on a random selection of patients revealed a false-negative rate of 6.7%. We believe that the SAAST is an effective tool for the detection of alcoholism and that it can be used in the general medical setting.

Reactive hypoglycemia.

The clinical characteristics and scores on the Minnesota Multiphasic Personality Inventory (MMPI) of 192 patients undergoing a five-hour oral glucose tolerance test (OGTT) for evaluation of reactive hypoglycemia were assessed. There were twice as many women as men. One hundred twenty-nine patients had spells of light-headedness, shakiness, diaphoresis, weakness, and fatigue. Hypoglycemic symptoms occurring during the test were not related to level of plasma glucose nadir or to rate of descent of glucose level. Hypoglycemia was not found when glucose levels were measured during occurrence of spontaneous symptoms in 86 patients. MMPI scores were significantly different from those of general medical patients. Both men and women evinced a conversion V profile. The five-hour OGTT seems unreliable for the diagnosis of reactive hypoglycemia, and most patients with symptoms suggestive of hypoglycemia may have emotional disturbances.

Carotid endarterectomy in a community hospital.

One hundred consecutive patients underwent carotid endarterectomy in a small community hospital in North Dakota during a period between 1969 through 1976. All operative procedures were performed by the same surgeon using the Javid shunt. A 1 per cent operative mortality and permanent morbidity resulted. These findings are comparable with those reported from large medical centers having extensive experience in carotid endarterectomy. It is concluded that patients with carotid artery disease can be safely and effectively treated in small medical centers by well trained experienced vascular surgeons.

Psychological factors involved in maxillofacial prosthetics.

1. No significant difference existed between the MMPI means of the test group and the MMPI means of the Mayo Clinic patient group. 2. The means of the test group and the Mayo Clinic patient group deviated from the MMPI normative data. 3. No apparent change in personality of the test group was suggested by the MMPI. 4. A much larger percentage of the patients than expected failed to complete the initial MMPI. One patient refused, and four patients had a raw score of "cannot say" responses greater than 120, thus invalidating the test. 5. The changes in the means of the ACL scales of total number checked, autonomy, change, and abasement were significant (p less than .05). 6. The patient became more outgoing and optimistic, as measured by the ACL, during the immediate postoperative period. 7. Speech and mastication were problems for some patients even after prosthodontic rehabilitation. 8. Most of the rehabilitated patients resumed their normal social habits. 9. The patients in the study seemed to respond to the new situation according to their already existing personality structure.