Showing papers in "JAMA in 1972"

Myocardial Infarction After General Anesthesia

Abstract: During 1967 and 1968, a total of 32,877 patients had general anesthesia at the Mayo Clinic; 422 had previous myocardial infarction. Of these 6.6% experienced another infarction during the first postoperative week. There was no relationship between incidence of postoperative reinfarction and type or duration of anesthesia. However, operations on the thorax and upper abdomen were followed by three times as many reinfarctions as operations at other sites. Patients who were operated on within three months of infarction had a 37% reinfarction rate. This rate decreased to 16% in patients at three to six months after infarction, and remained at 4% to 5% when infarction had occurred more than six months previously. A significantly higher number of myocardial infarctions occurred during the third postoperative day.

Predisposition to Atherosclerosis in the Head, Heart, and Legs: The Framingham Study

Abstract: Findings from a 16-year follow-up study of 5,209 Framingham adults indicate that blood pressure, serum cholesterol, cigarette smoking, electrocardiographic evidence of left ventricular hypertrophy, and glucose intolerance are precursors common to all three major atherosclerotic events—atherosclerotic brain infarction (ABI), coronary heart disease (CHD), and intermittent claudication (IC). The dominant factor predisposing to ABI is high blood pressure. None is clearly dominant for CHD. Glucose intolerance is only weakly related to this disease while cigarette smoking is related weakly (if at all) to angina pectoris. All five factors play an important role in IC. In general, relationships appear to be as strong for women as men. When all five variables are considered jointly, they have a closer relationship with ABI and IC than with CHD, and equally strong relationships in every age group between 45 and 74 years of age.

Joint Study of Extracranial Arterial Occlusion: VII. Subclavian Steal—A Review of 168 Cases

Abstract: Among 6,534 patients admitted to the study, 17% showed evidence of subclavian or innominate arterial occlusion or stenosis of 30% or more. Only 168 fulfilled the criteria of "subclavian steal" and more than 80% of these had associated lesions of other extracranial vessels. Differences were noted in operative mortality for various surgical procedures, and complications were higher when the thorax was opened. Mortality and morbidity from stroke were exceedingly high in the surgical group. No significant differences in survival were noted between the medically and surgically treated groups. Patients with subclavian artery disease only did not have strokes during the follow-up period whether they were treated medically, surgically, or not at all.

Carcinoembryonic Antigen in Patients With Different Cancers

Abstract: Carcinoembryonic antigen (CEA) is a cancer-specific antigen described by Gold in 1965. It is a glycoprotein present in malignant entodermal tissues, in fetal colonic mucosa, and in the plasma of patients with gastrointestinal tract cancers. We have measured plasma CEA levels in 346 patients using a new procedure which detects an ion-sensitive antigenic site in the carcinoembryonic molecule. Levels in 39 of 48 patients with gastrointestinal tract cancer and 90 of 281 with nonentodermally derived malignancies were abnormal. Following successful therapy CEA level returns to normal (colon, four of four; neuroblastoma, three of three). The identity between the antigen measured in the present study and the carcinoembryonic antigen of Gold has not been established. The assay appears to be useful in the follow-up of patients with cancer and may eventually be of diagnostic value in the asymptomatic patient.

Clinical characteristics of renovascular hypertension.

Abstract: Clinical characteristics of 175 patients with renovascular hypertension cured by surgery were compared with those of 339 patients with essential hypertension. Significant variables included abdominal or flank bruit, age, sex, race, duration and acceleration of hypertension, family history, symptoms, history of arterial occlusive disease outside of the kidney, body habitus, systolic blood pressure, orthostatic change in blood pressure, severity of retinopathy, cardiomegaly, blood urea nitrogen, serum creatinine and cholesterol levels, serum potassium and carbon dioxide contents, urinary casts, proteinuria, and bacteria. Some of the differences between the two populations were no longer apparent after matching 131 pairs of patients according to age, sex, race, and diastolic blood pressure. Patients cured by surgery were compared with patients who were improved, who failed to respond, and who had surgical deaths. In patients with atherosclerotic lesions, those who failed to respond had hypertension of longer duration and were more likely to show left ventricular hypertrophy than the cured patients. Those with surgical death had more widespread atherosclerosis, cardiac damage, and renal functional impairment.

