Showing papers in "JAMA in 1973"
TL;DR: There is real value in psychotherapy, which "relies primarily on the healer's ability to mobilize healing forces in the sufferer by psychological means," but the principal value lies in factors that are common to all the various forms of therapy.
Abstract: Psychoanalysis, individual psychology, gestalt therapy, client-centered counseling, faith healing, hypnosis, encounter groups, transactional therapy, behavior modification, and existentialist analysis are some of the different treatments available for unhappy, fearful, and anxious sufferers. The proponents of each method offer a theoretical explanation of their rationale and report sizable numbers of successes. Which is the best method? Which is the most correct theory? Are any of them of any value? Or should everyone be treated with pills or diet or surgery? Jerome D. Frank, professor of psychiatry at Johns Hopkins, believes there is real value in psychotherapy, which he describes as treatment that "relies primarily on the healer's ability to mobilize healing forces in the sufferer by psychological means." However, he believes that the principal value lies not in the postulated theoretical bases but in factors that are common to all the various forms of therapy. He points out that all patients
528 citations
TL;DR: Quite compelling evidence has been adduced to support the hypothesis that certain diseases might be unduly frequent in journeyman air traffic controllers working in towers and centers with regard to hypertension and peptic ulcer.
Abstract: The hypothesis that certain diseases might be unduly frequent in journeyman air traffic controllers working in towers and centers has been tested by reviewing the aeromedical certification examinations on 4,325 traffic controllers and 8,435 second class airmen. The subjects were all men who had an examination in 1969 to 1970 and at least one previous examination not more than two years before that. Quite compelling evidence has been adduced to support the hypothesis with regard to hypertension; on peptic ulcer the evidence is moderately strong and for diabetes it is slight but suggestive.
336 citations
TL;DR: The hypothesis "that obesity and anorexia nervosa are related to faulty hunger awareness; that `hunger' is not innate knowledge; learning is necessary for its organization into recognizable patterns" is advanced.
Abstract: "No human society... deals rationally with food," says Dr. Hilde Bruch. For nearly 40 years she has studied two manifestations of this irrationality—anorexia nervosa and obesity—and the present volume summarizes her experience. It is an excellent summary, reflecting the author's appreciation of current biological thinking, her refreshingly eclectic approach to psychodynamic theory, and her mature understanding of the uniqueness of "the person within." Neither obesity nor anorexia is a uniform entity. Dr. Bruch emphasizes this fact, yet she appreciates the many similarities in the underlying problems, similarities that may lead to inappropriate patterns of eating. She advances the hypothesis "that obesity and anorexia nervosa are related to faulty hunger awareness; that `hunger' is not innate knowledge; learning is necessary for its organization into recognizable patterns." Certainly, recent studies in obesity support such a hypothesis. The problem then becomes: How can people who have not learned to recognize physiological signals of
293 citations
TL;DR: The National Nutrition Survey, which emerged in 1972 from the maze of field studies, laboratories, computer analysis, and committee review, was published in five overwhelming volumes (plus a summary).
Abstract: The National Nutrition Survey, which emerged in 1972 from the maze of field studies, laboratories, computer analysis, and committee review, was published in five overwhelming volumes (plus a summary). The four years of work was culminated by the frantic effort of the Nutrition Program of the Center for Disease Control, which inherited the data after the field studies were completed. Only two members remain of Dr. Arnold E. Schaefer's original staff of 69 who began the surveys in 1968-1969. Considering the political overtones that permeated nearly every phase of the study, that a report has finally emerged is a minor miracle. The purpose of the survey was to determine the magnitude and location of malnutrition and related health problems. Limitations of time, money, and personnel dictated that appropriate samples be selected from the country at large. Ten states were selected (Washington, California, Texas, Louisiana, South Carolina, Kentucky, West Virginia, Michigan,
289 citations
TL;DR: Diarrhea may represent a defense mechanism when disease is caused by a bacterial pathogen that must penetrate the intestinal epithelium to produce illness where increased intestinal motility (diarrhea) may decrease contact time between the invasive bacteria and mucosal cells.
