Showing papers in "JAMA in 1963"
TL;DR: The Index of ADL as discussed by the authors was developed to study results of treatment and prognosis in the elderly and chronically ill. Grades of the Index summarize over-all performance in bathing, dressing, going to toilet, transferring, continence, and feeding.
Abstract: The Index of ADL was developed to study results of treatment and prognosis in the elderly and chronically ill. Grades of the Index summarize over-all performance in bathing, dressing, going to toilet, transferring, continence, and feeding. More than 2,000 evaluations of 1,001 individuals demonstrated use of the Index as a survey instrument, as an objective guide to the course of chronic illness, as a tool for studying the aging process, and as an aid in rehabilitation teaching. Of theoretical interest is the observation that the order of recovery of Index functions in disabled patients is remarkably similar to the order of development of primary functions in children. This parallelism, and similarity to the behavior of primitive peoples, suggests that the Index is based on primary biological and psychosocial function, reflecting the adequacy of organized neurological and locomotor response.
10,971 citations
TL;DR: It was found that occasionally a dog could survive temporarily on the function of the lung homotransplant alone, especially if the respiratory reflexes from the unexcised lung had been preserved.
Abstract: THE TECHNICAL FEASIBILITY of lung replantation and homotransplantation in animals was established by the work of previous investigators. 1, 2 It was found that occasionally a dog could survive temporarily on the function of the lung homotransplant alone, especially if the respiratory reflexes from the unexcised lung had been preserved. Preservation of these reflexes with exclusion of pulmonary function in this "normal" or contralateral lung was achieved by ligation of the pulmonary artery on this side. In addition to studies demonstrating that either a reimplanted lung or a homotransplanted lung could function fairly effectively to provide a significant degree of pulmonary function, the use of various agents in dogs to suppress the immune response had permitted substantial prolongation of the survival of lung homografts. In our own experience, the lung homograft had been rejected in untreated dogs in an average of from seven to eight days, whereas in dogs
514 citations
TL;DR: This book, although sociological rather than medical, should interest most physicians, since it will help them understand the problems many of their patients face, and may be a basis for mental conflict in the individuals who seek independence.
Abstract: Despite the expectation that ethnic differences would disappear as "true Americans" emerged from the melting pot, many racial and national groups have maintained their identity, and consequently face different problems. Glazer, a sociologist of Jewish family, and Moynihan, a political scientist of Irish background, have reviewed the history of five such ethnic groups in New York, and studied their present status. The authors have synthesized material from the literature with personal observations and have not hesitated to express their own opinions. This book, although sociological rather than medical, should interest most physicians, since it will help them understand the problems many of their patients face. The strong family loyalty of Italians may lead to lack of ambition for education and personal advancement, or may be a basis for mental conflict in the individuals who seek independence. The success of Jews in many areas, with their exclusion from high-level positions in
394 citations
TL;DR: The purpose of this article is to describe a few statistical tools and to illustrate how these tools may be useful in the practice of medicine.
Abstract: PRACTICING PHYSICIANS and statisticians may not seem to have many mutual interests, but perhaps they have more in common than is apparent at first. The purpose of this article is to describe a few statistical tools and to illustrate how these tools may be useful in the practice of medicine. As a starting point, consider a fairly frequently encountered medical problem, diabetes mellitus. According to some physicians, they believe that diabetics are best maintained at slightly elevated blood-glucose levels, but others feel that they should be maintained within limits of clinical normality. Which group is right or are they both right? And what is clinical normality and how is it determined? Suppose we consider the question of clinical normality first, partly because it is relatively easy to discuss and partly because it is a portion of the problem of maintaining diabetics in control. Normal Values According to one textbook, 1
298 citations
TL;DR: In a study of 27 patients with progressive muscular dystrophy of childhood, it was found that duration of ambulation from onset of symptoms could be increased from an average of 4.4 yr to 8.7 yr by a comprehensive rehabilitation program.
Abstract: In a study of 27 patients with progressive muscular dystrophy of childhood, it was found that duration of ambulation from onset of symptoms could be increased from an average of 4.4 yr to 8.7 yr by a comprehensive rehabilitation program. The program included early diagnosis, close supervision of patients, a physical therapy program with emphasis on passive stretching of flexion contractures about joints, and bracing for ambulation when independent walking was no longer possible. The total increase in ambulation will be greater, since eight patients are still walking independently in braces. This positive program is directed toward assisting the patient to lead as normal a life as possible, both physically and emotionally. The better preservation of the child's physical status should increase the chance for benefit from any future specific pharmacologic therapy.
