Showing papers in "JAMA in 1986"
TL;DR: The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or her own research.
Abstract: I have developed "tennis elbow" from lugging this book around the past four weeks, but it is worth the pain, the effort, and the aspirin. It is also worth the (relatively speaking) bargain price. Including appendixes, this book contains 894 pages of text. The entire panorama of the neural sciences is surveyed and examined, and it is comprehensive in its scope, from genomes to social behaviors. The editors explicitly state that the book is designed as "an introductory text for students of biology, behavior, and medicine," but it is hard to imagine any audience, interested in any fragment of neuroscience at any level of sophistication, that would not enjoy this book. The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or
7,563 citations
TL;DR: It is concluded that even after these adjustments, nonfasting HDL-C and total cholesterol levels are related to development of CHD in both men and women aged 49 years and older.
Abstract: The first report from the Framingham Study that demonstrated an inverse relationship between high-density lipoprotein cholesterol (HDL-C) and the incidence of coronary heart disease (CHD) was based on four years of surveillance. These participants, aged 49 to 82 years, have now been followed up for 12 years, and this report shows that the relationship between the fasting HDL-C level and subsequent incidence of CHD does not diminish appreciably with time. Since a second measurement of HDL-C is available eight years after the initial determination, the relationship of HDL-C measurements on the same subjects at two points in time is examined. This second HDL-C measurement is also used in a multivariate model that includes cigarette smoking, relative weight, alcohol consumption, casual blood glucose, total cholesterol, and blood pressure. It is concluded that even after these adjustments, nonfasting HDL-C and total cholesterol levels are related to development of CHD in both men and women aged 49 years and older. Study participants at the 80th percentile of HDL-C were found to have half the risk of CHD developing when compared with subjects at the 20th percentile of HDL-C.
2,428 citations
TL;DR: This annual publication for the US Department of Health and Human Services entitled Health: United States is a report to Congress on the health status of the nation and has dropped the essays on selected topics by experts within the government.
Abstract: This annual publication for the US Department of Health and Human Services entitled Health: United States is a report to Congress on the health status of the nation The current volume, for 1984, has dropped the essays on selected topics by experts within the government In exchange, there has been an extension of the statistical material Over the years, these surveys were interesting and valuable Material emerged in them, with appropriate commentary, that was not otherwise readily available It is to be hoped that they will be continued elsewhereThe 1984 report opens with a series of about 50 short paragraphs labeled "Highlights" Each contains some snappy facts: from the life table—life expectancy has reached a new high of 747 years, and is still 168 years at age 65; from general vital statistics— the fertility rate is stable; and from data on health care utilization and resources—15% of people over
2,373 citations
TL;DR: The data of high precision show that the relationship between serum cholesterol and CHD is not a threshold one, with increased risk confined to the two highest quintiles, but rather is a continuously graded one that powerfully affects risk for the great majority of middle-aged American men.
Abstract: The 356 222 men aged 35 to 57 years, who were free of a history of hospitalization for myocardial infarction, screened by the Multiple Risk Factor Intervention Trial (MRFIT) in its recruitment effort, constitute the largest cohort with standardized serum cholesterol measurements and long-term mortality follow-up. For each five-year age group, the relationship between serum cholesterol and coronary heart disease (CHD) death rate was continuous, gradecf, and strong. For the entire group aged 35 to 57 years at entry, the age-adjusted risks of CHD death in cholesterol quintiles 2 through 5 (182 to 202, 203 to 220, 221 to 244, and ≥245 mg/dL [4.71 to 5.22, 5.25 to 5.69, 5.72 to 6.31, and ≥6.34 mmol/L]) relative to the lowest quintile were 1.29, 1.73, 2.21, and 3.42. Of all CHD deaths, 46% were estimated to be excess deaths attributable to serum cholesterol levels 180 mg/dL or greater (≥4.65 mmol/L), with almost half the excess deaths in serum cholesterol quintiles 2 through 4. The pattern of a continuous, graded, strong relationship between serum cholesterol and six-year age-adjusted CHD death rate prevailed for nonhypertensive nonsmokers, nonhypertensive smokers, hypertensive nonsmokers, and hypertensive smokers. These data of high precision show that the relationship between serum cholesterol and CHD is not a threshold one, with increased risk confined to the two highest quintiles, but rather is a continuously graded one that powerfully affects risk for the great majority of middle-aged American men. (JAMA1986;256:2823-2828)
2,113 citations
TL;DR: For instance, this article found that the heritability for height, weight, and body mass index (BMI) was twice as high for monozygotic twins as for dizygotic twins.
