Showing papers in "The New England Journal of Medicine in 1968"
TL;DR: A small catheter is wedged in airways 2 to 3 mm in diameter in excised human lungs to have measure airway resistance central (Rc) and peripheral (Rp) to this site.
Abstract: We have wedged a small catheter in airways 2 to 3 mm in diameter in excised human lungs to have measure airway resistance central (Rc) and peripheral (Rp) to this site. In five normal lung...
1,282 citations
TL;DR: The beginning clinical clerk, the house officer and the practicing physician are all confronted with conditions that are frustrating in every phase of medical action.
Abstract: Implementation of More Comprehensive Care through the medical record and the Computer The organization of the record described above forms a framework that easily accommodates psychiatric, social a...
932 citations
TL;DR: Chronic granulomatous disease is an X-linked defect in the killing of certain bacteria by peripheral blood granulocytes and may be detected with the nitroblue tetrazolium (NBT) test.
Abstract: Chronic granulomatous disease is an X-linked defect in the killing of certain bacteria by peripheral blood granulocytes and may be detected with the nitroblue tetrazolium (NBT) test. The r...
860 citations
TL;DR: Serial immunochemical observations may be useful in the management of patients with systemic lupus erythematosus, as they reflect the in vivo formation of immune complexes that cause nephritis.
Abstract: To clarify the association between certain immunologic factors and clinical activity in patients with systemic lupus erythematosus, 96 patients were studied. Those with antibodies to deoxyribonucleic acid (DNA) or heat-denatured DNA, or with serum complement levels of less than 50 C′H50 units per ml, were more likely to have renal involvement. Very low complement levels and high titers of complement-fixing antibodies to DNA were always associated with active disease, especially active renal disease, whereas the absence of these abnormalities usually indicated inactive renal disease. A 50 per cent fall in serum complement levels in 22 patients was accompanied by, or preceded the onset of, active nephritis in 19 patients. These serologic factors may thus reflect the in vivo formation of immune complexes that cause nephritis. Serial immunochemical observations may be useful in the management of patients with systemic lupus erythematosus.
540 citations
TL;DR: Twenty-two isolates of methicillin-resistant Staphylococcus aureus were obtained from 18 patients; 21 of the strains were phage nontypable, exhibited methiillin resistance to other penicillins and cephalosporins tested, and had characteristics similar to those of previously reported methicillus-resistant strains.
Abstract: Twenty-two isolates of methicillin-resistant Staphylococcus aureus were obtained from 18 patients; 21 of the strains were phage nontypable, exhibited methicillin resistance to other penicillins and cephalosporins tested, and had characteristics similar to those of previously reported methicillin-resistant strains. These staphylococci were isolated from patients on seven of the 42 hospital wards. Fifteen of the 18 patients acquired their infection in the hospital. Thirteen of the 22 isolates were from the sputum of 12 patients with pulmonary superinfection, and four from the urine of two patients with catheter-associated urinary-tract infections. Evidence of patient-to-patient spread of infection was found during a ward outbreak involving four clinical cases and a nurse who was a nasopharyngeal carrier.
494 citations
TL;DR: The study from which this last term developed was conducted on postcardiotomy patients in the setting of the recovery room, and there has been a growing tendency to apply it to all situations of intensive care.
Abstract: THE frequency of psychiatric difficulties in intensive-care units ranges from 30 to 70 per cent. Confinement in these units is described as an "ordeal,"1 and the patient's expected psychologic response is presented as one of "catastrophic reaction."2 Although the study from which this last term developed was conducted on postcardiotomy patients in the setting of the recovery room, there has been a growing tendency to apply it to all situations of intensive care. This is an unfortunate application because intensive-care settings differ remarkably as do the emotional responses of the patients they house. The question of whether patients in coronary-care . . .
446 citations
TL;DR: It was found that a syndrome of phosphorus depletion characterized by Hypophosphatemia, hypophosphaturia, increased gastrointestinal absorption of calcium, hypercalciuria, increased resorption of skeletal calcium and phosphorus, and debility can be produced by prolonged treatment with nonabsorbable antacids such as magnesium-aluminum hydroxides.
