Showing papers in "JAMA in 1977"
TL;DR: A controlled study demonstrated that the clinical history may be sensitive and specific in the differential diagnosis of ankylosing spondylitis when reliance of five specific historic features is made.
Abstract: A controlled study of 138 subjects demonstrated that the clinical history may be sensitive (95%) and specific (85%) in the differential diagnosis of ankylosing spondylitis when reliance on five specific historic features is made. Back pain that is insidious in onset, in a patient younger than 40 years, persisting for at least three months, associated with morning stiffness and improving with exercise is characteristic of inflammatory spinal disease. (JAMA237:2613-2614, 1977)
596 citations
TL;DR: The 6- and 12-valent pneumococcal capsular polysaccharide vaccines were carried out in controlled studies among novice gold miners in South Africa and offer great promise for effective control of illnesses caused by pneumococci.
Abstract: Clinical studies of 6- and 12-valent pneumococcal capsular polysaccharide vaccines were carried out in controlled studies among novice gold miners in South Africa. In the studies 1,523 persons received pneumococcal vaccine, and 3,171 were included as controls. In the great majority of subjects given pneumococcal vaccine, antibodies developed against the capsular types included in the vaccine. The 6-valent vaccine afforded 76% reduction in cases of laboratory-verified pneumococcal pneumonia caused by the homologous types, and there was 92% reduction in the cases afforded by the 12-valent vaccine. The vaccines were well tolerated and offer great promise for effective control of illnesses caused by pneumococci. ( JAMA 238:2613-2616, 1977)
334 citations
TL;DR: Of 1,025 men and 1,445 women, aged 49 to 82 years, who were free of coronary heart disease (CHD), 79 men and 63 women subsequently had CHD, and predictability was at least as good as that obtained by the usual CHD risk profile at younger ages.
Abstract: Of 1,025 men and 1,445 women, aged 49 to 82 years, who were free of coronary heart disease (CHD), 79 men and 63 women subsequently had CHD. Using a risk function based on cholesterol in the high density and low density lipoproteins, systolic blood pressure, left ventricular hypertrophy, and diabetes, less than 2% of the subsequent CHD cases were found in the lowest decile of risk, whereas 25% of the cases for men and 37% for women were found in the highest decile. Predictability held for each specific age group. This predictability was at least as good as that obtained by the usual CHD risk profile at younger ages. (JAMA238:497-499, 1977)
233 citations
TL;DR: Acute fulminating pulmonary edema developed in three patients after acute airway obstruction secondary to tumor, strangulation, and interrupted hanging, and it is presumed that the pathogenesis is related to alveolar and capillary damage, induced by the severe negative pressure generated by attempting to inspire against the closed upper airway.
Abstract: Acute fulminating pulmonary edema developed in three patients after acute airway obstruction secondary to tumor, strangulation, and interrupted hanging (one case each). The common etiologic factor was vigorous inspiratory effort against a totally obstructed upper airway. Acute pulmonary edema followed the event in minutes to hours and required ventilatory assistance to maintain oxygenation. All patients eventually responded to fluid restriction, diuretics, and steroids. One case was complicated by aspiration of gastric contents following respiratory failure. To our knowledge, this condition is previously unreported in English literature. We presume that the pathogenesis is related to alveolar and capillary damage, induced by the severe negative pressure generated by attempting to inspire against the closed upper airway. (JAMA238:1833-1835, 1977)
221 citations
TL;DR: A 20-year experience with a consecutive series of 542 Jehovah's Witness patients ranging in age from 1 day to 89 years who underwent operation finds that cardiovascular operations can be performed safely without blood transfusion.
Abstract: Jehovah's Witnesses who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report a 20-year experience with a consecutive series of 542 Jehovah's Witness patients ranging in age from 1 day to 89 years who underwent operation. Early mortality (within 30 days after operation) was 9.4%. In 362 patients requiring temporary cardiopulmonary bypass, early mortality was 10.7%. Mortality was 13.5% among 126 patients who had single- or double-valve replacement. The only deaths among patients who had aortic valve replacement or repair of a ventricular septal defect occurred in those who had some serious complication before operation. Preoperative or postoperative anemia was a contributing factor in 12 deaths, and loss of blood was the direct cause of three deaths. Cardiovascular operations can be performed safely without blood transfusion. ( JAMA 238:1256-1258, 1977)
206 citations
TL;DR: The third edition of the AMA Drug Evaluations book (ADE ) has just been published and provides for the physician information on how to prescribe effective and safe agents for most clinical conditions.
