Showing papers in "The New England Journal of Medicine in 1970"
TL;DR: Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy.
Abstract: Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy. A No. 5 Fr double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8 ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35 seconds in the first 100 passages. The frequency of premature beats was minimal, and no other arrhythmias occurred.
1,927 citations
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TL;DR: In this article, it was shown that decreased levels of active T3 may play a role by sparing otherwise obligated calories by decreasing metabolic needs, but this can be nullified by amino acid or protein supplementation.
Abstract: Starvation entails a progressive selection of fat as body fuel. Soon after a meal glucose utilisation by muscle ceases and fatty acids are used instead. Ketoacid levels in blood become elevated over the first week, and the brain preferentially uses these instead of glucose. The net effect is to spare protein even further, as glucose utilisation by brain is diminished. Nevertheless, there is still net negative nitrogen balance, but this can be nullified by amino acid or protein supplementation. Insulin appears to be the principal regulatory hormone. Recent data suggest that decreased levels of active T3 may play a role by sparing otherwise obligated calories by decreasing metabolic needs.
1,293 citations
TL;DR: Osteomyelitis Associated with Vascular Insufficiency The special problems connected with the presentation, clinical course, prognosis and treatment of osteomyeliitis associated with vascular insufficiency are studied.
Abstract: ALTHOUGH osteomyelitis often falls into the purview of the orthopedic surgeon, the internist and pediatrician are also very frequently involved in the initial diagnosis and the subsequent antibioti...
915 citations
TL;DR: The effect of large carbohydrate or protein meals upon plasma glucagon was compared in nondiabetic and diabetic patients to compare the effects of carbohydrate suppressed mean glucagon and protein meals.
Abstract: The effect of large carbohydrate or protein meals upon plasma glucagon was compared in 14 nondiabetic and 24 diabetic patients. In nondiabetic subjects carbohydrate suppressed mean glucago...
613 citations
TL;DR: This presentation will summarize the experience gained in the study of healthy volunteers infected with typhoid bacilli to develop better methods of prevention and control of disease.
Abstract: TYPHOID fever is a disease unique to man. No other animal species acquires an illness simulating typhoid fever after oral ingestion of the organism. This lack of a suitable experimental animal has hindered the acquisition of knowledge on pathogenesis and control. This presentation will summarize the experience gained in the study of healthy volunteers infected with typhoid bacilli. The purpose of these ongoing investigations has been to develop better methods of prevention and control of disease. The primary objective has been the quantitative evaluation of experimental and conventional vaccines. Such studies have permitted a careful analysis of pathogenesis. Typhoid vaccine . . .
513 citations
461 citations
TL;DR: A fluorometric method showed the activity of hexosaminidase A in human serum to be markedly deficient in serum specimens from nine patients with Tay–Sachs disease.
Abstract: A fluorometric method showed the activity of hexosaminidase A in human serum to be markedly deficient in serum specimens from nine patients with Tay–Sachs disease. Parents (obligate hetero...
377 citations
Abstract: A syndrome of dermatologic response to infection with phage Group 2 coagulase-positive staphylococci with reactions ranging from bullous impetigo to generalized scarlatiniform rash without exfoliation to generalized exfoliative disease was observed in 17 children. Staphylococci isolated from these patients, as well as two additional Group 2 organisms, produced exfoliation in newborn mice. The experimental lesion progressed from the development of a Nikolsky sign to bullous formation and then widespread exfoliation. Histologic sections were characterized by a cleavage plane within the epidermis at the stratum granulosum. Among 36 strains, the capacity to produce exfoliation was unique to staphylococci of phage Group 2. The disease produced in newborn mice reproduces the scalded-skin syndrome. Staphylococci may be recovered from involved animals. Thus Koch's postulates are fulfilled, and staphylococci of phage Group 2 are established as the etiologic agent of this syndrome.
375 citations
TL;DR: Pima females 15 to 20 years of age were shown to be at high risk of early development of gallbladder disease and to offer unusual opportunities for further epidemiologic and clinical studies.
