Showing papers in "JAMA in 1980"
TL;DR: This third edition of what has now become a well-established textbook in cardiovascular medicine is again edited by Dr Eugene Braunwald with the assistance of 65 other authors who read like a Who's Who of American Cardiology.
Abstract: This third edition of what has now become a well-established textbook in cardiovascular medicine is again edited by Dr Eugene Braunwald with the assistance of 65 other authors who read like a Who's Who of American Cardiology. Since the second edition, 12 new chapters have been added or substituted and others have been significantly revised. The first volume includes Part I on "Examination of the Patient" and Part II on "Normal and Abnormal Circulatory Function." The second volume deals with specific diseases. Part III, "Diseases of the Heart, Pericardium and Vascular System," includes new sections on "Risk Factors for Coronary Artery Disease," "The Pathogenesis of Atherosclerosis," and "Interventional Catheterization Techniques." Part IV, "Broader Perspectives on Heart Disease and Cardiologic Practice," includes new chapters on "Genetics and Cardiovascular Disease," "Aging in Cardiac Disease," and "Cost Effective Strategies in Cardiology." The last 200 pages of the book (Part V) are devoted to
927 citations
TL;DR: While exercise induces a response of the sympathetic nervous system, psychological stress induces primarily an adrenal response, according to a technique devised, there was a disparity between plasma norepinephrine and epinephrine levels in different situations.
Abstract: A technique was devised to monitor plasma catecholamines in a minimally obtrusive fashion in subjects going about their working activities. There was a disparity between plasma norepinephrine and epinephrine levels in different situations. During public speaking, epinephrine levels increase twofold, whereas during physical exercise, norepinephrine levels increase threefold. It seemed that while exercise induces a response of the sympathetic nervous system, psychological stress induces primarily an adrenal response. (JAMA243:340-342, 1980)
523 citations
TL;DR: A group of 200 morbidly obese men admitted to a weight control program between 1960 and 1977 and were followed up for a mean period of 7 1/2 years, demonstrating a 12-fold excess mortality in the obese in the age group 25 to 34 years and a sixfold excess in theAge group 35 to 44 years.
Abstract: A group of 200 morbidly obese men (average weight, 143.5 kg; age, 23 to 70 years) were admitted to a weight control program between 1960 and 1977 and were followed up for a mean period of 7 1/2 years. There was complete follow-up until the termination of the study or until death for 185 men. Fifteen men were followed up for fractional periods. Fifty of the 200 died during the course of the study. Life-table techniques, comparing the mortality among the obese with that among men in the general population, demonstrated a 12-fold excess mortality in the obese in the age group 25 to 34 years and a sixfold excess in the age group 35 to 44 years. This ratio diminished with advancing age. Cardiovascular disease was reported as the cause of death more frequently and malignancies less frequently than they were for men in the US general population.
398 citations
TL;DR: Large carbohydrate intakes were associated with increases in CO2 production in all patients, while increases in O2 consumption were seen primarily in hypermetabolic patients, suggesting that the high glucose loads of TPN may be a physiologic stress.
Abstract: Total parenteral nutrition (TPN) using glucose as nonprotein calories was associated with increases in O2 consumption (VO2) and CO2 production (VCO2). The magnitude of the changes was a function of the patient's clinical state and glucose load. Depleted patients showed a minimal increase in VO2, while VCO2 increased 23%. Minute ventilation (VE) increased 32%. Hypermetabolic patients (major trauma, sepsis) had a 30% increase in VO2 and a 57% increase in VCO2, while VE increased 71%. Patients with mild to moderate injuries (energy expenditure +/- 15% of normal) showed a 21% increase in VO2 and a 53% increase in VCO2, while VE increased 121%. Large carbohydrate intakes were associated with increases in CO2 production in all patients, while increases in O2 consumption were seen primarily in hypermetabolic patients. These changes suggest that the high glucose loads of TPN may be a physiologic stress.
