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Approximately 30-40% of the patients have a history of previous attacks or acute intestinal obstruction with subsequent remission. Three patients were referred to the University of Mississip- pi Medical Center in Jackson within hours of injury for evaluation of multiple trauma and possible aortic injury. Rein- dollar et al, 3 in a single series of 252 patients with abnormal pubertal development, found vaginal agenesis to be the second-most common cause of primary amenorrhea. The AMA’s action reiterated the association’s long-standing policy of support for a physician-directed system of medical peer review rather than a federally-directed program. Rectal and vaginal palpation may help in locating the hernia sac which can be felt as a tender swelling in the area of the obturator foramen. Six have been selected to demonstrate different techniques of repair. Indeed, in 538 patients from nine case-series summarized by Ross and Vande Wiele, 2 congenital absence of the vagina ranked second only to gonadal dysgenesis as a cause of primary amenorrhea. Difficul- ties with the law increased and objections to the program grew, and in December 1980 the American Medical Association’s House of Delegates called for repeal of the program. The partial tears are the ones that go onto false aneurysm formation, and of these patients left untreated, 80- 90% will die from rupture if left unattended for greater than three weeks. Aortogram showing peri-aortic hematoma and intimal disruption. On the eighth day the styrofoam mold was removed and the Figure 2 . The law does not preclude a medical society from contracting as an UQCPRO, and some societies have expressed an interest in exploring the possibilities of bidding on contracts.

Kirsh from the University of Michigan cited their 10 year experi- ence with 43 patients. Illustration depicting proximal and distal insertion sites of heparin bonded shunt. vagina irrigated with saline and hydrogen peroxide. The secretary may designate a local or region- al area where the volume of review activity justifies the action, but the law’s provision for consolidation of geographic areas is expected to produce less than the 194 review areas established under the old PSRO law.

If in- carceration is present, the lower portion of the obtur- ator membrane should be incised, since the vessels and nerves lie lateral to the sac in 50-60% of the cases. M.: Gray’s Anatomy, Philadelphia, Lea & Febiger, 1967, 502. A heparin bonded shunt was utilized in each patient to bypass the injury. In this report we present a case of congenital absence of the vagina associated with renal and skeletal abnormalities. M.: Congenital absence of the vagina: Clinical and psychologic aspects. The Mississippi State Medical Association’s House of Delegates, in May of 1982, also adopted a statement encouraging the elimination of all govern- ment direction of peer review programs, including PSRO.

At the time of surgery the pelvis can be inspected and the herniated contents reduced. The patients were taken immediately to the operating 4 JOURNAL MSMA room and all injuries were approached through a left thoracotomy. The presenting complaint of afflicted women is failure to menstruate or failure to successfully achieve coitus. The action also was consistent with the Administra- tion’s advocacy of competition in health care as a means of encouraging private enterprise to promote quality medical care at a reasonable cost and to initiate necessary review systems.

The New York Academy of Medicine Gift from the Publisher Digitized by the Internet Archive in 2016 https://archive.org/details/journalofmississ24unse January 1983 State Medical Association Incarcerated Obturator Hernia Blunt Thoracic Aortic Injuries Management of Vaginal Agenesis: Report of a Case A Look at the Peer Review Improvement Act of 1982 Mississippi Foundation for Medical Care in Review Kidney Care fills a need. Inc., is filling an urgent need by providing limited care treatment facilities throughout Mississippi. Once aortography has confirmed the di- agnosis, operative repair is mandatory as soon as possible. Upon questioning, she reported that her vagina became lubricated with sexual stimulation; she was orgas- mic. A function of UQCPRO is to determine whether the services furnished are or were reason- ably and medically necessary, whether the quality of services furnished meets professionally recognized standards, and whether the services furnished could be “effectively provided more economically on an outpatient basis or in a different type of health care facility.” That wording differs from PSRO statutory language, which referred to “appropriate health care setting,” and did not specify outpatient or different type of health care facility.

Mississippi has the highest rate of chronic kidney failure in the nation. Kidney Care is a national leader in “home care”, training patients to dialyze at home for increased cost efficiency and greater patient well-being. Only severe neurological injury requiring immediate intervention or exsanguinating bleeding as from ruptured spleen takes precedent over repair of the aortic injury. Discussion Vaginal agenesis has been known since an- tiquity. The review process is similar to the review con- ducted by PSROs, with the UQCPRO authorized to make conclusive determinations, notify the practi- tioner or provider of claim disapproval and provide an opportunity to discuss a negative determination, including appeal if necessary.