Showing papers in "Annals of Internal Medicine in 1975"
TL;DR: Recognizing greater left ventricular mass and volume in well-trained athletes aids in interpreting values deviating from "normal" limits.
Abstract: Little is known about the structure of athletes' hearts of anatomic variations associated with training. Echocardiograms of 56 active athletes were obtained. Mean left ventricular end-diastolic volume and mass were increased in athletes involved in isotonic exercise, such as swimming (181 ml, 308 g) and running (160 ml, 302 g), compared with controls (101 ml, 211 g); wall thickness was normal (less than or equal to 12 mm). Athletes involved in isometric exercise, such as werstling and shot putting, had normal mean left ventricular end-diastolic volumes (110 ml, 122 ml), but increased wall thickness (13 to 14 mm) and mass (330 g, 348 g). Thus, athletes participating in isotonic exercise had increased left ventricular mass with cardiac changes similar to those in chronic volume overloads. Athletes participating in isometric exercise had increased left ventricular mass with cardiac changes similar to those in chronic pressure loads, recognizing greater left ventricular mass and volume in well-trained athletes aids in interpreting values deviating from "normal" limits.
755 citations
TL;DR: It is suggested that these lymphoproliferative disorders be grouped together as "cutaneous T-cell lymphomas", because the anergy noted in patients of this group with leukemia probably is related to both decreased percentages of normal T cells and presence in the serum of macrophage migration inhibitory activity.
Abstract: Substantial evidence has accumulated to indicate not only that mycosis fungoides and the Sezary syndrome are closely related malignancies, but to suggest that they are part of a larger spe...
602 citations
TL;DR: Of 248 patients with giant cell arteritis, 34 had evidence that the disease affected the aorta or its major branches, and angiography, performed in 10 patients, was helpful in indicating arteritis rather than atherosclerosis as the cause of large artery disease.
Abstract: Of 248 patients with giant cell arteritis, 34 had evidence that the disease affected the aorta or its major branches. Symptoms suggestive of large artery involvement were intermittent claudication of an extremity, paresthesias, and Raynaud's phenomenon. Physical findings included absent or decreased large artery pulses and bruits over large arteries. Four patients presented with decreased upper extremity pulses as the initial manifestation of their arteritis. Nine other patients under treatment for temporal arteritis or polymyalgia rheumatica first developed evidence of large artery involvement as corticosteroid therapy was tapered or discontinued. Angiography, performed in 10 patients, was helpful in indicating arteritis rather than atherosclerosis as the cause of large artery disease. Three patients died with aortic rupture, and, at autopsy, widespread giant cell arteritis was found. However, when corticosteroids were given in adequate doses, the response was favorable in most patients; intermittent claudication decreased and the pulses improved.
476 citations
TL;DR: Factors predisposing to the high serum concentrations in the patients with seizures were both higher drug dosage, compared with the other groups, and hepatic dysfunction, which was more common in both groups with drug-related symptoms.
Abstract: Eight patients developed grand mal seizures during intravenous theophylline therapy None had a history of neurologic disorder, and all were acutely ill with severe pulmonary or cardiovascular disease, or both Serum theophylline concentrations obtained within 1 hour of the seizure ranged from 25 mug/ml to 70mug/ml, with a mean value (53 plus or minus 48 mug/ml) more than twice the upper limit of the recommended therapeutic concentration This serum theophylline concentration was greater than the concentration found in a group of patients with less severe drug-related symptoms (35 plus or minus 18 mug/ml, P less than 001) A third group of patients without drug-related symptoms had a mean theophylline serum concentration of 19 plus or minus 20 mug/ml, which was less than that found in either group with toxicity symptoms (P less than 005) Factors predisposing to the high serum concentrations in the patients with seizures were both higher drug dosage, compared with the other groups (P less than 001), and hepatic dysfunction, which was more common in both groups with drug-related symptoms
414 citations
TL;DR: It is concluded that platelet aggregation may be increased early in diabetes mellitus and may be involved in the genesis of diabetic microangiopathy.
Abstract: In view of the tendency toward vascular disease in diabetes mellitus, we studied platelet aggregation in 15 normal, 7 prediabetic, 12 latent, and 20 frankly diabetic subjects. Platelets fr...
333 citations
TL;DR: There were distinct profiles of antinuclear antibodies in certain systemic rheumatic diseases, characterized by the presence or absence of certain antibodies and by differences in their mean titers.
