Showing papers in "The New England Journal of Medicine in 1966"
TL;DR: A technic was developed that provides repeated access to blood vessels that will provide a continuous flow of up to 250 to 300 ml per minute for chronic hemodialysis in terminal renal failure.
Abstract: THE success of chronic hemodialysis in terminal renal failure depends on repeated access to blood vessels that will provide a continuous flow of up to 250 to 300 ml. per minute. A technic was devel...
1,547 citations
TL;DR: Human experimentation since World War II has created some difficult problems with the increasing employment of patients as experimental subjects when it must be apparent that they would not have been available if they had been truly aware of the uses that would be made of them.
Abstract: Human experimentation since World War II has created some difficult problems with the increasing employment of patients as experimental subjects when it must be apparent that they would not have been available if they had been truly aware of the uses that would be made of them. Evidence is at hand that many of the patients in the examples to follow never had the risk satisfactorily explained to them, and it seems obvious that further hundreds have not known that they were the subjects of an experiment although grave consequences have been suffered as a direct result of experiments described here. There is a belief prevalent in some sophisticated circles that attention to these matters would “block progress.” But, according to Pope Pius XII,1 “. . . science is not the highest value to which all other orders of values . . . should be subordinated.”
1,501 citations
TL;DR: A new test for a disease is being evaluated it is customary to perform the test in two selected groups of subjects: those with an indisputable diagnosis of the disease by other criteria; and those from the normal population who have no evidence of the diseased and in whom all the factors known to result in a higher than normal risk can be excluded.
Abstract: WHEN a new test for a disease is being evaluated it is customary to perform the test in two selected groups of subjects: those with an indisputable diagnosis of the disease by other criteria; and those from the normal population who have no evidence of the disease and in whom all the factors known to result in a higher than normal risk of the disease can be excluded.1 2 3 The test results may be expressed dichotomously as "positive" or "negative," or by some numerical units along a scale, usually with the bulk of values on either side of an arbitrary dividing . . .
934 citations
TL;DR: Clinical Course of Treated Endocarditis Fever The institution of appropriate antibiotic therapy frequently leads to defervescence and increase in the sense of well-being within several days.
Abstract: IMPORTANT contributions to our knowledge and understanding of infective endocarditis were made by a number of students of this disease in the first third of this century. Thayer,1 among others, preferred the term infective endocarditis for this disorder, giving it equal emphasis with the more common designation bacterial endocarditis. We have chosen to employ Thayer's terminology because a significant aspect of the changing picture of this disease is an increasing involvement of agents such as fungi and even rickettsias; the term bacterial endocarditis, therefore, is not strictly applicable. In 1955 Kerr2 summarized all the significant information concerning subacute bacterial . . .
590 citations
TL;DR: The present investigation of the population of the Hypertension-Nephritis Clinic of the Presbyterian Hospital in New York City confirms the observation that there is an increased incidence of hyperuricemia among patients with either primary or renal hypertension, treated and untreated.
Abstract: AN increased incidence of hyperuricemia in patients with primary hypertension has been cited in several reports.1 2 3 The present investigation of the population of the Hypertension-Nephritis Clinic of the Presbyterian Hospital in New York City confirms this observation among patients with either primary or renal hypertension, treated and untreated. The data from a related series of studies suggest that the hyperuricemia in both types of hypertension results from diminished renal excretion of urate. Altered lactic acid metabolism in hypertensive disease may account in part for the altered renal transport of uric acid.4 The results also raise the possibility that elevations of . . .
480 citations
TL;DR: The indwelling urinary catheter is widely used to give temporary relief of anatomic or physiologic urinary obstruction, facilitate surgical repair of the urethra and surrounding structures, provide a dry environment for comatose or incontinent patients and permit accurate measurement of urinary output in severely ill patients.