Abstract: Height, weight, and body mass index (BMI) were assessed in a sample of 1974 monozygotic and 2097 dizygotic male twin pairs. Concordance rates for different degrees of overweight were twice as high for monozygotic twins as for dizygotic twins. Classic twin methods estimated a high heritability for height, weight, and BMI, both at age 20 years (.80, .78, and .77, respectively) and at a 25-year follow-up (.80, .81, and .84, respectively). Height, weight, and BMI were highly correlated across time, and a path analysis suggested that the major part of that covariation was genetic. These results are similar to those of other twin studies of these measures and suggest that human fatness is under substantial genetic control.
884 citations
TL;DR: Primary CMV infection during pregnancy poses a 30% to 40% risk of intrauterine transmission and adverse outcome is more likely when infection occurs within the first half of gestation.
Abstract: We studied 16 218 pregnant women from two income groups to determine the incidence of primary cytomegalovirus (CMV) infection and its consequences for the offspring. In the high-income group, 64.5% of the women were seronegative for CMV and 1.6% had primary CMV infection. In the low-income group, only 23.4% of the women were seronegative for CMV, but 3.7% experienced a primary infection. The rate of transmission in utero was similar in the two groups (39% and 31%). Congenital infections were more frequent in the low-income group; however, primary CMV accounted for 25% of the congenital infections in this group, in contrast to 63% of the high-income cases. Infections acquired early and late in gestation had similar rates of transmission in utero, but three infants (8%) with symptomatic congenital infection and five infants (13.5%) who have developed significant handicaps were exposed in the first half of pregnancy. Primary CMV infection during pregnancy poses a 30% to 40% risk of intrauterine transmission and adverse outcome is more likely when infection occurs within the first half of gestation. ( JAMA 1986;256:1904-1908)
801 citations
TL;DR: It is concluded that Lp(a) is an important attribute that should often be considered when coronary heart disease risk is assessed and was not explained by differences in total cholesterol levels, high-density lipoprotein or low-density lipid levels, subscapular skin fold, systolic blood pressure, history of smoking, alcohol consumption, or age.
Abstract: The Lp(a) lipoprotein is structurally related to low-density lipoprotein but is found in lower plasma concentration. It has been associated with coronary disease in several white populations. To test the generalizability of this association, we measured serum Lp(a) by quantitative immunoelectrophoresis in 303 Hawaiian men of Japanese ancestry with a prior myocardial infarction (MI) and in 408 population-based controls. Mean values were 17.1 and 13.7 mg/dL (0.171 and 0.137 g/L) respectively. Increased risk for MI was shown mainly for men in the upper quartile of the Lp(a) lipoprotein distribution (≥20.1 mg/dL [≥0.201 g/L]). Odds ratios at younger than 60, 60 to 69, and 70 years of age or older were 2.5, 1.6, and 1.2 times those for men in the lower three quartiles, respectively. In a multiple logistic model the association with MI remained significant and was not explained by differences in total cholesterol levels, high-density lipoprotein or low-density lipoprotein cholesterol levels, subscapular skin fold, systolic blood pressure, history of smoking, alcohol consumption, or age. We conclude that Lp(a) is an important attribute that should often be considered when coronary heart disease risk is assessed. (JAMA1986;256:2540-2544)
774 citations
TL;DR: Extracorporeal carbon dioxide removal with low-frequency ventilation proved a safe technique, and it is suggested as a valuable tool and an alternative to treating severe acute respiratory failure by conventional means.