Abstract: Twenty-five men with induced shigellosis received a mixture of diphenyoxylate hydrochloride with atropine (Lomotil), placebo and oxolinic acid (Oxabid), or a second placebo in four randomly assigned treatment groups. Diarrhea was decreased by oxolinic acid or Lomotil therapy, while fever was prolonged in the group receiving only Lomotil. Two men who received Lomotil alone had fever until the drug regimen was discontinued five days later. Shigellae were eradicated from stool in four of six men treated with oxolinic acid alone, but in only one of six men receiving oxolinic acid and Lomotil. Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism when disease is caused by a bacterial pathogen that must penetrate the intestinal epithelium to produce illness where increased intestinal motility (diarrhea) may decrease contact time between the invasive bacteria and mucosal cells.
265 citations
TL;DR: It is revealed that persons dying instantaneously differed from persons dying suddenly of coronary artery disease in that they rarely experienced acute symptoms or exhibited acute signs before death and their hearts rarely showed an acute lesion of any kind.
Abstract: A study of 59 persons dying of coronary artery disease revealed that persons dying instantaneously differed from persons dying suddenly of coronary artery disease in that (1) they rarely experienced acute symptoms or exhibited acute signs before death; (2) more than one half died during or immediately after physical exertion; (3) their deaths appeared to result from a primary arrhythmia; and (4) their hearts rarely showed an acute lesion of any kind and frequently exhibited two old occluded coronary arteries or one old occluded, left anterior descending artery. These latter differences should permit angiographic detection of many persons prone to instantaneous death.
264 citations
TL;DR: Three patients who had severe, protracted colitis associated with treatment with the drug clindamycin hydrochloride hydrate are reported.
Abstract: Although clindamycin hydrochloride hydrate is known to produce gastrointestinal symptoms, these have usually been reported as mild. We report three patients who had severe, protracted colitis associated with treatment with the drug.
263 citations
263 citations
TL;DR: The use of methoxyflurane in clinical anesthesia should be restricted to situations where it offers specific advantages and where dosages less than 2.5 MAC hours can be attained.
Abstract: Dose-related abnormalities in renal function occurred in ten of 18 patients following administration of methoxyflurane (Penthrane) with the usual anesthetic adjuvants. Eight control patients anesthetized with halothane (Fluothane) showed no abnormalities in renal function. Subclinical toxicity occurred following methoxyflurane at minimum alveolar concentration (MAC) for 2.5 to 3 hours, that is 2.5 to 3 MAC hours (serum inorganic fluoride, >50 micromols/liter), while clinical toxicity was present in all patients at dosages greater than five MAC hours (serum inorganic fluoride, >90 micromols/liter). Superimposed on the dose-response relationship were other factors that probably increased nephrotoxicity. These were as follows: individual variations in metabolism of methoxyflurane; increased sensitivity to the nephrotoxic effects of inorganic fluoride; presence of enzyme induction; and interaction of methoxyflurane with other nephrotoxic drugs. The use of methoxyflurane in clinical anesthesia should be restricted to situations where it offers specific advantages and where dosages less than 2.5 MAC hours can be attained.
257 citations
TL;DR: In this article, patients having maintenance treatment for heroin addiction (stabilized with methadone hydrochloride in high doses of 80 to 120 mg daily) found minimal side effects and no toxic effects.
Abstract: In studies of patients having maintenance treatment for heroin addiction (stabilized with methadone hydrochloride in high doses of 80 to 120 mg daily), we found minimal side effects and no toxic effects. These studies have included a prospective study of the first consecutive 214 patients admitted to methadone treatment and reevaluation of the 129 patients of this group still in treatment after three or more years. In addition, we studied 1,435 methadone maintenance patients retrospectively and performed special studies on a smaller group. Abnormalities in liver function and serum protein tests, which were found in 57% and 49% of patients at admission, persisted without significant change during treatment. Increased sweating was reported by 48% and persistent constipation by 17% of patients after methadone treatment for three or more years.