292 citations
TL;DR: Patients who had received a visit by an anesthetist before operation were not drowsy but were more likely to be calm on the day of the operation, suggesting the importance of the preoperative visit.
Abstract: The psychologic effect of the preoperative visit by an anesthetist has been compared with the effect of pentabarbital for preanesthetic medication Patients receiving pentobarbital 1 hour before an operation became drowsy but it could not be shown that they became calm Patients who had received a visit by an anesthetist before operation (informing them about the events which were to occur on the day of operation and about the anesthetic to be administered) were not drowsy but were more likely to be calm on the day of operation The importance of the preoperative visit probably explains, in part, the difficulties previous investigators have had in showing sedative effects from barbiturates and narcotics before operation The tremendous emotional significance to a patient of illness or an operation may explain why physicians are able to exert such influence upon their patients
275 citations
TL;DR: The condition diagnosed as porphyria cutanea tarda in adults began with bullous lesions which progressed to ulceration and generally healed, leaving pigmented scars characterized by the presence of microcysts.
Abstract: The condition diagnosed as porphyria cutanea tarda in adults began with bullous lesions which progressed to ulceration and generally healed, leaving pigmented scars characterized by the presence of microcysts. In children, the initial lesions resembled comedones and milia. In severe cases the picture was that of "monkey disease." Porphyrinuria appeared early, and the systemic effects were sometimes serious and permanent. More than 600 cases were observed durin a 5-yr period in the southeastern region of Turkey, and the total incidence is estimated to have exceeded 3,000. The outbreak was traced to the consumption of wheat as food, contrary to plan, after it had been prepared for planting by treating it with a fungicide, hexachlorobenzene.
266 citations
TL;DR: Postoperative studies revealed increasingly efficient function of the autotransplanted kidney as reflected by indigo carmine excretion, renal scanograms, and excretory urogram.
Abstract: Autotransplantation of the kidney provides a means of preserving renal function without nephrostomy when high ureteral injury cannot otherwise be corrected. A case is reported in which the right ureter, placed behind an aortic prothesis 6 yr earlier, was unwittingly severed during resection of a large aneurysmal homograft with insertion of a Teflon bifurcation replacement. The ureteroureteral anastomosis became strictured. The left kidney was hydronephrotic and right nephrostomy was associated with repeated infection. The right kidney was successfully transplanted to the right iliac fossa, the renal artery being anastomosed to the external iliac artery and the renal vein to the external iliac vein. The ureteral segment was readily implanted into the bladder. Postoperative studies revealed increasingly efficient function of the autotransplanted kidney as reflected by indigo carmine excretion, renal scanograms, and excretory urogram.
178 citations
TL;DR: In the first known incidence of a mass salt poisoning of infants, the case fatality rate was 6 of 14 exposed, and five died before the situation was recognized.
Abstract: In the first known incidence of a mass salt poisoning of infants, the case fatality rate was 6 of 14 exposed. Five died before the situation was recognized. All five whose brains were examined at autopsy showed hemorrhagic encephalopathy consistent with previous reports of salt poisoning in humans and animals. Eleven of 14 of these infants manifested neurological symptoms. Peritoneal dialysis was attempted in four patients, three of whom survived despite severe illness in two of them. The technique proved feasible under ordinary hospital conditions and may be instrumental in the recovery of patients. Some suggestions for improvement have come from the experience.
176 citations
TL;DR: This book is intended as an introductory text for students of child psychology and personality development and contains numerous examples drawn from medical and psychiatric practice, many of which either contain inaccuracies or suggest conclusions which a physician would reject.
Abstract: This book is intended as an introductory text for students of child psychology and personality development. The principal theoretical orientation is unchanged from that of the first edition and the authors remain convinced that "contemporary learning theory offers the best method for the analysis of behavior." This new edition also contains material derived from recent animal experiments, the observations of Piaget, and some of the clinical insights of psychoanalysis. It is unfortunate that the original two authors did not choose a psychiatrist as the new third author. The book contains numerous examples drawn from medical and psychiatric practice, many of which either contain inaccuracies or suggest conclusions which a physician, by virtue of his training and clinical experience, would reject. A third author, with a different theoretical orientation, might perhaps have presented the other points of view in a better light than do the present authors. A feature of this
TL;DR: The present classification of deaths into natural, accident, homicide, and suicide obscures the fact that individuals may make a considerable contribution toward their own deaths under circumstances not ordinarily considered suicide.
