Showing papers in "JAMA in 1969"
TL;DR: In this paper, von Bertalanffy presents nine papers which he had published from 1940 to 1969 and a newly written introductory chapter, together they present a clear picture of the theory and some of its applications, although with some repetition.
Abstract: When, in the forties, von Bertalanffy, a biologist, started writing about general system theory, relatively little attention was paid him. Gradually, however, scientists have become interested in seeing relationships among their fields and have been impressed by this promising effort to find common laws applying to such widely diverse subjects as biology, economics, psychology, and demography. Developments in information theory, computer and technology, and cybernetics are related to general system theory and have contributed to it. In this book von Bertalanffy presents nine papers which he had published from 1940 to 1969 and a newly written introductory chapter. Together they present a clear picture of the theory and some of its applications, although with some repetition. Two chapters include mathematical formulations which are difficult for the nonmathematician to follow, but the rest of the book is easily comprehended. The section on psychiatry and psychology is a brief condensation of the
634 citations
TL;DR: Sixty-six percent of a group of 163 patients with Parkinson's disease exhibited subjective or objective improvement of their akinesia, rigidity, and tremor while receiving amantadine hydrochloride.
Abstract: Sixty-six percent of a group of 163 patients with Parkinson's disease exhibited subjective or objective improvement of their akinesia, rigidity, and tremor while receiving amantadine hydrochloride. Of those showing improvement, benefits were sustained in 58% for a period of three to eight months. The maximum daily dose was 200 mg. Side effects occurred in 22% and consisted of increased jitteriness, insomnia, abdominal uneasiness, dizziness, depression, confusion, and, in a few cases, hallucinations. Convulsions have been reported with large doses of 800 mg per day. In most cases, side effects were controlled by adjustment of dosage of [ill] hydrochloride or the patient's concomitant medication.
559 citations
TL;DR: Results support the use of intermittent courses of concurrent chemotherapy with large doses of melphalan and prednisone in patients with multiple myeloma.
Abstract: Of 183 patients with multiple myeloma treated with melphalan, 43% demonstrated an objective response. Of the evaluable cases, 70% of the patients responded to combination therapy with melphalan and prednisone, 35% to intermittent melphalan therapy, and 19% to daily melphalan therapy. Symptomatic manifestations of disease decreased in almost all responding patients. The degree of remission was superior with melphalan-prednisone therapy since serum myeloma globulin peaks disappeared more frequently from the electrophoresis scan. In patients producing only λ Bence Jones proteins, azotemia was more frequent, the incidence of response was low, and survival was short. Median survival for patients treated with melphalan-prednisone was about six months longer than the survival of patients treated with melphalan alone. Results support the use of intermittent courses of concurrent chemotherapy with large doses of melphalan and prednisone in patients with multiple myeloma.
526 citations
TL;DR: In this paper, the authors present an introductory text for the medical student focusing on splanchnic circulation, motor mechanisms, secretion, digestion, and absorption, with a focus on presenting the material in an easy readable format.
Abstract: Of easily readable size and presenting its material in an attractive format, this work is oriented toward the medical student. It covers the subject under major headings of splanchnic circulation, motor mechanisms, secretion, digestion, and absorption. The bibliography is brief, and controversial points generally are passed over. Although opinions differ over what the medical student should be taught and how material should be presented, coverage certainly offers an adequate background in most areas of gastrointestinal physiology. Hepatic physiology, however, is incompletely examined, and the authors seem not to have decided how to approach this complicated subject. Perhaps hepatic physiology, now so extensive, can be covered adequately only in a separate volume. Some of the material is presented and discussed in a confusing or inadequate manner, especially for a book designed as an introductory text for students. For example, the authors mention results obtained by using a Pavlov pouch, but they
473 citations
TL;DR: Seven papers are presented on genetics, including a critical review of the literature, three of twins, and a genealogic study in Iceland where genealogy could be traced for seven people.