Abstract: An American Indian population was investigated to determine the true prevalence of gallbladder disease, to examine its relation to suggested etiologic factors and to identify high-risk persons. From an age–sexstratified random sample of 596 Pima Indians 15 to 74 years of age. subjects with clinically documented gallbladder disease were identified by review of medical records. An attempt was then made to examine the remainder of the sample by cholecystography. The overall prevalence of gallbladder disease was 48.6 per cent, which greatly exceeded that based on clinical diagnosis alone. The prevalence was significantly higher in females and increased with age in both sexes. No association was demonstrated between gallbladder disease and obesity, serum cholesterol level, diabetes or parity. Pima females 15 to 20 years of age were shown to be at high risk of early development of gallbladder disease and to offer unusual opportunities for further epidemiologic and clinical studies.
365 citations
TL;DR: The main source of cholesterol entering the miscible pools is dietary or exogenous cholesterol, and the essential features of the proce...
Abstract: Absorption of Cholesterol Mechanisms of cholesterol absorption. The second source of cholesterol entering the miscible pools is dietary or exogenous cholesterol. The essential features of the proce...
349 citations
TL;DR: Group C carrier acquisitions among vaccinated persons were markedly reduced, and the 87 per cent reduction in Group C disease was statistically significant.
Abstract: Group C meningococcal polysaccharide vaccine was administered to 13,763 Army recruit volunteers at five basic training centers. These men represented 20 per cent of 68,072 recruits under o...
TL;DR: In this paper, continuous positive pressure ventilation was used in eight patients with severe acute respiratory failure to improve their lung function and the mean end-expiratory pressure and lung function.
Abstract: Continuous positive-pressure ventilation was used in eight patients with severe acute respiratory failure. Cardiac output and lung function were studied during continuous positive-pressure ventilation (mean end-expiratory pressure, 13 cm of water) and a 30-minute interval of intermittent positive-pressure ventilation. Although the mean cardiac index rose from 3.6 to 4.5 liters per minute per square meter of body-surface area, the mean intrapulmonary shunt increased by 9 per cent with changeover to intermittent positive-pressure ventilation. Satisfactory oxygenation was maintained in all patients during continuous positive-pressure ventilation with 50 per cent inspired oxygen or less. With intermittent positive-pressure ventilation arterial oxygen tension promptly fell by 161 mm of mercury, 79 per cent occurring within one minute. Prevention of air-space collapse during expiration and an increase in functional residual capacity probably explain improved oxygenation with continuous positive-pressur...
TL;DR: Ethyl alcohol produced a profound depression in the rate of leukocyte mobilization into traumatized skin of nutritionally normal people, and was comparable to that observed in terminal phases of medical shock.
Abstract: Alcoholics are more susceptible than the general population to pneumonia, apparently in some cases because of nutritional deficiencies. Ethyl alcohol produced a profound depression in the rate of leukocyte mobilization into traumatized skin of nutritionally normal people, and was comparable to that observed in terminal phases of medical shock. Diabetic patients showed a less marked decrease in mobilization. No significant depression of polymorphonuclear-leukocyte mobilization was found in patients with cirrhosis or uremia, in coma or undergoing prolonged general Anesthesia for major surgery. Human polymorphonuclear leukocytes, obtained after alcohol was given, or leukocytes exposed to alcohol in vitro showed no decrease in ability to ingest or kill ingested bacteria. Diminished leukocyte mobilization may contribute substantially to the increased susceptibility to infection in the lung parenchyma noted in alcoholics and in diabetic patients or those with severe prolonged shock.
TL;DR: Lymphocytotoxic antibodies were found in 56 of 64 serum specimens from patients with systemic lupus erythematosus and 30 of 53 patients with rheumatoid arthritis.