Abstract: Forty-three patients were entered in an uncontrolled study designed to evaluate extracorporeal membrane lung support in severe acute respiratory failure of parenchymal origin. Most of the metabolic carbon dioxide production was cleared through a low-flow venovenous bypass. To avoid lung injury from conventional mechanical ventilation, the lungs were kept "at rest" (three to five breaths per minute) at a low peak airway pressure of 35 to 45 cm H2O (3.4 to 4.4 kPa). The entry criteria were based on gas exchange under standard ventilatory conditions (expected mortality rate, >90%). Lung function improved in thirty-one patients (72.8%), and 21 patients (48.8%) eventually survived. The mean time on bypass for the survivors was 5.4 ± 3.5 days. Improvement in lung function, when present, always occurred within 48 hours. Blood loss averaged 1800±850 mL/d. No major technical accidents occurred in more than 8000 hours of perfusion. Extracorporeal carbon dioxide removal with low-frequency ventilation proved a safe technique, and we suggest it as a valuable tool and an alternative to treating severe acute respiratory failure by conventional means. (JAMA1986;256:881-886)
632 citations
TL;DR: Since it is impossible in any one patient to predict either the effective or the toxic dose, small increments of antiarrhythmic drugs are given at frequent intervals until a therapeutic end point is reached.
Abstract: THE ECTOPIC TACHYCARDIAS are currently treated by either vagal stimulation or drugs. The 3 most effective drugs are quinidine, procainamide hydrochloride, and the digitalis glycosides. When the ectopic mechanism drives the ventricles at rates above 160 per minute, cardiac output falls and coronary blood flow is compromised. This is most likely to occur with ventricular tachycardia which constitutes a serious cardiac emergency requiring immediate treatment. Frequently, however, the arrhythmia cannot be terminated promptly. Reversion with drugs generally involves a time-consuming biologic titration. Since it is impossible in any one patient to predict either the effective or the toxic dose, small increments of antiarrhythmic drugs are given at frequent intervals until a therapeutic end point is reached. The interval between doses is determined by the gravity of the patient's illness as well as by the rapidity of action of the particular agent. It may thus take minutes, days, or even weeks
617 citations
TL;DR: It is concluded that disulfiram may help reduce drinking frequency after relapse, but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence or delay the resumption of drinking.
Abstract: We conducted a controlled, blinded, multicenter study of disulfiram treatment of alcoholism in 605 men randomly assigned to 250 mg of disulfiram (202 men); 1 mg of disulfiram (204 men), a control for the threat of the disulfiram-ethanol reaction; or no disulfiram (199 men), a control for the counseling that all received. Bimonthly treatment assessments were done for one year. Relative/ friend interviews and blood and urine ethanol analyses were used to corroborate patients' reports. There were no significant differences among the groups in total abstinence, time to first drink, employment, or social stability. Among the patients who drank and had a complete set of assessment interviews, those in the 250-mg disulfiram group reported significantly fewer drinking days (49.0 ±8.4) than those in the 1-mg (75.4±11.9) or the no-disulfiram (86.5 ± 13.6) groups. There was a significant relationship between adherence to drug regimen and complete abstinence in all groups. We conclude that disulfiram may help reduce drinking frequency after relapse, but does not enhance counseling in aiding alcoholic patients to sustain continuous abstinence or delay the resumption of drinking. (JAMA1986;256:1449-1455)
612 citations
TL;DR: This study confirms the reports from Sweden and several US states that NHL is associated with farm herbicide use, especially phenoxyacetic acids, and confirms the case-control studies and cohort studies of pesticide manufacturers and Vietnam veterans linking herbicides to STS or HD.
Abstract: A population-based case-control study of soft-tissue sarcoma (STS), Hodgkin's disease (HD), and non-Hodgkin's lymphoma (NHL) in Kansas found farm herbicide use to be associated with NHL (odds ratio [OR], 1.6; 95% confidence interval [CI], 0.9, 2.6). Relative risk of NHL increased significantly with number of days of herbicide exposure per year and latency. Men exposed to herbicides more than 20 days per year had a sixfold increased risk of NHL (OR, 6.0; 95% CI, 1.9, 19.5) relative to nonfarmers. Frequent users who mixed or applied the herbicides themselves had an OR of 8.0 (95% CI, 2.3, 27.9) for NHL. Excesses were associated with use of phenoxyacetic acid herbicides, specifically 2,4-dichlorophenoxyacetic acid. Neither STS nor HD was associated with pesticide exposure. This study confirms the reports from Sweden and several US states that NHL is associated with farm herbicide use, especially phenoxyacetic acids. It does not confirm the case-control studies or the cohort studies of pesticide manufacturers and Vietnam veterans linking herbicides to STS or HD. (JAMA1986;256:1141-1147)
TL;DR: Pregnancy outcome to bacterial vaginosis, an anaerobic vaginal condition, and to other selected genital pathogens among 534 gravid women was prospectively studied, finding that neonates born to women with bacterialvaginosis had lower mean birth weight than did neonatesBorn to women without bacterial vagInosis.
