Groin and leg pain after cancer surgery.

Dr. Lipkin has properly emphasized the importance of a physician's continuous focus on the psychologic, social, and economic factors involved in human disease. No one can argue with that viewpoint. However, his additional conclusion that CPC's are anachronistic and should be replaced by retrospective analyses highlighting the humanistic aspects of disease deserves closer scrutiny. From the purview of the editor of the Case Records of the Massachusetts General Hospital, I should like to present the opinion of our editorial staff on the educational role of the CPC, comment on practical problems raised by Dr. Lipkin's proposal, and attempt the difficult . . .

Sounding Boards. In defense of the CPC.

SEPTIC ARTHRITIS of the hip is a serious but little-known complication of perforation of abdominal organs. It is our purpose to bring this complication to the attention of physicians who care for either the patient with a perforation of an abdominal organ or with septic arthritis of the hip. It is also our purpose to discuss the anatomic pathways involved in this sequential complication. The magnitude of the signs, symptoms, and prognosis of the abdominal problem is such that frequently the hip-joint problem may be masked. Five cases of septic arthritis of the hip secondary to perforation of an abdominal organ have recently come to our attention. Three of the cases followed bowel perforations associated with diverticulitis; one followed traumatic rupture of the bladder and acetabular fracture; and the fifth case followed perforation of the uterus after remote radiation treatment for carcinoma of the cervix. The interval from the estimated

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=658813&pdfFileName=jama_195_13_039.pdf

Septic Arthritis of the Hip Complicating Perforation of Abdominal Organs

Presentation of Case A 63-year-old man was admitted to the hospital because of fever and hip pain. A subtotal gastrectomy had been performed many years earlier because of a peptic ulcer. Postoperative vitamin B12 deficiency had been treated with periodic injections. Eight years before admission exertional dyspnea developed. Three years later a physician heard a murmur and referred him to this hospital. Cardiac catheterization revealed mitral regurgitation, which was attributed to ruptured chordae tendineae. A thoracotomy disclosed prolapse of the posterior leaflet of the mitral valve and rupture of chordae tendineae. A Starr — Edwards ball-valve prosthesis was implanted. . . .

Case 33-1979

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Groin and leg pain after cancer surgery.

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References

Sounding Boards. In defense of the CPC.

Septic Arthritis of the Hip Complicating Perforation of Abdominal Organs

Case 33-1979