Abstract: Lymphocytotoxic antibodies were found in 56 of 64 serum specimens from patients with systemic lupus erythematosus and 30 of 53 patients with rheumatoid arthritis. These cytotoxic antibodies characteristically reacted with a temperature optimum of 15°C as was found earlier with serums from patients with infectious mononucleosis, rubella and rubeola. The lymphotoxin found in systemic lupus was cytotoxic to autologous lymphocytes in 24 of 32 specimens tested. No correlation was found to the antibodies detected by radioactive labeled deoxyribonucleic acid (DNA) immunoelectrophoresis, antibodies against single-strand DNA and DNA. However, a definite association with antinuclear-factor activity and a weak association with latex-fixation tests were found. Association of specificity was tested against 18 different HL-A specificities, and antibodies against HL-A11, Te54, Te56 and Te59 were frequently observed.
TL;DR: Kinetic studies of platelet and fibrinogen in 18 patients with artificial heart valves indicate that platelets are selectively consumed by interaction with the prosthetic valves in an amount directly related to the surface area of the valve.
Abstract: Kinetic studies of platelet and fibrinogen in 18 patients with artificial heart valves indicate that platelets are selectively consumed by interaction with the prosthetic valves in an amount directly related to the surface area of the valve. Dipyridamole effectively prevents the valve-related consumption. Although acetylsalicylic acid itself has little capacity to correct the consumption of platelets in this setting, it has a potentiating effect on dipyridamole.
TL;DR: The limulus test is a sensitive, reliable and practical method for the detection of endotoxemia, and there was a good correlation between positive tests for endotoxin and bacteremia due to gram-negative organisms.
Abstract: A test for endotoxin was performed on the blood of 98 patients in whom septicemia due to gram-negative bacteria was suspected. The method was derived from a previous observation that endotoxin causes gelation of lysates of Limulus polyphemus amebocytes in vitro. Seventeen per cent of the patients studied had endotoxemia, as defined by this test. There was a good correlation between positive tests for endotoxin and bacteremia due to gram-negative organisms. Patients with pneumococcal pneumonia and bacteremia due to gram-positive organisms had negative tests. Endotoxin or endotoxin-like material was detected in the blood in concentrations from approximately 0.005 to 0.0005 μg per milliliter. Our data indicate that the limulus test is a sensitive, reliable and practical method for the detection of endotoxemia.
TL;DR: The data suggest that a dopaminergic mechanism in the median eminence or a norepinephrine-sensitive site in the hypothalamus or limbic system may be involved in the regulation of growth-hormone secretion.
Abstract: The effect of L-dopa, a precursor of Central-nervous-system catecholamines, on growth-hormone secretion was studied in a group of patients with Parkinson's disease undergoing treatment with the drug. Oral doses (0.5 g) caused a significant rise in plasma growth hormone in patients initially starting therapy or on chronic therapy for as long as 11 months. The rise in plasma growth hormone persisted for 120 minutes after the administration of the drug. The L-dopa-induced rise in plasma growth hormone could not be blocked by either oral or intravenous glucose administration. The data suggest that a dopaminergic mechanism in the median eminence or a norepinephrine-sensitive site in the hypothalamus or limbic system may be involved in the regulation of growth-hormone secretion. Furthermore, patients with Parkinson's disease, on L-dopa therapy, appear to be under the influence of elevated plasma growth hormone for a substantial part of the day.
TL;DR: The reactions of mothers to the loss of a newborn infant are observed and the strength of the affectional ties between mothers and their infants before the first physical contact is explored.
Abstract: We observed the reactions of mothers to the loss of a newborn infant and explored the strength of the affectional ties between mothers and their infants before the first physical contact. ...
TL;DR: This disorder, which may represent an inborn deficiency of a protein necessary for C3 stability in vivo and in vitro, is detected by the lowered serum C3 concentration and a positive non-gamma (C3) Coombs antiglobulin test.
