Showing papers in "A.M.A. archives of internal medicine in 1958"

Transmission of the Common Cold to Volunteers Under Controlled Conditions: I. The Common Cold as a Clinical Entity

Abstract: The common cold is one of the most frequent and universal infections of man. Nevertheless, little is known regarding its specific etiology, and the diagnosis must be a clinical one. Until the infectious agent can be propagated, characterized by microbiologic and pathologic methods and consistently transmitted to experimental animals or in tissue cultures, transmission to humans appears to be the best method for study. In this manner, information can be obtained about the nature of the infection, factors that influence the susceptibility or resistance of the human host, and conditions that favor spread of the illness. During the past five years we have made observations upon more than 1000 volunteers who were challenged with infectious nasal secretions obtained from persons with a common cold or with a blank solution used as a control. The clinical findings were re- corded daily. Examination of the nose and throat was of no value

Familial Mediterranean fever.

Abstract: I. Introduction The purpose of this communication is to describe a disease which we define as a heredofamilial syndrome of undetermined pathogenesis in persons of Mediterranean stock, becoming manifest as a rule in infancy or adolescence and characterized by short recurrent bouts of fever accompanied by pain in the abdomen or chest or one or multiple joints, singly or in various combinations. Sometimes erysipelas-like erythemata appear. A certain number of cases terminate fatally through supervening renal involvement. This is not a new disease, nor have we been the first to describe it. Typical examples may be found in literature, especially in French papers of the last decade. 1-30 Various names have been attached to the case reports, the best known of which are probably "benign paroxysmal peritonitis" 4 and "periodic disease." 5 Many of these papers include within their series cases which bear only a superficial resemblance, if any, to

Textbook of Physiology and Biochemistry.

Abstract: This is one of the clearest and best illustrated textbooks of physiology I have had the opportunity and the pleasure to read. The biochemical portion of this book is on the weak side in reference to its use as a biochemical text as is usually used in this country. But it is adequate for most students and should be a valuable supplement to those who cannot understand the present-day complexities of modern biochemistry. It is a text that it would be well to have on a practitioner's desk. It does not attempt to cover the clinical applications of either physiology or biochemistry. It is an honest straightforward presentation of a basic science. Understand this, and the application will come easily. Steven M. Horvath, M.D.

Surfeit and deficit of sodium; a kinetic concept of sodium excretion.

Abstract: Normal man can maintain an over-all sodium balance at intakes varying from a few to 1000 mEq. or more of sodium daily. Although this balance is customarily referred to as a steady state, at all levels of sodium intake higher than a few milliequivalents daily it represents in reality a constantly fluctuating level of total body sodium. Each time sodium is ingested a positive balance is produced which is steadily reduced in the following hours by way of renal sodium excretion. This is well illustrated in a study from this laboratory1in which identical meals and quantities of salt were administered to constantly recumbent subjects at six-hour intervals. Figure 1, plotted for the second day of this study, reveals that the sodium ingested at the beginning of each six-hour period has just about been eliminated by the end of the period, save for the night hours, particularly from midnight

The Student-Physician: Introductory Studies in the Sociology of Medical Education.

Abstract: Anyone interested in teaching medical students should read "The Student-Physician." He will have to be very much interested in it to read the whole thing, because at least parts of it are written as though the writer were paid a bonus for superfluous words. Here is an example: "But whatever the consequences of these differences and these remain to be identified, it can be seen that the criteria and procedures for admission not only have the manifest function of selecting individuals more or less suited to the role of physician but also the indirect and latent function of producing a distinctive social environment for each student. In other words, the procedures and criteria of selection not only involve the psychological consideration of the personal qualities of each individual student but also the sociological consideration of the composition of the total student body." Far too many of the words are padding

An Autoimmune Reaction Against Human Tissue Antigens in Certain Acute and Chronic Diseases: I. Serological Investigations