Abstract: Antacids can impair phosphorus absorption in man. The long-term results of such impaired absorption are not fully appreciated despite knowledge of the vital role of phosphorus in life processes and the serious results of its depletion in animals. To determine depletion in man, studies were performed in three normal subjects and three patients with parathyroid dysfunction during prolonged treatment with antacids. It was found that a syndrome of phosphorus depletion characterized by hypophosphatemia, hypophosphaturia, increased gastrointestinal absorption of calcium, hypercalciuria, increased resorption of skeletal calcium and phosphorus, and debility, with anorexia, weakness, bone pain and malaise, can be produced by prolonged treatment with nonabsorbable antacids such as magnesium-aluminum hydroxides.
431 citations
TL;DR: It is proposed that orally administered live virus stimulates local lymphoid cells, leading to the production of immunoglobulins predominantly of the gamma A class, to explain the alimentary immunity that follows infection with attenuated or wild poliovirus.
Abstract: The responses of the major immunoglobulins (gamma G, gamma M and gamma A) in serum and nasal and duodenal secretions were studied in infants and children after immunization with live and inactivated poliovaccines and after natural poliomyelitis infection. The serum immunoglobulin responses to these procedures resembled each other although higher levels followed the natural infection. After immunization with live attenuated vaccine, antibody activity was found regularly in nasal and duodenal secretory gamma A immunoglobulin, but not after immunization with inactivated vaccine. To explain the alimentary immunity that follows infection with attenuated or wild poliovirus, it is proposed that orally administered live virus, which implants and replicates in the pharynx and intestinal tract, stimulates local lymphoid cells, leading to the production of immunoglobulins predominantly of the gamma A class.
377 citations
367 citations
TL;DR: Human growth hormone deficiency was documented by radioimmunoassay in 35 patients — 16 with isolated HGH, 7 H GH and TSH, 4 HGH and ACTH, and 8 H GH, TSH andACTH deficiencies.
Abstract: Human growth hormone (HGH) deficiency was documented by radioimmunoassay in 35 patients — 16 with isolated HGH, 7 HGH and TSH, 4 HGH and ACTH, and 8 HGH, TSH and ACTH deficiencies. Of 15 patients with TSH deficiency, six had a previously documented normal PBI, suggesting progressive acquisition of tropic hormone deficiency. Birth weight and gestational age were usually normal in patients with isolated and multiple deficiencies. The onset of HGH deficiency was variable, and growth failure usually occurred before one year; growth continued at a diminished rate. Hypoglycemia was present in 56 per cent of those with isolated HGH deficiency and in all with HGH and ACTH deficiencies. Therapy was associated with pubertal development in three patients with isolated HGH deficiency of pubertal age, suggesting the usefulness of HGH therapy in differentiating hypopituitary dwarfs with gonadotropin deficiency from those in whom delayed gonadal function is related to HGH deficiency. Dwarfism was nonfamilial, s...
366 citations
TL;DR: Findings suggest that serum antibody reacted with and became fixed to the histocompatibility antigens of the graft, thereby initiating an acute vascular reaction with early polymorphonuclear-leukocyte margination and progression to widespread capillary thrombosis.
Abstract: Biopsies of renal transplants taken within one hour after completion of vascular anastomoses revealed, in seven of 132 cases, the accumulation of large numbers of polymorphonuclear leukocytes within glomerular and peritubular capillaries, with eventual transplant failure in all cases. Serologic studies in all recipients demonstrated pre-existing antibodies reacting with human histocompatibility antigens. Heat eluates from three of four rejected kidneys also contained activity against human histocompatibility antigens. These findings suggest that serum antibody reacted with and became fixed to the histocompatibility antigens of the graft, thereby initiating an acute vascular reaction with early polymorphonuclear-leukocyte margination and progression to widespread capillary thrombosis.