Abstract: We prospectively studied the relationship of pregnancy outcome to bacterial vaginosis, an anaerobic vaginal condition, and to other selected genital pathogens among 534 gravid women. Bacterial vaginosis was presumptively diagnosed by gas-liquid chromatographic identification of microbial organic acid metabolites in 102 women (19%), and cervical infection with Chlamydia trachomatis was found in 47 (9%) of the women. Although women with and without bacterial vaginosis had similar demographic and obstetric factors, neonates born to women with bacterial vaginosis had lower mean birth weight than did neonates born to women without bacterial vaginosis (2960±847 g vs 3184 ±758 g). Bacterial vaginosis was significantly associated with preterm premature rupture of the membranes (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1 to 3.7), preterm labor (OR, 2.0; CI, 1.1 to 3.5), and amniotic fluid infection (OR, 2.7; CI, 1.1 to 6.1), but not with birth weight below 2500 g (OR, 1.5; CI, 0.8 to 2.0). Cervical infection with C trachomatis was independently associated with preterm premature rupture of the membranes, preterm labor, and low birth weight (OR, 1.5; CI, 0.8 to 2.0). ( JAMA 1986;256:1899-1903)
TL;DR: The results suggest that psoriasis may have an immunologic basis mediated by activated T cells and/or other immune cells; if a long-term regimen with a favorable efficacy-side effect ratio can be determined, cyclosporine would be a significant advance in the treatment of Psoriasis.
Abstract: In a double-blind trial, 21 patients with severe plaque psoriasis were randomly assigned to receive oral cyclosporine, 14 mg/kg/d, or its vehicle. After four weeks of therapy the 11 cyclosporine recipients had the following response to treatment: two had total clearing and six improved markedly, two moderately, and one minimally; whereas ten vehicle-treated patients showed no change or minimal improvement. Vehicle-treated patients, after a switch to cyclosporine for four weeks, demonstrated impressive improvement similar to that seen in patients who initially received only cyclosporine. Moderate or marked improvement or total clearing was noted in 17 (81%) of 21 and 20 (95%) of 21 after one and four weeks of therapy, respectively. Mitotic figures and leukotriene B4 levels in lesions decreased 86% and 64%, respectively, after seven days of cyclosporine therapy. Mononuclear (including activated T cells) and polymorphonuclear leukocyte infiltrates were markedly reduced in lesions of all patients after seven days of cyclosporine therapy. These results suggest that (1) psoriasis may have an immunologic basis mediated by activated T cells and/or other immune cells; (2) if a long-term regimen with a favorable efficacy—side effect ratio can be determined, cyclosporine would be a significant advance in the treatment of psoriasis. ( JAMA 1986;256:3110-3116)
TL;DR: The data are analyzed to provide physicians with quantitative data that will be helpful in clinical decision making when drug-induced exanthems, urticaria, or generalized pruritus occurs and to confirm and extend findings from an earlier study of the preceding 22,227 patients.
Abstract: We analyzed the data on 15 438 consecutive medical inpatients monitored by the Boston Collaborative Drug Surveillance Program from June 1975 to June 1982 to determine the rates of allergic cutaneous reactions to drugs introduced since 1975 and to confirm and extend findings from an earlier study of the preceding 22 227 patients. There were 358 reactions occurring in 347 patients, for an overall reaction rate among patients of 2.2%. Each patient received a mean of eight different drugs. Rashes were attributed to 51 drugs, and 75% of the allergic cutaneous reactions were attributed to antibiotics, blood products, and inhaled mucolytics. Amoxicillin (51.4 reactions per 1000 patients exposed), trimethoprim-sulfamethoxazole (33.8/1000), and ampicillin (33.2/1000) had the highest reaction rates. Drug-specific reaction rates ranged from zero to 51.4 per 1000 and were determined for 180 drugs or drug groups. These results provide physicians with quantitative data that will be helpful in clinical decision making when drug-induced exanthems, urticaria, or generalized pruritus occurs. ( JAMA 1986;256:3358-3363)
TL;DR: It is demonstrated that the administration of IL-2 can mediate the regression of established cancer in some patients.