Abstract: In a patient with Klinefelter's syndrome and lifelong increased susceptibility to infection, no abnormalities were found in humoral antibody production, cellular immunity or leukocyte function. In contrast, the patient's serum complement-mediated functions were grossly deficient. The concentrations of serum complement components were normal except for that of C3 (β1C-globulin), which was less than one-third normal. The bulk of this was in the form of the inactive conversion product, C3b, at all times that the patient's serum or plasma was examined over a two-year period. Addition of small amounts of normal serum, but not purified C3, to the patient's serum improved all complement-mediated functions in vitro. This disorder, which may represent an inborn deficiency of a protein necessary for C3 stability in vivo and in vitro, is detected by the lowered serum C3 concentration and a positive non-gamma (C3) Coombs antiglobulin test.
TL;DR: The two most common sites of infection with streptococci are the upper respiratory tract and the skin and for several decades the intense preoccupation of strePTococcal investigators with infec...
Abstract: IN man the two most common sites of infection with streptococci are the upper respiratory tract and the skin. For several decades the intense preoccupation of streptococcal investigators with infec...
TL;DR: Liver biopsies in 41 grossly obese subjects were evaluated during massive weight reduction and revealed histologically normal livers, which are the only reliable means of judging whether a bypass procedure is causing progressive parenchymal damage.
Abstract: Liver biopsies in 41 grossly obese subjects were evaluated during massive weight reduction (more than 100 lb). The subjects comprised three groups who had been treated by prolonged fasting, low-calorie dieting and intestinal bypass surgery. The first two groups manifested a transient increase in the degree of hepatocellular degeneration and focal necrosis along with progressive diminution of fatty infiltration during acute weight loss. Late follow-up biopsies revealed histologically normal livers. In contrast, bypass surgery was followed, variously, by massive fatty changes, cholestasis, polynuclear inflammatory infiltrates, diffuse fibrosis, bile-duct proliferation and fatal hepatic necrosis. Morphologic changes occurred while liver-function tests were still within normal limits. Follow-up biopsy examinations are the only reliable means of judging whether a bypass procedure is causing progressive parenchymal damage.
TL;DR: In Yale students EBV antibody was always present in serum specimens obtained as long as eight years after clinical or subclinical infection, usually at levels of 1:40 or higher, and in a prospective study of 150 Yale students 53 hadEBV antibody on entry into college.
Abstract: The prevalence rate for antibody to EB virus measured by the indirect immunofluorescence technic in 1084 young adults varied from 26 to 87 per cent depending on age and geographic area. In a prospective study of 150 Yale students 53 had EBV antibody on entry into college; 43 of 97 students lacking antibody had seroconversion during the next four to eight years, 28 with recognized clinical infectious mononucleosis and 15 with inapparent or unrecognized illness. This was an infection rate of 11.1 per cent per year in the susceptible group. Of 164 Peace Corps volunteers 76 per cent had detectable anti-EBV titers on entrance into service, and of 30 lacking antibody 27 per cent were infected over one year while working in Colombia, South America. In Yale students EBV antibody was always present in serum specimens obtained as long as eight years after clinical or subclinical infection, usually at levels of 1:40 or higher.
TL;DR: A radioimmunoassay using 131I-labeled synthetic human calcitonin and antiserum to human calcitin revealed normal basal levels of the peptide in serum of 0.02 to 0.4 ng per milliliter as discussed by the authors.
Abstract: A radioimmunoassay using 131I-labeled synthetic human calcitonin and antiserum to human calcitonin revealed normal basal levels of the peptide in serum of 0.02 to 0.4 ng per milliliter. Calcium infusion produced a twofold to threefold rise in serum calcitonin in most control subjects. Chronic hypercalcemia was not regularly associated with elevated serum calcitonin, and calcitonin levels were normal in six patients with chronic hypocalcemia. In medullary carcinoma of the thyroid gland basal serum calcitonin was 1 to 540 ng per milliliter. Calcitonin levels correlated with the extent of disease. In patients with medullary carcinoma, serum calcitonin responses to calcium and glucagon infusions tended to be greater than in control subjects. Results of family studies suggest that the immunoassay may prove useful in the early diagnosis of this tumor among high-risk persons. We conclude that calcitonin normally circulates in human serum, that its concentration may not always correlate directly with ser...