Abstract: Suicide implies a direct connection between the deceased's intention, his self-destructive action, and his subsequent death. Uncertainty about the correct certification results when the victim's intention is ambivalent, with coexisting wishes both to live and to die, or when the self-destructive action is in itself inconclusive, or when death follows the action after a considerable delay. Investigations of 100 such cases are reported with illustrative examples. The present classification of deaths into natural, accident, homicide, and suicide obscures the fact that individuals may make a considerable contribution toward their own deaths under circumstances not ordinarily considered suicide.
TL;DR: A syndrome of nausea, vomiting, proteinuria, acidosis, glycosuria, and aminoaciduria was observed in three patients found to have taken deteriorated preparations of tetracycline as treatment for maxillary sinusitis, pharyngitis, and respiratory infection.
Abstract: A syndrome of nausea, vomiting, proteinuria, acidosis, glycosuria, and aminoaciduria was observed in three patients. The clinical picture at first resembled that of diabetes mellitus. The three patients, a 54-yr-old woman, a 13-yr-old girl, and a 13-yr-old boy, were found to have taken deteriorated preparations of tetracycline as treatment, respectively, for maxillary sinusitis, pharyngitis, and respiratory infection. The two children had received tetracycline on previous occasions without bad effects. All three patients recovered in about a month. A degradation product of tetracycline such as epi-anhydrotetracycline or anhydrotetracycline was probably the etiologic factor.
TL;DR: Five types of fracture are described and it is recommended that Type 4 fractures be reduced accurately and by open reduction if necessary and Type 5 may best be treated by hand molding, supportive bandages, and early mobilization.
Abstract: On the basis of 1 to 20 years of observation of 146 patients with 154 fractures of the os calcis, five types of fracture are described. In the three simpler types (68 cases) conservative treatment never failed. In Type 4 (38 fractures extending into the subtalar joint), the over-all treatment failed completely in 27%, closed treatment gave good or excellent results in 50%. In Type 5 (48 complete comminuted fractures with central depression), though they appeared more severe, there were failures in only 15%, with good or excellent results in 50%. The authors recommend that Type 4 fractures be reduced accurately and by open reduction if necessary. Type 5 may best be treated by hand molding, supportive bandages, and early mobilization.
TL;DR: Mixed conjugated equine estrogens seemed to be effective in the long term therapy of myocardial infarction when high initial dosage was avoided, particularly in the months immediately after infarctions.
Abstract: This study, begun in 1952, assessed long-term estrogen therapy in middle-aged men surviving acute myocardial infarction. By double-blind stratified randomization, 275 such men under age 50 were assigned either to a placebo-treated or to an estrogen-treated group. In the estrogen-treated group, significantly prolonged survival and decreased mortality were found in both good-risk patients and poor-risk patients. Five-year mortality rates were reduced about 50% or more by hormone treatment. However, an unexpected number of deaths occurred in the first two months of study among those men started on 10.0 mg estrogens within three months of their most recent infarction. Mixed conjugated equine estrogens seemed to be effective in the long term therapy of myocardial infarction when high initial dosage was avoided, particularly in the months immediately after infarction.
TL;DR: Among salaried employees, the risk of infarction appeared to be inversely related to job level, and the immediate prognosis was not affected by overweight or physical activity at the time of the attack, but was more favorable when the attack occurred at work.
Abstract: Some clinical and epidemiologic aspects of myocardial infarction were examined in 1,356 employed patients from 25 to 64 years of age. Among salaried employees, the risk of infarction appeared to be inversely related to job level. The chances of developing an attack were increased during the waking hours and among persons with hypertension, diabetes, and certain electrocardiographic abnormalities. Overweight increased the risk of infarction among men under 45 years, but not in older persons. The case fatality rate in the entire series was 30%hyper-rate was significantly elevated among older hypertensives, when the attack occurred at night, and among patients with preexisting bundle-branch block or premature ventricular contractions. The immediate prognosis was not affected by overweight or physical activity at the time of the attack, but was more favorable when the attack occurred at work.