Abstract: During the course of investigations aimed at detecting infectious hepatitis virus antigen in human livers from patients dying early in the course of fulminating infectious hepatitis with acute yellow atrophy of the liver, many human sera were found to react with liver antigen with fixation of complement in a manner indistinguishable from classical antigen-antibody complementfixation reactions. It has subsequently been possible to demonstrate specific complement fixation, in some cases in extraordinarily high titer, with human sera from patients suffering from a number of different diseases, using saline suspensions of finely homogenized normal human tissues as antigens. In a preliminary communication 1 I reported study of 190 human sera by this technique, with the finding of high incidence of positive reactions in disseminated lupus erythematosus, "lupoid hepatitis" (see below), other chronic hepatitides, and macroglobulinemia. The current report is concerned with extension of these studies in these and other diseases and to

The Role of Hemodialysis (Artificial Kidney) in Acute Poisoning

Abstract: The role of the artificial kidney in acute human poisoning may be considered in two distinct categories: (1)dialyzable poisons, wherein the rate of removal is critical to the welfare of the patient, and (2)nephrotoxic poisons, which produce damage to the kidneys and are not qualitatively different from other causes of acute renal insufficiency. In some instances, general toxicity may be produced from the poison itself, while in others it is a product of the uremic syndrome. It is the purpose of the present study to review eight years of experience with clinical dialyses in acute poisonings and to summarize related studies, with particular emphasis on the role of the artificial kidney in dialyzable poisons. Dialyzable Poisons The effective use of hemodialysis in any acute poisoning is based on the following assumptions: That the poison molecule can diffuse through cellophane from plasma water and has a reasonable removal rate,

An analysis of five hundred percutaneous renal biopsies.

Abstract: No matter how important are new discoveries and methods, they cannot be considered to have reached fulfilment until generally applied to the sick. W. B. Castle, 1939* The development of a safe7and relatively simple method of doing percutaneous renal biopsies has provided the physician and the clinical investigator with a new and useful tool for the study of renal diseases.7,8Elsewhere we have discussed in some detail its value to the patient and the physician.9By its use, exact histologic diagnoses can be made which provide a sound background for etiology, diagnosis, treatment, and prognosis. The procedure has also been used to obtain cultures of organisms from infected kid- neys; to study, by serial biopsies, the natural history of diseases involving the kidney; to study reversible diseases of the organ, and to assess the effects of drugs on renal and cardiovascular diseases.10-21 Renal biopsies have

Intrathecal Amethopterin in Neurological Manifestations of Leukemia

Abstract: The difficulty in managing acute leukemia in children is enhanced by the occurrence of neurological manifestations. It is especially true when this component of the disease occurs, as it may, during a period with few positive physical findings and a bone marrow in remission. Prior to the use of current chemotherapeutic agents, leukemic-cell invasion of the parenchyma of the brain, meninges, and cranial nerves was noted frequently at postmortem examination.1,2At times this involvement was closely correlated with clinical symptoms which presented early in the course of the disease. At present the leukemic child who develops central nervous system manifestations often does so while being given maintenance antileukemic therapy months after the initial diagnosis is made. This suggests that these current agents are only partially effective against the leukemic cell in the central nervous system in the conventional dosage and route of administration. To supplement the incomplete response of

An autoimmune reaction against human tissue antigens in certain acute and chronic diseases. II. Clinical correlations.

Abstract: The serum from a proportion of patients suffering from acute viral hepatitis, active chronic hepatitis, and other parenchymatous diseases of the liver, disseminated lupus erythematosus (D L E) and other "collagen diseases"; macroglobulinemia and multiple myeloma, and certain other conditions has been shown by one of us 1,2 to contain antibody-like substances which fix complement in the presence of human tissue homogenates This reaction has been designated autoimmune complement fixation (AICF) This serum activity could represent an adventitious chemical reaction not evoked by any antecedent antigenic stimuli, and it may be impossible in any given case to exclude this Nevertheless, such an explanation has none of the heuristic value of the autoantibody hypothesis, and for the reasons given by one of us 2 we have adopted the view that these substances are autoantibodies which have developed as a result of the pathological antigenicity of some human tissue component For many years