Abstract: THE indwelling urinary catheter is an essential part of modern medical care. It is widely used to give temporary relief of anatomic or physiologic urinary obstruction, facilitate surgical repair of the urethra and surrounding structures, provide a dry environment for comatose or incontinent patients and permit accurate measurement of urinary output in severely ill patients. Unfortunately, when poorly managed, the indwelling catheter may present a hazard to the very patients it is designed to protect. It is the leading cause of nosocomial, induced urinary-tract infections.1 2 3 A number of approaches to the problem of the care of the catheter have been . . .
397 citations
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TL;DR: Bruton reported the remarkable finding of the absence of gamma globulin from the serum of an eight-year boy who had been followed for a number of years in the pediatric section of the Walte... as mentioned in this paper.
Abstract: IN 1952 Bruton reported the remarkable finding of the absence of gamma globulin from the serum of an eight-year boy who had been followed for a number of years in the pediatric section of the Walte...
390 citations
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TL;DR: The inert-gas technic for the quantitative measurement of cerebral blood flow is described, which was conceived and developed in the Pharmacology Labora in the 1970s.
Abstract: TWENTY years ago Drs. Seymour Kety and Carl Schmidt first described the inert-gas technic for the quantitative measurement of cerebral blood flow. Conceived and developed in the Pharmacology Labora...
385 citations
TL;DR: The hearts of patients with pheochromocytoma were reviewed in search of myocardial lesions, and experimental lesions were produced in the myocardium of rats by the administration of norepinephrine and epinephrine.
Abstract: MYOCARDIAL lesions have been described in patients who had received catecholamines for prolonged periods before death,1 2 3 4 and similar lesions have been produced in the myocardium of laboratory animals by the administration of norepinephrine3 and epinephrine.5 Myocardial lesions might thus be expected in patients harboring a functioning pheochromocytoma, but only a few morphologic studies of myocardial lesions in such patients have been reported.2 , 6 Since cardiovascular disorders are often predominant causes of death in patients with pheochromocytoma7 the hearts of such patients were reviewed in search of myocardial lesions. In addition, experimental lesions were produced in the myocardium of rats by the . . .
379 citations
TL;DR: The development of retroperitoneal fibrosis in 27 patients using methysergide for the prevention of headache is the occasion for this report.
Abstract: THE development of retroperitoneal fibrosis in 27 patients using methysergide for the prevention of headache is the occasion for this report. Irving Beck, of Providence, Rhode Island, was the first to suggest a possible connection between methysergide and retroperitoneal fibrosis in July, 1961, when this condition developed in 1 of his patients, supplied with this drug by one of us. When a second patient taking methysergide for headache was similarly afflicted in November, 1962, the 2 cases were reported.1 Since then, as of October, 1965, our attention has been directed to a total of 27 patients in whom, while they . . .
335 citations
TL;DR: The association of hepatic cirrhosis with cyanosis and finger clubbing and with arterial oxygen desaturation has been recognized for many years, and the possible basis investigated.
Abstract: THE association of hepatic cirrhosis with cyanosis and finger clubbing1 2 3 4 and with arterial oxygen desaturation4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 has been recognized for many years, and the possible basis investigated. Abnormalities in the oxygen dissociation curve in cirrhotic patients have been reported6 but not confirmed.11 , 12 More recently, Caldwell, Fritts and Cournand20 again called attention to abnormal oxygen tension-saturation relations in cirrhosis but concluded that the contribution of these toward oxygen unsaturation was probably small. Physiologic evidence for an admixture of venous to arterial blood has been presented.8 9 10 11 12 13 14 15 16 17 18 19 The possibility of anastomoses between the pulmonary veins and either the pulmonary artery or the portal venous . . .
TL;DR: A fourth type of humoral activity, that of hyperglucagonism, associated with an alpha-cell carcinoma of the pancreatic islets is reported, probable that cases of this disorder are at present unrecognized, or classified otherwise.