230 citations
TL;DR: This is the first successful case of a saphenous veincoronary artery bypass with the longest follow-up of a functioning coronary vein bypass graft, and seven years after the operation, the graft functions with normal left ventricular hemodynamics.
Abstract: A 42-year-old man had extensive occlusive disease of the coronary artery and angina pectoris. An autogenous saphenous vein bypass from the ascending aorta to the anterior descending coronary artery was performed on Nov 23, 1964. The patient suffered an asymptomatic anterior myocardial infarction during operation but made an uncomplicated recovery. Seven years after the operation, the graft functions with normal left ventricular hemodynamics, while the occlusive process has produced obstruction of the left main coronary artery and almost complete occlusion of the right coronary artery. To our knowledge, this is the first successful case of a saphenous veincoronary artery bypass with the longest follow-up of a functioning coronary vein bypass graft.
TL;DR: Variation in costs of laboratory and drug use was audited among 33 faculty internists caring for a homogeneous population at a university clinic and Laboratory and drug costs per physician were significantly correlated.
Abstract: Variation in costs of laboratory and drug use was audited among 33 faculty internists caring for a homogeneous population at a university clinic. Variation was more extreme for laboratory (17-fold) than for drug use (fourfold). Laboratory and drug costs per physician were significantly correlated ( P P P
TL;DR: The altered physiology of the postoperative period is reviewed, what respiratory maneuvers must be carried out to reverse that pathophysiology, and to examine the reports of specific maneuvers and devices are examined.
Abstract: Significant pulmonary complications occur in 20% to 40% of patients following abdominal or thoracic operations,1-3making pulmonary complications the single largest cause of morbidity and mortality in the postoperative period.4The desire of the surgeon and the inhalation therapist to prevent the familiar progression of atelectasis, tachypnea, hypoxia, fever, and pneumonitis has led to a wide variety of practices to prevent pulmonary complications. The prophylactic respiratory maneuver is one of many aspects of postoperative care that are intended to minimize pulmonary complications. Various respiratory maneuvers and devices to encourage those maneuvers are used in different centers. The purpose of this report is to review the altered physiology of the postoperative period, describe what respiratory maneuvers must be carried out to reverse that pathophysiology, and to examine the reports of specific maneuvers and devices. Pulmonary Physiology in the Postoperative Patient Major changes in lung volume, mechanics, and gas exchange
TL;DR: A two-hour postprandial serum bile acid determination is a sensitive screening test for hepatobiliary disorders and shows significant variations in values in association with normal fasting levels.
Abstract: Fasting and two-hour postprandial serum bile acid concentrations were measured in ten normal subjects and 26 patients with hepatobiliary disease. The two-hour postprandial serum bile acid was the only test with abnormal results in all 26 cases. No significant postprandial elevations occurred in normal controls. Ten patients had abnormal twohour postprandial serum bile acid values in association with normal fasting levels, and all showed a minimum 70% two-hour postprandial increase. A two-hour postprandial serum bile acid determination is a sensitive screening test for hepatobiliary disorders.
TL;DR: It seems reasonable to include this virus among intrauterine infective agents that may cause such congenital malformation as diffuse brain damage, mental retardation, microcephaly, intracranial calcifications, microophthalmia, retinal dysplasia, and chorioretinitis.
Abstract: Herpes simplex virus (type 1) was recovered from the cerebrospinal fluid and urine of a 2-month-old infant who had been born with diffuse brain damage and stigmata of intrauterine infection. At 1 month of age, he had microcephaly, intracranial calcifications, and "owl eye" inclusion bodies in his urine. At 3 months, herpes simplex virus was again recovered from his urine and he had IgM antibody specific for herpes simplex virus that persisted until he was 1 year old. When our findings are added to those of the five similar instances known to us, it seems reasonable to include this virus among intrauterine infective agents that may cause such congenital malformation as diffuse brain damage, mental retardation, microcephaly, intracranial calcifications, microophthalmia, retinal dysplasia, and chorioretinitis.
