Showing papers in "JAMA in 1967"
Journal Article•
1,223 citations
TL;DR: Cell lines established from hematopoietic cells from two staff members with no known malignant disease contained a herpetic-like virus (leukovirus), produced immunoglobulins, and grew rapidly in various suspension cultures.
Abstract: Rapidly growing and apparently permanent cultures were established from hematopoietic cells from two staff members with no known malignant disease. The cell lines were similar to those derived from leukocytes from the peripheral blood of patients with malignancies of either hematopoietic or nonhematopoietic origin and to the lymphoblastoid cell lines derived from Burkitt's lymphoma. Both cell lines contained a herpetic-like virus (leukovirus), produced immunoglobulins, and grew rapidly in various suspension cultures.
797 citations
TL;DR: The identification of two types of infectious hepatitis with distinctive clinical, epidemiological, and immunological features provided an explanation for the occurrence of second attacks of the disease.
Abstract: The identification of two types of infectious hepatitis with distinctive clinical, epidemiological, and immunological features provided an explanation for the occurrence of second attacks of the disease. One type resembled classical infectious hepatitis (IH); it was characterized by an incubation period of 30 to 38 days, a relatively short period of abnormal serum transaminase activity (3 to 19 days), a consistently abnormal thymol turbidity, and a high degree of contagion. The other type resembled serum hepatitis (SH); it was characterized by a longer incubation period (41 to 108 days), a longer period of abnormal transaminase activity (35 to 200 days) and a relatively normal thymol turbidity. Contrary to commonly accepted concepts, the SH type was moderately contagious. Patients with IH type were later proved to be immune to the same type. Patients with the SH type were not immune to the IH type infection.
528 citations
TL;DR: In the past two decades there have been momentous advances in the care of patients with cardiovascular ailments, yet, mortality from coronary-artery disease has remained unaffected, with 65% of deaths occurring in the initial three days and 85% during the first week of attack.
Abstract: In the past two decades there have been momentous advances in the care of patients with cardiovascular ailments. Yet, mortality from coronary-artery disease has remained unaffected. Year after year myocardial infarction and its complications exact the highest toll of any single disease. 1 In large metropolitan hospitals, the death rate from this condition 30 years ago ranged from 30% to 40% and remains unaltered today. Certain facts are forcing reevaluation of the problem. Peak mortality occurs at the very onset of myocardial infarction and then recedes almost exponentially, with 65% of deaths occurring in the initial three days and 85% during the first week of attack. Arrhythmias probably account for 40% of deaths. Of these about two thirds are due to ventricular fibrillation and one third to bradycardia, heart block, and asystole. 2 It is well established that these electrical catastrophes are usually not due to irreversible cardiac damage. On
497 citations
TL;DR: Indirect immunofluorescent (IF) staining revealed that in 14 of 16 patients with active lesions of bullous pemphigoid the sera contained antibodies specific for the basement zone beneath stratified squamous epithelium while the patients in remission contained no demonstrable antibodies.
Abstract: Indirect immunofluorescent (IF) staining revealed that in 14 of 16 patients with active lesions of bullous pemphigoid the sera contained antibodies specific for the basement zone beneath stratified squamous epithelium while the sera from six patients in remission contained no demonstrable antibodies. The sera of 18 patients with dermatitis herpetiformis and 94 patients with various bullous and nonbullous dermatoses yielded negative reactions to the basement zone by indirect IF staining. In four of five skin biopsy specimens from patients with bullous pemphigoid direct IF staining indicated that γ-globulin had been bound in vivo to the basement zone.
437 citations
TL;DR: Dr. Greenson's book is based primarily on the theory of dammed-up libido, correct in itself but not expanded and enriched by the last 40 years of study which have seen such revolutionary progress in every other clinical and scientific study.
Abstract: Psychoanalytic Techniques: A Handbook for the Practicing Psychoanalyst,edited by Benjamin B. Wolman, 596 pp, $15, New York and London: Basic Books, Inc., 1967. Psychotherapeutic techniques depend on the way the therapist understands the personality of each patient and what changes both patient and therapist strive for. The personality makeup of man may be simple in its broad essentials but is certainly complex in its details, and full of surprises. Freud opened up our understanding of it—he did not close it. Certainly no single school has all the answers, although this is the tone of much orthodox psychoanalytic writing as distinct from contributions that are free inquiries using all available knowledge. Dr. Greenson's book is based primarily on the theory of dammed-up libido, correct in itself but not expanded and enriched by the last 40 years of study which have seen such revolutionary progress in every other clinical and scientific
401 citations
TL;DR: Tolerance builds rapidly and an abstinence syndrome develops which leads to a typical pattern in which the user takes the drug continuously and in immense doses for about five days during which he does not sleep.