TL;DR: There could be no more eloquent testimony to overeating as the basic cause of this problem and within any country, a superabundance of food has led to a high and continuously rising incidence of obesity.
Abstract: OBESITY is a problem of affluent society and occurs only in those geographical areas and during those periods of human history that are characterized by an abundance of food available to great masses of people Conversely, during war, famine, and economic catastrophe, when food becomes scarce, obesity and related diseases rapidly disappear At mid-20th century Americans have been made acutely aware that, over many huge, underdeveloped areas of the earth representing more than one half of the world's population, a base subsistence level of food supply or actual famine and starvation are still the "normal" ways of life Among these people obesity is unknown In other countries, such as the US and those of western Europe, a superabundance of food has led to a high and continuously rising incidence of obesity There could be no more eloquent testimony to overeating as the basic cause of this problem Within any
TL;DR: The findings in 58 patients with acute viral or drug hepatitis who underwent laparotomy were reviewed to determine the effects of operation on mortality and morbidity in acute hepatitis and the reasons why operation had been advised.
Abstract: The findings in 58 patients with acute viral (42) or drug (16) hepatitis who underwent laparotomy were reviewed to determine the effects of operation on mortality and morbidity in acute hepatitis and the reasons why operation had been advised. In most cases, operation had been advised because of suspected extrahepatic biliary obstruction. Four patients with viral hepatitis died; nonfatal major complications occurred in five others. No deaths or serious complications occurred in patients with drug hepatitis. Misleading factors that contribute to an erroneous diagnosis are emphasized.
TL;DR: No experimental technique has yet reproduced the human forms of chronic distorting valvulitis, as in mitral stenosis, but the following concept is presented for the origin of bacterial endocarditis.
Abstract: SEVERAL ENIGMAS about the mechanism of valvular endocarditis still exist. Why such an entity prevails at all requires elucidation. The relation of vegetations on the valve to an underlying interstitial valvulitis and of the bacterial to the nonbacterial vegetation is still moot. Do the bacteria reach the valve via the interstitial capillary bed or as a deposit directly upon the surface of the valve? No experimental technique has yet reproduced the human forms of chronic distorting valvulitis, as in mitral stenosis. Bacterial endocarditis has been produced experimentally but by procedures which do not even mimic the conditions existing in the human. The following concept is presented for the origin of bacterial endocarditis. An underlying, prior, interstitial, edematous, and cellular valvular distortion occurs initially. This alteration in the valve substance is accompanied in localized areas of the valve by platelet vegetations, with and without fibrin and occasionally with collagen alteration and
TL;DR: Until a definitive cause that can be removed or a magic chemotherapeutic or other "bullet" is found for malignant tumors of the soft tissues, further progress toward the goal of their control must depend upon not only the efforts of individual physicians and investigators but also upon the close cooperation and sympathetic understanding of physicians and scientists representing a variety of disciplines concerned with care of the patient.
Abstract: Until a definitive cause that can be removed or a magic chemotherapeutic or other "bullet" is found for malignant tumors of the soft tissues, further progress toward the goal of their control must depend upon not only the efforts of individual physicians and investigators but also upon the close cooperation and sympathetic understanding of physicians and scientists representing a variety of disciplines concerned with care of the patient— the family physician, the surgeon, radiotherapist, chemotherapist or "oncologist," pathologist, and every other specialist, generalist, or dentist whom the patient might consult. Two briefly cited case reports will serve to introduce important points for consideration. Report of Cases Case 1. —The parents of a 2-yr-old girl consulted a physician when they noticed a "pea-sized pimple" on her neck. During a 10-week period of observation by two physicians the pimple grew slowly and adjacent glands became swollen. The swelling was associated with clinical
TL;DR: At the beginning of World War II, a number of workers throughout the world had reported the use of sulfonamides for treatment of meningococcal meningitis and had indicated that sulf onamides might be used to eliminate the menedococcal carrier state in otherwise healthy individuals, thereby limiting the spread of infection to susceptible persons.
