Showing papers in "JAMA in 1968"

Depression: Clinical, Experimental, and Theoretical Aspects

Abstract: His propensity to deal with the symptomatic aspects of depression, without regarding nosological classification of psychiatric diseases, creates some difficulties. Where he attempts to differentiate neurotic from true, endogenous depressions, Beck utilizes only cross-sectional symptomatology, and he finally concludes that there are no specific signs and symptoms, aside from delusions, to distinguish psychotic from neurotic depressions. Thus he supports the thesis that the two conditions differ only in quantitative aspects. However, in the reviewer's experience, longitudinal studies indicate a high incidence of hysterical reactions, alcoholism, and other pathological features in the personality of individuals with neurotic depressions, as well as the absence of manic episodes. After offering data which purport to indicate a higher incidence of orphanage in depressed individuals, Beck develops the thesis that parental deprivation in childhood may be a factor in later development of severe depression. Elsewhere, the reviewer has recorded detailed criticism of these data and

A means of assessing maximal oxygen intake. Correlation between field and treadmill testing

Abstract: One hundred and fifteen US Air Force male officers and airmen were evaluated on a 12-minute field performance test and on a treadmill maximal-oxygen-consumption test. The correlation of the field-test data with the laboratory-determined oxygen-consumption data was 0.897. The significance of this relationship makes it possible to estimate with considerable accuracy the maximal oxygen consumption from only the results of the 12-minute performance test. This test is readily adaptable to large groups, requires minimum equipment, and appears to be a better indicator of cardiovascular fitness than the more commonly accepted 600-yard run. Because of the high correlation with maximal oxygen consumption, it can be assumed that the 12-minute field performance test is an objective measure of physical fitness reflecting the cardiovascular status of an individual.

Initial Clinical Experience With Intraaortic Balloon Pumping in Cardiogenic Shock

Abstract: Our intraaortic cardiac assistance system for patients in cardiogenic shock following myocardial infarction consists of a catheter and balloon inserted through a femoral arteriotomy into the thoracic aorta. The pumping chamber, activated by helium, is synchronized with the heart by signals from the electrocardiogram or the central aortic pressure transducer. Pumping improved two patients' circulatory status; one survived. Two patients died before pumping could begin; in another, an abdominal aortic aneurysm prevented insertion of the pump. Thrombosis did not occur during pumping; hemolysis appeared minimal. Although final evaluation must await more data, balloon pumping appears to be effective in cardiogenic shock. Further study may establish a place for the procedure in myocardial infarction without cardiogenic shock and in low cardiac output syndromes associated with open-heart surgery.

Asbestos Exposure, Smoking, and Neoplasia

Abstract: Asbestos insulation workers, as a group, have a high risk of dying of bronchogenic carcinoma (about seven or eight times expected). We have observed 370 such workmen from Jan 1, 1963 to April 30, 1967. Our findings indicate that asbestos exposure alone is not the entire explanation. Of 87 noncigarette smokers, none died of bronchogenic carcinoma. Of 283 workmen with a history of regular cigarette smoking, 24 died of bronchogenic carcinoma, although only three were expected to die of this disease. Calculations suggest that asbestos workers who smoke have about 92 times the risk of dying of bronchogenic carcinoma as men who neither work with asbestos nor smoke cigarettes. We conclude that asbestos exposure should be minimized, that asbestos workers who do not smoke should never start, and that those now smoking should stop immediately.

Joint Study of Extracranial Arterial Occlusion II. Arteriography, Techniques, Sites, and Complications

Abstract: For 80% of 4,748 patients with cerebrovascular insufficiency, complete four-vessel examinations were made. Although the primary purpose was localization of surgically accessible extracranial lesions, intracranial studies were also obtained in a high percentage of cases. The overall grave complication rate was 1.2%. A test of interinstitutional comparability of x-ray interpretation revealed greatest agreement when lesions compromised more than 50% of the arterial lumen.

Growth and Development of an Infant Receiving All Nutrients Exclusively by Vein

Abstract: An infant weighing 2,300 gm (5 lb 1 oz) with atresia of the small bowel from the ligament of Treitz to within 3 cm of the ileocecal junction, and partial atresia of the colon, declined postoperatively to 1,816 gm (4 lb) despite vigorous but conventional supportive care. A 30% solution containing all required nitrogen, calories, and essential nutrients was then infused continuously into the superior vena cava for 44 days when gastrointestinal dysfunction precluded enteral feeding. During the period when nutrition was given entirely intravenously, normal growth and development accompanied increases of 5.0 cm (1.9 in) in head circumference, 6.3 cm (2.5 in) in length, and 1,447 gm (3 lb 3 oz) in weight.