Abstract: Abuse of amphetamines administered intravenously has become a well established and extensive form of drug abuse. The abuse potential of these drugs when taken by the intravenous route is greater than when taken orally and is comparable to that of heroin or cocaine. Tolerance builds rapidly and an abstinence syndrome develops which leads to a typical pattern in which the user takes the drug continuously and in immense doses for about five days during which he does not sleep. During this time he gradually becomes more paranoid and disorganized. He then desists for a day or two and falls into a prolonged semicomatose state. Upon awakening he is still lethargic and feels the need to resume his drug for a new round.
338 citations
TL;DR: An atypical measles illness occurred in ten children who had received inactivated (killed) measles virus vaccine five to six years earlier, but measles virus was recovered from none of them.
Abstract: An atypical measles illness occurred in ten children who had received inactivated (killed) measles virus vaccine five to six years earlier. The illness is characterized by a two- to three-day prodrome of fever and complaints of pain (head, muscle, and abdomen, or both muscle and abdomen) followed by the development of a maculopapular rash with petechial, vesicular, and urticarial components. Peripheral edema and pneumonia occurred in almost all the children. In three instances, significant pleural effusions were noted. Serologic determinations established the diagnosis in all ten children, but measles virus was recovered from none of them.
314 citations
TL;DR: A laboratory test to detect dependency of tumor cells on asparagine seems helpful for selection of cases for investigation of therapy, and a variety of human malignant diseases including acute lymphatic leukemia and acute and chronic granulocytic leukemia have been shown to be asParagine-dependent by this test.
Abstract: Enzyme therapy directed at depletion of an amino acid, asparagine, indispensable for tumor cell growth but not required by normal tissues, offers a new and promising approach to the problem of treatment of leukemia and disseminated cancer. Therapy with the enzyme L-asparaginase in three cases of acute lymphatic leukemia resulted in measurable improvement in two advanced cases. In the third case, there was a striking response to large dosage, with rapid necrosis of lymph node masses and clearing of leukemic infiltrates. A laboratory test to detect dependency of tumor cells on asparagine seems helpful for selection of cases for investigation of therapy. Furthermore, a variety of human malignant diseases including acute lymphatic leukemia and acute and chronic granulocytic leukemia have been shown to be asparagine-dependent by this test. Exploitation of further possible nutritional differences offers a fertile field for investigation.
294 citations
TL;DR: Professor Garnham, who has made many outstanding contributions to the authors' knowledge of malaria, brings together not only the wealth of new but also the important old research on malaria that goes back four centuries.
Abstract: During the past two decades man has learned much about the life cycle and the physiology of his own four species of malaria as well as those of other mammals, birds, and reptiles. The electron microscope has provided a fund of morphological detail, and biochemists have answered many questions concerning the nutrition of the parasite and its resistance to chemotherapy. The use of malaria's fever in the therapy of paresis and animal studies have advanced our understanding of immunity and chemotherapeutic response. The exo-erythrocytic portion of the life cycle explains some of the perplexing clinical facets of the disease. Professor Garnham, who has made many outstanding contributions to our knowledge of malaria, brings together not only the wealth of new but also the important old research on malaria that goes back four centuries. Laveran, Ross, Grassi, and Danilewsky live again on these pages. He paints in beautiful detail (with numerous
271 citations
TL;DR: In the introduction to this book J. D. Watson tells of the anxieties and concerns which he and Crick felt when they were first trying to elucidate the structure of DNA.
Abstract: When J. D. Watson received the Nobel Prize in medicine in 1962, a prize which he shared with Francis Crick and Maurice Wilkins, he demonstrated in his lecture at Stockholm that the synthesis of protein 1 required the ordered interaction of deoxyribonucleic acid and at least three types of functional ribonucleic acid. In the introduction he tells of the anxieties and concerns which he and Crick felt when they were first trying to elucidate the structure of DNA. He wrote, During the next eighteen months, until the structure became elucidated, we frequently discussed the necessity that the correct structure have a capacity for replication and, in pessimistic moods we often worried that the structure might be dull, that it would suggest absolutely nothing and excite us no more than something inert, like collagen. Watson's view of collagen is illustrative of the powerful vision of a great mind finding a new
TL;DR: A relationship was established between the institution of oral contraceptive therapy and the development or enhancement of high blood pressure in eight of 11 patients and in six of eight patients who stopped taking medication, marked improvement or complete correction of hypertension occurred.