383 citations
TL;DR: The hypothesis that thealpha 2-adrenergic agonist, clonidine, has substantial antiwithdrawal effect by replacing opiate-mediated inhibition with alpha 2- mediated inhibition of brain noradrenaline activity is supported.
Abstract: Clonidine hydrochloride was administered to ten patients in an inpatient setting after abrupt discontinuation of chronic methadone hydrochloride administration. Clonidine produced a rapid and statistically significant decrease in opiate withdrawal signs and symptoms. Clonidine administration for 14 days enabled all patients to be successfully detoxified from chronic opiate administration. In all patients studied, clonidine was a safe and effective nonopiate treatment of opiate withdrawal that suppressed the affect, signs, and symptoms of opiate withdrawal. These data support the hypothesis that the alpha 2-adrenergic agonist, clonidine, has substantial antiwithdrawal effect by replacing opiate-mediated inhibition with alpha 2-mediated inhibition of brain noradrenergic activity.
307 citations
TL;DR: The quantity of bone mineral present in the playing arms of the athletic population was greater than that of the dominant arms of nonathletes, which suggests that playing tennis during a lifetime may produce a localized increase in bone mineralization that is greater than those found in nonathlete.
Abstract: The effects of physical exercise on the status of bone mineralization for a population of lifetime athletes were investigated. The bone mineral content of the radii of experienced male tennis players was measured. The bone mass of the radius of the playing arm (mean, 1.37 g/cm) was greater than that of the nonplaying arm (mean, 1.23 g/cm) in all but one person. The results were compared with data for a nonathletic (normal) population. The quantity of bone mineral present in the playing arms of the athletic population was greater than that of the dominant arms of nonathletes, which suggests that playing tennis during a lifetime may produce a localized increase in bone mineralization that is greater than that found in non-athletes. ( JAMA 244:1107-1109, 1980)
297 citations
TL;DR: The self-perpetuating exapnding nature of the lesion appears to be due to the irritant effects of blood and its breakdown products, causing repeated exudation or bleeding from capillaries in the granulation tissue.
Abstract: Chronic expanding hematomas occur in many locations, often simulating neoplasms. All have the same structure with a central mass of blood, a wall of granulation tissue, and dense, fibrous tissue at the periphery. The self-perpetuating expanding nature of the lesion appears to be due to the irritant effects of blood and its breakdown products, causing repeated exudation or bleeding from capillaries in the granulation tissue. (JAMA244:2441-2442, 1980)
282 citations
TL;DR: Because anaphylactoid reactions are serious and unpredictable, IV iron dextran should be used only when iron deficiency anemia cannot be treated adequately with oral iron.
Abstract: Four hundred seventy-one adult patients and ten adult prisoner volunteers received 2,099 intravenous (IV) injections of iron dextran (Imferon), usually 250 to 500 mg at less than 100 mg/min. Intravenous iron supplies enough iron to permit RBC formation greater than 50 mL/day and repletion of tissue iron. Tissue iron did not always supply iron at an optimal rate. Hemoglobin production was higher after IV than oral or intramuscular iron if the hemoglobin level was less than 9 g/dL. Three life-threatening immediate anaphylactoid and eight severe delayed reactions were observed. There were no deaths. Delayed reactions were more frequent in women and collagen-vascular diseases and less frequent in pregnancy. Because anaphylactoid reactions are serious and unpredictable, IV iron dextran should be used only when iron deficiency anemia cannot be treated adequately with oral iron. ( JAMA 243:1726-1731, 1980)
267 citations
TL;DR: The association between estrogen replacement therapy and female breast cancer was studied in two Los Angeles area retirement communities and no risk modifiers could be identified except for a history of surgically confirmed benign breast disease.