Neurosyphilis. A study of 241 patients.

Abstract: The diagnosis of neurosyphilis is difficult due to lack of an ideal infallible laboratory test, the obscurity of the clinical symptoms, the rising incidence of its atypical forms, and the well-known occurrence of nontreponemal seronegative neurosyphilis.1 The incidence of neurosyphilis cannot be accurately assessed since venereal diseases remain vastly underreported. The problem has become more complicated by the fact that penicillin therapy in the first and second stages (infectious stages) of syphilis has altered the clinical picture of neurosyphilis.2The classical text book pictures of tabes dorsalis and general paresis of the insane (GPI) are becoming rare and seem to be replaced by atypical and in-between forms.2 Diagnosis The diagnosis of neurosyphilis is based on clinical judgement. The serologic tests are useful in confirming the diagnosis of syphilis, but nontreponemal serologic tests for syphilis (STS) are not sensitive enough, and can be negative in late stages of

On Death and Dying

Abstract: Dr. J. Russell Little, Chief, Division of Infectious Disease, the Jewish Hospital of St. Louis and Associate Professor of Medicine and Microbiology, Washington University School of Medicine: Our guest this morning is Elisabeth Kubler-Ross, MD. Dr. Ross has become something of a celebrity since the feature story inLifemagazine (Nov 21, 1969, p 36) concerning her and her work and the appearance of her recent book entitledOn Death and Dying.1The book provides a fascinating account of an experiment in teaching and therapy concerned with the emotional problems of seriously ill and dying patients. We have decided to dispense with the traditional case presentation today even though Dr. Ross could discuss any of our hospitalized patients with a terminal disease. Instead we shall turn over the entire hour to her discussion of her approach to the emotional problems of dying patients. Dr. Elisabeth Kubler-Ross, Medical Director, South

The Silent Epidemic

Abstract: Burns are occurring in epidemic proportions in the United States. The incidence of burn injuries in the United States exceeds that of every industrialized country, and deaths and crippling due to burns in this country, currently, are considerably greater than the mortality and morbidity due to poliomyelitis in the peak epidemic year of 1954. The impact of burns upon patients and their families is profound. For instance, to save an individual with a 50% burn, intensive treatment in a modern medical facility is required for about four months. However, despite such care, the mortality is about 50%. Furthermore, the cost to salvage a patient with such a life-threatening injury would be at least $36,000. Although a few highly specialized centers have lowered dramatically the mortality for patients with large burns, it is clear that such ideal care will not be available to the majority of burn victims in the near

The Coronary Drug Project

Abstract: To the Editor.— The directors of the Coronary Drug Project (220:996,1972) should be congratulated for including thyroid in an attempt to delay atherosclerosis. For more than 75 years evidence has been mounting that (1) thyroid deficiency promotes both experimental and clinical atherosclerosis, and (2) desiccated thyroid therapy is safe and effective in delaying vascular accidents in patients with advanced arterial damage. 1 By the same token, the directors should be censored for selecting dextrothyroxine sodium, a synthetic preparation of variable activity, which has been listed as contraindicated in coronary disease by the Physicians Desk Reference . Undoubtedly, they were misled by statements that this analogue has less metabolic activity than the natural hormone. Per unit of weight, this is true, but effective dosages of each compound reveal that desiccated thyroid or levothyroxine sodium is superior to dextrothyroxine for the reduction of serum lipids. Best and Duncan 2 found that in the

Demographic Analysis of the Study

Abstract: This report on the Cooperative Study of Renovascular Hypertension, includes details of its purposes, organization, diagnostic studies, statistical methodology, and demographic data. Of 2,442 patients studied, 1,128 subjects were judged to have primary (essential) hypertension, 880 renovascular disease, 355 parenchymal kidney disease, and 79 miscellaneous disorders. There were 577 operative procedures in 502 patients with renal arterial disease. There were 384 patients with follow-up of at least one year postsurgery. A unique aspect of this multidisciplinary cooperative study was its decentralization into special study groups for analysis and refinement of data. This and subsequent publications should provide prospective definitions of "renovascular hypertension," as well as an objective basis for the diagnosis and treatment of this condition.