Abstract: After years of relative neglect, schizophrenia is finally receiving research effort and money. However, the investigators are still uncertain how to define schizophrenia, and differ widely in their approach. Some seek the cause, others the cure. Some study statistics, some work in biochemical laboratories, some devise psychological tests; a few even observe patients and their families. Recently, the Foundations' Fund supported a conference at which investigators discussed the transmission of schizophrenia. The editors, who evidently planned the conference and selected the members, explain that they use the word "transmission" instead of "etiology" because the evidence to date "is concerned with how schizophrenic disorder is passed on to members of a family, class or culture, rather than with immediate and specific causes." Seven papers are presented on genetics, including a critical review of the literature, three of twins, and a genealogic study in Iceland where genealogy could be traced for seven
470 citations
TL;DR: The facial skin of white persons has been assessed throughout the human life span for the severity of elasticfiber changes as an indicator of sunlight damage, and sunlight, not innate aging, is mainly responsible for the worst manifestation of senile skin.
Abstract: The facial skin of white persons has been assessed throughout the human life span for the severity of elasticfiber changes as an indicator of sunlight damage. Elastic hyperplasia began as early as the first decade and was clearly evident in a majority of young adults before the age of 30. Beyond the fourth decade most persons had serious elastic-tissue abnormalities culminating in massive degeneration. The elastotic changes were quite advanced before the extensiveness of the damage became visible clinically. The unexposed skin of the buttock exhibited only a slight increase in elastic fibers in old age. The degree of elastic-tissue damage in different regions of the face was in relation to the amount of sunlight these received, greatest on the ear rim and cheek, least under the chin and eyebrows. Sunlight, not innate aging, is mainly responsible for the worst manifestation of senile skin.
361 citations
TL;DR: There has been a steady decline in surgical mortality over the past eight years and the highest complication rate, including mortality, was noted in patients operated on within two weeks of the development of an acute neurological deficit.
Abstract: Twenty-four centers participated in the Joint Study of Extracranial Arterial Occlusion. There were 2,400 operations carried out between 1961 and 1968 with an overall surgical mortality of 4.5%. The highest complication rate, including mortality, was noted in patients operated on within two weeks of the development of an acute neurological deficit. With improved intraoperative technique and more critical selection of patients, there has been a steady decline in surgical mortality over the past eight years.
331 citations
TL;DR: Pressure measurements are helpful in the evaluation of cases with doubtful arterial disease, in selection of patients for arterial surgery, in the objective assessment of the results of treatment, and in the follow-up of patients.
Abstract: Systolic pressures can be measured easily in the limbs with arterial occlusive disease using blood pressure cuffs. Pulse pick-ups, ultrasonic flow detector, spectroscope, or visual "flush" technique may be used to detect the end point. Systolic pressures were measured in 202 limbs with angiographically documented arterial disease and in 86 control limbs. The pressures were abnormal in all limbs with complete proximal occlusion and in the majority of limbs with proximal stenosis. Such measurements are helpful in the evaluation of cases with doubtful arterial disease, in selection of patients for arterial surgery, in the objective assessment of the results of treatment, and in the follow-up of patients. The described techniques should find wide clinical application, particularly since the measurements can be carried out easily at bedside and in the physician's office.
259 citations
TL;DR: Fatal aplastic anemia is a rare disorder, occurring in two per million population each year and usually follows overwhelming infection or hemorrhage, or both, and it is not related to dosage.
Abstract: Fatal aplastic anemia is a rare disorder, occurring in two per million population each year. Death usually follows overwhelming infection or hemorrhage, or both. The course from onset of anemia to death is often only a few months. Fatal aplastic anemia appeared to be 13 times more frequent after the use of chloramphenicol. Anemia may not appear until the second or even third course of chloramphenicol therapy, and it is not related to dosage.
248 citations
TL;DR: Sim One, a computer-controlled manikin, demonstrates the feasibility of using a simulator to teach medical students, interns, and residents some of the manual skills they must learn.
Abstract: Sim One, a computer-controlled manikin, demonstrates the feasibility of using a simulator to teach medical students, interns, and residents some of the manual skills they must learn. The simulated patient looks like a living person, "breathes" with chest and abdomen, has carotid and temporal pulses synchronous with an audible heartbeat, and can be ventilated by bag and mask or through an endotracheal airway. "He" also responds appropriately when oxygen, nitrous oxide, thiopental sodium, succinylcholine, and either of two vasopressors are given by the student. Each maneuver of the student and each response of the simulated patient are recorded and available in typed and graphic form for immediate reinforcement of the learning experience.
218 citations
TL;DR: After almost a year's absence from the book stores, Koss's Diagnostic Cytology is back again in its second edition, and among its new features are a greatly expanded discussion of basic cellular structures with abundant photographs of electron microscopy.