Abstract: The association between estrogen replacement therapy and female breast cancer was studied in two Los Angeles area retirement communities. The 138 study cases of breast cancer occurring in residents younger than 75 years were compared with age- and race-matched community control subjects. The risk ratio for a total cumulative dose in excess of 1,500 mg was estimated to be 2.5 in women with intact ovaries. This increase was present using various independent sources of drug usage information but was inconsistent at low dose and undetectable in oophorectomized women. No important sources of confounding could be identified, and no risk modifiers could be identified except for a history of surgically confirmed benign breast disease. In such women with intact ovaries, the risk ratio for a high cumulative dose rose to 5.7 relative to nonusers with normal breasts. ( JAMA 243:1635-1639, 1980)
241 citations
TL;DR: Findings of influenza vaccination in reducing pneumonia and influenza hospitalizations and deaths among elderly members of a prepaid health plan are consistent with those reported in vaccinated young persons, and hence it appears they may be broadly generalized.
Abstract: Effectiveness of influenza vaccination in reducing pneumonia and influenza hospitalizations and deaths among elderly members of a prepaid health plan was analyzed retrospectively. Two epidemics caused by the H3N2 subtype of type A influenza were studied. Vaccine derived from the H2N2 subtype of influenza A virus failed to protect against the Hong Kong (H3N2) virus during the 1968-1969 epidemic. Vaccine derived from the A/Hong Kong/68 (H3N2) virus yielded an estimated 72% (31% to 100%) reduction in hospitalization and 87% (52% to 100%) reduction in mortality during the 1972-1973 epidemic caused by A/England/72 (H3N2). These findings are consistent with those reported in vaccinated young persons, and hence it appears they may be broadly generalized.
229 citations
TL;DR: Results from an ongoing study of mineral loss in oophorectomized women suggest that vertebral cancellous bone loss was significant for the group as a whole at 12 months, while mean peripheral measurements showed no change.
Abstract: Computed tomography (CT) provides precise anatomic localization coupled with quantitative x-ray attenuation information that can be used to determine bone mineral content. A precise and sensitive method for vertebral mineral measurement by CT is described and illustrated with results from an ongoing study of mineral loss in oophorectomized women. Spinal mineral loss measured by quantitative CT is compared with peripheral loss determined by photon absorptiometry and radiogrammetry. Vertebral cancellous bone loss was significant for the group as a whole at 12 months, while mean peripheral measurements showed no change. In two subjects in whom mineral change was significant at both sites, spinal loss was approximately five times greater than peripheral loss. ( JAMA 244:2056-2059, 1980)
TL;DR: The sharp fall of the "antiatherogenic" lipop protein, high-density lipoprotein, associated with zinc administration supports the concept that zinc ingestion may be atherogenic in man.
Abstract: Zinc administration in rats is associated with a rise in serum cholesterol level. This study examined the effect of zinc administration on serum lipoprotein values in man. Twelve healthy adult men ingested 440 mg of zinc sulfate per day for five weeks. High-density lipoprotein-cholesterol concentration decreased 25% below baseline values (40.5 to 30.1 mg/dL). Total cholesterol, triglyceride, and low-density lipoprotein-cholesterol levels did not change throughout the study. The sharp fall of the "antiatherogenic" lipoprotein, high-density lipoprotein, associated with zinc administration supports the concept that zinc ingestion may be atherogenic in man.
TL;DR: The study concludes that a protocol strictly adhered to by knowledgeable persons is necessary for the proper administration of TPN in the hospitalized patient.
Abstract: Two groups of patients receiving total parenteral nutrition (TPN) were compared in a prospective study for a period of 24 months. The TPN in one group of 211 patients was exclusively managed by a nutrition support team. A variety of physicians managed the TPN of 164 patients in the other group. The complication rate of both groups was compared. The second group had a much higher incidence of all complications. The study concludes that a protocol strictly adhered to by knowledgeable persons is necessary for the proper administration of TPN in the hospitalized patient.
TL;DR: This publication presents the techniques of the AO-Group (the Swiss Association for the Study of Internal Fixation) and presents the basic principles of fixation with diagrammatic illustrations of their operative and postoperative techniques.