Infectious Mononucleosis: Clinical Manifestations in Relation to EB Virus Antibodies

Abstract: In each of 29 patients with infectious mononucleosis (IM) the development of antibodies against a herpes-type virus (EB virus) has been demonstrated by an indirect immunofluorescence test with a virus bearing cell line (EB-3) derived from a Burkitt lymphoma. These antibodies, absent in pre-illness serum specimens, usually appeared early in the disease, rose to peak levels within a few weeks, and remained at relatively high levels during convalescence. They are clearly distinctive from heterophile antibodies and, unlike the latter, they persist for years, probably for life. Tests on sera from 50 randomly selected college freshmen revealed EB virus antibodies in 12, two of whom had positive histories of IM. Of 38 without demonstrable antibodies none had had IM, but the illness developed in three in the next two years. These and other observations strongly indicate that EB virus, or a closely related one, is the etiologic agent of IM.

The length and variability of the human menstrual cycle.

Abstract: The Center for Population Research collected 30,655 recorded menstrual cycles from 2,316 women. Ninety-five percent of all cycles were between 15 and 45 days long. The mean and standard deviations for the total number of cycles were 29.1 and 7.46, respectively. Cycle lengths between 15 and 45 days averaged 28.1 days with a standard deviation of 3.95 days. Variability of menstrual-cycle lengths is highest for women under 25 years of age and declines steadily to reach a minimum for ages 35 to 39. It is then followed by a slight increase for women aged 40 to 44. The pattern of variability by age is demonstrated equally well by the percent of cycles between 25 and 31 days in length as by the standard deviation.

Integrative Activity of the Brain: An Interdisciplinary Approach

Abstract: Dr. Konorski, a leader in Polish neurophysiology, previously wrote a well-received book synthesizing Pavlovian concepts with the kind of neurophysiology represented by Sherrington and his school. In this newer work, account is taken of more recent discoveries in brain neurophysiology, and this has been related to the newer advances made in experimental psychology. Konorski has chosen not to restrict himself to objective behavior but uses introspection as a datum. A central concept is that of the "gnostic unit," eg, a pencil, an apple, a face. These gnostic units in the different sensory analyzers are not elaborated from sense-datum elements, eg, edges, corners, or more complex shapes of a visual input; but these apparently simpler elements require additional neuronal mechanisms for their isolation from primitive gnostic units. In addition to sensory excitation, gnostic units can be activated internally by associational mechanisms apart from a sensory input, as in a dream or

The sick sinus syndrome in atrial disease

Abstract: Although little basic information exists regarding atrial disease, certain clinical states can be grouped into a syndrome resulting from a failing sinoatrial (SA) node. One or more of the following symptoms appears: persistent, severe, and unexpected sinus bradycardia; cessation of sinus rhythm for short intervals with other rhythms supervening; long periods of sinus arrest without rescue rhythm, which produces cardiac arrest; untreated chronic atrial fibrillation with slow ventricular rate; no sinus rhythm after cardioversion; SA exit block. Symptoms spring from hypoperfusion of vital organs.

Profound neutropenia during the early phase of hemodialysis.

Abstract: Patients undergoing hemodialysis manifest marked temporary neutropenia occurring 2 to 15 minutes after the start of dialysis, followed by an increase in band neutrophils. Total leukocyte counts return to near normal levels approximately one hour later. The phenomenon is not due to simple filtration of leukocytes by the dialyzer nor to heparin sodium administration, and is independent of the administration set or the infusion pump mechanism. Rebound leukocytosis is not observed, and the neutropenia is unaccompanied by chills, fever, or other symptoms usually associated with intravenous infusions of pyrogenic substances.