Abstract: The prevalence of different antinuclear antibodies was examined in systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, progressive systemic sclerosis, dermatomyositis, discoid lupus erythematosus, and mixed connective tissue disease. Antibody to Sm antigen (a nuclear acidic protein) was found almost exclusively in serums of patients with systemic lupus erythematosus, suggesting that this antibody might be a "marker" antibody for this disease. However, antibodies to native DNA and to nuclear ribonucleoprotein were found in a variety of systemic rheumatic diseases. In systemic lupus erythematosus, antibody to native DNA was present in high titer but in other rheumatic diseases in low titer. Antibody to nuclear ribonucleoprotein occurred in certain other systemic rheumatic diseases besides the mixed connective tissue disease syndrome. These studies showed that there were distinct profiles of antinuclear antibodies in certain systemic rheumatic diseases, characterized by the presence or absence of certain antibodies and by differences in their mean titers.
325 citations
TL;DR: The LAF plus A and the W plus A patients had higher complete remission rates and longer median survival than the unprotected ward patients and those who could not tolerate the antibiotics had an incidence of infection comparable to the ward patients.
Abstract: Reverse isolation and prophylactic oral nonabsorbable antibiotics were evaluated among 64 consecutive noninfected adults with acute nonlymphocytic leukemia admitted for remission induction. Patients were randomly allocated to laminar air flow room reverse isolation with oral nonabsorbable antibiotics (LAF plus A), routine hospital ward care with antibiotics (W plus A), or ward care alone (W). The LAF plus A patients had a significantly decreased incidence of total infection, bacteremias, pneumonias, rectal abscesses, urinary tract infection, and pharyngitis. Infectious deaths were reduced in the LAF plus A group and the time to the first infection or to fatal infection was delayed. The W plus A patients who regularly ingested the antibiotics had a reduction in infections similar to that of the LAF plus A patients but those who could not tolerate the antibiotics had an incidence of infection comparable to the ward patients. The LAF plus A and the W plus A patients also had higher complete remission rates and longer median survival than the unprotected ward patients.
310 citations
TL;DR: The objective was to establish an experimental procedure and show direct results that unequivocally can be assigned as safe and effective handwashing procedures for the prevention of nosocomial infections.
Abstract: Handwashing is generally considered the most important procedure in preventing nosocomial infections, because many types of these infections may be caused by organisms transmitted on the hands of personnel. Personnel should wash their hands before and after significant contact with any patient. The risk of personnel acquiring transient hand carriage of organisms is usually greatest after contact with excretions, secretions, or blood; patients at greatest risk are those undergoing surgery, those with catheters, and newborn infants. Although handwashing with an antiseptic agent between patient contacts is theoretically desirable, handwashing with soap, water, and mechanical friction are sufficient ro remove most transiently acquired organisms. Antiseptic agents may produce excessively dry skin if used frequently, and any regimen of handwashing that leads to dermatitis negates the purpose of handwashing. We favor antiseptics for handwashing before surgery and other high-risk invasive procedures and in the care of newborn infants but prefer soap and water for other handwashing.
307 citations
TL;DR: Most patients with staphylococcal prosthetic valve endocarditis should undergo cardiac valve replacement in addition to antimicrobial therapy, and closely monitored anticoagulant therapy should be cautiously continued in patients with prosthetic valves endocarditas.
Abstract: From January 1963 until January 1974, 45 patients had prosthetic valve endocarditis. Symptoms of prosthetic valve endocarditis developed within 2 months after operation (early onset) in 16...
290 citations
TL;DR: In this article, the authors compared two daily corticosteroid regimens for the treatment of giant cell arteritis, and found that the arteritis seemed to be completely suppressed in 18 patients in group A and 16 in group B but in only 6 in group C.
Abstract: Alternate-day corticosteroid therapy was compared with two daily corticosteroid regimens for the treatment of giant cell arteritis. In a prospective study 60 patients with this disease were randomly assigned to three treatment groups: group A, 15 mg of prednisone every 8 hours; group B, 45 mg of prednisone every morning; and group C, 90 mgof prednisone every other morning. After 1 month of treatment, the arteritis seemed to be completely suppressed in 18 patients in group A and 16 in group B but in only 6 in group C. In the 14 other patients in group C, the continuing symptoms were cyclic and developed during the day steroids were not given. By changing to a daily regimen, the arteritis was controlled in most patients in group C. Adverse reactions to prednisone were noted frequently in groups A and B but rarely in group C.
272 citations
TL;DR: A diffusible tumor angiogenesis factor seems to be responsible for the growth of solid tumors that has unique properties in avascular phase and vascular phase.