The Shock Syndrome Associated with Bacteremia Due to Gram-Negative Bacilli

Abstract: Antibiotics have caused remarkable changes in the incidence and management of infectious diseases Infections due to Gram-positive organisms, notably those caused by pneumococci and streptococci, have diminished in incidence and in severity On the other hand, this decline has been paralleled by a decided increase both in the frequency and in the severity of disease caused by Gram-negative bacteria, including the coliform group1-9 This changing pattern has been attributed to at least two factors First, the Gram-positive bacteria are effectively suppressed by chemotherapeutic agents Secondly, there has been the emergence of an increasingly larger proportion of Gram-negative micro-organisms that are highly resistant to the action of available antibiotics1-4Studies in individual patients have shown that the relatively nonpathogenic strains of bacteria, such as Escherichia coli, Proteus vulgaris, Aerobacter aerogenes, or Pseudomonas aeruginosa, may actually invade and cause infection during the course of antibiotic treatment5-9This paradox has

A follow-up study of hereditary chronic nephritis.

Abstract: In 1951 we reported the genetically predictable occurrence of chronic renal disease with associated nerve deafness in a large family. 1,2 One hundred thirty-four members of the family were examined, and adequate clinical data were available concerning three of seven males in the family who had died of uremia in the recent or remote past. Of the 44 members involved, 43 had pyuria, 32 had hematuria, all had cylinduria, and for 17 of 32 studied, the urine cultures were positive for bacteria. Of 59 patients studied, 14 had abnormal audiograms. Five of those with hearing deficits showed no evidence of renal disease at the time of examination, but two of these were found to be carriers of the trait for renal disease in that the renal lesion was observed in their descendants. Microscopic sections from one postmortem examination showed severe, diffuse interstitial pyelonephritis with inflammatory infiltrate, microscopic abscesses, normal glomeruli,

The anemia of renal failure.

Abstract: The association of anemia with uremia is a striking one. However, just as the actual pathogenesis of the signs and symptoms associated with renal disease is poorly understood, so also is the mechanism of development of anemia in this syndrome. It is the purpose of these investigations to evaluate the relative importance of productive and destructive defects and to correlate them with the clinical state. Methods and Materials Hemoglobin was measured according to Crosby et al. 1 Reticulocytes were counted by the dry method and expressed as per cent of the 1000 cells counted. Osmotic fragility was measured according to the technique of Shen 2 and increment curves plotted and compared as previously described. Mechanical fragility was measured by a modification of the method of Shen et al., 4 with use of rotation of 35 rpm and a radius of 13 cm. Time intervals varied from 90 to 270 minutes.

Parkinson's Law, and Other Studies in Administration.

Abstract: We have seen a spate of books dealing with the inevitable confusions and frustrations of a society in which institutions proliferate at a rate far faster than any faint improvement in the moral or intellectual capacities of man. We have been told about these in "The Managerial Revolution" and "The Organization Man." Medical people long familiar with Parkinsonism, Parkinson's disease, or Parkinson's syndrome will be pleased to learn of the recent discovery and mathematical demonstration of Parkinson's law. In any event, a citizen purporting to be one C. Northcote Parkinson, "Raffles Professor of History at the University of Malaya," defines briefly and in Parkinson's own and splendid style, Parkinson's law. It holds that in any administrative organization, administrators multiply at a rate of increase of approximately six per cent per annum no matter what. His derivation of the formula shows mathematical genius of a kind never quite achieved by Einstein.

Differences Between Smokers and Nonsmokers

Abstract: Why some men smoke and others do not has never been adequately explained. The question has some medical relevance now that heavy smoking has been shown to have relationship to lung cancer and possibly to coronary disease and since there have been certain therapeutic indications for the control of smoking. It is at least theoretically possible that smoking is often a symptom or sign of physiologic or personality characteristics which themselves may influence disease. The opportunity has recently come to explore some data already collected in respect to differences of physique, physiology, and personality between smokers and nonsmokers. This is a part of a larger study of smoking habits. Charles C. McArthur, Ph.D., is preparing material from the same source on the psychodynamics of smoking, 1 and Carl C. Seltzer, Ph.D., on physique of smokers. The group under study comprises 252 college graduates, now in the age range of 33

Sarcoidosis; clinical observation on one hundred sixty cases.