Sex and Gender: On the Development of Masculinity and Femininity

Abstract: "Sex" in this title refers to biological sex, "gender" to the concept that people have of themselves as male or female. How sex relates to gender—or, more precisely, fails to relate—is the subject of the book. The author is a psychoanalyst with ten year's experience of treating patients with congenital sexual anomalies and those of normal biological endowment whose "genders" are awry. The latter consist mainly of individuals who dress like the opposite sex (transvestities) and those who ardently desire to be the opposite sex (transexuals), even to the point of seeking surgical manipulation to that end. Stoller marshals an impressive array of clinical evidence to indicate that psychological sex is largely independent of biological sex—at least in humans. Early parental influences are held to be the decisive factor in molding gender identity, and the author, true to his professional background, explains these influences largely in freudian terms, with a

Whiplash injury and brain damage: an experimental study

Abstract: Experimental whiplash injury in rhesus monkeys has demonstrated that experimental cerebral concussion, as well as gross hemorrhages and contusions over the surface of the brain and upper cervical cord, can be produced by rotational displacement of the head on the neck alone, without significant direct head impact. These experimental observations have been studied in the light of published reports of cerebral concussion and other evidence for central nervous system involvement after whiplash injury in man.

An Operation for the Correction of Truncus Arteriosus

Abstract: An operation achieved success in correcting the truncus arteriosus anomaly. The pulmonary arteries were disconnected from the truncus, and, by the manner in which the ventricular septal defect was closed, it became the true aorta. A new outflow from the right ventricle to the pulmonary arteries was established by the use of a homograft of ascending aorta including the aortic valve. This use of a homograft may be the factor that allowed success in the operation as opposed to previous attempts at similar operations with synthetic materials. The corrective operation will probably prove to be the method of choice for the treatment of patients with truncus arteriosus.

Successful treatment of 750 criminal addicts.

Abstract: A four year trial of methadone blockade treatment has shown 94% success in ending the criminal activity of former heroin addicts. The majority of these patients are now productively employed, living as responsible citizens, and supporting families. The results show unequivocally that criminal addicts can be rehabilitated by a well-supervised maintenance program.

The palpable nodule of prostatic cancer. Results 15 years after radical excision.

Abstract: Until Jan 1, 1951, radical perineal prostatectomy was performed on 111 patients with clinically localized and discrete cancer. Of these, 103 patients were followed for 15 years or longer. No patient with high-grade cancer or with cancer extending microscopically beyond the prostate survived without recurrence. Of 86 patients with locally limited cancer, 28 lived 15 years free of the disease (33%). This represents twice the success rate achieved with endocrine treatment of patients with what was thought to be comparable conditions. One patient died in the hospital. Complications were infrequent, minor, and temporary. In 82 recent cases an improved technique has provided complete urinary control in 80 instances.

Management of epilepsy with diphenylhydantoin sodium. Dosage regulation for problem patients.

Abstract: Levels of diphenylhydantoin sodium in the blood can be correlated with its clinical effects and intoxication. Therapeutic levels (10μg/ml to 15μg/ml are reached within 5 to 15 days when 300 mg are given daily; and with a larger (up to 1,000 mg) initial dose, within a few hours (orally) or minutes (intravenously). Two groups of unusual responses to commonly used doses of diphenylhydantoin have been observed. (1) Low tolerance to the drug which can be caused by congenital enzymatic deficiency, liver disease, or metabolic interference by other drugs. A reduction of the daily dose is necessary in these patients. (2) Refractoriness to diphenylhydantoin which can be caused by excessive diphenylhydantoin metabolism, deficient absorption, and unreliable diphenylhydantoin intake. An increase of dose, administering diphenylhydantoin parenterally, or supervising drug intake will provide adequate blood levels in these patients.

Licorice-Induced Pseudoaldosteronism: Hypertension, Hypokalemia, Aldosteronopenia, and Suppressed Plasma Renin Activity

Abstract: Hypertension, initially ncrmokalemic, was eventually associated with hypokalemia, alkalosis, suppressed plasma renin activity, and aldosteronopenia in a 58-year-old man who had ingested two to three 36-gm licorice candy bars daily for six years to seven years. Metabolic balance studies recorded complete recovery upon cessation of licorice ingestion. The syndrome was reproduced experimentally by oral administration of ammonium glycyrrhizate, the compound in licorice responsible for sodium retention. In categorizing mechanisms of hypertension, it is important to assess the functional state of the renin-aldosterone system by measuring both factors. When both yield low values it is likely that a potent sodium-retaining substance, other than aldosterone, either of endogenous or of exogenous origin, is at work. Licorice-induced hypertension serves a model of hypertensive disease developing as the result of ingestion of a foodstuff possessing sodium retaining activity.