Abstract: A relationship was established between the institution of oral contraceptive therapy and the development or enhancement of high blood pressure in eight of 11 patients. In six of eight patients who stopped taking medication, marked improvement or complete correction of hypertension occurred. In two patients, with a second trial of treatment, hypertension again appeared and disappeared. Oral contraceptive therapy produced impressive abnormalities in renin-substrate concentration and in its reactivity to exogenous renin as well as in endogenous renin activity and aldosterone excretion. The relevance of these abnormalities to the development of hypertension is not clear because similar effects occur in treated normotensive women. Further study of a possible connection between excesses of estrogenic and progestogenic substances, renin, aldosterone, and hypertension seems warranted.
TL;DR: Several facets of hypertension in diabetes mellitus were studied in 662 employed diabetics and an equal number of matched controls, all of whom received periodic health examinations at work.
Abstract: Several facets of hypertension in diabetes mellitus were studied in 662 employed diabetics and an equal number of matched controls, all of whom received periodic health examinations at work. The prevalence of hypertension was 54% greater among the diabetics. Hypertension was also more common in the diabetics before the onset of the clinical stage of the disease. The increased prevalence of hypertension among the diabetics occurred independently of overweight. Diabetics taking 50 or more units of insulin per day had a lower prevalence of hypertension than the other diabetics. Among hypertensive subjects, the prevalence of arteriosclerotic heart disease was twice as great in the diabetics as in the controls, but among normotensive subjects there was no significant difference between the two groups.
TL;DR: In 206 cases of bacterial endocarditis with positive blood cultures, 95% of 789 blood cultures were positive for the causative microorganisms.
Abstract: In 206 cases of bacterial endocarditis with positive blood cultures, 95% of 789 blood cultures were positive for the causative microorganisms. In streptococcal endocarditis, the first blood culture was positive in 96% of the cases, and one of the first two blood cultures was positive in 98% of the cases. In endocarditis caused by microorganisms other than streptococci, the first blood culture was positive in 82% of the cases, and one of the first two blood cultures was positive in all of the cases. The incidence of positive cultures was slightly reduced in those cases in which the patient had received an antimicrobial agent within two weeks prior to blood culture. The bacteremia in the 206 cases of bacterial endocarditis was persistent and of low magnitude.
TL;DR: Volume 1 ranges from protozoa to platyhelminths; the other volumes, promised for 1967 and 1968, will be devoted to fishes, sea snakes, turtles, etc.
Abstract: Sponsored by the Department of Defense and handsomely gotten out by the Government Printing Office, the first volume is now available. For almost a quarter-century, its author, a physician, has been preparing the work, initially to be limited to fishes, but now devoted to all marine life, from protozoa to turtles. During a preliminary phase (14 years), 30 major expeditions and field trips were made to many places, from the Carolinas to the Mediterranean. As the preface states, thousands of histologic sections were made of venom organs and 25,000 fish samples screened for toxicity. Volume 1 ranges from protozoa to platyhelminths; the other volumes, promised for 1967 and 1968, will be devoted to fishes, sea snakes, turtles, etc. For whom is the work intended? To begin with, any lover of natural history, especially if he enjoys numerous and striking photographs, both in black-and-white and in color. For the dermatologist, particularly
TL;DR: Indocyanine green (ICG) has proven much less sensitive than BSP in detecting mild liver-cell damage or demonstrating the excretory defect produced by synthetic androgenicanabolic steroids.
