Showing papers in "JAMA in 1982"
TL;DR: The treadmill exercise test is shown to provide surprisingly little prognostic information beyond that obtained from basic clinical measurements.
Abstract: A method is presented for evaluating the amount of information a medical test provides about individual patients. Emphasis is placed on the role of a test in the evaluation of patients with a chronic disease. In this context, the yield of a test is best interpreted by analyzing the prognostic information it furnishes. Information from the history, physical examination, and routine procedures should be used in assessing the yield of a new test. As an example, the method is applied to the use of the treadmill exercise test in evaluating the prognosis of patients with suspected coronary artery disease. The treadmill test is shown to provide surprisingly little prognostic information beyond that obtained from basic clinical measurements.
2,735 citations
TL;DR: In their book the authors present mathematical, physical, physiological, engineering, and medical facts in an effort to diminish a communication gap amongst electroencephalographers, engineers, and physicists.
Abstract: Computer technology is widely used to process biomedical information. Indeed, electrodiagnostic studies of heart, nervous system, and blood flow as well as radiographic procedures are dependent on computer assistance. Clinical electroencephalography, by contrast, remains largely a test, the interpretation of which must be done the old-fashioned way—by people. In their book the authors present mathematical, physical, physiological, engineering, and medical facts in an effort to diminish a communication gap amongst electroencephalographers, engineers, and physicists. In fact, their book is directed to practitioners of each of those disciplines. The book focuses on the various aspects of electrophysiology of the brain. The first three chapters concern the relationship of physics and electrophysiology, while subsequent chapters are related to potentials in different biologic media and the generation and recording of cerebral electrical activity. Computer methodology applicable to electroencephalography is mentioned. This book has considerable value in its presentation of clinical, theoretical, and speculative
2,057 citations
TL;DR: If this new technique involving delivery of DC shocks to an electrode catheter positioned adjacent to the His bundle proves safe and effective, it should supplant the need for open heart surgical procedures for His-bundle ablation.
Abstract: Five patients with recurrent bouts of supraventricular tachycardia proved resistant or became intolerant of both conventional and experimental drugs. These patients were subjected to a new procedure involving delivery of DC shocks to an electrode catheter positioned adjacent to the His bundle. Complete atrioventricular (AV) block was produced in all, one patient died suddenly six weeks after shock therapy, and the remainder had complete AV block with follow-up intervals ranging from four to 12 months. Shock therapy was associated with mild elevations of creatine phosphokinase MB (31 +/- 18 units), but there was no hemodynamic evidence of tricuspid insufficiency. If this new technique proves safe and effective, it should supplant the need for open heart surgical procedures for His-bundle ablation.
768 citations
TL;DR: Patients suffering from an irreversible dementia reported disturbances of patient behavior such as catastrophic reactions, waking at night, suspiciousness, and communication disorders, some of which can be alleviated by physician-initiated intervention.
Abstract: To determine the impact of dementia on the family, we interviewed the primary care givers of 55 patients suffering from an irreversible dementia. Problems reported included disturbances of patient behavior such as catastrophic reactions, waking at night, suspiciousness, and communication disorders, some of which can be alleviated by physician-initiated intervention. Care givers also reported that they themselves had feelings of anger, depression, and fatigue, which can be treated as well. (JAMA1982;248:333-335)
707 citations
TL;DR: The third edition of DeVita, Hellman, and Rosenberg's by now classic text on cancer preserves the multimodal, integrated approach to clinical evaluation and treatment of that disease.