Psychological Evaluation of Children's Human Figure Drawings

Abstract: Often a physician would like a measure for a child's intelligence and emotional state but does not wish either to refer the child to a psychologist or to carry out lengthy tests himself. If he asks the child to "draw a whole person" and then evaluates the drawing by the methods described in this book, he can get a quick estimate of the mental ability, the probability of serious emotional disturbance, and the possibility of organic brain disorder. For a long time many psychologists have used the Goodenough Draw-A-Man test as a measure of intelligence, but the scoring is somewhat complicated and probably few physicians have used the test. Other psychologists have used human figure drawings as projective tests to investigate personality but have not developed definite scoring methods. Now Koppitz presents a relatively simple method of scoring a single drawing, first for approximate intelligence, then for evidence of emotional

Resuscitation from ventricular fibrillation. Drug therapy

Abstract: In resuscitating dogs subjected to ten minutes of circulatory arrest due to ventricular fibrillation, a number of drugs were used with artificial ventilation of the lungs, external cardiac massage, and external electrical counter-shock. Resuscitation was more successful when epinephrine was used than when no drug therapy or sodium bicarbonate were used. Combination of lidocaine with epinephrine increased the frequency of defibrillation, but circulation was not restored more often than with epinephrine alone. The use of methoxamine hydrochloride was followed by successful resuscitation more often than was the use of epinephrine. Combination of epinephrine and sodium bicarbonate was as effective as methoxamine in restoring circulation, and inspection of the survivors after 24 hours suggested that the combination might be preferable.

Temperament and Behavior Disorders in Children

Abstract: This book, the latest resulting from the authors' longitudinal study of a group of young children, is basically oriented toward impressing the reader with the importance of the "temperament" in the emotional development of the child. The sample chosen represents 42 of the original 136 children in the study. These youngsters developed some symptom or other behavioral problem and were subsequently studied in detail. Nine categories of "reactivity" were utilized to establish the basic "temperament" of each subject. These categories were activity level, rhythmicity, approach or withdrawal, adaptability, intensity of reaction, threshold of responsiveness, quality of mood, distractibility, and attention span and persistence. Each of these was rated on a three-point scale. The ratings were begun in infancy and continued throughout childhood. The investigators also studied the homes of the children, their intellectual levels, and the reports from teachers. The sample consisted of children of various ages ranging from those

Impaired Delayed Hypersensitivity in an Aging Population: Association With Antinuclear Reactivity and Rheumatoid Factor

Abstract: The ability to develop delayed hypersensitivity was studied in 116 normal elderly subjects who were between 59 and 98 years old, with 2,4-dinitrochlorobenzene (DNCB) as an antigen. Only 84 (72%) were sensitized to the chemical. The impaired responsiveness was confined to those subjects more than 70 years of age, 69% of whom reacted, and was in contrast to the normal responsiveness (94%) of those 69 years of age or less. Sixteen subjects who reacted to tuberculin skin testing could not be sensitized to DNCB, suggesting that previously developed delayed hypersensitivity might persist despite the demonstration of anergy to a new allergen. Fourteen of 16 subjects with circulating antinuclear factor reacted to DNCB but only 3 of 6 with rheumatoid factor could be sensitized. No correlation was observed between serum immunoglobulin concentrations and reactivity to DNCB or tuberculin.

The Social Meaning of Suicide

Abstract: The finality of a successful suicide imparts to this subject transcendent importance. Physician, friend, and family may share in its deep involvement. Any who seek some sort of physical, metaphysical, or psychological assistance from this book will be disappointed. In sociological vein, Douglas reviews first Durkheim's Suicide , originally published in 1897. In brief, Durkheim advanced the proposition that social (altruistic) forces influence the general trend of suicide or "suicidal rates," while individual forces (egoism) determine the end result or action of the individual in this direction. Imbalance of these forces may tip the scale. One might say that society predisposes while man disposes. Douglas devotes much of his book to critical analysis of Durkheim's work and others that followed. Little escapes criticism or questioning—from evaluating methods of collecting statistical data to philosophical inquiry into the meaning of suicide and death. Douglas hesitates to accept official reports of suicide; he stresses

Anicteric hepatitis associated with Australia antigen. Occurrence in patients with Down's syndrome.