Abstract: A study of clearance of dyes which are removed from the circulation principally by the liver constitutes one of the best methods for evaluating hepatic function. This approach has not been widely used because of the need for multiple blood sampling to calculate accurately removal rate of sulf obromophthalein (BSP) and for radioisotope-counting equipment for clearance studies of rose bengal I 131. 1 These disadvantages are largely overcome by indocyanine green (ICG), which possesses physical properties which permit external recording of blood dye levels. The major limitation of ICG has been the fact that, in doses conventionally used, it has proven much less sensitive than BSP in detecting mild liver-cell damage 2 or demonstrating the excretory defect produced by synthetic androgenicanabolic steroids. 3 Levels of ICG have been recorded by use of an air-cooled oximeter to measure light transmission 4 or electric eye to determine light reflection. 5 Accuracy of
TL;DR: Children with an X-linked neurological disease often classed as cerebral palsy show an absence of an enzyme of purine metabolism, hypoxanthine-guanine phosphoribosyltransferase (PRTase), in the brain, liver, fibroblasts, and erythrocytes, which suggests that the brain also has an increased purine synthesis.
Abstract: Children with an X-linked neurological disease often classed as cerebral palsy show an absence of an enzyme of purine metabolism, hypoxanthine-guanine phosphoribosyltransferase (PRTase), in the brain, liver, fibroblasts, and erythrocytes. The absence in these patients of PRTase activity in the basal ganglia where the enzyme is normally of highest activity can be correlated with the fact that the major clinical symptoms are attributable to basal ganglia dysfunction. The concentration of oxypurines (hypoxanthine and xanthine) in the cerebrospinal fluid (CSF) was four times normal and was greater than in plasma, which suggests that the brain also has an increased purine synthesis. The possible role of high oxypurine concentration in CSF in development of the neurological disease has been discussed. Treatment with allopurinol produced a further increase in the concentration of oxypurines in CSF.
TL;DR: If a positive reaction is obtained from a multiple stool occult blood test, the patient should be further examined with barium sulfate enema roentgenograms, one of the best methods for detecting large-bowel cancer during routine well-patient examinations.
Abstract: In a survey of 2,000 physical examinations performed in an internist's office, seven patients with invasive carcinoma of the colon were found. None of the patients in the survey was examined because of large-bowel symptoms. All seven patients had positive tests for occult blood in at least one of three stool specimens. This finding led to the preparation of an easier method for multiple stool examination as a routine office procedure. Recent reports have emphasized the limitations of the sigmoidoscope in cancer detection. If a positive reaction is obtained from a multiple stool occult blood test, the patient should be further examined with barium sulfate enema roentgenograms. This is one of the best methods for detecting large-bowel cancer during routine well-patient examinations.
TL;DR: A low urine sodium concentration is not helpful in distinguishing functional renal insufficiency from parenchymal renal failure unless oliguria is present.
Abstract: Eleven cases of nonoliguric acute renal failure, all but one following burns, as well as 14 cases of postburn oliguric acute renal failure, have been treated at the US Army Surgical Research Unit since 1960. Mild azotemia not attributed to parenchymal renal failure occurred in an additional ten burned patients. The urine sodium concentration exceeded 20 mEq/liter in eight of 11 patients with oliguric acute renal failure, whereas only one of nine nonoliguric patients had a urine sodium concentration above 20 mEq/liter. Thus, a low urine sodium concentration is not helpful in distinguishing functional renal insufficiency from parenchymal renal failure unless oliguria is present.
TL;DR: The findings support other data indicating that serum neutralizing antibody develops following the majority of rhinovirus illnesses and is important in preventing symptomatic rhInovirus infection.
Abstract: Rhinovirus illness in young adults was characterized by rhinorrhea, nasal obstruction, sneezing, and pharyngeal discomfort. Length of illness ranged from 1 to 33 days, with a median of 7.42 days; one fourth of the illnesses lasted two weeks. Nasal symptoms, hoarseness, and cough occurred more frequently with confirmed rhinovirus common colds than with illnesses from which rhinoviruses were not cultured. Significant neutralizing antibody responses were measured in 77% of 77 paired serum specimens from patients with rhinovirus illness; only 5% had homologous titers of 8 or more in the acute phase of illness. The findings support other data indicating that serum neutralizing antibody develops following the majority of rhinovirus illnesses and is important in preventing symptomatic rhinovirus infection.
TL;DR: The findings suggest that suicide is often a response to social disturbance in alcoholism, chiefly to depressive symptoms in affective disorder, which should improve suicide prevention.
Abstract: Two diagnostic groups, affective disorder (depression) and alcoholism account for the majority of urban suicides. Alcoholic suicides are more often divorced, separated, or living alone than is the general population. Suicides with affective disorder differ little from the US population except in the proportion living alone. Unlike the affectivedisorder group, alcoholics are found frequently (32%) to have experienced obvious disruption of affectional relationships within six weeks of suicide. The findings suggest that suicide is often a response to social disturbance in alcoholism, chiefly to depressive symptoms in affective disorder. The alcoholic appears particularly vulnerable to suicidal impulses on losing an important affectional relationship. This knowledge should improve suicide prevention.