Abstract: The third edition of DeVita, Hellman, and Rosenberg's by now classic text on cancer preserves the multimodal, integrated approach to clinical evaluation and treatment of that disease. The editors see to that approach by close supervision of the 66 individual chapters, each of which is written by one or more recognized experts. For a multiauthored text to be successful, information presented must be cogent and up-to-date. For the busy practitioner, it helps to read a scientific style that is lucid, if not graceful, succinct but not overwhelming. Most of us have tried to look up specific material and find information that will help us deal with daily clinical problems. Too often a comprehensive text leaves us no better off than we began—bogged down with excess cumbersome detail and without the help we had hoped to find. Happily, such is not the case with this text, nor was it a problem
615 citations
TL;DR: The situational BP changes were generally similar, but both hypertensive groups differed from normal subjects in that they showed consistently higher BPs in the physician's office than at home, whereas normal subjects showed a similar rise of systolic pressure to that of normal subjects.
Abstract: Blood pressure (BP) readings were taken every 15 minutes using a noninvasive ambulatory BP recorder during 24 hours in 25 subjects with normal BP, 25 with borderline hypertension, and 25 with established essential hypertension. Readings were analyzed for four situations: (1) physician's office, (2) work, (3) at home, and (4) asleep. Treadmill exercise tests were also performed on a separate occasion with the Bruce protocol. The 24-hour recording in all three groups showed the highest BPs at work and the lowest during sleep. The situational BP changes were generally similar, but both hypertensive groups differed from normal subjects in that they showed consistently higher BPs in the physician's office than at home, whereas normal subjects showed little difference. During exercise, the hypertensive groups showed a similar rise of systolic pressure to that of normal subjects. Pressures recorded in the physician's office gave good predictions of the average 24-hour pressure in normal and established hypertensive subjects, but not in the borderline group; in such patients, 24-hour monitoring may be of particular value in establishing the need for treatment. ( JAMA 1982;247:992-996)
529 citations
TL;DR: The occurrence of only one death per 7,620 joggers per year demonstrates that the risk of exercise is small and suggests that the routine exercise testing of healthy subjects before exercise training in not justified.
Abstract: In the six years from 1975 through 1980, a total of 12 men died during jogging in the state of Rhode Island. The cause of death in 11 was coronary heart disease (CHD). One man died of an acute gastrointestinal hemorrhage. The prevalence of jogging in the Rhode Island population was determined using a random-digit telephone survey. Among men aged 30 through 64 years, 7.4%±2.6% (mean±SE e ) reported jogging at least twice a week. The incidence of death during jogging for men of this age group was one death per year for every 7,620 joggers, or approximately one death per 396,000 man-hours of jogging. This rate is seven times the estimated death rate from CHD during more sedentary activities in Rhode Island and suggests that exercise contributes to sudden death in susceptible persons. The occurrence of only one death per 7,620 joggers per year demonstrates that the risk of exercise is small and suggests that the routine exercise testing of healthy subjects before exercise training is not justified. ( JAMA 1982;247:2535-2538)
508 citations
TL;DR: Under the organizational aegis of Project Sleep and the Association of Sleep Disorders Centers (ASDC), nearly 5,000 patient records from 11 sleep-wake disorders clinics were analyzed in a cooperative study, and the most prevalent diagnoses were sleep apnea and narcolepsy.
Abstract: Under the organizational aegis of Project Sleep and the Association of Sleep Disorders Centers (ASDC), nearly 5,000 patient records from 11 sleep-wake disorders clinics were analyzed in a cooperative study. These cases represented the diagnostic experience of each of these centers over a two-year period. Each patient underwent polysomnographic study, and his or her condition was diagnosed according to the ASDC classification system, a new, standardized nosology of sleep disorders medicine. The most common major diagnostic category was "disorders of excessive sleepiness (hypersomnia)," 42%; this was followed by "disorders of initiating and maintaining sleep (insomnia)," 26%; "penile tumescence evaluations for impotency," 17%; "parasomnias," 3%; and "disorders of the sleep-wake schedule," 2%. If the impotency evaluations performed in the sleep clinics are removed from the total, leaving only the population that was studied because of sleep complaints, the proportions of the diagnostic categories are hypersomnia, 51%; insomnia, 31%; parasomnias, 15%; and sleep-wake schedule disturbances, 3%. The most prevalent diagnoses in the hypersomnia category were sleep apnea (43%) and narcolepsy (25%). Psychiatric disorders (35%) comprised the most frequent group of insomnia diagnoses, though a variety of other disorders were common. The applications of these results for the practicing physician are discussed. ( JAMA 1982;247:997-1003)
352 citations
TL;DR: The majority of incontinent patients had substantial cognitive impairment and limitations in mobility and the severity of these impairments was related to the extent ofincontinence.