Abstract: The use of metal wire, screws, plates, pins, and rods for skeletal internal fixation in orthopedic surgery has been evolving for several decades with the progressive development of improved techniques, materials, and instruments. This publication presents the techniques of the AO-Group (the Swiss Association for the Study of Internal Fixation). This second revised edition represents their continuing effort to formalize the methodology for internal fixation of fractures in every area of the body. The publication is divided into three sections. The first section presents the basic principles of fixation with diagrammatic illustrations of their operative and postoperative techniques. The second section deals specifically with the application of the techniques to fractures in all areas of the skeleton. The third section presents their fixation principles for other orthopedic problems, such as pseudarthroses, osteotomies, and arthrodeses. The book is definitely not a narrative text and is appropriately titled "Manual." Much important information
TL;DR: To reduce operative mortality in elderly patients, a system of preoperative staging, based on invasive monitoring, was developed, but only 13.5% of patients studied had normal measured, hemodynamic, respiratory, and oxygen transport function.
Abstract: To reduce operative mortality in elderly patients, a system of preoperative staging, based on invasive monitoring, was developed. All of the 148 consecutive patients studied had been cleared for surgery by standard assessment, but only 13.5% had normal measured, hemodynamic, respiratory, and oxygen transport function. Mild physiologic aberrations, not requiring a delay in surgery, or more severe abnormalities, indicative of high operative risk, were found in 63.5% of the patients. Advanced and incorrigible functional defects found in the remaining 23% made them unacceptable risks for major surgery under general anesthesia, and all who underwent the planned operation in spite of the warning died. Invasive preoperative assessment of elderly patients discloses a high percentage of serious physiologic abnormalities requiring a delay in some and cancellation of the operation in others. ( JAMA 243:1350-1355, 1980)
TL;DR: It is concluded that vigorous pulmonary therapy in the prospective group was associated with increased survival, a decreased incidence of pulmonary complications, and a decreased need for ventilatory support.
Abstract: A prospective study of the pulmonary complications occurring in 22 consecutive patients admitted to hospital within 24 hours after acute traumatic quadriplegia was compared with the findings of a retrospective survey of 22 comparable patients. Patients in the prospective group received therapy designed to prevent or reverse secretion retention. All patients in this group survived. In the retrospective group there were nine deaths; pulmonary complications and the need for tracheal intubation and mechanical ventilation were three times more frequent. Serial pulmonary function testing in the prospective group demonstrated a greater compromise of expiration than inspiration and progressive improvement in diaphragm function with time. It is concluded that vigorous pulmonary therapy in the prospective group was associated with increased survival, a decreased incidence of pulmonary complications, and a decreased need for ventilatory support. (JAMA243:528-531, 1980)
TL;DR: A computerized medical record system was designed to detect and remind the responsible clinician about clinical events that might need corrective action, and these reminders significantly increased the clinician response rate to the events in question.
Abstract: A computerized medical record system was designed to detect and remind the responsible clinician about clinical events that might need corrective action. These reminders significantly increased the clinician response rate (in terms of test orders and treatment changes) to the events in question. The addition of relevant medical literature citations to the reminders did not significantly change the clinician response rate as compared with that with reminders alone, nor did it stimulate the physicians to read any of the cited articles kept in an immediately available "library" of reprints.
TL;DR: Some physiologic actions of corticosteroids possibly responsible for development of these untoward effects are considered.
Abstract: Unusual complications associated with local microcrystalline corticosteroid injections were observed in four patients with diverse rheumatic disorders. Adverse reactions included (1) bilateral digital flexor tendon rupture following carpal tunnel injection for idiopathic median nerve compression syndrome; (2) bowstring deformity of a finger after local corticosteroid treatment of psoriatic digital flexor tendonitis; (3) carpal tunnel infection following dorsal arthrocentesis of a wrist in a patient with rheumatoid arthritis; and (4) pronounced flushing of the face, neck, and chest after intrasynovial corticosteroid injection in a patient with psoriasis and arthritis. This article considers some physiologic actions of corticosteroids possibly responsible for development of these untoward effects. ( JAMA 243:1547-1548, 1980)
TL;DR: Screening serum testosterone levels of 105 consecutive patients with impotence showed that 37 patients had previously unsuspected disorders of the hypothalamic-pituitary-gonadal axis, and potency was restored in 33 patients.
