Showing papers in "The New England Journal of Medicine in 1964"
TL;DR: It is shown that patients who were told about their operations before the procedure remembered the operation and its sequelae more favorably than those who were not well informed.
Abstract: MANY reports have discussed the treatment of patients suffering after operation. Narcotics are not without danger; they also vary considerably in effectiveness. Hypnosis will reduce pain but is difficult to achieve and requires special training for the operator. Despite considerable effort the problems of treating postoperative pain remain. Janis1 has shown that patients who were told about their operations before the procedure remembered the operation and its sequelae more favorably than those who were not well informed. We have determined the effects of instruction, suggestion and encouragement upon the severity of postoperative pain. Method We studied 97 patients after elective . . .
1,041 citations
TL;DR: A large number of the patients with confirmed or suspected cases of central giant cell granuloma have had previously treated with chemotherapy or radiation, and the prognosis for these procedures is generally good.
Abstract: WHEN, through epidemiologic study of persons or families, diseases are found to be associated, the opportunities for determining their etiology may be very much increased. The association of leukem...
559 citations
TL;DR: The unusually high species specificity of human growth hormone has been further demonstrated by immunologic studies, in which antigenic similarity and biologic effectiveness have closely paralleled one another among various mammalian species.
Abstract: THE recent isolation of human growth hormone from pituitary glands collected at autopsy has been of major importance in the investigation of human pituitary physiology.1 , 2 Metabolic studies have confirmed the remarkable anabolic and growth-promoting actions of this hormone in man,3 , 4 in contrast to the negative or equivocal clinical results previously observed with bovine growth hormone. The unusually high species specificity of human growth hormone has been further demonstrated by immunologic studies, in which antigenic similarity and biologic effectiveness have closely paralleled one another among various mammalian species.5 An assay taking advantage of immunologic specificity was first reported by Read and . . .
519 citations
TL;DR: BETA-hemolytic streptococci of Lancefield Group B have been implicated in human disease almost from the time when the precipitin-grouping technic first came into use, and it is established that these organisms occasionally cause severe infection in parturient women, and less frequently in other adult patients and in newborn infants.
Abstract: BETA-hemolytic streptococci of Lancefield Group B have been implicated in human disease almost from the time when the precipitin-grouping technic first came into use.1 2 3 Since that time additional reports4 5 6 7 8 have established the fact that these organisms occasionally cause severe infection in parturient women, and less frequently in other adult patients and in newborn infants. Streptococcus agalactiae, the species designation9 of Group B streptococcus, has been recognized for many years at the Boston City Hospital from its characteristic colonial morphology on suitable solid mediums10 and observed frequently in primary cultures from obstetric patients and newborn infants. Recently, there appeared to be . . .
428 citations
TL;DR: 5 children described below had an illness characterized by excessively rapid growth, acromegalic features and a nonprogressive cerebral disorder with mental retardation.
Abstract: THE 5 children described below had an illness characterized by excessively rapid growth, acromegalic features and a nonprogressive cerebral disorder with mental retardation. The pattern of clinical...
322 citations
TL;DR: The diagnosis of massive pulmonary embolism is frequently difficult and always uncertain, primarily because the symptoms and signs may mimic those of some other diseases, such as myocardial infarction or pneumonia.
Abstract: THE diagnosis of massive pulmonary embolism is frequently difficult and always uncertain, primarily because the symptoms and signs may mimic those of some other diseases, such as myocardial infarction or pneumonia. Ancillary examinations, including x-ray study of the chest and electrocardiography, are rarely definitive. The diagnosis can be suspected when sudden dyspnea, pleural pain, hemoptysis, syncope or a bloody pleural effusion occurs in patients who are predisposed to pulmonary embolism — that is, those who are suffering from congestive heart failure or polycythemia, or who are bedridden, as during the postoperative or postpartum state. A high degree of suspicion is . . .
272 citations
267 citations
261 citations
TL;DR: Confrontation of mammals with tissues or cells of alien genetic constitution is not restricted to the professional activities of surgeons and experimental biologists.
Abstract: CONFRONTATION of mammals with tissues or cells of alien genetic constitution is not restricted to the professional activities of surgeons and experimental biologists. Every pregnancy in an outbred ...
245 citations
TL;DR: Chyluria per se can cause serious difficulties for the patient such as dysuria, hematuria and proteinuria, and these complications may result in prolonged suffering, anemia and hypoproteinemia.