Abstract: Among elderly nursing home patients, urinary incontinence is a prevalent and costly condition. In seven nursing homes studied, 419 (50%) of the elderly patients were incontinent of urine. Most had been incontinent at admission (64%), had more than one incontinent episode per day or a catheter (72%), and had concomitant fecal incontinence (64%). The majority of incontinent patients had substantial cognitive impairment and limitations in mobility. The severity of these impairments was related to the extent of incontinence. Complications such as urinary tract infection and skin breakdown occurred in almost 45% and were more common in patients with catheters. Physicians recorded incontinence as a problem, or any efforts to evaluate it, in the nursing home records of less than 15% of these patients. (JAMA1982;248:1194-1198)
331 citations
TL;DR: Clinical data from 113 patients in whom the diagnosis was proved by viral isolation of herpes simplex encephalitis shows that diagnosis can be confirmed only by brain biopsy.
Abstract: Continuing evaluations of antiviral agents for treatment of herpes simplex encephalitis (HSE) provided an opportunity to collect clinical data from 113 patients in whom the diagnosis was proved by viral isolation. Occurrence of HSE was in all ages and in both sexes and was nonseasonal. Characteristically, patients had behavioral changes, fever, confusion, speech disturbances, and, less frequently, seizures. The EEG was the most useful neurodiagnostic aid followed by technetium and computed axial tomographic scans. Employing a logistic regression model for variable selection, the diagnosis could be predicted by clinical findings and neurodiagnostic tests in 83% of the proved cases, but the evidence in 25% was falsely positive. There was evidence of localization by either clinical or neurodiagnostic assessment in all patients with proved disease. Among patients wtih negative findings for HSE, similar focal findings predominated in all but a few. The CSF and brain scans were normal in many patients with proved HSE. This extensive clinical experience in patients wtih diagnosis proved by viral isolation shows that diagnosis cna be confirmed only by brain biopsy.
319 citations
TL;DR: Five homosexual men dying at UCLA Center for the Health Sciences, Los Angeles, with acquired immunodeficiency and Pneumocystis pneumonia, Kaposi's sarcoma, or cryptosporidiosis since May 1981 have all had mycobacteria of the Mycobacterium avium-intracellulare complex cultured from tissues taken just before death or at postmortem examination.
Abstract: Five homosexual men dying at UCLA Center for the Health Sciences, Los Angeles, with acquired immunodeficiency and Pneumocystis pneumonia, Kaposi's sarcoma, or cryptosporidiosis since May 1981 have all had mycobacteria of the Mycobacterium avium-intracellulare complex cultured from tissues taken just before death or at postmortem examination. Each man had histological evidence of disseminated mycobacterial infection. Acid-fast organisms were seen in macrophages in the lung, spleen, and lymph nodes in all cases and in a variety of additional organs in two cases. Other severe infections were always found at postmortem examination — cytomegalovirus, cryptosporidiosis, and Pneumocystis . Disseminated M avium-intracellulare infection has been so striking in homosexual males dying with acquired immunodeficiency at our institution that we believe a vigorous search for mycobacteria should be made in all such patients. Empiric therapy for mycobacterial infection may be justified in selected cases of immunodeficiency before a specific microbiological diagnosis. ( JAMA 1982;248:2980-2982)
TL;DR: The data suggest that anal intercourse may be a risk factor for anal cancer in men, but not in women, having had syphilis and being single are associated with the practice of anal intercourse.