Anticoagulant Therapy After Acute Myocardial Infarction: Relation of Therapeutic Benefit to Patient's Age, Sex, and Severity of Infarction

Abstract: The value of anticoagulant therapy after acute myocardial infarction has been assessed in 1,136 patients admitted to the Bronx Municipal Hospital Center. The treatment reduced the overall mortality in women from 31% to 15%, particularly those 55 years of age or over, with moderately severe infarction. The low overall mortality in control men (16%) was not reduced with treatment, though there was significant reduction of the mortality in a subgroup of men with moderately severe infarction showing Q-wave evolution. Age and sex, as well as the severity of the episode of acute myocardial infarction, are important in determining whether anticoagulant therapy is likely to be beneficial.

Influence of Social Class on Obesity and Thinness in Children

Abstract: Several social factors have been closely linked to obesity and thinness in adults. This study, based on 3,344 measurements of triceps skin-fold thickness found similar relationships in white urban children. Obesity was far more prevalent in the lower-class girls than in those of the upper class—nine times as prevalent by age 6. Similar though less striking differences were found between boys of upper and lower socioeconomic status. The pattern of thinness among girls was similar to that previously reported in women, with significantly more thinness in the upper-class group. Among boys, as among men, there were no such differences. The remarkably early onset of class-linked differences in prevalence of obesity underlines the importance of attempts to prevent the disorder in childhood. These attempts should be directed particularly toward those at high risk because of their lower socioeconomic status.

Evidence for X-Linkage in the Transmission of Manic-Depressive Illness

Abstract: Seven families were found in which manic-depressive illness and either protan or deutan color blindness (X-linked recessive traits) occurred in successive generations. In these seven families, as well as in two others previously reported in the literature, detailed analysis suggests that the genetic loci for manic-depressive illness and the two kinds of colorblindness may be located on the same chromosome. A dominant X-linked gene may thus be involved in the pathogenesis of manic-depressive illness.

Sexual Activity and Vaginal Colonization With Genital Mycoplasmas

Abstract: The relationship of sexual activity to vaginal colonization with the genital mycoplasmas (T-strain mycoplasmas and Mycoplasma hominis) was studied in 183 student and graduate nurses. Participants with no history of sexual contact were virtually free of mycoplasmas, whereas 37.5% of those with a history of intercourse with a single partner and 75.0% of those who had had intercourse with three or more partners were colonized with T-mycoplasmas. These data suggest that T-mycoplasmas are acquired through sexual contact and are part of the vaginal flora of healthy sexually active young women.

Treatment for early syphilis and reactivity of serologic tests.

Abstract: The Venereal Disease Branch, Center for Disease Control, in a cooperative study has reevaluated the comparative efficacy of antibiotic schedules for the treatment of early syphilis in 586 patients. All parenteral penicillin, tetracycline, and erythromycin treatment schedules recommended by the Public Health Service were studied. Erythromycin in base form, 20 gm, was given in a divided-dose schedule over a ten-day period. Subsequently, the dose of erythromycin had to be raised to 30 gm because of a high failure rate. All penicillin schedules tested showed a satisfactory cure rate with a cumulative re-treatment rate of only 10% in the 24-month observation period. The 30-gm schedule of erythromycin base proved as effective as tetracycline and penicillin G.

Physiology of Marathon Running

Abstract: Like most endurance athletes, marathon runners are characterized by their highly developed aerobic capacities (Vo2max) and an ability to tolerate high rates of energy expenditure (70% to 90% Vo2max) without accumulating blood lactate. During marathon competition these men must alter their speed to compensate for the detrimental effects of uneven terrain, wind resistance, and thermal stress. Such factors add to the circulatory and metabolic demands of running. Heat produced in the active muscles must be transported to the body surface via the circulatory system and subsequently dissipated to the environment. Since the major responsibility of circulation is to transport nutrients and metabolic wastes, increasing the environmental heat stress will overload the circulatory system, thereby reducing performance and posing a risk to the runners' health.