Abstract: After almost a year's absence from the book stores, Koss's Diagnostic Cytology is back again in its second edition. This is probably the most complete book on cytology available, correlating the exfoliated cell with its parent healthy or diseased organ. As is the trend of modern texts, the new book is almost 300 pages longer than the original. Among its new features are a greatly expanded discussion of basic cellular structures with abundant photographs of electron microscopy. There also are several new chapters by Miles on the chromosome. Coverage of normal female genital-tract cytology has been increased by more illustrations of excellent quality. However, the second edition still describes what are probably metaplastic cells as parabasal cells with intercellular bridges. Another error has been corrected. In the new volume a special variety of multinucleated cells which previously had been called "trophoblastic syncitial cells" now is correctly identified as a cell
TL;DR: Twenty-eight patients had infections due to Clostridium septicum ; 21 of them had documented septicemia; and a malignancy was present in 23 of the 27 patients for whom hospital records were available.
Abstract: Twenty-eight patients had infections due to Clostridium septicum ; 21 of them had documented septicemia. A malignancy was present in 23 of the 27 patients for whom hospital records were available. In three, an intestinal tumor was found one to two months after C septicum was cultured. In contrast with wartime reports, no wound infections due to this organism were observed in otherwise healthy individuals. Of the 27 patients, 13 of 15 treated with antibiotics survived, but 11 of 12 in the untreated group died. In each case the source of the organism was probably the patient's own intestinal tract.
TL;DR: A review of studies purporting to show that diets high in carbohydrate or fat stimulate sebaceous secretion and adversely affect acne vulgaris indicates that these claims are unproved.
Abstract: To test the widespread idea that chocolate is harmful in instances of acne vulgaris, 65 subjects with moderate acne ate either a bar containing ten times the amount of chocolate in a typical bar, or an identical-appearing bar which contained no chocolate. Counting of all the lesions on one side of the face before and after each ingestion period indicated no difference between the bars. Five normal subjects ingested two enriched chocolate bars daily for one month; this represented a daily addition of the diet of 1,200 calories, of which about half was vegetable fat. This excessive intake of chocolate and fat did not alter the composition or output of sebum. A review of studies purporting to show that diets high in carbohydrate or fat stimulate sebaceous secretion and adversely affect acne vulgaris indicates that these claims are unproved.
TL;DR: Radiation, method of examination, diagnostic criteria, and bias in autopsy selection did not appear to explain the observed high frequency of thyroid carcinoma at autopsy in Japan.
Abstract: Carcinoma of the thyroid at autopsy was found to be far more frequent in Japan than in any recorded American series. In 3,067 consecutive autopsies from the fixed population sample of the Japanese National Institute of Health-Atomic Bomb Casualty Commission Life-Span Study in Hiroshima and Nagasaki, 536 primary thyroid carcinomas were found—97% were occult papillary. The prevalence was significantly higher in women and those exposed to 50 rads or more of direct atomic radiation. The prevalence rate in the 1,096 persons in this study with no radiation dose whose entire thyroid gland was examined was 17.9% compared to 1.0% to 4.0% in the American series. Radiation, method of examination, diagnostic criteria, and bias in autopsy selection did not appear to explain the observed high frequency of thyroid carcinoma at autopsy.
TL;DR: It is suggested but not proved that the pulmonary disease represented an adverse reaction to methotrexate therapy, and an allergic type granulomatous reaction was revealed on one patient.
Abstract: A severe but self-limited respiratory illness characterized by fever, cough, dyspnea, cyanosis, and bilateral pulmonary infiltrates developed in seven consecutive patients with acute lymphoblastic leukemia who received intermittent therapy with methotrexate, while in clinical and hematologic remission of the leukemia. No infectious agent could be identified, and a moderate blood eosinophil count accompanied the illness in five of the seven patients. Lung biopsy performed on one patient revealed an allergic type granulomatous reaction. It is suggested but not proved that the pulmonary disease represented an adverse reaction to methotrexate therapy.
TL;DR: The delineation of four clinical stages of the disease, markedly elevated measles antibody titers in serum and cerebrospinal fluid, ultrastructural observation of intranuclear and intracytoplasmic inclusions in neurons and neuroglia in three patients, and alteration of serum and CSF immunoglobulins indicate that the measles myxovirus may be the etiological agent in these patients.