Abstract: TUMORS of the islands of Langerhans have been associated with three distinct entities: hyperinsulinism; the nlcerogenie Zollinger – Ellison syndrome; and a syndrome of diarrhea unassociated with gastric hypersecretion. This report documents a fourth type of humoral activity, that of hyperglucagonism, associated with an alpha-cell carcinoma of the pancreatic islets. It is probable that cases of this disorder are at present unrecognized, or classified otherwise. Therefore, the clinical, laboratory and cytologic findings whereby this condition may be identified are set forth. Case Report A 42-year-old housewife was first seen in February, 1963, because of a bullous and eczematoid dermatitis of . . .
TL;DR: The traditional method of taking and recording medical histories involves serious problems for both the practicing physician and the clinical research worker.
Abstract: IN spite of the homage devoted to the importance of the medical history, there has been remarkably little research on the subject. Neither the method of history taking and recording nor the reliability and usefulness of the data collected has been studied as rigorously as the other tools of clinical medicine, in large part because neither the method nor the data lend themselves well to research. The traditional method of taking and recording medical histories involves serious problems for both the practicing physician and the clinical research worker. History taking consumes a large amount of the physician's time, and inadequate . . .
TL;DR: Improvements in technology occurred that facilitated the isolation of rhinoviruses and shifted emphasis to these agents in the etiology and epidemiology of acute respiratory disease in a population of working adults.
Abstract: RHINOVIRUSES have been associated with 10 to 30 per cent of acute upper respiratory illnesses in several groups of adults.1 2 3 4 5 6 In March, 1963, a study was undertaken to define the etiology and epidemiology of acute respiratory disease in a population of working adults, and the role of a number of viruses was studied initially. Coincident with the beginning of the investigation, improvements in technology occurred that facilitated the isolation of rhinoviruses and shifted emphasis to these agents. During the first three years of the study, the period considered in this report, approximately a quarter of the acute respiratory illnesses were . . .
TL;DR: Adverse reactions to penicillin occur in 1 to 8 per cent of patients treated, and the different reaction rates are probably related to numerous factors, including the difficulty in attributing reactions specifically to Penicillin, particularly when several drugs are being administered.
Abstract: THE remarkable lack of pharmacologic toxicity of penicillin is now well established, but penicillin hypersensitivity reactions have become a serious problem. A projection of statistics from some surveys estimates that 100 to 300 fatalities occur annually in the United States from reactions to penicillin,1 and an estimated 2,500,000 people in the United States are allergic to this widely used antibiotic.2 Adverse reactions to penicillin occur in 1 to 8 per cent of patients treated.3 The different reaction rates are probably related to numerous factors, including the difficulty in attributing reactions specifically to penicillin, particularly when several drugs are being administered . . .
TL;DR: Adult and older children undergoing reinfection probably constitute an important source of acute respiratory disease in infants and children, and most older children and adults have serum neutralizing antibody to this virus.
Abstract: PARAINFLUENZA Type 1 virus is an important cause of acute respiratory disease in infants and children.1 , 2 During primary infection the lower respiratory tract is often involved, and illness may be quite severe. Initial infection usually occurs during childhood, and most older children and adults have serum neutralizing antibody to this virus.2 Reinfection with Type 1 virus has been observed in adults under both experimental and natural conditions despite the presence of serum neutralizing antibody.3 4 5 Illness associated with reinfection is generally mild and limited to the upper respiratory tract. Adults and older children undergoing reinfection probably constitute an important source of . . .
TL;DR: The protean nature of the neurologic disturbances associated with liver failure and the absence of specific neuropathological findings suggest that "hepatic coma" is metabolic in origin.
Abstract: IN recent years numerous publications have dealt with the pathogenesis and treatment of hepatic coma. The protean nature of the neurologic disturbances associated with liver failure and the absence...
TL;DR: The results indicated that there was less obesity in the colleges than in the high schools, and no differences were found in academic criteria and application rates between obese and nonobese high-school students.