Abstract: The concept that impotence is psychogenic in 95% of cases is reconsidered. Screening serum testosterone levels of 105 consecutive patients with impotence showed that 37 patients had previously unsuspected disorders of the hypothalamic-pituitary-gonadal axis. Twenty patients had hypogonadotropic-hypogonadism, seven had hypergonadotropic-hypogonadism, eight had hyperprolactinemia, and two had occult hyperthyroidism. Once the specific defect was defined, appropriate therapy was instituted, and potency was restored in 33 patients. Screening serum testosterone levels is useful in identifying hypothalamic-pituitary-gonadal dysfunction in patients with impotence. (JAMA243:750-755, 1980)
TL;DR: It is suggested that alcohol enhances acetaminophen hepatotoxicity in mice and provides supportive evidence that these three alcoholic patients probably had a similar pathophysiological basis for their liver disease.
Abstract: Severe liver failure developed in three chronic alcoholics after they ingested acetaminophen for therapeutic reasons. The clinical course was characterized by SGOT levels of 5,000 to 10,000 IU. Concomitant renal failure developed in two of these patients, and one died in hepatic coma. To determine whether alcohol enhances acetaminophen hepatotoxicity, a lethal dose for 50% survival of a test group (LD50) was performed for mice fed 10% alcohol in their water supply for three weeks and for mice receiving a normal diet only. A significant reduction in the LD50was seen in the alcoholpretreated mice, and correlations were noted between histological findings in the liver and the LD50data. These findings suggest that alcohol enhances acetaminophen hepatotoxicity in mice and provides supportive evidence that these three alcoholic patients probably had a similar pathophysiological basis for their liver disease. (JAMA244:251-253, 1980)
TL;DR: The use of various information sources was related to such factors as their type of practice, specialty, location ofpractice, professional's age, and the size of their primary hospital.
Abstract: Interviews with 402 randomly selected health professionals identified the information habits health professionals used to stay abreast of current advances in medicine. The use of various information sources was related to such factors as their type of practice, specialty, location of practice, professional's age, and the size of their primary hospital. In addition to medical literature, the most common source, the typical responder spent one to five hours each week in discussions with colleagues. He or she also spent five to ten hours each year at local professional meetings, five to ten hours per year at state meetings, ten to 15 hours per year at national meetings, and ten to 15 hours per year at educational courses sponsored by various medical schools. Unsolicited medical literature was used extensively, particularly by those in rural, solo practice. ( JAMA 243:140-143, 1980)
TL;DR: Medroxyprogesterone can be used to treat the vasomotor flushes of postmenopausal women when estrogen use is undesirable, and it is shown that when these women were given placebo, an immediate worsening of their symptoms occurred.
Abstract: A double-blind crossover study was designed to compare the effects of placebo and medroxyprogesterone acetate, 20 mg, on vasomotor flushes and blood hormones in 27 postmenopausal women. In women receiving placebo, vasomotor flushes were decreased by 25.9% during the last four weeks of treatment compared with baseline, and a further decrease of 34.5% was achieved by the last four weeks after patients were given medroxyprogesterone. In women who initially took medroxyprogesterone, there a 73.9% decline by the last four weeks in the number of vasomotor flushes. However, when these women were given placebo, an immediate worsening of their symptoms occurred. The drug produced a decline of 27% and 29% in serum levels of follicle-stimulating hormone and luteinizing hormone, respectively, while the serum prolactin level rose slightly. Thus, medroxyprogesterone can be used to treat the vasomotor flushes of postmenopausal women when estrogen use is undesirable.
TL;DR: A one-hour posttransfusion count is a simple test that correlates well with the presence of antibody against HLA antigens, is valuable in predicting the need for HLA-matched platelets, and helps avoid wasteful, empirical use of such transfusions.