Abstract: Clinical, electroencephalographic, and other laboratory features and subacute sclerosing panencephalitis (SSPE) were studied in eight patients by the same group of investigators. The relatively high frequency of the disease within a small geographical area in a short period of time suggests that SSPE may be unusually common in the vicinity of Memphis. The delineation of four clinical stages of the disease, markedly elevated measles antibody titers in serum and cerebrospinal fluid, ultrastructural observation of intranuclear and intracytoplasmic inclusions in neurons and neuroglia in three patients, and alteration of serum and CSF immunoglobulins indicate that the measles myxovirus may be the etiological agent in these patients.
TL;DR: Diagnostic management of 1,400 patients with severe, active upper-gastrointestinal tract hemorrhage by immediate esophagogastroscopy and contrast roentgenography provided confident identification of the bleeding lesion in 93% andreexamination ice-water lavage of the stomach by Ewald tube and syringe proved remarkably effective for control of active hemorrhage.
Abstract: Diagnostic management of 1,400 patients with severe, active upper-gastrointestinal tract hemorrhage by immediate esophagogastroscopy and contrast roentgenography provided confident identification of the bleeding lesion in 93%. Preexamination ice-water lavage of the stomach by Ewald tube and syringe proved remarkably effective for control of active hemorrhage. Seven hundred and eleven potentially bleeding lesions that were not playing a part in the hemorrhage were discovered. Duodenal ulcer was responsible for only one fourth of the hemorrhages. Erosive esophagitis and erosive gastritis were the cause of approximately 7% and 12% of the hemorrages, respectively, with death rates of 3% and 9%, respectively. There was one endoscopic injury (perforation through Zenker's diverticulum). Emergency surgical treatment was necessary to control hemorrhage in 16.1% of the 1,400 patients. The overall mortality was 7.9%.
TL;DR: Tympanic thermometry was the only measurement with unequivocally defined location of insertion and was never found to be out of place, and rarely contraindicated, while contrainDications with rectal or esophageal measurements were frequent.
Abstract: Simultaneous, continuous recordings of tympanic and esophageal measurements of body temperature were obtained during anesthesia and surgery. Their patterns were found mutually consistent in the clinical situations as studied. Rectal patterns were abandoned as unpredictable in their relation to temperature in the cranium or at the crossroads of central circulation. Tympanic was the only measurement with unequivocally defined location of insertion. With the other methods a reproducible position could not be reached, maintained, or restored. In cleanliness (dry site and disposable probe); sterility; and minimum inconvenience, embarrassment or discomfort to patients, surgeons or physicians and medical personnel, men or women tympanic thermometry was superior to esophageal and rectal. It was never found to be out of place, and rarely contraindicated, while contraindications with rectal or esophageal measurements were frequent.
TL;DR: Preliminary studies indicated that women, older patients, and those with attacks of less than one hour's duration were at increased risk of subsequent thrombosis.
Abstract: Sixty cases of transient cerebral ischemic attack (TIA) were noted during five years of observation of a large retirement community. The incidence of new cases was 1.1/1,000/yr and was 1.8 times greater in men than in women. Electrocardiographic abnormalities were associated with increased risk of TIA development; hypertension and cardiomegaly on chest roentgenograms were not. Most patients were not hospitalized for TIA. Forty-four patients with TIA and without previous cerebrovascular disease were followed up for an average of 27.4 months. Subsequent thromboses developed in eight (18%), confirming the prognosis of TIA reported from hospitals and neurologic clinics. The incidence of subsequent thrombosis was greatest during the first year after the initial TIA. Preliminary studies indicated that women, older patients, and those with attacks of less than one hour's duration were at increased risk of subsequent thrombosis.
TL;DR: The data suggest that maternally deprived infants are underweight because of undereating which is secondary to not being offered adequate food or not accepting it, and not because of some psychologically induced defect in absorption or metabolism.
Abstract: This study was instituted to test the validity of the assumption that the growth failure in the "maternal deprivation syndrome" is due to psychological factors. Eleven of 13 maternally deprived infants gained weight at an accelerated rate when fed adequately while living in a hospital environment which simulated their home environment. Two failed to gain, but their intakes were low. In addition, seven of seven deprived infants gained rapidly in their own homes when fed an adequate diet by the mother (in the presence of our observer) during a period when it was unlikely that overall maternal handling improved. The data suggest that maternally deprived infants are underweight because of undereating which is secondary to not being offered adequate food or not accepting it, and not because of some psychologically induced defect in absorption or metabolism.