Abstract: CASUAL observation had suggested to us that obesity was less prevalent in high-ranking, so called "prestige" colleges than in public high schools. We therefore decided to investigate whether or not obesity affected college acceptance. If it did, it would have important implications for public-health programs directed at obesity. We chose for our investigation an outstanding high-school system and an Ivy League and a Seven Sister college.§ Our results did, indeed, indicate that there was less obesity in the colleges than in the high schools. No differences were found in academic criteria and application rates between obese and nonobese high-school students. . . .
TL;DR: The old hypothesis, originally postulated by Frank, of a toxic depression of megakaryocytes and their activity resulting in thrombocytopenia has been disproved since a shortened platelet life-span has regularly been found in the disease.
Abstract: A CHANGE in the concepts regarding idiopathic thrombocytopenic purpura has occurred during the past fifteen years mainly because of the recognition of three important facts: The thrombocytopenia is the result of increased platelet destruction. The old hypothesis, originally postulated by Frank,1 , 2 of a toxic depression of megakaryocytes and their activity resulting in thrombocytopenia has been disproved since a shortened platelet life-span has regularly been found in the disease. An antiplatelet factor with characteristics of an antibody is present in the plasma of these patients.3 In fact, normal donor platelets infused into the patient are destroyed as rapidly as . . .
TL;DR: The immune mechanisms of penicillin allergy are of interest to physicians, not only because of their practical value but also because they can serve as a model for the study of the immunologic mechanisms of other immune diseases.
Abstract: THE immunologic mechanisms of penicillin allergy are of interest to physicians, not only because of their practical value but also because they can serve as a model for the study of the immunologic...
TL;DR: The manner of discovery on either side of the Atlantic was basically the same as in Europe and America just forty years ago.
Abstract: HYPERPARATHYROIDISM was discovered nearly simultaneously in Europe and America just forty years ago (1925 and 1926).1 2 3 4 5 The manner of discovery on either side of the Atlantic was basically different. Neither side was aware of what was happening on the other, but all on both sides thought of it then as a disease of bone and rare. Over the years, however, we have come to realize that the primary glandular disorder appears in a variety of clinical forms and the disease is by no means uncommon. It was the American approach to the discovery that led to the wider recognition of . . .
TL;DR: In 1927 the condition now known as Fanconi's aplastic anemia was first described in 3 brothers with pancytopenia and multiple congenital anomalies.
Abstract: IN 1927 the condition now known as Fanconi's aplastic anemia was first described in 3 brothers with pancytopenia and multiple congenital anomalies.1 Since that time numerous reports have analyzed t...
TL;DR: HYPERCALCEMIA occurs in a wide variety of diseases and is often responsible for many of the symptoms associated with them and may lead to nephrolithiasis and nephrocalcinosis.
Abstract: HYPERCALCEMIA occurs in a wide variety of diseases (for example, hyperparathyroidism, hypervitaminosis D, sarcoid, cancer, hyperthyroidism and poliomyelitis)1 and is often responsible for many of the symptoms associated with them. Most often, these symptoms are more distressing than disabling and include such nonspecific complaints as constipation, dyspepsia, lassitude, easy fatigability and polyuria. Underlying these mild symptoms, however, is a process that may lead to nephrolithiasis and nephrocalcinosis. Of even more serious import2 is the usually fatal syndrome that has been called hypercalcemic crisis — intractable nausea and vomiting, dehydration, stupor, coma and azotemia. Since this constitutes a true medical emergency . . .
TL;DR: For example, over a period of ten years, the laboratory responsible for the identification of miscellaneous types of bacteria at the Communicable Disease Center received 63 strains of Actinobacillus actinomycete as discussed by the authors.
Abstract: OVER a period of ten years the laboratory responsible for the identification of miscellaneous types of bacteria at the Communicable Disease Center received 63 strains of Actinobacillus actinomycete...