Abstract: The third edition of the AMA Drug Evaluations book ( ADE ) has just been published. * The first edition that appeared in 1971 was prepared by the American Medical Association Department of Drugs under the direction of the Association's Council on Drugs. The second edition issued in 1973 was compiled by the Department of Drugs with assistance from ad hoc consultants who gave generously of their time and knowledge. This most recent edition is a collaborative effort between the AMA and the American Society for Clinical Pharmacology and Therapeutics. This collaboration has resulted in the most comprehensive and authoritative reference source currently available on prescription drugs. The ADE is arranged by chapters that deal with drugs that have a similar pharmacological action or clinical usefulness, and it provides for the physician information on how to prescribe effective and safe agents for most clinical conditions. Described are 1300 pharmaceutical products, including 50 new
194 citations
TL;DR: The systemic metabolic response following intracranial vascular damage was measured in 65 consecutively seen patients and significantly greater mortality and eventual disability occurred in patients excreting more than 200 microgram of urinary norepinephrine and epinephrine daily early in their acute illness.
Abstract: The systemic metabolic response following intracranial vascular damage was measured in 65 consecutively seen patients (56 with cerebral infarction and nine with subarachnoid hemorrhage). Significantly ( P P ( JAMA 238:1374-1376, 1977)
191 citations
TL;DR: Use of CCT substantially decreased the perceived need for other neurodiagnostic tests in this patient population and there was a reduction of a least 41% in radionuclide scans, 52% angiograms, and 73% in pneumoencephalograms compared to the needs projected had CCT not been available.
Abstract: The effect of computerized cranial tomography (CCT) on physicians' diagnostic and therapeutic plans in 194 patients scanned consecutively during a 17-day period at the Massachusetts General Hospital was studied Use of CCT substantially decreased the perceived need for other neurodiagnostic tests in this patient population There was a reduction of at least 41% in radionuclide scans, 52% in angiograms, and 73% in pneumoencephalograms compared to the needs projected had CCT not been available Therapy was altered after 37 scans in 36 patients (19% of those examined): new treatment was begun after 15 scans, previously planned therapy became more precise after 9 scans, treatment was found to be unnecessary after 7 scans, and treatment was abandoned as worthless after 6 scans (JAMA238:224-227, 1977)
189 citations
TL;DR: This zoologic text invites the reader to imagine how the eating habits of the blowfly might give insight into the ambitions and activities of other forms of life.
Abstract: Busy, curious, thirsty fly, Drink with me, and drink as I; Freely welcome to my cup, Could'st thou sip, and sip it up; Make the most of life you may, Life is short and wears away. (William Oldys, "On a Fly Drinking Out of a Cup of Ale") Scientific books rarely begin with poetry and are not usually written in a delightful philosophic manner. Hence, this zoologic text is rather special, inviting the reader to imagine how the eating habits of the blowfly ( Phormia regina ) might give insight into the ambitions and activities of other forms of life. Numerous experimental techniques are described in detail, designed to analyze the behavioral components of eating and correlate them with underlying physiologic mechanisms. Particularly interesting is the typical day of the fly, which begins with a restless, random search for food that ends with the interception of a delectable cloud of odor. Contact
184 citations
TL;DR: Among 26,462 carefully monitored medical inpatients, 24, or 0.9 per 1,000, were considered to have died as a result of a drug or group of drugs, and six of the deaths may have been preventable.
Abstract: Among 26,462 carefully monitored medical inpatients, 24, or 0.9 per 1,000, were considered to have died as a result of a drug or group of drugs. Most of the patients were seriously ill prior to the event that caused death. Six of the deaths—five from fluid overload and one from excessive potassium therapy—may have been preventable. ( JAMA 237:879-881, 1977)
182 citations
TL;DR: Both B and T lymphocyte functions were absent in approximately 80% of the children and markedly depressed in the remainder, and six-month survival rates for patients who received fetal tissue transplants or marrow from mixed leukocyte culture (MLC) negative donors were significantly higher.