Abstract: Experience with the administration of high doses of interleukin 2 (IL-2) alone is described herein. Ten patients with a variety of malignant disorders unresponsive to conventional treatments were treated with at least 30 000 U/kg of IL-2 by bolus administration three times a day. Patients were treated intravenously or intraperitoneally from four to 21 days in a single course, usually interrupted by a week of recovery. Three of six patients with melanoma experienced an objective regression (>50% decrease in volume); there was no response to treatment in patients with colorectal (0/3) or ovarian (0/1) cancer. Two patients with initial objective regressions who subsequently developed progression were re-treated and one sustained a second partial response. Responses lasted 1, 3, and 7 months without additional treatment. Responses in the three patients with melanoma were in visceral sites (lung, liver, and spleen), as well as cutaneous sites in one patient. Progressive shrinkage of tumors for three to six months after the conclusion of therapy has been noted in two patients. Marked lymphocytic infiltrate was noted in a patient with lesions accessible to repeated biopsies. This study demonstrates that the administration of IL-2 can mediate the regression of established cancer in some patients. ( JAMA 1986;256:3117-3124)
TL;DR: Tuberculosis was more common among Haitians and intravenous drug abusers and homosexuals than among homosexuals who did not abuse drugs and may be considered an infection predictive of the presence of AIDS.
Abstract: Tuberculosis has not been well documented as a complication of the acquired immunodeficiency syndrome (AIDS). We studied 48 cases of mycobacterial diseases among a group of 136 adult patients with AIDS over a 43-month period. Twenty-nine of them had severe and unusual manifestations of disease due to Mycobacterium tuberculosis , predominantly extrapulmonary and disseminated. Tuberculosis was more common among Haitians (4/8) and intravenous drug abusers (24/102) than among homosexuals who did not abuse drugs (0/22). Twelve of 21 patients with tuberculosis who were treated responded well, whereas three developed progressive disease indicative of treatment failure. Severe and unusual presentation of overwhelming tuberculosis in appropriate clinical circumstances may be considered an infection predictive of the presence of AIDS. ( JAMA 1986;256:362-366)
TL;DR: This volume, a bargain at $18, will serve as an introduction to the BLSA, which has served as a useful antidote to the many studies that have been based on such skewed samples as persons in nursing homes or old patients from hospitals mostly serving the indigent.
Abstract: The two outstanding longitudinal studies in the United States are the Framingham Study of Cardiovascular Disease and the Baltimore Longitudinal Study of Aging (BLSA). The latter deserves to be better known. Hopefully, this volume, a bargain at $18, will serve as an introduction to the BLSA. Started in 1958 with a group of volunteers, the BLSA admittedly lacks the breadth one would like to see in an epidemiologic study. The volunteers were all male (females were not admitted until 1978) and mostly middle-class and professional, and thus the study has a restricted socioeconomic base. However, with this restricted study population, the BLSA has served as a useful antidote to the many studies that have been based on such skewed samples as persons in nursing homes or old patients from hospitals mostly serving the indigent. It is apparent that only a select group would have volunteered for this kind of study
TL;DR: A new class of cholesterollowering drugs, namely, competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme in cholesterol synthesis, has been shown to markedly lower cholesterol levels.
Abstract: SEVERAL important developments have recently given new impetus to prevention of coronary heart disease (CHD) through control of the plasma cholesterol level. Three advances have been particularly dramatic. First, the Nobel prize in medicine was awarded in 1985 to Drs Joseph Goldstein and Michael Brown for their discovery of cell-surface receptors for low-density lipoproteins (LDLs); their finding was fundamental to our understanding of how plasma cholesterol levels are controlled. Second, the Lipid Research Clinics (LRC) Coronary Primary Prevention Trial (CPPT)1reported that lowering of the plasma cholesterol level by bile acid sequestrants reduces the frequency of several manifestations of CHD, including myocardial infarction. And third, a new class of cholesterollowering drugs, namely, competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, the rate-limiting enzyme in cholesterol synthesis, has been shown to markedly lower cholesterol levels.2-4Although these inhibitors are not yet approved for clinical use, they reveal the potential for
TL;DR: The annual surveys of residency programs on which this statistical report is based have had a higher than 95% response for the past four years and the number of accredited programs increased in 1984 and again in 1985, primarily as a result of the accreditation of additional subspecialty programs.