TL;DR: The bronchial tree of patients with asthma is hypersensitive to the effects of dust, cold air, histamine, methacholine and pollen extracts, so that bronchia obstruction roughly proportional to the severity of the asthma can be demonstrated after such exposures.
Abstract: ASTHMA can be defined as a disease of the bronchi producing diffuse, reversible bronchial obstruction. The bronchial tree of patients with asthma is hypersensitive to the effects of dust, cold air, histamine, methacholine and pollen extracts, so that bronchial obstruction roughly proportional to the severity of the asthma can be demonstrated after such exposures.2 3 4 5 The cause of this bronchial hypersensitivity is not known. Patients with other forms of chronic obstructive pulmonary disease or allergic rhinitis have similar but less marked bronchial sensitivity to these materials.5 , 6 A series of investigations in animals has led to the hypothesis that a partial beta-adrenergic . . .
TL;DR: The effect of the synthetic glucocorticoid dexamethasone on the plasma insulin response of normal, mildly diabetic and acromegalic subjects to oral administration of glucose and intravenous administration of tolbutamide has been determined.
Abstract: ALTHOUGH the diabetogenic activity of adrenoglucocorticoids has been studied extensively in terms of increased gluconeogenesis and impaired peripheral glucose utilization1 2 3 4 the effects of these steroids on pancreatic islet-cell function have not received much attention. In the present study the effect of the synthetic glucocorticoid dexamethasone on the plasma insulin response of normal, mildly diabetic and acromegalic subjects to oral administration of glucose and intravenous administration of tolbutamide has been determined. In addition, since increased gluconeogenesis is a characteristic feature of glucocorticoid action, the effect on the response of insulin secretion to intravenously infused tolbutamide in mild hyperglycemia maintained by prolonged . . .
TL;DR: 5 cases of fatal strongyloidiasis in association with corticosteroid therapy are reported, all of which are confirmed to be cases of severe strongyloidsiasis.
Abstract: THE influence of corticosteroids in initiation or aggravation of infections has been described in detail.1 In addition to bacterial, viral, rickettsial or fungous infections,2 3 4 there is clinical and experimental evidence that some protozoan diseases such as trypanosomiasis, malaria and amebiasis may be aggravated by steroid therapy.5 6 7 Galliard and Berdonneau8 have reported that dogs previously refractory to Strongyloides stercoralis infection may become susceptible after treatment with cortisone. In spite of these observations the use of corticosteroids has been suggested in the treatment of selected cases of severe strongyloidiasis.9 This communication reports 5 cases of fatal strongyloidiasis in association with corticosteroid therapy . . .
TL;DR: General Diabetic Acidosis Anorexia, nausea and vomiting are common early symptoms of diabetic acidosis,occasionally referred to as ketoacidosis.
Abstract: DIABETES mellitus affects every organ system; the gastrointestinal tract is no exception. General Diabetic Acidosis Anorexia, nausea and vomiting are common early symptoms of diabetic acidosis, occ...
TL;DR: In this paper, the role of age as a covariable to distance in the appearance time of acute leukemia developing in such persons was investigated and a decreased appearance time, defined as the interval between exposure to radiation and the clinical or symptomatic onset of leukemia, was noted in patients exposed within 1500 meters.
Abstract: The occurrence of leukemia in Hiroshima and Nagasaki for the period 1946 to 1964 is reported. During this period leukemia developed excessively in persons exposed within 1500 meters from the hypocenter. A decreased appearance time, defined as the interval between exposure to radiation and the clinical or symptomatic onset of leukemia, was noted in patients exposed within 1500 meters. Attention is directed to the role of age as a covariable to distance in the appearance time of acute leukemia developing in such persons. In this group chronic granulocytic leukemia developed in persons up to twenty-nine years of age at the time of the bombings in the period 1946 to 1955 at a disproportionate rate as compared to the distally exposed and the pattern of spontaneous leukemia for this age group.