Abstract: Pretransplant and posttransplant data for 69 patients with severe combined immunodeficiency disease are presented Both B and T lymphocyte functions were absent in approximately 80% of the children and markedly depressed in the remainder Transplantation of marrow from HLA genotypically identical donors provided the highest six-month survival rate (63%); six-month survival rates for patients who received fetal tissue transplants (43%) or marrow from mixed leukocyte culture (MLC) negative donors (38%) were significantly higher ( P ( JAMA 238:591-600, 1977)
TL;DR: Plasma TCA measurements more reliably define patients who are at risk for major medical complications following overdose than does the amount of drug ingested by history.
Abstract: Forty consecutively hospitalized patients who had overdosed primarily with a tricyclic antidepressant (TCA) were observed until discharge. The severity of the overdose was documented by serial measurements of plasma TCA levels. Nineteen of the patients became comatose, 16 required supportive respiration, and 2 died. Individual symptoms in the 13 patients having plasma TCA levels greater than 1,000 ng/ml are shown. Plasma TCA measurements more reliably define patients who are at risk for major medical complications following overdose than does the amount of drug ingested by history. In the absence of plasma measurements, a QRS duration of 100 msec or more on a routine ECG within the first 24 hours defined all patients with major TCA overdoses. (JAMA238:135-138, 1977)
TL;DR: Clostridium botulinum organisms and toxin were identified in the feces of six infants, aged 5 to 20 weeks, who had illnesses clinically consistent with botulism, and a characteristic electromyographic pattern termed "brief, small, abundant, motor-unit action potentials" was observed.
Abstract: Clostridium botulinum organisms and toxin were identified in the feces of six infants, aged 5 to 20 weeks, who had illnesses clinically consistent with botulism. Five of the infants lived in California and became ill within a six-month period in 1976; one infant became ill in New Jersey in 1975. Three cases were type A botulism, and three were type B. No source of ingested botulinal toxin could be found in any case. However, one infant with type B botulism had ingested a food containing C botulinum type B organisms, but no toxin was found in it. The clinical findings in these cases include constipation, weak sucking and crying ability, pooled oral secretions, cranial nerve deficits, generalized weakness, and, on occasion, sudden apnea. A characteristic electromyographic pattern termed "brief, small, abundant, motor-unit action potentials" (BSAP) was observed. The sources of C botulinum toxin for these six infants is thought to have been in vivo (gastrointestinal) production following ingestion of C botulinum organisms. Studies are underway to determine the full clinical spectrum, incidence, and potential public health importance of this infectious disease newly recognized in infants. ( JAMA 237:1946-1951, 1977)
TL;DR: Although PCI did not improve response rate or survival, brain metastasis with its attendant neurologic complications was effectively prevented and was the cause of major neurologic disability in each.
Abstract: Twenty-nine patients with small cell carcinoma of the lung and without evidence of brain metastasis were randomized into two treatment groups consisting of 14 patients who received prophylactic cranial irradiation (PCI) and 15 who received none (non-PCI). All patients were treated with irradiation of the primary lesion and concomitant chemotherapy. The response rate and median survival of the two groups were not significantly different: 93% and 7.2 months in the non-PCI; 86% and 9.8 months in the PCI; P ≥.05. Brain metastasis occurred in 0/14 patients in the PCI and 4/15 in the non-PCI ( P ≤.05) and was the cause of major neurologic disability in each. Although PCI did not improve response rate or survival, brain metastasis with its attendant neurologic complications was effectively prevented. ( JAMA 237:2730-2733, 1977)
TL;DR: Mechanical ventilation in status asthmaticus is a life-support system associated with substantial morbidity and should be instituted only when it becomes evident that maximal medical therapy will not be efficacious.