Abstract: MENINGOCOCCAL INFECTIONS are relatively common at military recruit camps. In World War I, for example, carrier rates of 60% or more were commonplace throughout the US camps and the number of clinical cases of meningococcal disease were appropriately great. During World War II an outbreak of meningococcal disease began among military bases and spread to the US civilian population. Before the epidemic had run its course during the years 1943 and 1944, some 34,000 persons had become ill and 4,700 of them had died as a result of meningococcal disease. At the beginning of World War II, a number of workers throughout the world1-5had reported the use of sulfonamides for treatment of meningococcal meningitis and had, in addition, indicated that sulfonamides might be used to eliminate the meningococcal carrier state in otherwise healthy individuals, thereby limiting the spread of infection to susceptible persons. In 1943 Awe, Babione,
TL;DR: In a series of 74 women with systemic lupus erythematosus (SLE) who became pregnant during the period of study, there was no evidence that pregnancy mitigated the course of SLE.
Abstract: In a series of 74 women with systemic lupus erythematosus (SLE) there were 43 who became pregnant during the period of study. The 43 women had 111 pregnancies, all together, of which 81 occurred before and 30 after the onset of SLE. Of the 111 pregnancies, 20 ended in presumably spontaneous abortions, of which 11 occurred before and 9 after the onset of SLE. In the 81 pregnancies that occurred before the onset of SLE, the incidence of presumably spontaneous abortions was 14%; in the 30 that occurred after the onset, the incidence was 30%. Detailed records of the course of SLE before and after pregnancy were available in 12 cases; the 12 patients had 29 pregnancies. In 6 of the 12, symptoms of SLE were first observed during pregnancy or soon post partum. There was no evidence that pregnancy mitigated the course of SLE.
TL;DR: This paperback volume is an unabridged and corrected republication of the pioneer work on dermatoglyphics first published in 1943 and is pleased to see it is again available.
Abstract: This paperback volume is an unabridged and corrected republication of the pioneer work on dermatoglyphics first published in 1943. The very fact that a scientific book is reprinted after an interval of 18 years speaks for its lasting value. I feel sure that everybody who has used the "Cummins and Midlo" regretted that it was out of print and is pleased to see it is again available. Dermatoglyphics is one of those fields in which many interests meet. Anatomists, anthropologists, geneticists, and criminologists have a long-standing devotion to this science. Recently, pediatricians and psychologists have joined them in connection with the manifestations of Down's syndrome (mongolism). Dermatologists, with few exceptions, have not been much interested in the ridge configurations on fingers, palms, and soles, but they may be assured that the study of dermatoglyphics is a fascinating hobby if nothing else, as recently pointed out by Felsher ( Arch Derm [Chic]
TL;DR: Thiopropazate and prochlorperazine showed a statistically significant therapeutic advantage over the placebo, while Pipamazine, cinnarizine, and trimethobenzamide were progressively less effective, although each appeared to exert some antiemetic effect.
Abstract: A controlled double-blind study of five orally administered antiemetic agents and a placebo was carried out during the administration to patients of a known emetic agent, fluorouracil. One hundred eighty patients were observed during their first course of treatment with fluorouracil and 120 patients during their second course. Thiopropazate and prochlorperazine showed a statistically significant therapeutic advantage over the placebo. Pipamazine, cinnarizine, and trimethobenzamide were progressively less effective, although each appeared to exert some antiemetic effect. Those agents showing the greatest antiemetic potency also showed the highest incidence of oversedation.
TL;DR: BACTERIA of the Mima-Herellea group were not recognized as distinct and remained undescribed until 1942, when De Bord 1 suggested the name Mimeae for a new tribe of gram-negative, nonmotile organisms which resembled Neisseria morphologically, but differed in biochemical characteristics.
Abstract: BACTERIA of the Mima-Herellea group were not recognized as distinct and remained undescribed until 1942, when De Bord 1 suggested the name Mimeae for a new tribe of gram-negative, nonmotile organisms which resembled Neisseria morphologically, but differed in biochemical characteristics. He named the two new organisms Mima polymorpha and Herellea vaginicola. During subsequent years, other authors reported similar organisms but gave them different names so that the situation became extremely confusing. Synonyms for bacteria in this group include "B5W," 2 Bacterium anitratum , 3 Moraxella glucidolytica , 4 Achromobacter lwoffi , 5 and Acinetobacter anitratum . 6 Reviews of the literature are given by Rosebury in 1962 7 and Daly et al in 1962. 8 Presumably due to the uncertain taxonomic position of these bacteria, they were not included in the seventh edition of Bergey's Manual of Determinative Bacteriology . This, combined with the confusing variety of synonyms, resulted in failure to identify this group
TL;DR: Using dogs, the technique of increasing the cerebrospinal fluid pressure to produce cessation of the cerebral blood flow is used to learn more about mechanisms behind transient period of hypertension and collapse in patients with apparent severe brain damage secondary to anoxia.