Abstract: The frequency of Australia antigen is high in patients with Down's syndrome in large institutions (27.7%) and is low in patients without this syndrome in the same institutions (3.2%). It is rare in patients with Down's syndrome in small institutions (1.5%) and absent in newborn patients and those who are not institutionalized. Serum glutamic pyruvic transaminase levels were studied in age- and sex-matched groups of 16 patients with Down's syndrome and Australia antigen [phenotype Au (1)], 16 with Down's syndrome but without Australia antigen [Au(0)] and 16 Au(0) mental defectives without Down's syndrome. The findings indicated active liver cell breakdown in Au(1) patients, and were confirmed in an extensive study including 581 individuals. The findings are best explained by the operation of an environmental factor, probably infectious, present in the large institutions, and a host susceptibility factor present in association with Down's syndrome.

Incidence of leukemia following treatment of hyperthyroidism. Preliminary report of the Cooperative Thyrotoxicosis Therapy Follow-Up Study.

Abstract: This study was conducted to test for an increase in the incidence of leukemia in hyperthyroid patients treated by radioactive iodine 131 I as compared to the incidence in patients treated differently. Of 36,000 patients from 26 medical centers, approximately 22,000 were treated with 131 I and about 14,000 were treated surgically or solely with antithyroid drugs. More than 96% of patients were followed up. Forty-four cases of leukemia occurred after, and 16 before, treatment. The incidence of leukemia in patients treated with 131 I for hyperthyroidism and the incidence in those treated surgically do not differ. Patients both undergoing surgery and receiving 131 I have a higher incidence of leukemia than any other treatment group. The observed mortality from leukemia for hyperthyroid patients is 50% higher than that of the US population.

Signs and Symptoms

Abstract: Most physicians, if asked to distinguish between signs and symptoms, would reply in a fashion something like this: Asymptomis a manifestation of disease apparent to the patient himself, while asignis a manifestation of disease that the physician perceives The sign is objective evidence of disease; a symptom, subjective Symptoms represent the complaints of the patient, and if severe, they drive him to the doctor's office If not severe, they may come to light only after suitable questions The patient perceives, for example, subjective pains and discomforts [Doctor, I have a bad headache], or disturbances of function [Doctor, I can't move my arm the way I used to], or some simple appearance [Doctor, I have had this rash for the past ten days and I'm worried about it] But the physician, as a skilled observer, can discern what the patient cannot He can look, palpate and percuss,

Treatment of Candida sepsis and Cryptococcus meningitis with 5-fluorocytosine. A new antifungal agent.

Abstract: The two patients whom we treated for systemic fungus infections with 5-fluorocytosine, an antifungal agent effective in experimental animal infection with Candida and cryptococci, had a satisfactory clinical response in association with therapy. One patient with Candida sepsis received 5-fluorocytosine for 21 days in a dose ranging from 2 to 4 gm daily. The other patient, with cryptococcal meningitis recurring after amphotericin B treatment, received 5-fluorocytosine in a dose of 2.25 to 9 gm daily for 50 days. There was little evidence of drug toxicity. The new agent deserves controlled clinical evaluation in systemic fungus infections.

Assessment of Adverse Reactions Within a Drug Surveillance Program

Abstract: As part of a comprehensive drug surveillance program, we devised a system for identifying and characterizing adverse reactions to drugs. The overall program includes measurements of drug efficacy and a description of the patient population being studied. The data collected thus far suggest that drug reactions represent a major health hazard. Adverse reaction information on any drug must be evaluated for careful consideration of total drug usage, the reasons for prescribing the drug, and its overall efficacy.

Incidence of Primary Aldosteronism Uncomplicated Essential Hypertension: A Prospective Study With Elevated Aldosterone Secretion and Suppressed Plasma Renin Activity Used as Diagnostic Criteria

Abstract: In a prospective study of the incidence of primary aldosteronism among patients with "essential" hypertension, this diagnosis could be excluded in 87 of 90 patients by the demonstration of normal aldosterone secretion or lack of suppression of plasma renin activity or both. In contrast, at least four of ten patients observed during the same period because of concomitant hypertension and unprovoked hypokalemia were proven to have primary aldosteronism. Primary aldosteronism is, thus, a relatively rare cause of hypertension among patients with normal serum potassium concentrations, but should be carefully considered as a possible cause of hypertension among patients with hypokalemia. Subnormal plasma renin activity was found to be a characteristic of patients with "essential" hypertension as a group; marked suppression of plasma renin activity was found in five (21%) of 24 patients with "essential" hypertension. Thus, although subnormal plasma renin activity can be used to distinguish primary from secondary aldosteronism, taken by itself, this finding is of limited value in diagnosis since it also occurs in many patients with "essential" hypertension.