TL;DR: Early diagnosis and treatment of inoperable adrenal cortical carcinoma with mitotane seem to be useful.
Abstract: One hundred fifteen patients with inoperable adrenal cortical carcinoma were treated with mitotane (o,p' = DDD). Eighty-five percent of the patients with elevated urinary steroid levels showed a marked reduction, 61% of the patients whose conditions we were able to evaluate showed a measurable disease response, and 45% showed an overall clinical response. These results are all markedly better than those described in earlier reports. In previous reports earlier recognition of the disease and institution of chemotherapy with mitotane resulted in the improvements described. There was no evidence of serious organ poisoning, except for the effects upon the adrenal cortex. On the basis of these data, early diagnosis and treatment of inoperable adrenal cortical carcinoma with mitotane seem to be useful.
TL;DR: All patients who received significant x-ray exposure during childhood or adolescence should be examined for thyroid abnormalities, which may develop two or more decades after exposure.
Abstract: Radiation-associated thyroid carcinomas continue to occur with alarming frequency. Among 50 patients with thyroid carcinoma seen over the past four years, 20 had received prior neck x-ray treatment. These patients developed tumors an average of 20 years after x-ray exposure, and were nearly all under 35 years of age. Clinical findings were similar to those of the nonexposed carcinoma patients, but the tumors were less invasive and never undifferentiated. One patient in the x-ray group succumbed to the illness. Two thirds of our patients who have a history of known x-ray exposure and who showed clinical thyroid abnormalities had cancer. All patients who received significant x-ray exposure during childhood or adolescence should be examined for thyroid abnormalities, which may develop two or more decades after exposure.
TL;DR: Tinnitus was not a reliable guide in 22 patients with preexisting hearing loss, as 15 of them did not experience it despite an average serum salicylate level of 43.1 mg/100 ml.
Abstract: The clinical adage, "Push to tinnitus, then back off slightly," has been used to regulate aspirin dosage for intensive salicylate therapy. Its value in subjects with normal hearing was demonstrated in a study of seven healthy volunteers and 67 patients with rheumatoid arthritis. The dose of buffered aspirin was gradually increased until tinnitus was noted. In 59 subjects experiencing tinnitus, the serum salicylate level was invariably greater than 19.6 mg/100 ml (average, 30.4 mg/100 ml), although their aspirin dose varied from 12 to 36 standard 300-mg tablets daily. However, tinnitus was not a reliable guide in 22 patients with preexisting hearing loss, as 15 of them did not experience it despite an average serum salicylate level of 43.1 mg/100 ml. Aspirin dosage should be increased with caution and monitored with serum determinations in this predominantly elderly group.
TL;DR: Of 13,349 hospitalized medical patients monitored in a drug surveillance program, 788 (5.9%) received spironolactone during one or more admissions and Hyperkalemia was reported in 68 patients; frequency increased with the level of blood urea nitrogen (BUN) and reached 20.3% in patients with BUN values of 50 mg/100 ml or greater.
Abstract: Of 13,349 hospitalized medical patients monitored in a drug surveillance program, 788 (5.9%) received spironolactone during one or more admissions. Adverse reactions were attributed to spironolactone in 164 patients (20.8%). Hyperkalemia was reported in 68 patients (8.6%). Frequency increased with the level of blood urea nitrogen (BUN) and reached 20.3% in patients with BUN values of 50 mg/100 ml or greater. Hyperkalemia was far more common in patients who received potassium chloride concurrently (15.8%) than in those who did not (5.7%). Of patients with BUN values of 50 mg/100 ml or greater who received potassium chloride, 42.1% became hyperkalemic. Other adverse reactions were less common; dehydration (3.4%), hyponatremia (2.4%), gastrointestinal symptoms (2.3%), neurological disturbances (2.0%), and skin rashes (0.5%). The frequency of these events was not related to BUN levels.
TL;DR: Rabies virus was recovered from the brain by cultural techniques and demonstrated in neural tissue by electron microscopy and apparently resulted from inhalation of an aerosol generated in a biological laboratory during the manufacture of animal rabies vaccine.