Abstract: THE patient with chyluria offers an unusual opportunity for the study of fat absorption. Within a few hours after ingestion of a meal in which fat is present such a person often will pass milkyappearing urine containing a portion of the chyle that normally would have entered the systemic circulation via the thoracic duct. Apart from the underlying process, chyluria per se can cause serious difficulties for the patient such as dysuria, hematuria and proteinuria. These complications may result in prolonged suffering, anemia and hypoproteinemia. Sometimes, chyluria is amenable to surgical or pharmacologic treatment, or the use of an abdominal . . .
235 citations
TL;DR: Malabsorption The Blind-Loop Syndrome Abnormal intestinal function has been observed in a number of conditions characterized by excessive proliferation of bacteria within the lumen of the small bow...
Abstract: Malabsorption The Blind-Loop Syndrome Abnormal intestinal function has been observed in a number of conditions characterized by excessive proliferation of bacteria within the lumen of the small bow
TL;DR: It is established that congenital infection with rubella virus does not result in a state of immunologic tolerance; such an infection may induce a persistent antibody response that may permit a retrospective serologic diagnosis in the .
Abstract: ALTHOUGH the teratogenic potential of rubella virus was established by Gregg1 in 1941 the pathogenesis of fetal damage associated with maternal rubella, of necessity, has remained ill defined. The recent development of procedures for the propagation of rubella virus in the laboratory2 , 3 permits virologic and serologic investigation of congenital rubella infections. Already, rubella virus has been recovered from an aborted human fetus.4 Furthermore, it is established that congenital infection with rubella virus does not result in a state of immunologic tolerance5 , 6; such an infection may induce a persistent antibody response that may permit a retrospective serologic diagnosis in the . . .
TL;DR: It is shown that patients afflicted with alcoholism suffer from poor nutrition, and often their consumption of the ordinary and important foodstuffs is inversely related to the magnitude of the alcoholic subject's disease.
Abstract: IT is well known that the chronic or excessive ingestion of alcohol is associated with derangements in liver function and the development of liver disease. Nevertheless, the exact mechanisms whereby the intake of alcohol produces a fatty liver or Laennec's cirrhosis have remained unclear. In the past considerable emphasis has been placed on the role of the impairment of nutrition as a major factor in the development of liver disease in the alcoholic subject. Many patients afflicted with alcoholism suffer from poor nutrition, and often their consumption of the ordinary and important foodstuffs is inversely related to the magnitude of . . .
TL;DR: WHOLE-organ homotransplantation is a modality of therapy that has only recently been submitted to clinical investigation in man and reports on the natural history of patients so treated are fragmentary.
Abstract: WHOLE-organ homotransplantation is a modality of therapy that has only recently been submitted to clinical investigation in man,1 and reports on the natural history of patients so treated are therefore fragmentary. The clinical course of such patients obviously is profoundly influenced by the chemotherapy that they receive, usually including corticosteroids and immunosuppressive antimetabolites. These compounds have a wide range of effects on the host metabolic reactions, and they so alter immunologic responsiveness that changes in the spectrum of infectious disease may reasonably be expected. Up to February, 1964, 61 patients had received homotransplants or heterotransplants at this center; of these . . .
TL;DR: The tuberculin test can become negative with measles, and it is shown that larger doses of Old .
Abstract: THAT the tuberculin test can become negative with measles has been known since the report of Pirquet1 in 1908. At that time he gave credit to Preisich, in Budapest, who had found in November, 1907, that measles caused a negative tuberculin reaction. Pirquet,2 in 1911, stated that in the first days of the eruption, the tuberculin reaction always "disappears" and reappeared only after a week. Textbooks3 note "anergy" to tuberculin in measles, but an absolute negative reaction to tuberculin in measles has not been reported. In fact Gruner,4 in 1909, using subcutaneous tuberculin tests, showed that larger doses of Old . . .
TL;DR: Lysozymuria has been reported in some children with nephrotic syndrome and in some adults with renal disease, but no definitive evidence of the source of urinary lysozyme is available.
Abstract: LYSOZYME, a bacteriolytic enzyme discovered in 1922 by Sir Alexander Fleming,2 is found in a number of biologic fluids. The enzyme is a basic protein of low molecular weight that lyses susceptible bacteria by a reaction with cell-wall mucopolysaccharides releasing N-acetyl amino sugars and N-acetyl amino sugar-peptide complexes.3 Kidney contains more lysozyme activity than any other mammalian tissue,4 but little, if any, lysozyme activity is found in normal urine.5 , 6 Lysozymuria has been reported in some children with nephrotic syndrome7 and in some adults with renal disease,6 but no definitive evidence of the source of urinary lysozyme is available. In the . . .
