Hawaii through the ophthalmoscope.
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A ten year review (1966-1975) of extrahepatic bile duct carcinoma in three major Honolulu hospitals is presented. Fifty-seven patients satisfied the criteria for the study. The disease occurs predominantly in the Japanese population. Survival of patients with upper third lesions proximal to the cystic duct is poor, and all patients followed died within seventeen months of hospitalization or operation. In patients undergoing bypass procedures for lower third (intrapancreatic) lesions, palliation averages ten months. The Whipple operation, performed in fourteen selected patients with favorable lesions, affords palliation averaging twenty months, and five patients were long-term survivors, including two with five year cures. However, morbidity and mortality for the Whipple procedure is high. Methods for improving palliation in upper third lesions and lowering morbidity and mortality from pancreatoduodenectomy are proposed.
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To investigate the phenomenon of acute psychiatric decompensation in travelers, charts of all psychiatric-emergency patients with a history of recent travel involving time-zone changes were reviewed at a major medical center in Honolulu, HI. Charts of a control group with no history of travel were also reviewed. Significantly more travelers than controls showed symptoms of depression and mania (P < .012). East-bound travelers were significantly more likely to show symptoms of mania than controls (P < .001). In an eastbound-versus-westbound comparison, significantly more eastbound travelers showed symptoms of mania, whereas significantly more westbound travelers showed symptoms of depression (P < .05). These findings support the phase-advance hypothesis of depression. Psychosocial and biologic factors that may contribute to psychiatric decompensation in travelers are discussed.
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The incidence and clinical features of enteritis associated with Aeromonas in Honolulu were studied. The stool isolation rate was 2.9% for Aeromonas, the third most common bacterial pathogen in this population. Clinical features of Aeromonas-associated enteritis were compared with clinical features of enteritis without an associated bacterial pathogen. Although there was a trend toward more abdominal pain, tenderness, nausea and prolonged illness in patients with Aeromonas, these differences were not statistically significant. In most cases, Aeromonas enteritis is a self-limited illness, indistinguishable from other causes of diarrhoea seen in our clinic.
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Ninety-six high school students reported their own behavior and the behavior of their parents in the resolution of conflicts during the previous year, using the Conflict Tactics Scale (Straus, 1979). Parent-teen dyadic aggression levels for Americans of European, Japanese, Polynesian, and Filipino ancestry were compared in a series of orthogonal contrasts. The adolescent children of Polynesian American parents reported significantly higher parent aggression levels than did adolescents with parents of other ethnicity. Parent aggression was the best predictor of teen aggression directed toward parents. Subjects reciprocated with counteraggression toward European American parents significantly more often than toward parents of other ethnicity. Aggression by one parent was highly correlated with aggression by the other parent. Aggression by either parent was more highly correlated with teen aggression toward the mother, than with teen aggression toward the father.
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