Abstract: A 56-year-old man died of rabies 21 days after exposure to a "fixed" strain of rabies virus. Rabies virus was recovered from the brain by cultural techniques and demonstrated in neural tissue by electron microscopy. Infection apparently resulted from inhalation of an aerosol generated in a biological laboratory during the manufacture of animal rabies vaccine. The victim had received preexposure vaccination against rabies 13 years earlier but had not developed demonstrable serum antibodies.
TL;DR: A survey by the Center for Disease Control and a review of the literature indicate that the risk of infection can be substantially reduced if stringent infection control measures are practiced.
Abstract: Infection is a significant hazard, and disseminated fungal infection has been a particularly frequent and dread complication of total parenteral nutrition. Rates of septicemia as high as 27% have been reported. A survey by the Center for Disease Control and a review of the literature indicate that the risk of infection can be substantially reduced if stringent infection control measures are practiced. Accordingly, the Center's Hospital Infections Section has developed infection control guidelines for total parenteral nutrition programs.
TL;DR: Eighteen of 20 patients treated with the active medication noted symptomatic improvement superior to that experienced with any form of therapy previously used, and in virtually all patients a 50% or greater improvement in healing time was noted.
Abstract: Herpes simplex virus can be inactivated if exposed to any of several heterotricyclic dyes and irradiated briefly with an ordinary fluorescent light. This finding has been applied in a double-blind study in a group of patients with at least four episodes of recurrent herpes simplex infection per year. Therapy consisted of rupturing early vesicular lesions, application of the dye, and subsequent exposure to fluorescent light for 15 minutes. Eighteen of 20 patients treated with the active medication noted symptomatic improvement superior to that experienced with any form of therapy previously used. Also, in virtually all patients a 50% or greater improvement in healing time was noted. After follow-up study from 18 to 30 months, 85% of the patients had a 50% or greater decrease in recurrence rate and only 11% had a recurrence to exactly the same site. These results were superior to those obtained in a group of 12 control patients.
TL;DR: Serial percutaneous transvenous endomyocardial biopsy is now a part of the routine management of patients receiving heart transplants, and the histologic information has been valuable in diagnosing acute rejection episodes.
Abstract: To obtain endomyocardial biopsies, a catheter sheath is introduced into the right internal jugular vein with the patient under a local anesthetic, and a catheter bioptome is advanced under fluoroscopic control to the apex of the right ventricle. Adequate specimens are obtained for light and electron microscopy and for immunofluorescent studies. In 20 biopsy specimens obtained from ten patients following cardiac transplantation, the histologic information has been valuable in diagnosing acute rejection episodes. Serial percutaneous transvenous endomyocardial biopsy is now a part of our routine management of patients receiving heart transplants.
TL;DR: The present volume includes further analyses of the results for normal children and comparative findings for exceptional children: those with reading disability, mental retardation, social and emotional disturbance, speech handicaps, and learning disability.
Abstract: Volume 1 under this title, published in 1965, was concerned mainly with the development of a "Picture Story Language Test." The present volume includes further analyses of the results for normal children and comparative findings for exceptional children: those with reading disability, mental retardation, social and emotional disturbance, speech handicaps, and learning disability. Specific disability in acquiring facility with spoken, read, and written words has been recognized as a syndrome in children since the end of the last century, although speech disorders were recognized long before that time. Difficulties in all three fields frequently occur in varying degrees in the same child. Speech disorders are obvious and reading disability is being recognized more and more, but writing disability has been neglected, probably because it is not so obviously handicapping. Samuel T. Orton, in his classic book, Reading, Writing and Speech Problems in Children , published in 1937, called attention to the
TL;DR: Serum enzyme studies were made on a large, well-defined group of patients with neuromuscular diseases, and control values for creatine phosphokinase, aldolase, and lactic dehydrogenase were significantly higher in males than in females.