TL;DR: The chromosomal-damage hypothesis, at least as it applies to leukemia in childhood, implicates factors operating during the earliest divisions of the zygote, parental gametogenesis or .
Abstract: MANY current studies of the etiology of childhood leukemia are motivated by one of two types of hypothesis — those relating leukemia to chromosomal damage and those implicating viral or other leukemogenic agents. The two types are not mutually exclusive; nor are they clearly separable, since "leukemogens" may operate through the mechanism of chromosome damage. But as commonly applied, the two hypotheses are distinguished by the assumed time of origin of the etiologic agent. Thus, the chromosomal-damage hypothesis, at least as it applies to leukemia in childhood, implicates factors operating during the earliest divisions of the zygote, parental gametogenesis or . . .
TL;DR: Data is presented dealing with the immediate and long-term prognosis of 1331 male employees of the E. I. du Pont de Nemours and Company who were stricken with a myocardial infarction.
Abstract: THIS article presents data dealing with the immediate and long-term prognosis of 1331 male employees of the E. I. du Pont de Nemours and Company who were stricken with a myocardial infarction. The data have been analyzed to answer the following questions: What are the chances of surviving the acute attack? What are the chances of surviving five years after recovery from the acute attack? How are these probabilities of survival affected by such factors as age, hypertension, overweight and socioeconomic status? To what extent does disability or death remove from active employment over a five-year period the men who . . .
TL;DR: This poster presents a probabilistic procedure for quantitative analysis of the relationships between cytologic compartments within the bone marrow and the distribution and fate of cells in order to derive prognosis for leukaemia.
Abstract: THE quantitative analysis of granulopoiesis requires knowledge not only of the complex relations between cytologic compartments within the bone marrow but also of the distribution and fate of cells...
TL;DR: In the present report 40 cases of cryptococcal meningitis seen at the National Institutes of Health will be reviewed, particular attention being given to symptoms and cerebrospinal-fluid and cultural findings before treatment and the relation.
Abstract: BEFORE the introduction of amphotericin B in 1956 cryptococcal meningitis was almost always fatal, three quarters of the patients dying during the first year of illness.1 2 3 4 5 6 7 8 9 10 11 Occasionally, progression of the disease was interrupted by temporary remissions12; nevertheless, survival for longer than three years was unusual. Since amphotericin B has come into use, however, improvement and recovery have been described in a number of cases.13 14 15 16 17 18 19 20 21 22 In the present report 40 cases of cryptococcal meningitis seen at the National Institutes of Health will be reviewed, particular attention being given to symptoms and cerebrospinal-fluid and cultural findings before treatment and the relation . . .
TL;DR: A cerebral intoxication, which Sherlock and her co-workers have termed portal–systemic encephalopathy, has been observed in some of the patients in the course of chronic liver disease.
Abstract: IN the course of chronic liver disease the development of portal hypertension and the subsequent formation of portal collateral circulation may permit certain nitrogen-containing substances in the portal blood to bypass the extraction mechanism of the hepatic parenchyma. A cerebral intoxication, which Sherlock and her co-workers1 have termed portal–systemic encephalopathy, has been observed in some of these cases. This phenomenon has been known since 1893, when Hahn et al.2 described the "meat-intoxication" syndrome — that is, stupor, ataxia, convulsions and coma — in animals with an Eck fistula that were fed high-protein diets. Recently, there have been a few patients . . .
TL;DR: A recently introduced bacterial inhibition assay provides a simple and practical mass screening method for phenylketonuria, the only inborn error of amino acid metabolism characterized by the accumulation of large amounts of one or more amino acids in the blood.
Abstract: GUTHRIE'S1 2 3 recently introduced bacterial inhibition assay provides a simple and practical mass screening method for phenylketonuria. Although phenylketonuria is the best known it is by no means the only inborn error of amino acid metabolism characterized by the accumulation of large amounts of one or more amino acids in the blood. Ten such disorders have been reported in the literature.4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 These are listed in Table 1, together with their most striking clinical features. Several others are known to be under investigation. All except tyrosinosis have been associated with mental retardation in some if not all persons affected. This report describes . . .
TL;DR: It has been demonstrated that the various specific hydrolytic enzymes (disaccharidases) are localized predominantly in the brush-border region (microvilli) of the mucosal cells.