Abstract: Sarcoidosis can no longer be regarded as a rare disease. A recent investigation disclosed 1194 cases of this disease in Veterans' Administration Hospitals in a five-year interval, 1 and chest x-ray surveys of 1,000,000 inhabitants of Sweden between 1950 and 1954 detected almost half as many cases of sarcoidosis as of tuberculosis. 2 Whether these impressive numbers of cases are merely the result of better recognition or whether sarcoidosis is actually increasing in prevalence remains to be determined. In either event, because of its growing importance, sarcoidosis is a disease with which all physicians should be familiar. Reported here are observations in 160 patients who came under our observation between 1938 and 1956, in clinic, hospital, or office practice. All cases included in this series had one or more biopsies demonstrating epithelioid tubercles. The age and sex distribution of these patients, shown in Table 1, is typical of that observed

A twenty-year appraisal of BCG vaccination in the control of tuberculosis.

Abstract: Few topics in the field of tuberculosis have engendered such divergent opinions as has the use of BCG vaccination in the control of tuberculosis. The views held by the medical profession in the United States on this subject have been either adversely critical, enthusiastic, or skeptical. Unfortunately, some of the unfavorable views have been expressed by those who have had no firsthand experience in this field and whose opinions have been often based on selected reports rather than on a critical review of the available literature. On the other hand, there was little justification for the enthusiasm of some advocates, based as it was on the results either of uncontrolled studies or of studies which were open to criticism. Although the introduction of antimicrobial agents ushered in a new era in the treatment of tuberculosis, the prophylactic value of these agents for man remains to be proved. Foci of tuberculous

A study of heart disease in one hundred eight hospitalized patients dying with portal cirrhosis.

Abstract: The general status of the cardiovascular system in portal cirrhosis has been referred to in many excellent studies. It would appear from these studies that moderate to severe coronary arteriosclerosis is less common in patients with portal cirrhosis up to the age of 55 years than in patients without portal cirrhosis. 5 The incidence of hypertension associated with portal cirrhosis has been recorded as less than that in a similar age group without portal cirrhosis, 3,5,6 although there is not complete agreement on this point. 4 Although not stated implicitly in these studies, it is suggested that serious heart disease may be less common in patients with portal cirrhosis than in the normal population. Materials and Methods In order to assess the incidence and type of heart disease in patients with portal cirrhosis, 108 consecutive patients who died with portal cirrhosis and were autopsied were studied. It should be noted that the patients did not all

Erythropoietic Function in Uremic Rabbits

Abstract: Introduction A moderate or often severe anemia of the normochromic normocytic type is usually present in patients with chronic renal disease. In 1950, Callen and Limarzi 1 made a careful hematologic study of 102 patients with renal disorders and reviewed the literature pertinent to this anemia. They concluded (1) that there was a functional suppression of the normoblastic elements of the bone marrow in renal disease with uremia and (2) that the degree of anemia appeared to be roughly proportional to the impairment in kidney function as measured by the level of nonprotein nitrogen in serum. Kidney pathology per se without retention of nitrogenous products in the blood was not associated with anemia. Recent studies of nephrectomized animals, 2-3 as well as studies of patients with uremia in whom the turnover of radioactive iron was measured, 4-6 have supported these conclusions. Such studies have shown, in addition, that the anemia

The Significance of Nonesterified Fatty Acids in Plasma

Abstract: Recent studies have clarified some aspects of fatty acid transport. The results promise to be of clinical importance, since fat, as a major energy source and as a component of body structure, plays a central role in chronic diseases of metabolism. For example, obesity can be conceived as an abnormal balance between the total amount of fatty acid stored in adipose tissue and its availability as substrate for working cells. Arteriosclerosis is characterized by abnormal deposits of fatty acid esters. Diabetes, although usually defined by high blood sugar, is in fact a general disturbance of metabolism, and its most dangerous complications can be traced to faulty handling of fatty acids. During the past few years a number of laboratories, including ours, have been studying a fatty acid fraction which is remarkable for both its speed of turnover and its close relation to the state of carbohydrate metabolism. This fraction, the

Experience with amphotericin B for the treatment of systemic mycoses.