Abstract: A retrospective analysis of 811 patients admitted to the hospital for status asthmaticus over a nine-year period was performed. Eight patients died, and 19 required mechanical ventilation. All persons who died of status asthmaticus were in the group that required mechanical ventilation. In 12 of the patients who received ventilation, no definite cause for the acute exacerbation could be identified, although initial arterial blood gas analyses showed profound hypoxemia, hypercapnia, and acute respiratory acidosis. Seventy-eight major complications occurred during mechanical ventilation. Pneumothorax, endotracheal tube malfunction, alveolar hypoventilation on the ventilator, and pneumonia were associated with decreased survival. Mucous plugging of the airways was found in all autopsied patients. Mechanical ventilation in status asthmaticus is a life-support system associated with substantial morbidity and should be instituted only when it becomes evident that maximal medical therapy will not be efficacious. (JAMA238:1158-1162, 1977)
TL;DR: In one patient, the prostheses broke, with silicone particles present in synovium ("detritic synovitis"), and in another patient, silicone particles were found in an axillary lymph node five years after insertion of prostheses in the ipsilateral hand.
Abstract: We report two complications of silicone elastomer finger joint prostheses. In one patient, the prostheses broke, with silicone particles present in synovium ("detritic synovitis"). In another patient, silicone particles were found in an axillary lymph node five years after insertion of prostheses in the ipsilateral hand (prostheses were intact at the time). Microscopically, silicone particles in synovium and lymph node were identical to particles abraded from a new prosthesis. (JAMA237:1463-1464, 1977)
TL;DR: Distribution patterns of metastatic bone disease in 62 patients with soft-tissue cancers showed that 60% of bone lesions were located in the axial and 40% in the appendicular skeleton.
Abstract: Distribution patterns of metastatic bone disease in 62 patients with soft-tissue cancers showed that 60% of bone lesions were located in the axial and 40% in the appendicular skeleton. Thirteen percent of the lesions were in appendicular regions not usually included in routine imaging studies. The majority of the metastatic skeletal lesions were clinically asymptomatic. The serum alkaline phosphatase level is a poor indicator of early bone metastases. ( JAMA 237:2504-2506, 1977)
TL;DR: Determinants of circulating high density lipoproteins (HDL) were sought in 301 men studied during a year of participation in a coronary prevention program and indicates that increased plasma HDL levels occur when plasma triglyceride level is decreased, cigarette smoking is reduced, and habitual alcohol intake is increased.
Abstract: Determinants of circulating high density lipoproteins (HDL) were sought in 301 men studied during a year of participation in a coronary prevention program. Mean plasma HDL-cholesterol concentration rose by 2.8 mg/dl (6%) in the group receiving multifactor intervention, but the change did not differ significantly from that in the comparison group. Larger changes in both directions were seen in many individuals. Multiple regression analysis of these changes indicates that increased plasma HDL levels occur when plasma triglyceride level is decreased, cigarette smoking is reduced, and habitual alcohol intake is increased. Increases in the concentration of HDL-cholesterol also tended to accompany adherence to the fat-controlled diet, reduction in LDL-cholesterol level, and loss of body weight. Conventional coronary prevention programs are unlikely to have an adverse influence on this new, risk-lowering factor. ( JAMA 238:2269-2271, 1977)
TL;DR: Recommendations were formulated on areas needing further basic or applied research and Guidelines for the appropriate clinical use of albumin were proposed and are currently being circularized to concerned persons for comment.
Abstract: THE INCREASING use of human serum albumin, which recently has threatened to stress the usual annual supply and to add considerably to health care costs, prompted a cooperative study in early 1975 between the federal government and the private sector. This led to the development of three projects: (1) A workshop was convened in Bethesda, Md, under joint sponsorship of the Division of Blood Diseases and Resources, National Heart and Lung Institute, and the Division of Blood and Blood Products, Bureau of Biologics. This meeting in February 1975 defined the present state of knowledge of the structure, synthesis, and function of albumin and reviewed in depth its current clinical use. The proceedings were subsequently published. 1 (2) Recommendations were formulated on areas needing further basic or applied research. (3) Guidelines for the appropriate clinical use of albumin were proposed and are currently being circularized to concerned persons for comment. Although
TL;DR: Diagnostic evaluation and treatment should be strongly considered for any patient with recurrent stones, and for those in whom recurrence is likely to pose more than the usual risk.