TL;DR: Overall alveolar hypoventilation and increased venous admixture were found to contribute to the hypoxemia in some patients with very severe levels of airway obstruction, and the cause of the depressed oxygen tensions was found to be an alteration in ventilation-perfusion ratios.
Abstract: Arterial oxygen and carbon dioxide tensions, pH and forced expiratory volumes were measured in 101 asthmatic patients during acute attacks of bronchospasm. Hypoxemia was observed in 91 subjects. The cause of the depressed oxygen tensions was found to be an alteration in ventilation-perfusion ratios. Overall alveolar hypoventilation and increased venous admixture were found to contribute to the hypoxemia in some patients with very severe levels of airway obstruction. Seventy-three subjects had hypocarbia and respiratory alkalosis. Carbon dioxide retention (observed in 11 patients) occurred only at extreme degrees of obstruction. Age, history of asthma and duration of the acute attack were unrelated to the alterations in blood gas tensions, pH or severity of airway obstruction.
TL;DR: Adult males with cystic fibrosis are infertile because of failure of normal development of the vas deferens, a finding not previously recognized.
Abstract: Adult males with cystic fibrosis are infertile because of failure of normal development of the vas deferens, a finding not previously recognized. Twenty-five patients over 17 years of age ...
TL;DR: The data indicate that in normal nonalcoholic people, alcohol itself is hepatotoxic, independent of nutritional factors, and non alcoholic people are not less susceptible than alcoholic patients to the injurious effects of alcohol.
Abstract: Isocaloric substitution of alcohol for carbohydrate in young nonalcoholic volunteers rapidly led to hepatic fat accumulation and ultrastructural changes, both on a standard diet and on a diet high in protein and low in fat. The addition of alcohol to a normal diet for two days resulted in similar changes, which could not be prevented by a diet high in protein with minimal fat (5 per cent of total calories). Blood alcohol levels in every subject studied were almost all well below accepted legal limits for intoxication. The data indicate that in normal nonalcoholic people, alcohol itself is hepatotoxic, independent of nutritional factors. Nonalcoholic people are not less susceptible than alcoholic patients to the injurious effects of alcohol. Amounts of alcohol consumed by many "social" drinkers are enough to damage the liver, and one need never have been drunk to sustain alcohol-induced hepatic injury.
TL;DR: During the past four years 104 patients who had received kidneys from either living unrelated or cadaver donors were typed and analyzed, to assess the effect of matching on endogenous crea...
Abstract: During the past four years 104 patients who had received kidneys from either living unrelated or cadaver donors were typed and analyzed, to assess the effect of matching on endogenous crea...
TL;DR: It is suggested that pulmonary sequestration, intralobar sequestration and the sequestration communicating with the gut share a common embryogenesis and be collectively identified as "congenital bronchopulmonary-foregut malformation".
Abstract: The pathological anatomy and clinical features of three cases of pulmonary sequestration with gastrointestinal communication and of 10 cases reported in the literature suggest that extralobar sequestration, intralobar sequestration and the sequestration communicating with the gut share a common embryogenesis and be collectively identified as "congenital bronchopulmonary-foregut malformation."
TL;DR: Since intestinal sodium absorption was so enhanced by an actively transported sugar, fructose and galactose perfusion fluids were prepared, and it was found that fructose was less well absorbed than glucose or Galactose: in general, the results with these sugars were consistent with the sodium-dependent active transport of galactOSE and the passive transport of fructose.