Abstract: Serum enzyme studies were made on a large, well-defined group of patients with neuromuscular diseases. Control values for creatine phosphokinase, aldolase, and lactic dehydrogenase were significantly higher in males. (P
TL;DR: Serum digoxin concentrations were measured in 101 outpatients by radioimmunoassay with radioactive iodine 125 to evaluate factors affecting these concentrations and patient compliance was the most important determinant.
Abstract: Serum digoxin concentrations were measured in 101 outpatients by radioimmunoassay with radioactive iodine 125 to evaluate factors affecting these concentrations. Patient compliance, ascertained by asking how often patients missed taking digoxin, was the most important determinant of serum digoxin concentrations. "Compliant" patients had mean serum digoxin concentrations (±SD) of 1.2±0.8 ng—l; "noncompliant" patients had a mean of 0.7±0.7 ng/ml(P ( P P Analysis of relationships between serum concentration of digoxin and renal function, age, and dosage in outpatients should include compliance as a variable. Physicians should find out if patients are adhering to the prescribed regimen and search for correctable causes of noncompliance.
TL;DR: Doctor Musto has performed a splendid task of historical research, tracing the various attempts at reform and control, the relationships between legislative processes and various interested groups—social reformers, physicians, the American Medical Association, pharmacists, manufacturers, politicians (in both the favorable and unfavorable senses), addicts and criminals, bureaucrats, and others.
Abstract: How can society control the so-called addictive drugs—opium, morphine, heroin, cocaine, marihuana? This problem, so acute today, extends far back in American history, with many earlier attempts at solution on the international, federal, and local levels. Doctor Musto has performed a splendid task of historical research, tracing the various attempts at reform and control, the relationships between legislative processes and various interested groups—social reformers, physicians, the American Medical Association, pharmacists, manufacturers, politicians (in both the favorable and unfavorable senses), addicts and criminals, bureaucrats, and others. Legislative proposals and enactments, the influences and counterinfluences brought to bear, and the way the laws actually worked out in practice comprise the framework of the book. Musto has shown extreme diligence in tracing down his sources, principally from various archives, and has brought together an immense amount of material that will prove invaluable for future researchers. After describing the early attempts at international control
TL;DR: The incidence of major malformations following maternal chickenpox, mumps, measles, and viral hepatitis was observed in a controlled, cohort study of offspring followed up until five years of age.
Abstract: The incidence of major malformations following maternal chickenpox, mumps, measles, and viral hepatitis was observed in a controlled, cohort study of offspring followed up until five years of age. Major congenital defects occurred in each viral group, but the malformations were equal in frequency and often similar in type to those observed among comparable controls for the respective viral groups. Consequently, the malformations that occurred could not be attributed directly to the associated diseases under study.
TL;DR: Pregnancy was observed 105 times in narcotic-addicted women in the Methadone Maintenance Treatment Program of the Beth Israel Medical Center and followup revealed normal growth and development.
Abstract: Pregnancy was observed 105 times in narcotic-addicted women in the Methadone Maintenance Treatment Program of the Beth Israel Medical Center. There was no maternal mortality. Complications of pregnancy and fetal wastage were unremarkable. One third of the infants were premature by weight. Management in labor was modified only by the addition of methadone hydrochloride treatment. No serious effects attributable to methadone were seen in the neonatal period, and followup revealed normal growth and development.
TL;DR: Patients who died within a week after onset presented important differences in the probable causes of death from those who died later, and in the latter group, death appeared much more frequently to be due to nonneurologic diseases such as pneumonia, pulmonary embolism, and urinary tract infections.
Abstract: Although cerebrovascular disease is the third most common cause of death in the United States, there is little information about the actual mechanism of death in patients with an acute, terminal stroke. We have investigated the records of 200 patients who were admitted to the Evanston Hospital with the diagnosis of stroke, died, and had autopsies. Our data show that patients who died within a week after onset presented important differences in the probable causes of death from those who died later. In the latter group, death appeared much more frequently to be due to nonneurologic diseases such as pneumonia, pulmonary embolism, and urinary tract infections.