Abstract: Seventy-nine platelet transfusions to 73 thrombocytopenic patients with cancer were analyzed to determine whether a platelet count obtained one hour after transfusion could help differentiate between alloimmunization and other clinical factors that result in rapid platelet destruction. These transfusions were selected because 18- to 24-hour increments were inadequate in response to fresh, random donor platelets. A corrected count increment (CI) (CI=[posttransfusion count—pretransfusion count]×body surface area [sq m]/platelets transfused×10 11 ) at one hour of 10×10 3 /μL or greater was associated with absence of lymphocytotoxic antibody, whereas increments of less than 10×10 3 /μL were generally associated with high levels of strongly cytotoxic antibody. HLA-matched transfusions produced no improvement in increments when the previous one-hour CI had been 10×10 3 /μL or greater, whereas in the other group significantly better increments were obtained. A one-hour posttransfusion count is a simple test that correlates well with the presence of antibody against HLA antigens, is valuable in predicting the need for HLA-matched platelets, and helps avoid wasteful, empirical use of such transfusions. ( JAMA 243:435-438, 1980)
TL;DR: Analysis of 145 reports of adverse occurrences involving patients in a medical-surgical intensive care unit (ICU), during the years 1974 through 1978, disclosed 92 instances of human error and 53 cases of equipment malfunction.
Abstract: Analysis of 145 reports of adverse occurrences involving patients in a medical-surgical intensive care unit (ICU), during the years 1974 through 1978, disclosed 92 instances of human error and 53 cases of equipment malfunction. A peak occurrence of reported incidents was found between midnight and 1 am. Harm occurred more frequently if the patient was unattended (72%) than attended (49%) during the incident. Mortality for patients with an incident report filed during their ICU admission (41%) was higher than for all ICU patients (21%). The importance of a well-structured incident-reporting program to minimize problems of human error and device malfunction is stressed. (JAMA244:1582-1584, 1980)
TL;DR: The results suggest that the syndrome of painful diabetic neuropathy of the lower extremities represents a depressive equivalent in a large proportion of cases and that treatment with imipramine or amitriptyline is a successful mode of therapy for such persons.
Abstract: Fifty-nine patients referred for painful diabetic neuropathy of the lower extremities were evaluated for depression and response to antidepressant drug therapy in a double-blind controlled study All patients were found to have substantial degrees of depression during psychiatric interview and by Kupfer-Detre test scores (81±06, as compared with control values of 40 to 43±02) Treatment with imipramine hydrochloride or amitriptyline hydrochloride resulted in complete remission of lower extremity pains in all patients in 10±2 weeks, with concomitant relief of depression and return of depression test scores to 38 These results suggest that the syndrome of painful diabetic neuropathy of the lower extremities represents a depressive equivalent in a large proportion of cases and that treatment with imipramine or amitriptyline is a successful mode of therapy for such persons ( JAMA 243:1147-1150, 1980)
TL;DR: A review of the available data, including experimental evidence, does not support a cause-and-effect relationship between primary hyperparathyroidism or hypercalcemia and pancreatitis.
Abstract: Of 1,153 patients with surgically confirmed primary hyperparathyroidism operated on at the Mayo Clinic between 1950 and 1975, only 17 (1.5%) had coexisting or prior pancreatitis. This frequency of association approximates the reported incidence of pancreatitis among general hospital patient populations. Other factors of possible etiologic significance in pancreatitis, such as gallstones or alcohol abuse, were present in 11 of the 17 patients. Cure of the hyperparathyroidism was usually not associated with amelioration of symptoms due to pancreatitis. A review of the available data, including experimental evidence, does not support a cause-and-effect relationship between primary hyperparathyroidism or hypercalcemia and pancreatitis. ( JAMA 243:246-247, 1980)
TL;DR: A consent to treatment form provides required information that a patient may use to give intelligent, informed consent to proposed treatment, and was found slightly less difficult to comprehend than medical journals but substantially more difficult than comparable materials from the popular press.