Abstract: The growth of solid tumors has an avascular phase and vascular phase. These discrete phases each have unique properties; a diffusible tumor angiogenesis factor seems to be responsible for ...
TL;DR: The clinical and biochemical features of type III hyperlipoproteinemia are described in 49 patients from 23 to 70 years of age, and an increase in very low-density lipoproteins (VLDL) of abnormal chemical composition was the basis for diagnosis.
Abstract: The clinical and biochemical features of type III hyperlipoproteinemia are described in 49 patients from 23 to 70 years of age. An increase in very low-density lipoproteins (VLDL) of abnor...
TL;DR: This study showed a strong association between serologic evidence of type B hepatitis and patterns of sexual behavior, however, whether or not transmission of hepatitis type B virus occurs through vaginal intercourse could not be ascertained.
Abstract: There is a significant excess of serologic evidence of hepatitis type B infection in two high-promiscuity populations: patients with venereal diseases and their unrelated sexual contacts (...
TL;DR: It is concluded that bilateral trephine bone marrow biopsies should be routinely performed when searching for tumor in the bone marrow.
Abstract: We have evaluated the usefulness of bilateral rather than unilateral posterior iliac spine trephine biopsies in searching for lymphoma and other neoplastic diseases in the bone marrow. Two hundred and eighty-two patients with these diseases were studied. Tumor was found on only one side in 22% of patients with non-Hodgkin's malignant lymphoma, in 43% of patients with Hodgkin's disease, and in 36% of patients with other neoplastic processes. Thus, the second biopsy yields an additional 11% to 22% of positive biopsies. We conclude that bilateral trephine bone marrow biopsies should be routinely performed when searching for tumor in the bone marrow.
TL;DR: The data suggest that the aminopyrine breath test is a safe, simple, qualitative and quantitative liver function test.
Abstract: The rate of hepatic metabolism of dimethylaminoantipyrine (aminopyrine), which occurs primarily through N-demethylation, was assessed by measurement of the specific activity of14CO2excrete...
TL;DR: For example, Placental proteins and their unique subunits are not normally detected in the circulation, even with immunoassays sensitive to 1 ng/ml as discussed by the authors, and their presence in the serum of a man or non-pregnant woman is unknown.
Abstract: Placental proteins and their unique subunits are not normally detected in the circulation, even with immunoassays sensitive to 1 ng/ml. Their presence in the serum of a man or nonpregnant ...
TL;DR: Based upon current understanding of the epidemiology of nosocomial urinary tract infections, guidelines for the prevention of catheter-associated urinary tract infection are presented.
Abstract: The most common site of nosocomial infection, involving more than 400 000 patients in this country annually, is the catheterized urinary tract. These infections cause significant morbidity, prolong hospital stay, increase hospitalization costs, and contribute to mortality caused by Gram-negative septicemia. Strict adherence to appropriate infection control procedures is necessary if the incidence and sequels of catheter-related infections are to be reduced. Based upon current understanding of the epidemiology of nosocomial urinary tract infections, guidelines for the prevention of catheter-associated urinary tract infections are presented.
TL;DR: Sublingual medroxyprogesterone acetate therapy is useful in the management of the Pickwickian syndrome and causes improvement in both the oxygen and carbon dioxide tensions.
Abstract: Ten patients with the Pickwickian syndrome, characterized by obesity, hypoxemia, hypercapnia, polycythemia, and cor pulmonale, underwent long-term treatment as outpatients with medroxyprogesterone acetate. Although there was no significant weight change in the group, PaO2 rose 12.6 +/- 2.7 mm Hg (SEM) from 49 +/- 2.6 mm Hg to 62 +/- 2.3 mm Hg (P less than 0.001), while PaCO2 fell 13 +/- 2.6 mm Hg from 51 +/- 1.9 mm Hg to 38 +/- 1.2 mm Hg (P less than 0.001). Hematocrit fell from 56 +/- 2.5% to 50 +/- 1.2%, a mean fall of 6% (P less than 0.01), during medroxyprogesterone acetate therapy. In the 2 patients who had cardiac catheterization before and during medroxyprogesterone acetate therapy, mean pulmonary arterial pressure fell 13 and 19 mm Hg. There were no recurrences of cor pulmonale during treatment. These effects on arterial blood gas values and clinical state were sustained during therapy. On withdrawal of medroxyprogesterone acetate during 1-month period, arterial oxygen and carbon dioxide tensions deteriorated to their previous pretreatment values. Reinstitution of medroxyprogesterone acetate caused improvement in both the oxygen and carbon dioxide tensions. We conclude that sublingual medroxyprogesterone acetate therapy is useful in the management of the Pickwickian syndrome.