Abstract: Amphotericin B is an antibiotic produced by a species of Streptomyces. It appears to have no important antibacterial properties, but possesses highly significant activity against those yeast-like fungi which produce deep mycotic infection in man. Table 1 contains the in vitro sensitivities of the major producers of deep mycotic infection in man as determined by various investigators.1-3Our own findings, on Sabouraud's dextrose agar at pH 7, are indicated in the Table. Studies in experimental animals2,3have indicated a good correlation between in vivo effectiveness and in vitro sensitivity to amphotericin B. Animal toxicity studies carried out by the Squibb Institute for Medical Research indicated that amphotericin B had a therapeutic index sufficient to justify clinical trial in human mycotic infections. Several reports4-6of its use in histoplasmosis and cryptococcosis have already appeared in the American literature. Routes of Administration and Toxicity The insolubility of crystalline or

Bilateral Polycystic Disease of the Kidneys: A Follow-Up of Two Hundred and Eighty-Four Patients and Their Families.

Abstract: The physician usually looks at bilateral polycystic disease of the kidneys as an inherited condition characterized by enlarged kidneys, uremia, and a gloomy prognosis and lets it go at that. Dalgaard has made a painstaking analysis of three hundred fifty patients with bilateral polycystic disease of the kidneys, which amply fulfills his stated aim of adding to our knowledge of the heredity and the clinical aspects of this condition. The author began his study by attempting to ascertainallthe cases of bilateral polycystic kidneys that appeared in Greater Copenhagen from 1920 to 1953, inclusive. He examined the card indexes and annual statistics of the medical and surgical departments of the Copenhagen hospitals, the autopsy records of the hospitals (143 propositi were culled from 98,000 autopsy records), the card indices of the radiology departments of the hospitals (he examined all available x-rays of kidneys said to contain cysts of any

Studies in myasthenia gravis; review of two hundred eighty-two cases at the Mount Sinai Hospital, New York City

Abstract: Reviewed for therapeutic results were 282 proved cases of myasthenia who were attending the Myasthenia Gravis Clinic of The Mount Sinai Hospital, New York City. Various statistical studies were presented as an exhibit, which is summarized as follows. Patients with this illness present varying clinical pictures but with the common denominator of muscle fatigability made worse by exercise and partially reversible by rest or the administration of anticholinesterase drugs. Within this broad picture there are many variants, such as sex, age of onset, localization or spread of symptomatology, and prognosis. Sex, Age, and Race There were 188 female and 94 male patients, confirming the previously reported 2:1 sex ratio.1As the clinical picture varied in the over-all group, our tendency was to segregate patients showing similar features. The sex ratio was 1:1 in the milder forms of the disease and varied from two to four females to one male

Observations on Staphylococcus albus septicemia in mice and men.

Abstract: Porcelain-white colonies of Staphylococcus albus in cultures from patients usually are dismissed as nonpathogenic commensals or as contaminants. The recent occurrence of S. albus septicemia in three patients after valvulotomy for mitral stenosis led us to reexamine this subject. Reviews of subacute bacterial endocarditis both in the past and recently show that approximately 1% of cases are caused by S. albus. A survey 36 of cases of staphylococcal bacteremia at this hospital in the years 1936 to 1955 showed that 5 of the 338 cases were caused by this organism. The criteria used for the diagnosis of S. albus septicemia in this study are that the organism should be isolated on two or more occasions from the blood of a sick person with evidence of generalized disease and that no other pathogens should be isolated from the blood. S. albus has for the purpose of this study been accepted as an

The Gastric and Jejunal Mucosae in Healthy Patients with Partial Gastrectomy

Abstract: Studies of the gastric and jejunal mucosae may help to throw a light on some of the postgastrectomy syndromes. In this paper we present the detailed results of 41 biopsies done with a suction biopsy tube. Between March and July, 1956, we saw a number of patients who had had partial gastrectomy or gastroenterostomy for benign ulcers during the previous five years. They had been requested to attend the outpatient clinic, and they were asked if they would volunteer for gastric biopsy. Most of those who attended did accept biopsy, whether they had symptoms or not. At the first interview, one of us (L. C. G.) made a clinical assessment of the patient regarding symptoms and general physical status. A completely unbiased analysis of symptoms was recorded before the results of biopsy were known. Some patients did not attend when requested or for the biopsy session, thus no statistical data

Classics in Arterial Hypertension.