Abstract: To determine whether characteristics that are correlated with male homosexual behavior are associated with the incidence of cancer, the names of persons with a diagnosis of cancer in western Washington during 1974 to 1979 were linked to those in the state syphilis registry. Eight of 47 men with anal cancer were found to have had a reactive FTA test result; the expected number, based on the proportion of reactive cases among men with other sites of cancer, was only 0.40. Among men with anal cancer identified through ten population-based cancer-reporting systems in the United States, 24.4% had never been married, compared with 7.8% of men with colon and rectal cancer. Neither of these relationships was observed for women with anal cancer. Because in men, but not in women, having had syphilis and being single are associated with the practice of anal intercourse, our data suggest that anal intercourse may be a risk factor for anal cancer. ( JAMA 1982;247:1988-1990)
TL;DR: The morbidity and mortality associated with the 1980 heat wave in St Louis and Kansas City, Mo, were assessed retrospectively and public health preventive measures should be directed toward the urban poor, the elderly, and persons of other-than-white races.
Abstract: The morbidity and mortality associated with the 1980 heat wave in St Louis and Kansas City, Mo, were assessed retrospectively. Heat-related illness and deaths were identified by review of death certificates and hospital, emergency room, and medical examiners' records in the two cities. Data from the July 1980 heat wave were compared with data from July 1978 and 1979, when there were no heat waves. Deaths from all causes in July 1980 increased by 57% and 64% in St Louis and Kansas City, respectively, but only 10% in the predominantly rural areas of Missouri. About one of every 1,000 residents of the two cities was hospitalized for or died of heat-related illness. Incidence rates (per 100,000) of heatstroke, defined as severe heat illness with documented hyperthermia, were 26.5 and 17.6 for St Louis and Kansas City, respectively. No heatstroke cases occurred in July 1979. Heatstroke rates were ten to 12 times higher for persons aged 65 years or older than for those younger than 65 years. The ratios of age-adjusted heatstroke rates were approximately 3:1 for nonwhitevwhite persons and about 6:1 for lowvhigh socioeconomic status. Public health preventive measures in future heat waves should be directed toward the urban poor, the elderly, and persons of other-than-white races. (JAMA1982;247:3327-3331)
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TL;DR: A review of biologic changes commonly attributed to the process of aging demonstrates the close similarity of most of these to changes subsequent to a period of enforced physical inactivity.
Abstract: A review of biologic changes commonly attributed to the process of aging demonstrates the close similarity of most of these to changes subsequent to a period of enforced physical inactivity The coincidence of these changes from the subcellular to the whole-body level of organization, and across a wide range of body systems, prompts the suggestion that at least a portion of the changes that are commonly attributed to aging is in reality caused by disuse and, as such, is subject to correction There is no drug in current or prospective use that holds as much promise for sustained health as a lifetime program of physical exercise (JAMA1982;248:1203-1208)
TL;DR: Diverse respondents view clinical trials as important, ethical, and as a means of attaining superior clinical care as well as making contributions to medical knowledge and to helping future patients.
Abstract: Attitudes toward clinical research, the focus of recent and damaging media attention, were assessed through questionnaires completed anonymously by 104 patients with cancer, 84 cardiology patients, and 107 members of the general public. Responses differed neither by subgroup nor by demographic variables. Data are therefore reported on the total population of 295 subjects. Most respondents (71%) believed that patients should serve as research subjects. In support of this belief, the majority cited potential benefit to others and the opportunity to increase scientific knowledge, but a different bias emerged when they were asked about their own potential participation. This study shows that diverse respondents view clinical trials as important, ethical, and as a means of attaining superior clinical care. Major importance is attributed to making contributions to medical knowledge and to helping future patients. Contrasts are noted in patients' views of their own treatments v treatments of "hypothetical others." ( JAMA 1982;248:968-970)
TL;DR: It is concluded that potentially serious mistakes in diagnosis are currently made by the physicians who care for most diabetic patients, and further education or greater use of referrals may be necessary to provide optimal patient care.