TL;DR: Surgical or nonsurgical treatment was randomly selected for 1,225 patients with occlusive cerebrovascular disease and appeared more beneficial for unilateral carotid artery stenosis in patients with transient attacks or a mild-to-moderate neurological deficit.
Abstract: Surgical or nonsurgical treatment was randomly selected for 1,225 patients with occlusive cerebrovascular disease. Statistically significant differences in cumulative survival rate at 42 months were as follows: (1) Surgical treatment appeared more beneficial for unilateral carotid artery stenosis in patients with transient attacks or a mild-to-moderate neurological deficit. (2) Nonsurgical treatment produced better results for unilateral carotid artery stenosis in patients with a moderateto-severe neurological deficit. (3) Nonsurgical treatment appeared more beneficial for combined unilateral carotid artery stenosis and contralateral carotid artery occlusion if patients had a moderate-to-severe neurological deficit. (4) Nonsurgical treatment appeared more beneficial for patients with completed strokes who had a marked and persistent neurological deficit.
TL;DR: Electron microscopy revealed morphologically similar virus-like particles both in sera from patients with hepatitis and from healthy apes, and a single virus group may be responsible for both infectious and serum hepatitis.
Abstract: In a prospective study of patients with serum hepatitis, 46 (74%) of 62 had Australia antigen in their serum. This high frequency of detectable antigen was probably due to sampling at weekly intervals during the acute phase of the disease. Antigen became detectable 35 to 120 days after exposure to contaminated blood products and persisted for one week to three months in 42 patients, and for more than ten months in 4 patients. Two of 128 healthy chimpanzees and one of 14 healthy gibbons also had the antigen. Antigens found in sera of patients with infectious or serum hepatitis and in ape sera were immunologically identical. Electron microscopy revealed morphologically similar virus-like particles both in sera from patients with hepatitis and from healthy apes. Australia antigen appears to be hepatitis virus itself, and a single virus group may be responsible for both infectious and serum hepatitis.
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TL;DR: Rollo May rehabilitates the concept of will, makes new interpretations of love, and shows their necessary relationship to each other.
Abstract: It takes courage today to write a book about love and will. Ever since Freud expounded his deterministic psychology and, perhaps inconsistently, pointed out the danger of repression by willpower, to speak of will has appeared not quite intellectually respectable. As for love, so many authors have discussed the subject that one might assume there was little more to say. But Rollo May rehabilitates the concept of will, makes new interpretations of love, and shows their necessary relationship to each other. May asserts that we are living in a schizoid age. Apathy has increased as a defense against anxiety and overstimulation. Although this schizoid lack of feeling may be protective and may even be used constructively, as by the artist Cezanne, the feeling of emptiness which it engenders may lead to violence and destruction. The author describes apathy as withdrawal of love and will, and in this book tries to
TL;DR: In the tarsal tunnel syndrome, the posterior tibial nerve is entrapped beneath the flexor retinaculum and deep fascia along the medial border of the foot, and results have been observed after surgical decompression.
Abstract: In the tarsal tunnel syndrome, the posterior tibial nerve is entrapped beneath the flexor retinaculum and deep fascia along the medial border of the foot. This syndrome is not recognized as readily as its counterpart in the upper extremity, the carpal tunnel syndrome. Seventeen patients with compression of the posterior tibial nerve were seen during the past 15 years; 16 have had surgical decompression. Entrapment has resulted from post-traumatic fibrosis, chronic compression from fascial bands, and entrapment by the abductor hallucis muscle. Electromyographic studies have aided diagnosis. Treatment has ranged from local steroid injection and weight reduction to surgical decompression of the posterior tibial nerve. The most consistent and satisfactory results have been observed after surgical decompression.
TL;DR: In a group of 435 adolescents of the Evans County Epidemiologic Study, 11% had hypertension (≥140 and/ or ≥90 mm Hg) in 1961, after seven years, 30 of this group were reevaluated and the most impressive associated finding was overweight and subsequent weight gain in eventual sustained hypertensives.