Abstract: A consent to treatment form provides required information that a patient may use to give intelligent, informed consent to proposed treatment. This study applied two standard techniques to assess the degree to which 60 informed consent forms from five national cancer clinical trial groups were readable and understandable by patients. The forms were found slightly less difficult to comprehend than medical journals but substantially more difficult than comparable materials from the popular press. Three of four passages describing treatment methods, procedures, discomforts, and risks required a college level or greater reading ability to comprehend. Informed consent documents may not be understood by a substantial portion of patients who sign them. The very regulations designed to ensure a patient's informed cooperation with treatment may inadvertently lead to forms that are so complex as to make informed cooperation virtually impossible. ( JAMA 244:56-58, 1980)
TL;DR: Continuation of smoking during the treatment of small cell lung cancer was associated with a poor prognosis, while discontinuation ofsmoking, even at diagnosis, may have beneficial effects on survival.
Abstract: The prognostic implications of cigarette smoking were investigated in 112 patients with small cell lung cancer. Twenty had stopped smoking permanently before diagnosis (NS-Prior), 35 had stopped at diagnosis (NS-Dx), and 57 patients continued smoking (S). Therapies included chemotherapy alone or with radiation therapy, with or without thymosin fraction V. The survival difference among the three groups was statistically significant. The NS-Prior patients had the best survival, followed by NS-Dx patients and finally S patients. No S patient has survived, disease free, more than 96 weeks, while three NS-Prior and three NS-Dx patients are disease free 103 to 220 weeks after start of treatment. Thymosin, 60 mg/sq m, yielded survival benefits for the S group only. Continuation of smoking during the treatment of small cell lung cancer was associated with a poor prognosis, while discontinuation of smoking, even at diagnosis, may have beneficial effects on survival. ( JAMA 244:2175-2179, 1980)
TL;DR: The authors of this mongraph attempt the difficult task of combining in a single volume both the clinical and laboratory aspects of immunohematology needed for a comprehensive understanding of this subject.
Abstract: The authors of this mongraph attempt the difficult task of combining in a single volume both the clinical and laboratory aspects of immunohematology needed for a comprehensive understanding of this subject. In so doing, they present a broad range of subject matter that varies in complexity from the most elementary definitions of clinical and laboratory terms—hemolytic anemia, Coombs' test—to state-of-the-art discussions of management of autoimmune hemolytic anemias and sophisticated autoanalyzer techniques for differentiation of types of antibody-RBC interactions. The text is well organized and clearly written. It has excellent references at the end of each chapter and a good index. The original illustrations are generally well done, although there are occasional typographical inconsistencies between diagrams and text. The concise, illustrated reviews of the complement pathways, immunoglobulin structure and function, and the mechanisms of immune hemolysis are attractive as teaching references for related curricula. A full chapter is devoted to details
TL;DR: The Systematized Nomenclature of Medicine (SNOMED) as discussed by the authors is a system for the classification of medical information that uses a standardized language for disease classification and schemas for the naming of signs, symptoms, diseases, and procedures.
Abstract: THE LAST 50 years have witnessed an explosion in the scientific advances available to the medical practitioner in his evaluation and treatment of the patient. The arrival of computer technology has helped to augment the physician's recall of myriad pieces of information to help him evaluate the data for diagnosis and treatment. Inherent in this process is the need for medicine to develop a standardized language for the classification of disease into general groups, as well as detailed schemas for the naming of signs, symptoms, diseases, and procedures. To be useful, the system needs to be completely integrated. We review the historical development of classifications for statistical purposes and the conceptual evolution of nomenclatures and discuss the new nomenclature-classification system called the Systematized Nomenclature of Medicine (SNOMED) . 1 Present and future requirements of the management of medical information will be presented, including SNOMED applications. PART I STATISTICAL MANAGEMENT: CLASSIFICATION VS