Abstract: The correct diagnosis of proliferation diabetic retinopathy is essential, because it is a treatable disease and missing the diagnosis can lead to the patient becoming blind. We examined the ability of internists and ophthalmologists to diagnose proliferative retinopathy under optimal conditions. Twenty-three physicians performed retinal examinations on ten diabetic patients and one normal patient with dilated pupils. Physician examiners were members of a university medical center and included 10 internists, 2 diabetologists, 4 senior medical residents, 4 general ophthalmologists, and 3 ophthalmologists who were subspecialists in retinal disease. Correct diagnosis was determined separately by the consensus of three ophthalmologists specializing in retinal disease, who reviewed seven-view stereo fundus photographs and medical charts. Of a possible 483 individual eye a examinations, 438 were completed. The overall error rate was 61%. The error rate for missing the diagnosis of proliferative retinopathy varied from 0% for retinal specialists to 49% for internists, diabetologists, and medical residents. We conclude that potentially serious mistakes in diagnosis are currently made by the physicians who care for most diabetic patients. Experience and specialized knowledge lessen that the error rate. Further education or greater use of referrals may be necessary to provide optimal patient care.
TL;DR: During a heat wave, the greatest attention should be directed toward high-risk groups, and relief efforts should include measures shown to be associated with reduced risk, as well as effective preventive measures.
Abstract: To identify risk factors associated with heatstroke, a case-control study in St Louis and Kansas City, Mo, was conducted during July and August 1980. Questionnaire data were gathered for 156 persons with heatstroke (severe heat illness with documented hyperthermia) and 462 control subjects matched by age, sex, and neighborhood of residence. A stepwise linear logistic regression procedure was used to identify factors significantly associated with heatstroke. Alcoholism, living on the higher floors of multistory buildings, and using major tranquilizers (phenothiazines, butyrophenones, or thioxanthenes) were factors associated with increased risk. Factors associated with decreased risk were using home air conditioning, spending more time in air-conditioned places, and living in a residence well shaded by trees and shrubs. Being able to care for oneself, characteristically undertaking vigorous physical activity, but reducing such activity during the heat, and taking extra liquid were also associated with decreased risk. Our findings also suggest effective preventive measures. During a heat wave, the greatest attention should be directed toward high-risk groups, and relief efforts should include measures shown to be associated with reduced risk.
TL;DR: This surgically noninvasive, outpatient method, approved by the Food and Drug Administration in November 1979, produced confirmed end results in 1,007 ununited fractures and 71 failed arthrodeses, worldwide.
Abstract: Pulsing electromagnetic fields (PEMFs) induce weak electric currents in bone by external coils on casts or skin. This surgically noninvasive, outpatient method, approved by the Food and Drug Administration in November 1979, produced confirmed end results in 1,007 ununited fractures and 71 failed arthrodeses, worldwide. Overall success at Columbia-Presbyterian Medical Center was 81%; internationally, 79%; and in other patients in the United States, 76%. Treatment with PEMFs was effective in 75% of 332 patients (a subset) with an average 4.7-year disability duration, an average of 3.4 previous operative failures to produce union, and a 35% rate of infection. Eighty-four percent of carpal naviculars and 82% of femoral neck-trochanteric nonunions were united. After attempted arthrodeses could not salvage a failed total-knee prosthesis, PEMFs promoted healing in 85% of patients. When coils were unsuccessful alone, combining them with surgical repair was effective.
TL;DR: Infected women were significantly younger than noninfected women, and significantly more often unmarried, supported by public assistance, and pregnant for the first time, among women followed up from 19 weeks' gestation until delivery, the mean duration of gestation was significantly shorter for those with antepartum chlamydial infection.