Spread of pertussis by hospital staff.

Abstract: Two separate outbreaks of pertussis occurred within a three-month period on the pediatric units at the University of Colorado Medical Center. Secondary cases developed among adult members of the hospital staff, as well as among pediatric patients. While most adults were only mildly ill, two adults were seriously incapacitated. Pertussis agglutination titers were performed on sera from 341 adults. Results emphasize the susceptibility of adults to pertussis, and suggest that exposure to pertussis is high among pediatric house officers, medical students, and pediatric nurses as compared to the general population. In individual cases, difficulty may be experienced making a firm diagnosis of pertussis with available techniques. This contributed to the late identification of the outbreak, and emphasizes the need for improved reporting systems in hospitals.

The sad truth about hemodialysis in diabetic nephropathy.

Abstract: Nine patients with renal failure resulting from diabetic nephropathy were treated by hemodialysis. Average duration of diabetes was 21 years, and mean duration of nephropathy was 26 months. One patient survives after more than three years. Others survived for 9, 20, 19, and 13 months, respectively. Overall mortality was 78% at the end of one year. All patients had problems with clotting or infection of bloodstream access routes or both. All had further visual deterioration. Neuropathy was not accelerated. Muscle-wasting, hypoproteinemia, and fluid overload were common. Dialysis for such patients may be considered as a palliative measure with little likelihood of long-term survival or improvement in quality of life.

Carcinoembryonic Antigen (CEA) in Colonic Cancer: Use in Preoperative and Postoperative Diagnosis and Prognosis

Abstract: Radioimmunoassay for serum carcinoembryonic antigen (CEA) was performed in 127 colonic cancer patients. The test results were positive in 57 (72%) of 79 patients in whom tumor was present at the time of assay. In the 51 patients tested prior to tumor resection, the incidence of positivity varied from 19% in those with localized tumors to 100% in those with metastatic disease. Preoperatively, undetectable CEA in patients with known colonic cancer suggested localized tumor and good prognosis. Strongly positive CEA test results in such patients correlated with extensive tumors and poor prognosis. Postoperatively, a positive result for serum CEA indicated presence of residual tumor. A negative CEA test result postoperatively, however, did not exclude residual tumor. Periodic CEA determination in the patients who have undergone resection of colonic cancer may detect tumor recurrence that is at a treatable stage.

Doxorubicin in Disseminated

Abstract: Doxorubicin (adriamycin) is a new cytotoxic antibiotic with antitumor activity in a variety of neoplasms in man. Thirteen patients with pulmonary metastases from osteogenic sarcoma were given adriamycin at a dose ranging from 17.5 to 35 mg/sq m of body surface area daily for three or four days, repeated at monthly intervals. Of these, one patient had complete remission; three, partial remissions; and one improvement by 25% tumor regression was also obtained. Toxic manifestations of adriamycin administration were pancytopenia, capital alopecia and hair loss from other parts of the body, stomatitis, and nausea and vomiting. Adriamycin appears to be effective therapy for disseminated osteogenic sarcoma, and the toxic reactions from its administration do not preclude the practical application of the drug in the treatment of this usually fatal neoplasm.

Septic Complications of War Wounds

Abstract: Wound and blood cultures were obtained from 30 US marines with severe combat-inflicted extremity injuries. On admission to the hospital, the predominant organisms isolated from the wounds were gram-negative bacteria belonging to the Enterobacter and Mimeae groups,Escherichia coli, andKlebsiella. By the fifth hospital day, a significant increase in the number of wounds yieldingPseudomonasandProteus organismswas noted. Twelve of 30 patients developed positive blood cultures. Enterobacter and Mimeae were most frequently cultured from the bloodstream. In eight instances, the same strain of gram-negative bacteria was isolated from the wounds and blood. Three patients died in gram-negative septicemia. Recommendations for initial antibiotic therapy in severely wounded patients in a combat area are presented.

Correlation of serum creatinine concentration and gentamicin half-life.