Abstract: Glucose-electrolyte solutions were administered to cholera patients by intestinal tube and the effect of this treatment on net stool output was assessed; an ancillary concern was the comparison of the sugar used in the rehydration solution comparing glucose galactose and fructose. All 8 patients studied were cholera victims who had been given intravenous rehydration upon presentation with severe shock; 25 controls were studied for comparison. Average net stool rate of the controls not given perfusions declined at an approximately linear rate throughout the course of diarrhea. However in every case when glucose was added to perfusion solution net stool output decreased compared with the decline seen in the total course of non-sugar-containing per fusion studies. In fact the rate of intestinal fluid loss was decreased with the glucose solution within 12-32 hours of perfusion. Since intestinal sodium absorption was so enhanced by an actively transported sugar fructose and galactose perfusion fluids were prepared and it was found that fructose was less well absorbed than glucose or galactose: in general the results with these sugars were consistent with the sodium-dependent active transport of galactose and the passive transport of fructose unrelated to sodium transport.
TL;DR: Nephropathy due to penicillin or methicillin was observed in seven patients and maximum dosage ranged from 20 to 24 gm per day for methamphetamineicillin and from 20,000 to 60,000,000 units for peni...
Abstract: Nephropathy due to penicillin or methicillin was observed in seven patients. Maximum dosage ranged from 20 to 24 gm per day for methicillin and from 20,000,000 to 60,000,000 units for penicillin. Fever appeared in a minimum of eight days, associated with marked eosinophilia and rash (in four patients). Urinary abnormalities and azotemia (blood urea nitrogen of 50 to 130 mg per 100 ml) occurred in all. All but one recovered. Renal tissue, examined in four patients, showed tubular damage and interstitial accumulation of mononuclear cells and eosinophils without glomerular abnormalities or arteritis. In the only patient investigated immunologically an unusually intense immune response to penicillin was found. Immunofluorescent studies showed penicilloyl hapten firmly bound to his kidney tissue and the presence there of gamma globulin. The clinical features of an allergic reaction together with the immunologic findings support, but do not prove, a hypersensitivity mechanism for this nephropathy.
TL;DR: Detailed coagulation analyses in 36 pediatric cases of septicemia revealed 22 gram-negative and eight gram-positive infections, two Rocky Mountain spotted fevers, and four with no etiologic agent isolated.
Abstract: Detailed coagulation analyses in 36 pediatric cases of septicemia revealed 22 gram-negative and eight gram-positive infections, two Rocky Mountain spotted fevers, and four with no etiologic agent isolated. Various changes in the clotting mechanism were encountered irrespective of the infectious agent but apparently related to blood pressure. The most frequent single abnormality was thrombocytopenia in 61 per cent of all cases. Multiple coagulation changes, regularly noted in patients with hypotension or shock, were interpreted as being secondary to diffuse intravascular coagulation. Similar changes were not seen in cases with normal blood pressures. The most reliable laboratory guides seemed to be a reduced platelet count, low factor V levels in plasma and fibrinolytic split products in serum. Heparin was given in all patients with hypotension suspected of having the defect. Most patients with septicemia and low blood pressure apparently have the defect.
TL;DR: In vitro all strains tested were sensitive to chloramphenicol, kanamycin, nitrofurantoin and nalidixic acid and resistant to ampicillin, and most strains were also sensitive to tetracycline, streptomycin and colymycin.
Abstract: Thirty cases in which Aeromonas hydrophila and A. (Plesiomonas) shigelloides were cultured from human specimens are reported. Aeromonads are found in natural water sources and may be transmitted to man. A small percentage of the healthy population apparently carries the organisms in the intestine. Our cases and those of other authors suggest a connection between diarrheal disease and the presence of large numbers of aeromonads in the stool. The organisms can also cause cellulitis and septicemia. In 19 of our cases they were found together with other pathogens. Their role in hospital infections is still unclear. In vitro all strains tested were sensitive to chloramphenicol, kanamycin, nitrofurantoin and nalidixic acid and resistant to ampicillin. Most strains were also sensitive to tetracycline, streptomycin and colymycin. Sensitivity to erythromycin and cephalothin was erratic.
TL;DR: An estimate, based on the natural history of Wilson's disease in 121 symptomatic patients, suggests that during this interval symptoms of the disorder could have been expected to develop in at least eight of these subjects.