Abstract: In a prospective study of morbidity associated with Chlamydia trachomatis infections during pregnancy, we isolated C trachomatis from the endocervix of 18 (6.7%) of 268 women examined before 19 weeks' gestation. Infected women were significantly younger than noninfected women, and significantly more often unmarried, supported by public assistance, and pregnant for the first time. Among women followed up from 19 weeks' gestation until delivery, the mean duration of gestation was significantly shorter for those with antepartum chlamydial infection. Stillbirth or neonatal death occurred in six (33%) of the 18 pregnancies of infected women compared with eight (3.4%) of the 238 pregnancies of noninfected women followed up from the 19th week of gestation through delivery. Stillbirth or neonatal death occurred ten times more often among Chlamydia infected women than among uninfected controls matched for age, marital status, socioeconomic status, pregnancy order, and race. ( JAMA 1982;247:1585-1588)
TL;DR: The low risk of fulminant sepsis aftersplenectomy in the general adult population justifies a policy of individualization of each case as to the relative merits of splenectomy v splenic preservation.
Abstract: From 1955 to 1979, in Rochester, Minn, 193 residents with a mean age of 46 years underwent splenectomy. Only two cases of fulminant sepsis were documented during the 1,090 person-years of follow-up (0.18 cases per 100 person-years) in this unselected population. The incidence of any type of serious infection subsequent to splenectomy was estimated at 7.16 infections per 100 person-years of follow-up (78 cases). The incidence of infections was significantly increased among patients undergoing incidental splenectomy in conjunction with abdominal operations for malignant neoplasms or other conditions. Immunosuppression, radiation, and chemotherapy also significantly increased the risk of subsequent infection. The low risk of fulminant sepsis after splenectomy in the general adult population justifies a policy of individualization of each case as to the relative merits of splenectomy v splenic preservation. ( JAMA 1982;248:2279-2283)
TL;DR: It is concluded that more research is needed to determine how patients and practitioners contribute to this phenomenon of low intensity of somatic treatment.
Abstract: We report on the treatment received by 217 patients in the community with a diagnosis of major depressive disorder of at least one month's duration. Only a low proportion of subjects received intensive treatment with antidepressant medication or electroconvulsive therapy, as judged by research standards and current clinical teaching. Specific associations emerge between treatment and several clinical, sociodemographic, and diagnostic variables; however, taken together these variables account for only a small fraction of the variance in treatment received. Even among patient subgroups based on severity and long duration of illness, high proportions did not receive adequate therapeutic trials. Substantial differences are found in treatment across community centers that are not attributable to variation in the clinical characteristics of patients. We conclude that more research is needed to determine how patients and practitioners contribute to this phenomenon of low intensity of somatic treatment. ( JAMA 1982;248:1848-1855)
TL;DR: The clinical picture in these three patients suggests a distinct clinical entity of spontaneous osteoporotic fracture of the sacrum (SOFS), characterized by severe low back, hip, and leg pain that suggests initially lumbosacral radicular compression, either from disk disease, spinal stenosis, tumor.
Abstract: Three elderly patients with incapacitating back and leg pain were found to have spontaneous osteoporotic fractures of the sacrum. The clinical picture in these three patients suggests a distinct clinical entity of spontaneous osteoporotic fracture of the sacrum (SOFS). This is characterized by severe low back, hip, and leg pain that suggests initially lumbosacral radicular compression, either from disk disease, spinal stenosis, or tumor. However, objective mechanical signs more typical of those entities may be absent or minimal in SOFS. Symptoms suggestive of a cauda equinasyndrome may be present, but there is minimal or no neurological deficit on examination. Marked sacral tenderness is a hallmark of SOFS. ( JAMA 1982;248:715-717)
TL;DR: Age-standardized comparisons between the unexplained syncope group, the US population, and other ICU patients suggest that patients with syncope unexplained at hospital discharge do not have an increased risk of death during the subsequent year.