Abstract: IN the absorption of disaccharides from the intestine, hydrolysis of the sugars into their component monosaccharides is necessary. Largely through the elegant studies of Crane and his associates,1 , 2 it is now recognized that this hydrolysis occurs not primarily in the lumen of the intestine as previously believed but more probably just within the epithelial cells of the mucosa. It has been demonstrated that the various specific hydrolytic enzymes (disaccharidases) are localized predominantly in the brush-border region (microvilli) of the mucosal cells. Over the past five years reports from a number of laboratories have shown the occurrence of primary or hereditary . . .
TL;DR: A PECULIAR facies suggesting kinship has been found in some nonfamilial cases of supravalvular aortic stenosis in childhood and it seems unlikely that this remarkable similarity is coincidental.
Abstract: A PECULIAR facies suggesting kinship has been found in some nonfamilial cases of supravalvular aortic stenosis in childhood.1 2 3 4 5 In addition, it has been recognized that infants with idiopathic hypercalcemia have a rather characteristic "elfin" facial appearance. Recently described are a group of older children with "aortic stenosis" and an "elfin" fades. An illness during infancy in each patient was suggestive of idiopathic hypercalcemia.2 Their facies appeared identical to those of patients with supravalvular aortic stenosis described by others.1 , 3 , 4 It seems unlikely that this remarkable similarity is coincidental. Although an association between idiopathic hypercalcemia and supravalvular aortic stenosis has been alluded . . .
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TL;DR: It is shown that despite many obstacles, most pregnancies, at least when measured in terms of perinatal mortality, can be considered a success.
Abstract: NATURE, in her lavish efforts to populate the earth, has devised such a miraculous process that despite many obstacles, most pregnancies, at least when measured in terms of perinatal mortality, hav...
TL;DR: No conventional form of therapy is of practical value in the management of patients with diffuse primary or secondary liver tumors and since these forms of cancer are often localized to the distribution of the hepatic artery it is important to evaluate the effects of chemotherapy.
Abstract: No conventional form of therapy is of practical value in the management of patients with diffuse primary or secondary liver tumors. This is also true in most cases of cancer of the gallbladder or bile ducts. Approximately 20 to 30 per cent of patients with cancer of the colon or rectum die as a result of progressive liver metastasis although the primary lesion in the bowel has been or may be susceptible of control by surgical resection. Since these forms of cancer are often localized to the distribution of the hepatic artery it is important to evaluate the effects of . . .
TL;DR: Evidence that the Group A streptococcus possesses antigens immunologically related to human heart tissue and that such crossreactive autoantibodies are associated with both the poststreptococcal state and rheumatic heart disease is supported.
Abstract: RECENT evidence has supported the concept that the Group A streptococcus possesses antigens immunologically related to human heart tissue1 2 3 and that crossreactive autoimmunity to heart may be stimulated in certain persons after streptococcal infection.4 It has been observed further that such crossreactive autoantibodies are associated with both the poststreptococcal state and rheumatic heart disease.4 Consistent with the possible role of autoimmunity in the pathogenesis of rheumatic fever are the additional observations of focal deposits of bound gamma globulin in the myocardium of 18 per cent of 100 biopsies of the rheumatic atrial appendage studied,5 and of extensive and massive deposition . . .
TL;DR: HYPERPIGMENTATION in patients with adrenocortical insufficiency or some kinds of pituitary tumors is produced by increased release from the pituitARY gland of peptide hormones that cause melanocytes to darken.
Abstract: HYPERPIGMENTATION in patients with adrenocortical insufficiency or some kinds of pituitary tumors is produced by increased release from the pituitary gland of peptide hormones that cause melanocytes to darken.1 2 3 These peptides are the melanocyte-stimulating hormones (alpha and beta MSH) and adrenocorticotrophin (ACTH). The background of this subject is both interesting and confusing, and its historical development will be pursued before our present experiments are described. During the period 1916–1932 it was shown that the intermediate lobe of the pituitary gland of amphibians and mammals contains substances that darken the skin of frogs and tadpoles.4 5 6 Changes in color occur much more . . .
TL;DR: The vasomotor control of the circulation is accomplished principally in the arteriolar vessels, which control the flow of blood through the microvasculature and are as vital to life as that through the heart and great vessels.
Abstract: THE flow of blood through the microvasculature is as vital to life as that through the heart and great vessels. Vasomotor control of the circulation is accomplished principally in the arteriolar ve...