Abstract: A biochemical diagnosis of Wilson's disease was established in 53 asymptomatic subjects, ranging in age from 15 months to 31 years. None had any pathognomonic physical sign of the disease. In 36 of these patients a liver biopsy specimen was examined by light microscopy, and in 31 histologic changes were found. Forty-two of these patients have been treated with a de-copperizing regimen, based on the continued and daily administration of D,L-penicillamine or D-penicillamine, and have remained asymptomatic during a period of observation of 142 patient years. An estimate, based on the natural history of Wilson's disease in 121 symptomatic patients, suggests that during this interval symptoms of the disorder could have been expected to develop in at least eight of these subjects.
TL;DR: EBV antibody was present in the serums of all 135 patients who had heterophil-antibody-positive infectious mononucleosis and also in six with clinically and hematologically typical cases whose serums were persistently heterophIL-Antibody negative, suggesting that EB virus may be associated with both forms of illness.
Abstract: Certain epidemiologic features of infectious mononucleosis are indicated by antibody patterns to the EB or herpes-like virus of Burkitt lymphoma. The absence of antibody correlated well with susceptibility: of 268 entering college students whose serums lacked EBV antibody, infectious mononucleosis developed in 15 per cent; in 94 whose serums already contained antibody, none had clinical disease. EBV antibody also correlated well with heterophil antibody; EBV antibody was present in the serums of all 135 patients who had heterophil-antibody-positive infectious mononucleosis and also in six with clinically and hematologically typical cases whose serums were persistently heterophil-antibody negative, suggesting that EB virus may be associated with both forms of illness. In a third group of patients clinical features resembled infectious mononucleosis, but the serums contained neither heterophil nor EBV antibodies. At present, EB virus is strongly implicated as a cause of infectious mononucleosis.
TL;DR: Dietary surveys and 48-hour urine collections from subsamples indicate that sodium intake in Rarotonga is about 50 mEq a day higher than in Pukapuka, compatible with Dahl's hypothesis that higher salt intake and higher blood pressures are related.
Abstract: The populations of the Polynesian islands Rarotonga and Pukapuka are ethnically similar but observe different economic, social and dietary habits. In Rarotonga mean blood pressure increases with age, particularly in women. In Pukapuka rise of blood pressure with age is slight and only seen in women. Blood-pressure differences between the populations are greater than are accounted for by differences in height and weight. Dietary surveys and 48-hour urine collections from subsamples indicate that sodium intake in Rarotonga is about 50 mEq a day higher than in Pukapuka. No within-population correlation between blood pressure and 24-hour urinary sodium output is demonstrable. Many differences between the two groups may explain the differences in blood pressure, but the findings are compatible with Dahl's hypothesis that higher salt intake and higher blood pressures are related.
TL;DR: This work has shown that the association of pheochromocytoma and thyroid tumors has been recognized for some time, but only in recent years has the amyloid-producing medullary thyroid carcinoma been specifica for thyroid cancer.
Abstract: Although the association of pheochromocytoma and thyroid tumors has been recognized for some time, only in recent years has the amyloid-producing medullary thyroid carcinoma been specifica...
TL;DR: Serum gastrin levels in all the patients with the Zollinger-Ellison syndrome exceeded by approximately tenfold or greater the mean serum gastrin level of 425 μμg per milliliter in the control population.
Abstract: A radioiodine-immunoassay technic was used to measure fasting serum gastrin levels in four patients with the Zollinger-Ellison syndrome and 24 patients without gastrointestinal diseases. Serum gastrin levels in all the patients with the Zollinger-Ellison syndrome exceeded by approximately tenfold or greater the mean serum gastrin level of 425 μμg per milliliter in the control population. Gastrin was identified immunochemically in an extract derived from a pancreatic islet-cell tumor from one of the patients with the Zollinger-Ellison syndrome.
TL;DR: Improvement of the uremic state by adequate hemodialysis or peritoneal dialysis does not always relieve the itching, and in certain cases pruritus may even worsen, suggesting that factors other than uremia itself may be involved.