TL;DR: L-DOPA is a precursor for the biosynthesis of both melanins and catecholamines and both groups of substances are diminished within the Parkinsonian brain.
Abstract: L-DOPA is a precursor for the biosynthesis of both melanins and catecholamines. Both groups of substances are diminished within the Parkinsonian brain.1 2 3 L-dopa administration might therefore in...
TL;DR: In four of 27 office workers, symptoms of intermittent chills, fever and dyspnea, or progressive Dyspnea alone developed, and contamination of the air-conditioning system with a thermophilic actinomycete known to cause a hypersensitivity pneumonitis such as farmer's lung was revealed.
Abstract: In four of 27 office workers, symptoms of intermittent chills, fever and dyspnea, or progressive dyspnea alone developed. Pulmonary-function studies indicated restrictive and diffusion defects, and x-ray examination demonstrated diffuse nodular infiltrates in all four patients. Examination of their environment revealed contamination of the air-conditioning system with a thermophilic actinomycete known to cause a hypersensitivity pneumonitis such as farmer's lung. Serum specimens of all patients contained high titers of rheumatoid factor and precipitating antibodies against the offending organism. Inhalation of the antigen by one of the ill workers during an asymptomatic period reproduced all clinical features of the disorder. Treatment with steroids and subsequent avoidance of exposure resulted in complete recovery. Hypersensitivity pneumonitis should be suspected in cases of interstitial pneumonitis, even in the absence of clear-cut contact with organic dusts.
TL;DR: A possible etiologic role of melphalan therapy in the development of acute leukemia is suggested, based on the fact that the leukemia was myelomonocytic.
Abstract: A rapidly progressive acute myelomonocytic leukemia developed in four patients who had received prolonged courses of melphalan, ranging from 30 to 57 months. Three patients were being treated for typical multiple myeloma (anemia, elevated sedimentation rate, monoclonal serum peak, Bence-Jones protein in the urine, lytic bone lesions and increased numbers of myeloma cells in the marrow), and one for a plasma-cell dyscrasia, with systemic amyloidosis of five years' duration. Because of the remote likelihood of chance association of acute leukemia and multiple myeloma, the known effect of alkylating agents on deoxyribonucleic acid, the fact that the leukemia was myelomonocytic, and the long period of treatment with melphalan, a possible etiologic role of melphalan therapy in the development of acute leukemia is suggested.
TL;DR: Physical activity may have a more striking influence on myocardial infarction than on atherosclerosis, and heavier cigarette smoking and higher systolic blood pressure had stronger influences in coronary mortality than sedentary work activity or heavier weight for height.
Abstract: In a 16-year follow-up study after multiphasic screening, 291 of 3263 longshoremen died of coronary disease, and 67 of stroke. Men with more sedentary jobs expended 925 fewer calories per work day and sustained coronary death rates one third higher than those among cargo handlers. Rate differences were largest at youngest ages and decreased steadily thereafter. Yet heavier cigarette smoking and higher systolic blood pressure had stronger influences in coronary mortality than sedentary work activity or heavier weight for height. Cargo handlers sustained death rates from stroke similar to those of more sedentary longshoremen. Mortality from stroke, however, was three times higher among men with higher levels of systolic blood pressure than among those with lower levels. Physical activity thus may have a more striking influence on myocardial infarction than on atherosclerosis.
TL;DR: The scope of the infectious disease problems in most hospitals today are those that occur in the hospital — so-called nosocomial infections, and the scope of this discussion is defined briefly.
Abstract: THE major infectious disease problems in most hospitals today are those that occur in the hospital — so-called nosocomial infections. In this discussion I shall define briefly the scope of the problem, explore some of the causes of the unacceptably high prevalence of hospital-acquired infections, evaluate some of the current preventive measures, and speculate on developments that may improve prevention and therapy. I shall focus on bacterial infections, although in certain classes of patients other organisms at times may be etiologic. The Problem Prevalence In 1959, Rogers1 presented data from an autopsy study confirming that the types of infection causing . . .