Abstract: Hypertension in adolescents is still a debatable subject in regard to prognosis. Conclusions on the significance of "prehypertension" have been divided and no long-term follow-up has been reported in a representative population. In a group of 435 adolescents of the Evans County Epidemiologic Study, 11% had hypertension (≥140 and/ or ≥90 mm Hg) in 1961. After seven years, 30 of this group were reevaluated. Two deaths from cerebral hemorrhage occurred. One patient has hypertensive heart disease; sustained hypertension with cardiovascular and cerebrovascular symptoms developed in three more. Five were found to have asymptomatic sustained hypertension. Seven more had hypertension not reaching levels of sustained hypertension (≥160 and/or ≥95 mm Hg). Twelve have become normotensive. The most impressive associated finding was overweight and subsequent weight gain in eventual sustained hypertensives.
TL;DR: Hypothyroid patients receiving cholestyramine should be examined periodically for evidence of hypothyroidism, and adjustments in dose and time interval between the two agents should be made if malabsorption of thyroid hormone is significant.
Abstract: Cholestyramine resin, an anionic exchange resin, currently being investigated as an agent for lowering serum cholesterol levels, has been shown to interfere with the absorption of ingested thyroid hormone. A small quantity of the resin is capable of binding thyroxine under the conditions encountered in the gastrointestinal tract. Interference with thyroid hormone absorption by cholestyramine can be minimized by allowing a time interval of at least four hours between the ingestion of the two agents. Hypothyroid patients receiving cholestyramine should be examined periodically for evidence of hypothyroidism, and adjustments in dose and time interval between the two agents should be made if malabsorption of thyroid hormone is significant.
TL;DR: A clinical syndrome of acute psychosis associated with Cannabis derivatives and environmental stress has been observed in 12 soldiers seen in Vietnam, each case was characteristic of acute toxic psychosis with organic features and ten cases had paranoid features as well.
Abstract: A clinical syndrome of acute psychosis associated with Cannabis derivatives and environmental stress has been observed in 12 soldiers seen in Vietnam. Each case was characteristic of acute toxic psychosis with organic features and ten cases had paranoid features as well. Factors unique to Vietnam and combat situations seem pertinent; treatment was conservative and supportive.
TL;DR: During and following vaccination these children experienced 18 group-A streptococcal infections (none type 3) with a rise in antistreptolysin O titer, which indicates the need for extreme caution in the use of strePTococcal Vaccines in human subjects.
Abstract: Twenty-one healthy siblings of patients with rheumatic fever were vaccinated with a type 3 streptococcal M protein. During and following vaccination these children experienced 18 group-A streptococcal infections (none type 3) with a rise in antistreptolysin O titer. Two infections were followed by definite rheumatic fever and one by probable rheumatic fever. This high rate contrasts with the observation of five cases of rheumatic fever in 447 similar streptococcal infections in nonvaccinated siblings. This experience necessitates giving consideration to the possibility that streptococcal vaccination of children may alter their tissue response to subsequent streptococcal infection. Most importantly, this experience indicates the need for extreme caution in the use of streptococcal Vaccines in human subjects.
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TL;DR: The report of 15 infants who would probably have died as fetuses save for intrauterine exchange transfusion and who, at an average age of 2 years, have normal physical and mental development will compel us to enlarge the concepts of the patient-doctor contract.
Abstract: Gregg and Hutchinson (p 1059) tell of 15 infants who would probably have died as fetuses save for intrauterine exchange transfusion and who, at an average age of 2 years, have normal physical and mental development. Their report confirms the hopes that have led mothers and physicians to accept risks, discomforts, and complications in order that the techniques of intrauterine exchange transfusion might be developed and refined. The report will also be a stimulus for the many who have watched such studies with reservations to undertake treatment of the unborn child with isoimmune hemolytic disease. Most important, however, the report will compel us to enlarge our concepts of the patient-doctor contract, the contract that exists whenever there is a sick patient and a doctor who will provide care. The qualities of choice, knowledge, and direct interaction that are crucial to the doctor-patient relationship are not basic to the patient-doctor contract.
TL;DR: The group treated with dextran 40 showed lower mortality and better quality of survival in terms of the neurological status and the improvement in the treated group was significantly better than in the untreated group.
Abstract: In a random manner, 100 patients with acute cerebral infarction due to thromboembolism were assigned to two groups. The patients in one group received continuous intravenous therapy with dextran 40 for three days; the others received an equivalent volume of fluid without the dextran 40. In the treated group, levels of dextran 40 remained greater than 1% for three to five days after the infusion was stopped. The group treated with dextran 40 showed lower mortality and better quality of survival in terms of the neurological status. The improvement in the treated group was significantly better than in the untreated group ( P