TL;DR: In a clinic group of 212 patients taking an oral contraceptive agent, melasma developed in 61 (29%) as a direct result of the drug, and both combination and sequential oral contraceptives showed the capability to produce this facial hyperpigmentation.
Abstract: In a clinic group of 212 patients taking an oral contraceptive agent, melasma developed in 61 (29%) as a direct result of the drug. Both combination and sequential oral contraceptives showed the capability to produce this facial hyperpigmentation, which does not completely regress after cessation, in contrast to melanoderma in pregnancy. It appears that continued use of the newer oral contraceptive agents will lead to the conclusion that all are capable of producing hyperpigmentation. Eighty-seven percent (52 of 61) having melasma from oral contraceptives also had melanoderma during pregnancy. Thus, melasma in pregnancy can be used as an indicator in detecting the susceptible individual. The perplexing question of estrogen or progesterone as the cause of melasma remains unanswered. No lessening in the incidence of melasma could be found with decreased dosage in estrogen component.
TL;DR: The criteria for the diagnosis of pneumomediastinum should include the combination of roentgenographic free mediastinal air and subcutaneous emphysema and the most common symptoms are pain and dyspnea.
Abstract: Pneumomediastinum is an entity in which free air is found within the mediastinum. It occurs principally in healthy young men and parturient women and is found most frequently without apparent precipitatory cause. Functionally, however, alveolar hyperpressure, pulmonary capillary hypotension, or aveolar wall defects on a localized basis may occur as a result of, or may be associated with an acute, transient, respiratory obstruction, a type found most commonly in parturition, simple cough, emesis, or asthma. The most common symptoms are pain and dyspnea. Fever and leukocytosis without apparent infection are also frequently encountered. With obvious extrathoracic sources of mediastinal air excluded, the criteria for the diagnosis of pneumomediastinum should include the combination of roentgenographic free mediastinal air and subcutaneous emphysema.
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TL;DR: A room in a house in the Greek town of Modik long ago, five nobles are lounging on couches, and Empedocles and Patroclus look for something to do that shapes man's destiny.
Abstract: Act I A room in a house in the Greek town of Modik long ago. Five nobles are lounging on couches. Philolaus: Fellow nobles, this dull, inactive life is deplorable. No war. No excitement. Empedocles: You're right! Since the advent of Greek fire it looks like war is a thing of the past. Heraclitus: And we haven't had a good public scandal since the furor over Isosceles' triangle died down. Patroclus: Maybe we'll regain political favor. Empedocles: Fat chance with Lysanias Boeotia Junius in power. Heraclitus: Right! With LBJ ruling the roost we might as well look for something else to do. Philolaus: Well, whatever we do, it should be worthy of us as nobles. Empedocles: Something that shapes man's destiny. Democritus: There's that fellow named Asclepios who goes around treating the sick. Calls himself a doctor. He shapes men's destinies. Heraclitus: You mean that nut with the snake on
TL;DR: A follow-up study of 50 patients with in situ lobular carcinoma, treated in most instances by local excision, reveals the following subsequent cumulative risk of infiltration: 8% after five years, 15% after ten years, 27% after 15 years, and 35% after 20 years.
Abstract: In situ lobular carcinoma is a preinvasive form of breast cancer which if inadequately treated will frequently progress to infiltrative cancer. A follow-up study of 50 patients with in situ lobular carcinoma, treated in most instances by local excision, reveals the following subsequent cumulative risk of infiltration: 8% after five years, 15% after ten years, 27% after 15 years, and 35% after 20 years. After 23 years, the cumulative risk is thought to exceed 50%. In addition, the cumulative risk of cancer developing in the breasts contralateral to those in which in situ lobular carcinoma was found was 10% after ten years, 15% after 15 years, and 25% after 20 years. The cumulative risk of contralateral breast cancer after 22 years appears to exceed 30%.
TL;DR: Infusion of vasoconstrictor drugs into the arm circulation of normal subjects reproduced the clinical situation of normal arterial pressure with absent Korotkoff sounds and diminished radial pulses.