Abstract: The serum half-life of gentamicin sulfate following an intravenous dose was compared to the serum creatinine concentration in 21 adult patients with different degrees of renal failure. A correlation was found such that the gentamicin half-life (in hours) could be estimated by multiplying the serum creatinine concentration (mg/100 ml) by four. The apparent distribution volume for gentamicin is about 24% of the body weight, but may be larger in patients with renal insufficiency. An injection of 2 mg/kg of body weight will result in therapeutic drug levels. Kinetic analysis predicts that repetition of this loading dose every third half-life will result in therapeutic, nontoxic serum levels in patients with renal failure. An alternate approach using a constant dose interval but varying the quantity of drug can be predicted from a nomogram.

Amantadine in Parkinson's disease. Review of more than two years' experience.

Abstract: Four hundred thirty patients with Parkinson's disease were treated with amantadine hydrochloride alone or in conjunction with other anti-Parkinsonism medications over a 2 1/2-year period. Of 351 patients who took 200 mg a day for 60 days, 64% showed a favorable response to the drug at 60 days and thereafter. Of those patients who received amantadine and levodopa, 79% responded favorably, as compared with 48% in the group who did not receive levodopa. In one half of the patients treated, a decline in the therapeutic efficacy of amantadine was observed between 30 and 60 days. Few side effects were noted even after long periods of administration, and laboratory studies disclosed no consistent significant abnormalities.

An autopsy study of cancer patients. I. Accuracy of the clinical diagnoses (1955 to 1965) Boston City Hospital.

Abstract: At the Boston City Hospital between 1955 and 1965 one fourth of all autopsies involved cancer patients Forty percent of these 2,734 patients had serious clinical errors for diagnosing cancer, and 63% of patients with these errors died from cancer Twenty-six percent of all patients reviewed had clinically undiagnosed cancer, and 45% of these neoplasms were fatal Nonmalignant diseases caused death in 24% of all cancer patients reviewed Generally, errors in clinical diagnoses of cancer were most common with the most common cancers Cancer patients were almost a decade older than control patients without cancer

Current Status of Hypertension Control in an Industrial Population

Abstract: Evidence for the beneficial effect of antihypertensive treatment has recently been obtained in controlled clinical trials. 1,2 For men with moderate and severe hypertension, there can now be little doubt of the efficacy of current available drug treatment in preventing serious complications, including death. Although statistically significant evidence has not yet been obtained for patients with the mildest degrees of hypertension, it is likely that for them, too, treatment will be beneficial. In the absence to date of a definitive trial, it is also reasonable to infer that the consequences of hypertension in women will be ameliorated by effective treatment. The recent findings on the value of antihypertensive therapy highlight the need to assess the current status of efforts to identify and treat persons with this disease. From 1967 on, the Chicago Heart Association Detection Project in Industry has been systematically investigating these matters in an extensive survey of men

Penicillin Treatment of Streptococcal Pharyngitis: A Comparison of Schedules and the Role of Specific Counseling

Abstract: Of 300 children with streptococcal pharyngitis, one group received a mixture of penicillin G procaine and penicillin G benzathine; a second was given a prescription for ten days of penicillin phenoxymethyl (parents of this group were given no special instructions); and a third was given identical prescriptions but their parents received specific counseling on the importance of taking the medication. There were 14 treatment failures plus relapse in group 1, 25 in group 2, and 10 in group 3. Compliance in taking penicillin was 58% in group 2 and 80% in group 3, a significant difference. Oral therapy with adequate parental counseling is as efficacious as intramuscular injection.

Calcification of the aorta and osteoporosis. A roentgenographic study.

Abstract: X-ray films of 589 persons studied to determine the relationship between osteoporosis and calcification of the abdominal aorta showed the prevalence of osteoporosis to be 24.1%, being highest in white females (39.2%). White females had a greater prevalence than black females, and white males more than black males. In contrast to white males, in whom osteoporosis became common after the age of 55 years, white females demonstrated a high frequency a decade earlier. The prevalence of patients with calcification of the abdominal aorta was 20.2%, the highest being in white females (28%). Statistical analysis demonstrated a positive correlation between the two conditions. The association is present also after the effects of age have been removed statistically. Perhaps the loss of calcium from bone which occurs in osteoporosis predisposes to calcification of the abdominal aorta.