Abstract: INTRODUCTION This annual report on graduate medical education in the United States for the 1985-1986 academic year contains data on the number of residency programs by specialty and by region, the number of positions offered, the number of trainees by specialty and by region, the number of foreign medical graduates in each specialty and in each state, and information on the ethnic background and citizenship of trainees. It also includes the results of a special survey of programs that accept medical school graduates who have had no previous graduate medical training, ie, programs that offer "postgraduate-year-1" (PGY-1) positions. RESIDENT AND RELATED TERMS In the medical education community, the terms intern, resident , and fellow are used with widely different meanings. Variation in the use of these terms occurs from specialty to specialty, from institution to institution, and even from department to department within the same institution. At times, the generic term
TL;DR: The impact on health includes increased morbidity from cirrhosis, gastrointestinal hemorrhage, trauma, cancer, and infection, and factors that contribute to the high incidence of infection among alcoholics include dulled mental function, breakdown of local protective barriers, aspiration, exposure, and malnutrition.
Abstract: THE INTEMPERATE use of alcoholic beverages is a serious problem for American society. In 1985 an estimated 10.6 million Americans were alcohol dependent, and 7.3 million more experienced some negative consequence of alcohol abuse such as arrest, accident, or impairment of health or job performance.1Alcohol is involved in 35% to 50% of marital violence cases and 10% of occupational injuries. In 1984 at least 18 500 traffic deaths (approximately 40% ) were alcohol related. The National Institute on Alcohol Abuse and Alcoholism estimated that alcoholrelated problems cost our society $117 billion in 1983. The impact on health includes increased morbidity from cirrhosis, gastrointestinal hemorrhage, trauma, cancer, and infection. Factors that contribute to the high incidence of infection among alcoholics include dulled mental function, breakdown of local protective barriers, aspiration, exposure, and malnutrition. Both malnutrition and cirrhosis of the liver are known to adversely affect the body's immune response, and so
TL;DR: It is concluded that resumption of menses was the primary factor for the significant increase in the vertebral BMD of the formerly amenorrheic athletes.
Abstract: Amenorrheic athletes have been found to have a lower vertebral bone mineral density (BMD) than matched groups of eumenorrheic athletes. This study reports changes in BMD over a 15.5 month period in athletes who regained menses, athletes who remained amenorrheic, and athletes with regular cycles. The BMD was measured at two sites on the radius and at the lumbar vertebrae (L-1 through L-4), using single- and dual-photon densitometry, respectively. Changes in vertebral BMD were significant for the amenorrheic group (+6.3%), but not for cyclic women (-0.3%). A slight increase in radial density at S-1 and S-2 was not significant for either group. Two athletes who remained amenorrheic during this period continued to lose bone (-3.4%). We conclude that resumption of menses was the primary factor for the significant increase in the vertebral BMD of the formerly amenorrheic athletes.
TL;DR: The Department of Anaesthesia of Harvard Medical School, Boston, has devised specific, detailed, mandatory standards for minimal patient monitoring during anesthesia at its nine component teaching hospitals.
Abstract: As part of a major patient safety/risk management effort, the Department of Anaesthesia of Harvard Medical School, Boston, has devised specific, detailed, mandatory standards for minimal patient monitoring during anesthesia at its nine component teaching hospitals. Such standards have not previously existed, and resistance to the concept was anticipated but not seen. The standards are technically achievable in all settings and affordable in terms of effort and cost. Early detection of untoward trends or events during anesthesia will result in prevention or mitigation of patient injury; this, in turn, may also help counter the explosive increases in anesthesia-related malpractice actions, settlements, judgments, and insurance premiums. The committee process used is applicable to the promulgation of standards of practice for all medical specialties and any organized group of medical practitioners. (JAMA1986;256:1017-1020)
TL;DR: Analysis of cancer cases collected by the New Mexico Tumor Registry shows that cancer therapy varies with age and suggests that decision making regarding therapy is influenced by the presence of other diseases.