Abstract: The course of untreated calcium renal stones, derived from the retrospective study of 300 patients with defined metabolic disorders and from the analysis of two prospective, published studies, is complex and heterogeneous. Generally, stones provoke considerable morbidity; hyperuricosuria is associated with an unusually severe stone disease. Stone recurrence rates usually remain stable, or rise with successive stones; in a minority of patients, the reverse is true. A single stone is likely to be followed by a recurrence. The mean time to recurrence averages 6.78 years, with peaks at 1.56 and eight years. Because the disease is likely to be morbid and chronic and does not wane with age, diagnostic evaluation and treatment should be strongly considered for any patient with recurrent stones, and for those in whom recurrence is likely to pose more than the usual risk. (JAMA238:1519-1523, 1977)
TL;DR: The underlying causes of 80% of perinatal deaths were identified in a study of 53,518 pregnacies in the United States: 17% of the deaths were due to amniotic fluid infections, 11% to abruptio placentae, 10% to premature rupture of the membranes, 9% to congenital anomalies, 6% to large placental infarcts, and the rest to more than 20 specific disorders.
Abstract: The underlying causes of 80% of perinatal deaths were identified in a study of 53,518 pregnancies in the United States: 17% of the deaths were due to amniotic fluid infections, 11% to abruptio placentae, 10% to premature rupture of the membranes, 9% to congenital anomalies, 6% to large placental infarcts, and the rest to more than 20 other specific disorders. ( JAMA 238:228-229, 1977)
TL;DR: It is suggested that fluphenazine alone or in combination with amitriptyline may be of benefit in treating the painful peripheral neuropathy associated with diabetes.
Abstract: The pain of diabetic peripheral neuropathy responds poorly to current modes of treatment. We treated eight patients with this disorder whose pain was refractory to standard regimens but who experienced remarkable pain relief within two to five days after treatment with fluphenazine hydrochloride, amitriptyline hydrochloride, or a combination of the two. In four patients whose regimens were discontinued, pain recurred within two days and again remitted on reinstitution of the drug regimens. These findings suggest that fluphenazine alone or in combination with amitriptyline may be of benefit in treating the painful peripheral neuropathy associated with diabetes. ( JAMA 238:2291-2292, 1977)
TL;DR: A review of 132 consecutive cases of acute pulmonary embolism documented by pulmonary angiography indicated that syncope was the initial or predominant clinical feature in 17 cases, and both arterial blood gas determinations and pulmonary scintigraphy are helpful in making this diagnosis.
Abstract: A review of 132 consecutive cases of acute pulmonary embolism (PE) documented by pulmonary angiography indicated that syncope was the initial or predominant clinical feature in 17 (13%). When massive PE causes syncope in a nonhospitalized patient, the diagnosis of PE is frequently overlooked. Hypotension after PE may resolve spontaneously after a short interval. In this circumstance, the syncopal episode might easily be attributed to another cause. The appropriate diagnosis can be established only if other clues, suggestive of PE, are sought. Both arterial blood gas determinations and pulmonary scintigraphy are helpful in making this diagnosis. (JAMA238:2509-2511, 1977)
TL;DR: Although adolescence was hardly recognized as a crucial life stage or social problem before 1900, Kett has assembled a wealth of information about the schooling, work, family relationships, and experiences of teenagers at various periods of the authors' history.
Abstract: Although adolescence was hardly recognized as a crucial life stage or social problem before 1900, Kett has assembled a wealth of information about the schooling, work, family relationships, and experiences of teenagers at various periods of our history. In the early 19th century, boys and girls attended school sporadically, worked on farms, in factories, or in shops, and often left home early. Gradually school attendance increased, occupations became more varied, and greater social class differences developed. Around 1900 many adult-sponsored organizations flourished—Christian Endeavor, YMCA, Boy Scouts, most of which have declined in recent decades. Around 1920 adults became more worried about "flaming youth," young people perhaps became more conscious of themselves, and discussion of intergenerational conflict was more prevalent. Kett notes, "Since the end of World War II, investigation into youth subculture has become virtually an autonomous branch of sociology." This interesting historical study may not help us understand individual
TL;DR: It is reported that cocaine, packaged in condoms, was deliberately ingested to avoid detection by customs agents, and one survivor and two deaths from cocaine toxicity are reported.