TL;DR: A striking relation of FVC to mortality was noted in both sexes, which was not accounted for by associated cigarette habits, which is not responsible for the decline in the older age groups.
Abstract: The relation of pulmonary function to aging and cigarette habits has been examined cross sectionally and longitudinally in the Framingham cohort. On cross-sectional analysis, women were found to have lower forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV-1) values than men even after adjusting for height. Their FEV-1 percent was, on the other hand, higher than those of men. As the population aged over 10 years, their FVC and FEV-1 declined 9% to 27% depending upon age and sex. The FEV-1 percent, however, showed a decline only in the older age groups. In a cross-sectional analysis, cigarette smoking showed an inverse association to FVC and FEV-1 percent. Longitudinally, cigarette smokers showed a more rapid decline in FVC in 10 years than nonsmokers. On giving up smoking their FVC became more like that of the nonsmokers. A striking relation of FVC to mortality was noted in both sexes, which is not accounted for by associated cigarette habits.
TL;DR: Data show that pulmonary calcification occurs with high frequency in patients undergoing long-term hemodialysis and that such lesions are associated with restrictive and diffusion ventilatory defects.
Abstract: A prospective study of 31 chronically hemodialyzed patients was made to investigate the incidence and pathology of pulmonary calcification and the relation of the latter to ventilatory function. Fifteen of the patients have died thus far; 9 had evidence of lung calcification. The lesions occurred predominately in alveolar septa and were associated with varying degrees of fibrosis and alveolar septal thickening. Only one patient had X-ray evidence of calcification. An X-ray diffraction analysis showed a predominant pattern of whitlockite (CaMg)3(Po4)2 in deposits. Patients with the severest pulmonary calcification had abnormalities of vital capacity, carbon monoxide diffusion, and Po2. Serum calcium levels were slightly higher in patients with calcification, but there was no measurable association with the duration of dialysis, serum phosphorus, calcium X phosphorus product, magnesium, bicarbonate, or arterial pH. These data show that pulmonary calcification occurs with high frequency in patients undergoing long-term hemodialysis and that such lesions are associated with restrictive and diffusion ventilatory defects.
TL;DR: Cytotoxic drugs, which are widely used as immunosuppressive and antiinflammatory agents in patients with neoplastic conditions, and cancer chemotherapy preparations, are of long-range concern due to the problem of cumulative organ toxicity which is not manifested until damage is extensive.
Abstract: Cytotoxic drugs are being widely used as immunosuppressive and anti-inflammatory agents in patients with nonneoplastic conditions. In addition, patients with specific forms of malignancies...
TL;DR: The data imply that, in at least some cases, isolation of Gram-negative rods from sputum of untreated patients may be a normal finding, and that in some patients with pulmonary infection, the pretreatment, upper respiratory tract flora may serve as the source of subsequent superinfection with Gram- negative rods.
Abstract: We obtained throat cultures from 100 randomly selected people free from any chronic upper or lower respiratory disease who did not work in a hospital and who had not experienced any acute illness or received any antibacterial therapy in the 4 weeks preceding culture. Eighteen percent harbored either a species of Enterobacteriaceae or Pseudomonas aeruginosa in their pharynx. In all cases, colony counts were low, the majority being detected in broth media selective for Gram-negative rods. There were no clear-cut age or sex distributions of Gram-negative pharyngeal carriage. These data imply that, in at least some cases, isolation of Gram-negative rods from sputum of untreated patients may be a normal finding, and that in some patients with pulmonary infection, the pretreatment, upper respiratory tract flora may serve as the source of subsequent superinfection with Gram-negative rods.
TL;DR: From 1961 through 1973, 60 patients with brain abscess were treated at the Mayo Clinic by surgical excision and antimicrobial therapy, which was identical to a similar series reported in 1959.
Abstract: From 1961 through 1973, 60 patients with brain abscess were treated at the Mayo Clinic by surgical excision and antimicrobial therapy. The operative mortality was 17%, which was identical to a similar series reported in 1959. The patients who had the diagnosis of brain abscess confirmed at autopsy and who never underwent operation (24 patients) were more elderly than the group operated on, and a higher percentage had multiple brain abscess. Severe systemic disease or multisystem disease, or both, usually precluded a vigorous surgical approach among the nonsurgical group. Etiologic, diagnostic, and microbiologic factors were examined to develop an approach to antimicrobial therapy.
TL;DR: It is concluded that the chemical index to VLD lipoprotein composition is the better, albeit, temporary definition for this disorder.