Abstract: We used data on 22,899 cancer cases collected by the New Mexico Tumor Registry to examine the relationship between patient age and the use of potentially curative therapy for cancers of selected sites and acute leukemias. For cancers of most sites, either local or regional stage, the proportion of cases receiving potentially curative therapy declined with age. For local-stage cancers, the proportion not given any treatment increased with age. Overall mortality rates during the first year after diagnosis were much higher for local-stage cases without treatment than for those who received treatment. These data show that cancer therapy varies with age and suggest that decision making regarding therapy is influenced by the presence of other diseases. ( JAMA 1986;255:3385-3390)
TL;DR: The successor to Fundamentals, Textbook of Clinical Chemistry, follows an outline similar to the original text but adds many new subjects and updates older topics, resulting in a text that is 50% larger than its predecessor.
Abstract: The last edition of Tietz's Fundamentals of Clinical Chemistry appeared more than ten years ago and survives as a dated but valuable reference. The successor to Fundamentals, Textbook of Clinical Chemistry , follows an outline similar to the original text but adds many new subjects and updates older topics. This has resulted in a text that is 50% larger than its predecessor. Much of the newer material centers on interpretation and understanding of data and its limitations. For example, more than 200 pages (compared with 50 pages) are dedicated to an introductory section entitled "Acquisition, Management, and Application of Laboratory Data," covering the use of reference ranges, statistics, quality assurance, method evaluation, and computers. The remaining introductory chapters discuss general procedures, instrumentation, and automation. Unfortunately, the chapter that discusses current automated instrumentation already has been outdated by equipment evolution and could have been incorporated into the chapter about general instrumentation principles.
TL;DR: The proposed formula is more precise for plasmas or sera with a TG concentration within the normal range and produced a more accurate estimate of very low-density lipoprotein cholesterol relative to values obtained by the standard Lipid Research Clinics procedure for this component.
Abstract: Using data from over 10 000 men, women, and children who participated in the Lipid Research Clinics prevalence studies, we have examined the formula adopted by Friedewald et al for estimating plasma or serum concentrations of low-density lipoprotein cholesterol (LDL-C) when (for economy, or in the absence of an ultracentrifuge) only fasting total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations are measured in milligrams per liter, ie, LDL-C = TC-(HDL-C + 0.20 X TG). Values for LDL-C obtained by use of the Friedewald formula were compared with values derived from the Lipid Research Clinics ultracentrifugal procedure for LDL-C, which was used as a reference. Participants who were pregnant, who had not fasted, or whose plasma contained chylomicrons or floating beta-lipoproteins were excluded. We concluded that a better estimator for LDL-C was provided by the equation LDL-C = TC-(HDL-C + 0.16 X TG), since it produced an error (relative to the reference method) of lesser magnitude than the previous formula. The expression 0.16 X TG (0.37 X TG when measurements are reported in millimoles per liter) also produced a more accurate estimate of very low-density lipoprotein cholesterol relative to values obtained by the standard Lipid Research Clinics procedure for this component. The proposed formula is more precise for plasmas or sera with a TG concentration within the normal range.
TL;DR: The stability of human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) under environmental conditions encountered in a clinical or laboratory setting and its inactivation by commonly used chemical disinfectants were investigated.
Abstract: The stability of human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) under environmental conditions encountered in a clinical or laboratory setting and its inactivation by commonly used chemical disinfectants were investigated. Under our experimental conditions utilizing a highly concentrated viral preparation, virus with an initial infectious titer of approximately 7 log 10 tissue culture infectious dose (TCID 50 ) per milliliter can be recovered for more than a week from an aqueous environment held at room temperature (23 to 27 °C) or at 36 to 37 °C. Virus recovery is reduced at a rate of approximately 1 log 10 TCID 50 per 20 minutes when held at 54 to 56 °C. Dried and held at room temperature, HTLV-III/LAV retains infectivity for more than three days with a reduction of approximately 1 log 10 TCID 50 per nine hours. Viral infectivity is undetectable and reduced more than 7 log 10 TCID 50 within one minute with 0.5% sodium hypochlorite, 70% alcohol, or 0.5% nonidet-P40, and within ten minutes with 0.08% quaternary ammonium chloride or with a 1:1 mixture of acetone-alcohol. These results help provide a rational basis to prevent the accidental spread of HTLV-III/LAV in the laboratory or clinical setting. ( JAMA 1986;255:1887-1891)
TL;DR: Results indicate that alcohol has a greater effect on hemorrhagic strokes that are subarachnoid in origin, conferring a threefold to fourfold increased risk for moderate and heavy drinkers compared with nondrinkers.