Abstract: Arterial pressure was considerably higher than the cuff pressure obtained by auscultation or palpation of the brachial artery in 18 patients with shock and high total peripheral vascular resistance. Pulse pressure was also greatly underestimated by indirect measurement. This discrepancy was not observed in 21 hypotensive patients with low or normal resistance. Infusion of vasoconstrictor drugs into the arm circulation of normal subjects reproduced the clinical situation of normal arterial pressure with absent Korotkoff sounds and diminished radial pulses. High vascular resistance in the upper extremity prevents the hemodynamic events which normally produce the Korotkoff sounds. Disappearance of peripheral pulses is probably the result of reduced stroke volume and increased arterial wall stiffness.
TL;DR: Obscuring abnormal data on the laboratory slip with removable fluorescent tape resulted in significant improvement, more than half of which was maintained six months after use of the tape was discontinued.
Abstract: The feasibility of developing continuing education programs based on patient care research has been explored through a study of physician response to apparently unexpected abnormalities in three routine screening tests (urinalysis, fasting blood glucose, and hemoglobin). Initial assessment revealed no apparent response of any kind to approximately two thirds of these test abnormalities. A specially designed workshop conference, a full complement of interns, and repeated newsletter reminders failed to improve the quality or quantity of responses. Obscuring abnormal data on the laboratory slip with removable fluorescent tape resulted in significant improvement, more than half of which was maintained six months after use of the tape was discontinued. This study illustrates the complementary relationship between patient care research and continuing education that can be profitably integrated in programs to improve medical care.
TL;DR: Mycoplasma hominis, which has produced exudative pharyngitis in adult volunteers, was not recovered from persons in this investigation; however, in other studies performed concurrently, M hominis was isolated from 0.5% of subjects including three adults with pharygitis.
Abstract: Methods for identification of bacteria, viruses, and mycoplasmas were used to study pharyngitis in patients from a pediatric practice. Etiologic agents were recovered from 50% of 715 cultures from patients with pharyngitis and from 22% of 206 cultures from asymptomatic household contracts. Pharyngitis was diagnosed most often in children ages 6 through 8 years, and over one half of these illnesses were associated with group A streptococcus infections. Viruses were the most important cause of pharyngitis in infants, and Mycoplasma pneumoniae was associated with pharyngitis in early adolescence. Disease produced by viruses or M pneumoniae could not be distinguished from classical streptococcal pharyngitis. Mycoplasma hominis, which has produced exudative pharyngitis in adult volunteers, was not recovered from persons in this investigation; however, in other studies performed concurrently, M hominis was isolated from 0.5% of subjects including three adults with pharyngitis.
TL;DR: In a clinical comparative study, 49 patients were treated for the tremulous and agitated states and acute hallucinosis of alcohol withdrawal and paraldehyde with chloral hydrate was most effective and best tolerated.
Abstract: In a clinical comparative study, 49 patients were treated for the tremulous and agitated states and acute hallucinosis of alcohol withdrawal. Thirteen patients were treated with promazine hydrochloride, and 12 each with paraldehyde and chloral hydrate, alcohol, or chlordiazepoxide hydrochloride. Of these therapies, paraldehyde with chloral hydrate was most effective and best tolerated. Twenty-three patients were treated for delirium tremens. Twelve were treated with promazine and suffered numerous complications, including death in two cases. Eleven were treated with paraldehyde and chloral hydrate with prompt clearing of hallucinations; there were no failures and only one complication (transient fever).
TL;DR: The present study was undertaken to determine the accuracy and reliability of the reflected ultrasound pattern obtained from the chest of one patient with pleural effusion and the pattern which might be expected following thoracentesis.
Abstract: Reflected ultrasound, using the echo-ranging technique, has had increasing application as a diagnostic method over the past few years. Subsequent to the introduction of echoencephalography in 1955, the technique has been widely accepted as a diagnostic procedure in the determination of space-occupying lesions within the skull.1The technique has also proved to be of value in the delineation of soft-tissue structures within the abdomen, the diagnosis of pelvic masses, and the measurement of fetal head size.2,3In cardiology, ultrasound has provided a method of proved accuracy in the diagnosis of mitral valve disease and has been of value in the detection of pericardial effusion and atrial tumors.4-8In 1964, Pell presented the ultrasound pattern obtained from the chest of one patient with pleural effusion and discussed the pattern which might be expected following thoracentesis.9The present study was undertaken to determine the accuracy and reliability of the