Abstract: Two current definitions of type III hyperlipoproteinemia, "floating beta" lipoproteins and an estimate of the relative content of cholesterol and triglyceride in lipoproteins of density le...
TL;DR: Primary hypopituitarism due to a hypothalamic lesion after radiotherapy for nasopharyngeal cancer may be more common than suspected and primary hypothyroidism may result from irradiation of regional neck nodes.
Abstract: Endocrine complications after radiotherapy for tumors of the head and neck are thought to be relatively rare. The availability of synthetic hypothalamic hormones for clinical investigations and the radioimmunoassay of hormones have enabled us to study function of the hypothalamic pituitary axis in 15 patients who had radiotherapy for nasopharyngeal cancer. Fourteen had evidence of endocrine deficiency. Twelve patients had evidence of hypothalamic dysfunction, 7 developed primary pituitary hormone deficiencies, and 3 developed primary hypothyroidism. These results indicate that [1] secondary hypopituitarism due to a hypothalamic lesion after radiotherapy for nasopharyngeal cancer may be more common than suspected in the past; [2] primary hypopituitarism after irradiation of extracranial tumors can occur; and [3[ primary hypothyroidism may result from irradiation of regional neck nodes.
TL;DR: One hundred patients with Parkinson's disease, who started taking levodopa before the end of 1968, have been assessed after 5 years as discussed by the authors, and the average functional rating is returning toward baseline from its remarkable improvement at 1/2 to 2 years.
Abstract: One hundred patients with Parkinson's disease, who started taking levodopa before the end of 1968, have been assessed after 5 years. Forty-seven patients are still being followed on levodopa, and half of them are at least 25% better than at their pretreatment evaluation. However, the average functional rating is returning toward baseline from its remarkable improvement at 1/2 to 2 years. Abnormal involuntary movements, rapid oscillations in motor performance, postural instability, and dementia have become the major adverse effects. Thirty-two of the 100 patients have died. Life-table analysis shows an excess mortality of 1.9 compared with the U.S. population, a figure that is lower than the 2.9 reported before levodopa's use. Despite its inability to cure Parkinson's disease, levodopa provides symptomatic relief for a prolonged time and it remains the single most effective medication for the illness.
TL;DR: Although the clinical and pathologic abnormalities were those of Goodpasture's syndrome, immunofluorescence microscopic studies in the one case tested showed an interrupted, rather than linear, fluorescence pattern.
Abstract: Fatal pulmonary hemorrhages and rapidly progressive glomerulonephritis occurred in three patients with Wilson's disease (hepatolenticular degeneration) who had been treated with penicillam...
TL;DR: In a female patient with unexplained anemia, ascorbic acid ingestion and apparent false-negative occult blood tests were related and her stools became strongly reactive by three tests for occult stoolBlood tests remained reactive throughout this observation, and the observation was confirmed by in-vitro studies.
Abstract: In a female patient with unexplained anemia, ascorbic acid ingestion and apparent false-negative occult blood tests were related. When she stopped ascorbic acid, her stools became strongly reactive ("4+") by three tests for occult stool blood; this association was observed repeatedly. A test developed to measure stool occult blood in the presence of ascorbic acid remained reactive throughout this observation, and the observation was confirmed by in-vitro studies. Current tests for occult blood depend on the pseudoperoxidase activity of heme and are inhibited by low levels of ascorbic acid. Reducing substances chemically similar to ascorbic acid also inhibits occult blood tests; oxidized ascorbic acid and sulfhydryl reducing agents do not inhibit them at physiologic levels.
TL;DR: The pattern of inheritance in this kindred suggests either a single or two closely linked autosomal dominant determinants for gastrointestinal carcinoma and polyposis.
Abstract: A kindred contained at least 10 members with single or multiple juvenile polyps of the stomach and large intestine. Several additional polyps had both adenomatous and juvenile features. Eleven members of the kindred have had gastrointestinal carcinoma of the stomach, duodenum, pancreas, or proximal colon. The pattern of inheritance in this kindred suggests either a single or two closely linked autosomal dominant determinants for gastrointestinal carcinoma and polyposis. Management of this kindred is complicated due to the occurrence of gastrointestinal carcinoma without polyposis.
TL;DR: Although definitive evidence of communicability was not established, patients with suspected or proved pneumocystis pneumonia are now isolated in this hospital.
Abstract: An unusual cluster of 11 patients withPneumocystis cariniipneumonia occurred in a 3-month period at Memorial Hospital, New York. Ten of the 11 patients had lymphoma or leukemia. In 7 patie...