Abstract: Those interested in heart disease, in hypertension, in medical classics, and in medical history will greet the collection of reprints gathered by Ruskin in "Classics in Hypertension" with enthusiastic pleasure. Though it seems to be written into the definition of an anthologist that he omits one's favorite item, I think that no one could find fault with the selection of essays, monographs, and papers included in this volume. The book is divided into two sections, one dealing with methods, the other and larger one, with significance. Ruskin has included a few relatively unknown contributions which are justly considered classics. Omission of the little-known contributions of Hagen to the flow of small tubes done independently and somewhat before Poiseuille's work is not surprising. Recently I called attention to this forgotten discoverer, whom I found out about in Hunter Rouse's "History of Hydraulics." Ruskin himself provided all the translations for this book

The use of diphenylhydantoin (dilantin) sodium in the treatment of ventricular tachycardia.

Abstract: Ventricular tachycardia, which appears in about 2% of the cases, is admitted to be a serious complication of acute myocardial infarction. It most commonly occurs within the first five days but may occur later during the course of the disease, particularly in those patients who have been given digitalis. 1 Spontaneous reversion to a normal sinus mechanism is rare, and it is therefore a situation which calls for prompt, exact diagnosis and therapy. Sabathie 2 has reported the treatment of ventricular tachycardia with morphine sulfate. It has been suggested by Gold 3 that other central nervous system depressants, particularly barbiturates and bromides, might be used for the treatment of ventricular ectopic beats. Harris, 4 noting that the heart and central nervous system respond to many drugs in a similar fashion, reported that diphenylhydantoin (Dilantin) sodium caused cessation of ventricular ectopic activity, produced by ligating the anterior descending coronary artery in

Jejunal and ileal diverticulosis.

Abstract: Recent reports 1-6,29 indicate that diverticula of the jejunum and ileum other than Meckel's diverticulum are not as rare as has generally been thought. Forty-five patients with diverticula of the mesenteric small intestine have been studied at The New York Hospital in an effort to correlate the clinical and radiographic patterns of this condition. Twenty-one cases of jejunal diverticula were previously reported from this hospital and surgical aspects and operative procedures discussed. 29 Meckel's diverticulum has been excluded from this group, since it represents a specific congenital diverticulum of the ileum as a remnant of the omphalomesenteric (vitelline) duct. Diverticula of the jejunum and ileum have been less often recognized radiographically than at autopsy, with incidence reports varying from 0.3% to 1.3% of the hospital population. Special postmortem studies of the small intestine, including air insufflation, have yielded the higher incidence figures. 7 Radiographic study of the small intestine is

The use of serum protein electrophoresis in clinical medicine.

Abstract: Human plasma is a complex solution containing many proteins, probably hundreds, some of which are present only in trace quantities. The distribution of these proteins in the normal adult shows an amazing degree of uniformity. However, in disease states considerable variation in the quantity of the individual plasma protein components takes place, which is referred to asdysproteinemia. Less frequently, certain qualitatively abnormal proteins may develop as a response to disease, and these proteins are referred to asparaproteins. These variations in plasma proteins in disease have intrigued clinicians since the early salt fractionation of human serum at the turn of the century. In 1921, Howe,1utilizing 21.5% sodium sulfate as a simple method of fractionation, precipitated a protein from serum which was defined as "albumin." This quantity of "albumin" subtracted from the total serum proteins (corrected for nonprotein nitrogen) represented "globulin." These two fractions related to the total

The results of five hundred percutaneous renal biopsies.

Abstract: More than eight years have elapsed since the first percutaneous renal biopsy was carried out (Iversen and Brun 6 ), and so far the results of about 1800 renal biopsy attempts have been published. Experience has now become so comprehensive that it is possible to form a broad impression of the nature and frequency of the complications in this procedure. The aim of the present paper has been to examine the more than 500 renal biopsy attempts with any associated complications which have been carried out in Medical Department III of Kommunehospitalet throughout the period May, 1949, to January, 1958. The literature to date contains a number of descriptions of complications in renal biopsy which are worth mentioning in detail. Alwall 1 reported in 1952 that in 1944 he had had 1 death after renal biopsy in a series of 13 biopsies. The death occurred in a patient who went into