Abstract: The records of 108 patients admitted to a medical intensive care unit (ICU) for syncope during a two-year period were reviewed. Explicit criteria were used to classify patients by presumed etiologic diagnosis. Thirty-six percent of the cases of syncope were due to cardiovascular disease, 17% were due to noncardiovascular disease, and 47% were unexplained at hospital discharge. Seventy-two percent of presumed etiologic diagnoses were based on information available at the time of patient admission. The remainder were based on ICU monitoring and additional diagnostic tests. Patients were prospectively studied after hospital discharge. The one-year mortality was 19% in the cardiovascular group, 6% in the noncardiovascular group, and 6% among patients whose syncope remained unexplained. Age-standardized comparisons between the unexplained syncope group, the US population, and other ICU patients suggest that patients with syncope unexplained at hospital discharge do not have an increased risk of death during the subsequent year. ( JAMA 1982;248:1185-1189)
TL;DR: Giving up smoking was significantly more common for current runners than for "retired" runners, and weight loss was commonly associated with running and was greater in those persons who were overweight when they began running.
Abstract: To better estimate rates of certain benefits and risks of recreational running, we sent questionnaires to 1,250 randomly selected male and 1,250 female registrants for a 10-km road race. The response rate was 55% for men and 58% for women. Telephone interviews of a randomly selected group of nonrespondents indicated that the only significant differences between respondents and nonrespondents were that (1) respondents were older than nonrespondents, (2) more male nonrespondents had stopped running during the year after the race, and (3) more male nonrespondents had been hit by thrown objects. One year after the race, 89% of male and 79% of female respondents were still running regularly. Eighty-one percent of men and 75% of women who smoked cigarettes when they began running had stopped smoking after beginning recreational running. Giving up smoking was significantly more common for current runners than for "retired" runners. Weight loss was commonly associated with running and was greater in those persons who were overweight when they began running. More than a third of respondents had a musculoskeletal injury attributed to running in the year after the race and about one seventh of all respondents sought medical consultation for their injury. The risk of injury increased with increasing weekly mileage. This study uses epidemiologic methods to quantify some of the benefits and risks of running.
TL;DR: The tongue-retaining device (TRD) as discussed by the authors was designed to increase the unobstructed dimension of the nasal breathing passage during sleep and significantly reduced the number of obstructive and central apneic episodes.
Abstract: The tongue-retaining device (TRD) was designed to increase the unobstructed dimension of the nasal breathing passage during sleep Twenty male patients with diagnoses of sleep apnea syndrome, primarily of the obstructive type, confirmed by clinical polysomnography, were fitted with the device The TRD holds the tongue in a forward position by negative pressure Fourteen patients have been tested before and after this treatment, and ten of these have also completed two follow-up recordings four to six months after being trained in the use of this device There was significantly improved sleep and significantly fewer and shorter apneic events on all nights when the device was worn On the first night of wearing the TRD for a half night only, there was a significant reduction in the number of obstructive and central apneic episodes The mean apnea plus hypopnea index while wearing the TRD is comparable with the rate reported for patients who have been treated surgically by either tracheostomy or by uvulopalatopharyngoplasty, although the tracheostomy group contained more severe cases ( JAMA 1982;248:705-709)
TL;DR: In these Tourette's-susceptible patients, stimulants may exacerbate severe motor and phonic tics, requiring discontinuation of administration of stimulants and institution of haloperidol therapy for tic control.
Abstract: Following treatment with stimulant medications for symptoms of attention deficit disorder, Gilles de la Tourette's syndrome occurred in 15 patients. Early signs of Tourette's syndrome may be difficult to distinguish from hyperactive and attention disordered symptoms, leading the clinician to consider treatment with stimulants. In these Tourette's-susceptible patients, stimulants may exacerbate severe motor and phonic tics, requiring discontinuation of administration of stimulants and institution of haloperidol therapy for tic control. Clinical evaluation for tics and Tourette's syndrome in children and their families should precede and dictate use of stimulant medications in children. ( JAMA 1982;247:1729-1731)
TL;DR: It is often difficult to tell if a condition represents a primary hypersensitivity reaction or a response to another form of organ damage, so an understanding of the distinction is important.