Abstract: Since 1965, the Honolulu Heart Program has followed up 8,006 men in a prospective study of cardiovascular disease. Of those subjects free of stroke at the time of study entry, 2,916 were classified as nondrinkers of alcohol and 4,962 as drinkers. In 12 years of follow-up, 197 drinkers and 93 nondrinkers experienced a stroke. No significant relationships were noted between alcohol and thromboembolic stroke. When compared with nondrinkers, however, the risk of hemorrhagic stroke more than doubled for light drinkers and neatly tripled for those considered to be heavy drinkers. These findings are statistically significant and independent of hypertensive status and other risk factors. Results further indicate that alcohol has a greater effect on hemorrhagic strokes that are subarachnoid in origin, conferring a threefold to fourfold increased risk for moderate and heavy drinkers compared with nondrinkers. ( JAMA 1986;255:2311-2314)
TL;DR: Runners, both male and female, have approximately 40% more bone mineral than matched controls, but female runners appear to have somewhat more sclerosis and spur formation in spine and weight-bearing knee x-ray films, but not in hand x-rays.
Abstract: Forty-one long-distance runners aged 50 to 72 years were compared with 41 matched community controls to examine associations of repetitive, long-term physical impact (running) with osteoarthritis and osteoporosis. Roentgenograms of hands, lateral lumbar spine, and knees were assessed without knowledge of running status. A computed tomographic scan of the first lumbar vertebra was performed to quantitate bone mineral content. Runners, both male and female, have approximately 40% more bone mineral than matched controls. Female runners, but not male runners, appear to have somewhat more sclerosis and spur formation in spine and weight-bearing knee x-ray films, but not in hand x-ray films. There were no differences between groups in joint space narrowing, crepitation, joint stability, or symptomatic osteoarthritis. Running is associated with increased bone mineral but not, in this cross-sectional study, with clinical osteoarthritis.
TL;DR: Risk for endometriosis may relate to menstrual factors that predispose to greater pelvic contamination with menstrual products and to constitutional factors that influence endogenous hormonal levels.
Abstract: We compared menstrual characteristics and constitutional factors in 268 white women with primary infertility due to endometriosis and in 3,794 white women admitted for delivery at seven collaborating hospitals from 1981 to 1983. Adjusting for confounding factors, including location, age, religion, and education, women with short-cycle lengths (≤27 days) and longer flow (greater than or equal to one week) had more than double the risk for endometriosis compared with women with longer cycle lengths and shorter duration of flow. There was a trend for increasing risk for endometriosis to be associated with increasing menstrual pain. Adjusting for these menstrual characteristics, we found decreased risk for endometriosis associated with smoking or exercise that was largely confined to women who began either habit at an early age and were heavier smokers or more strenuous exercisers. We conclude that risk for endometriosis may relate to menstrual factors that predispose to greater pelvic contamination with menstrual products and to constitutional factors that influence endogenous hormonal levels. (JAMA1986;255:1904-1908)
TL;DR: The increased HTLV-I and -II infection seen in intravenous drug users suggests that once introduced into a population, these viruses may be transmitted by the same routes asHTLV-III.
Abstract: Antibody prevalences for human T-cell lymphotropic virus (HTLV) types I, II, and III were determined for 56 intravenous drug abusers from Queens, NY. While control serum samples lacked antibodies to all HTLV subgroups, seropositivity among drug users was 41% for HTLV-III, 18% for HTLV-II, and 9% for HTLV-I. Infection by HTLV-I and -II occurred independently of HTLV-III infection. Blacks had greater HTLV-III antibody prevalence than whites (54% vs 16%) and were more likely than whites to be seropositive for HTLV-I or -II (46% vs 11%). They exhibited a greater incidence than whites of double infection with HTLV-I or -II and HTLV-III (27% vs 0%), and 73% were seropositive for at least one of the viruses, compared with only 26% of the whites. The increased HTLV-I and -II infection seen in intravenous drug users suggests that once introduced into a population, these viruses may be transmitted by the same routes as HTLV-III. Transmission may have been restricted mainly to blacks in this study because of local drug use practices. ( JAMA 1986;255:3133-3137)