Abstract: We report one survivor and two deaths from cocaine toxicity. Cocaine, packaged in condoms, was deliberately ingested to avoid detection by customs agents. Because cocaine is a toxic drug, we recommend surgical removal of the ingested packages, as alternative methods of removal are unreliable and potentially dangerous. ( JAMA 238:1391-1392, 1977)
TL;DR: A retrospective analysis of 50 randomly selected patients, according to the Kunin's categories of use, showed 64% of total antibiotic therapy as not indicated or inappropriately administered in terms of drug or dosage.
Abstract: A study of antibiotic use at Duke University Medical Center in June 1973 showed that 34.2% of all patients received antibiotics (43.6% surgical, 21.4% medical patients). Cephalothins were most frequently ordered for surgical patients, ampicillin sodium and penicillin G or penicillin V with potassium for other patients. A retrospective analysis of 50 randomly selected patients, according to the Kunin's categories of use, showed 64% of total antibiotic therapy as not indicated or inappropriately administered in terms of drug or dosage. These results are similar to previous reports of antibiotic surveillance and further establish the need for continuing education of prescribing physicians. ( JAMA 237:2819-2822, 1977)
TL;DR: Stool screening for occult blood, barium enema roentgenographic examination, and colonoscopy become more important diagnostic tools in light of a statistically significant trend of a decreasing percentage of distal and an increasing percentage of proximal large-bowel lesions observed at a large midwestern hospital.
Abstract: Analysis of the changing distribution of origin site of 1,990 colorectal cancers observed at a large midwestern hospital shows a statistically significant trend of a decreasing percentage of distal (rectum,P=.0192) and an increasing percentage of proximal (cecum,P=.0015) large-bowel lesions during a period of at least 30 years. Mortality data for 11,635 colorectal cancers in the state of Kansas for this period confirm this trend (P (JAMA238:1641-1643, 1977)
TL;DR: An efficient protocol for the evaluation of hypertensive cases included renal arteriography, suppression and stimulation of the renin-aldosterone system, and, when indicated, renal venous renin measurements.
Abstract: An efficient protocol for the evaluation of hypertensive cases included renal arteriography, suppression and stimulation of the renin-aldosterone system, and, when indicated, renal venous renin measurements. It permitted identification of 38 patients with renal artery stenosis, 28 with primary aldosteronism, and 51 with high renin, 92 with normal renin, and 27 with low renin essential hypertension. (JAMA237:1331-1335, 1977)
TL;DR: It appears that if the potential for enhanced productivity is to be realized, rehabilitative measures must be intensified following coronary artery surgery.
Abstract: Coronary artery bypass surgery has gained a major role in the management of ischemic heart disease. Relief of symptoms is often the primary goal for these surgical procedures while other effects relating to rehabilitation of such patients have been neglected. To determine change in work status as a result of operation, job status and hours worked before and after surgery were analyzed in 350 patients who had coronary artery bypass grafting procedures. Overall, there was no improvement in return to work or hours worked after surgery. Hours worked before surgery, relief of symptoms, severity of disease, number of bypass grafts placed, and level of education all related substantially to a change in work capacity. It appears that if the potential for enhanced productivity is to be realized, rehabilitative measures must be intensified following coronary artery surgery.
TL;DR: Oral contraceptive use is associated with a slight but statistically significant rise in mean blood pressure, which is reversible, and women continuing oral contraceptive use had no appreciably greater change in blood pressure between two visits than persistent nonusers.
Abstract: Both cross-sectional and longitudinal analysis of data from 13,358 women showed that oral contraceptive use is associated with a slight but statistically significant (P lesser than .05) rise in mean blood pressure, which is reversible. The age-adjusted proportion of oral contraceptive users with a blood pressure over 140/90 mm Hg was about three times that on nonusers. These findings are caused by a uniform upward shift in the blood pressure distribution of oral contraceptive users compared to nonusers. Women continuing oral contraceptive use had no appreciably greater change in blood pressure between two visits than persistent nonusers. The clinical implications of a mild contraceptive-induced blood pressure elevation (systolic, 5 to 6 mm Hg; diastolic, 1 to 2 mm Hg) remain unsettled but disturbing.