Abstract: ADVERSE reactions to drugs are common clinical problems and a significant source of morbidity and mortality The true prevalence is difficult to determine, but estimates of drugrelated complications have ranged from 6% to 15% of hospitalized patients A variety of mechanisms, presumably unrelated to hypersensitivity, account for the majority of these reactions (Table 6-1) Actual allergic or immunologic drug reactions likely account for 25% or less of the overall number of adverse drug reactions (Table 6-2) A minority of adverse drug reactions, perhaps 6% to 10%, are secondary to or closely associated with immunologic mechanisms (Table 6-2) The classification (as listed in Tables6-1 and 6-2) is arbitrary Many of the mediators of hypersensitivity are involved in the host's response to toxic injury It is often difficult to tell if a condition represents a primary hypersensitivity reaction or a response to another form of organ damage An understanding of the
TL;DR: Risk of cancer was studied prospectively in four families described in 1969 as having diverse neoplasms, especially breast cancer and soft-tissue sarcoma, and in ten of 31 surviving family members, there developed 16 additional cancers between 1969 and 1981.
Abstract: Risk of cancer was studied prospectively in four families described in 1969 as having diverse neoplasms, especially breast cancer and soft-tissue sarcoma. Between 1969 and 1981, in ten of 31 surviving family members, there developed 16 additional cancers (expected, 0.5). There were five breast carcinomas, four soft-tissue sarcomas, and seven other cancers. In eight patients, multiple primary cancers developed, including three softtissue sarcomas and one mesothelioma at sites of prior radiotherapy. (JAMA1982;247:2692-2694)
TL;DR: Spironolactone is a highly effective and safe agent for the treatment of hirsutism through its inhibitory action on both ovarian androgen secretion and peripheral androgen action.
Abstract: Clinical and endocrine evaluations of 39 patients with hirsutism were performed to determine the effectiveness and site(s) of action of an antiandrogenic compound, spironolactone. Treatment with spironolactone at a dose of 200 mg/day resulted in a clear beneficial effect on the quantity and quality of facial hair growth in 19 of 20 patients with moderate to severe hirsutism. Regression of hirsutism in terms of diameter, density, and the rate of facial hair growth was noticeable within two months. The maximal effect was observed at six months and was maintained at 12 months of treatment. Spironolactone was equally effective in reducing hirsutism in women with polycystic ovary syndrome and idiopathic hirsutism. These clinical observations were associated with a prompt and sustained reduction in levels of androgen of ovarian origin without affecting levels of adrenal androgen and cortisol. Apart from diuresis, which was limited to the first few days of treatment, there were no discernible side effects during the one year of this study. Our results indicate that spironolactone is a highly effective and safe agent for the treatment of hirsutism through its inhibitory action on both ovarian androgen secretion and peripheral androgen action. (JAMA1982;247:1295-1298)
TL;DR: The extensive volume reviews, in separate chapters, the principle etiologic agents of cutaneous, subcutaneous, systemic, and opportunistic mycoses, and there are comprehensive chapters on histoplasmosis, coccidioidomycosis, and blastomycoses.
Abstract: This edition retains the classic approach to medical mycology. The first four chapters and part of chapter 5 offer a review of the pathogenic actionomycetes. Chapter 6 provides a general review of the classification and morphology of microfungi with brief summary statements on fungi as animal pathogens and on the principles of antimycotic therapy. The extensive volume reviews, in separate chapters, the principle etiologic agents of cutaneous, subcutaneous, systemic, and opportunistic mycoses. There are comprehensive chapters on histoplasmosis, coccidioidomycosis, and blastomycoses. The major differences between this edition and the second edition, published in 1982, are the additions of chapters on phaeohyphomycosis and hyalohyphomyces. In the latter chapter brief sections are devoted also to pythiosis, algosis, and rare mycoses. Regretfully, the useful separate chapter on culture methods, media, stains, and procedures of the second edition has been omitted. The book is notable for its extensive lists of full references at the