Abstract: ALL OF US have observed patients with apparent severe brain damage secondary to anoxia. These patients frequently have a transient period of hypertension, and then many go into shock. Nevertheless some survive such an episode with an apparently normal recovery as reported by Sadove et al. 1 One wonders whether the lowered blood pressure is caused by cardiovascular collapse which is primary or collapse which is secondary to central nervous system damage. Using dogs, we have attempted to learn more about these mechanisms by utilizing some of the techniques employed by Harvey Cushing as well as more modern methods. Specifically, we have used the technique of increasing the cerebrospinal fluid pressure to produce cessation of the cerebral blood flow. Cushing 2 demonstrated the rise in blood pressure that accompanies the rise in cerebrospinal pressure. He also demonstrated, by means of transparent fluid-tight windows maintained in the skulls of dogs,
TL;DR: The most striking ethnic difference was that the rate for unmixed Hawaiians was about six times that for persons classified as Caucasian, which served as a case-finding procedure, for three of five of those diagnosed as diabetic were previously unknown.
Abstract: In order to discover possible differences among various ethnic groups in Hawaii with respect to the prevalence of diabetes mellitus, blood samples were secured from 38,103 gainfully employed persons. The sample, taken from a finger 2½ hr after a meal containing at least 50 gm of carbohydrate, was tested by an instrument which automatically determined whether the concentration of glucose was above or below 130 mg/100 cc. Those whose blood glucose was found to be elevated were referred to their personal physicians for further diagnostic study. The over-all, age-adjusted prevalence of diabetes was 18.4/1,000. The most striking ethnic difference was that the rate for unmixed Hawaiians was about six times that for persons classified as Caucasian. In addition to finding ethnic variations, the study served as a case-finding procedure, for three of five of those diagnosed as diabetic were previously unknown.
TL;DR: The role played by the catheter in local and systemic infection is of particular interest, and it has been suggested that bacteria may invade the vein through the cutaneous portal of catheter entry or infect the thrombus which propagates at theCatheter tip.
Abstract: THE INTRODUCTION of plastic indwelling intravenous catheters has greatly facilitated longterm parenteral therapy. This technique, however, has been associated with numerous complications, the most common of which are thrombophlebitis1-7and phlebitis associated with sepsis.3-5, 8, 9Other hazards include pulmonary embolism, acute bacterial endocarditis, catheter breakage, and embolism and thrombus formation of the atrial and ventricular endocardium.10 Of particular interest to the authors is the role played by the catheter in local and systemic infection. It has been suggested that bacteria may invade the vein through the cutaneous portal of catheter entry or infect the thrombus which propagates at the catheter tip.9This initially bland thrombus may become infected through the blood stream by bacteria from a remote site.5The catheter itself then serves to disseminate infection. The present study was prompted by these possibilities. Methods Patients were selected at random from the wards of
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TL;DR: In his usual delightful style, Professor Magoun illustrates his appreciation of the issues basic to the form and function of the brain with repeated hints of his own search for a universal natural truth.
Abstract: The new and enlarged edition of this superbly lucid book will be welcomed equally by the serious student and the casual dilettante. In his usual delightful style, Professor Magoun illustrates his appreciation of the issues basic to the form and function of the brain. His intrinsic anatomical approach repeatedly shines through the murk of interdisciplinary approaches to brain function. His first chapter, on historical aspects, is imaginatively done despite almost excessive illustration. Repeated hints of his own search for a universal natural truth appear, viz: a comparison between geological and neurological stratifications—a sort of philosopher's Liesegang ring, as it were. An authoritative chapter on regulation of spinal reflexes regrettably adheres primarily to Eccles' version of synaptic events, whereas the views of Bishop, quoted in the first edition, seem more relevant to brain function. It is also disappointing that the author persists in his own version of sources of activation for