Showing papers by "Ralph B. D'Agostino published in 1985"

Maternal factors in onset of Huntington disease.

Abstract: Analyses of father-offspring and mother-offspring similarity in onset age suggest that nuclear genes account for a significant portion of the modification of onset age in Huntington disease. The effects of non-nuclear modifiers are supported by the finding that the offspring of affected women have significantly older mean ages of onset than offspring of affected men irrespective of the onset age in the parent. The absence of increased father-daughter similarity indicates that modification is not X-linked. The absence of reproductive advantage for late-onset individuals and the absence of a multigenerational maternal-lineage effect suggest that the modifying effect of the sex of the affected parent occurs in a single parental generation. Offspring of affected women with onset between ages 35 and 49 had a significantly older mean onset age than their mothers. This suggests that a protective effect may be conferred upon the offspring of affected women.

Optimal Identification of the Patient with Acute Myocardial Ischemia in the Emergency Room

Abstract: Although angina pectoris was meticulously described more than 200 years ago by Heberden [1] and the presentation of myocardial infarction was first reported 50 years ago by Herrick [2], accurate identification of acute ischemic heart disease (AIHD) in the emergency room (ER) remains a task that challenges the skill of the most seasoned clinician. In the United States, for each coronary care unit (CCU) patient in whom AIHD is confirmed, two patients are admitted with this as an ER diagnosis. There are great costs to patients and to the medical reimbursement system resulting from the large number of false-positive AIHD diagnoses and the resulting CCU overuse. Since each year in this country more than 1.5 million patients with suspected AIHD are admitted to CCUs, even a modest improvement in admitting practices would yield substantial savings. Additionally, many patients would be spared the needless physical and psychological side effects resulting from unnecessary admission to intensive care units. This chapter reviews studies that have attempted to optimize AIHD diagnostic accuracy in the ER setting.