Abstract: PRURITUS, a common symptom in uremic patients, is usually observed in the absence of visible skin lesions.1 , 2 The underlying cause of the itching in these patients is unknown, but the "toxic" effect of uremia has usually been implicated. However, improvement of the uremic state by adequate hemodialysis or peritoneal dialysis does not always relieve the itching, and in certain cases pruritus may even worsen,3 suggesting that factors other than uremia itself may be involved. We have previously observed the disappearance of severe pruritus after subtotal parathyroidectomy in two patients with chronic renal failure who were maintained with adequate hemodialysis.†3 This . . .
TL;DR: Thyroxine-binding prealbumin (TBPA) together with serum albumin participate in the peripheral transport of the thyroid hormones and the concept of a multiple equilibrium between thyroxine bound to the plasma proteins and Thyroxine in the unbound or "free" state was extensively developed by Robbins and Rall.
Abstract: ALTHOUGH it has been recognized for many years that thyroxine is tightly associated with plasma proteins little attention was paid to this phenomenon until the discovery, in 1952, of thyroxine-binding globulin (TBG) by three groups of investigators working independently of each other.1 2 3 Subsequently, Ingbar4 described thyroxine-binding prealbumin (TBPA). These proteins together with serum albumin participate in the peripheral transport of the thyroid hormones. The concept of a multiple equilibrium between thyroxine bound to the plasma proteins and thyroxine in the unbound or "free" state was extensively developed by Robbins and Rall.5 These investigators suggested that the concentration of free thyroxine, . . .
TL;DR: Monospecific rabbit antiserum against a human fetoglobulin was tested by double-gel diffusion against coded serums of patients with hepatoma and other liver diseases and controls in Uganda.
Abstract: Monospecific rabbit antiserum against a human fetoglobulin was tested by double-gel diffusion against coded serums of patients with hepatoma and other liver diseases and controls in Uganda. A precipitin line indicated the presence of a human fetal alpha1 globulin in 50 per cent of the serums from 40 patients with hepatoma. The test was positive in only two of 118 patients with other forms of liver disease, including other malignant tumors metastatic to the liver, and negative in 50 hospital outpatient controls and 25 relatives of patients with hepatoma.
TL;DR: Healthy university students and hospital staff taking no medications were surveyed by questionnaire to obtain data on the occurrence of many symptoms often listed as side effects of drugs.
Abstract: Healthy university students and hospital staff taking no medications were surveyed by questionnaire to obtain data on the occurrence of many symptoms often listed as side effects of drugs. Of 670 people surveyed, 414 indicated that they had had no illnesses and taken no medications during the previous three days and were included in the study. Only 19 per cent of the 414 stated that they had experienced none of 25 symptoms listed in the previous 72 hours. The median number of symptoms experienced per person was two. Thirty people experienced six or more of these symptoms. In the study of adverse drug reactions proper controls are just as important as in any other form of research.
TL;DR: Plasma volume was diminished in hypertensive men, contrast with reports of expanded plasma volume in primary aldosteronism and renoprival hypertension, and emphasize the importance of diagnostic grouping in st...
Abstract: Plasma volume (RISA) was measured in 37 men with essential hypertension uncomplicated by cardiac or renal failure, and results compared with values obtained in 20 normal male subjects. Body height was found to be a better reference index than weight for expressing results, but conclusions were identical whatever the frame of reference used. Plasma volume was diminished in hypertensive men. This decrease was greater the higher the diastolic pressure (r equal to -0.434; p less than 0.01), so that it was only evident in the patients with diastolic blood pressures over 105 mm of mercury. Plasma volume measured 19.4 ml per centimeter in normotensive, and 19.6 ml per centimeter in hypertensive men with diastolic pressure less than 105 mm of mercury, and 16.9 ml per centimeter in those with higher blood pressure (p less than 0.02). These findings contrast with reports of expanded plasma volume in primary aldosteronism and renoprival hypertension, and emphasize the importance of diagnostic grouping in st...