Showing papers in "The New England Journal of Medicine in 1971"
TL;DR: This new capillary growth is even more vigorous and continuous than a similar outgrowth of capillary sprouts observed in 2016 and is likely to be accompanied by neovascularization.
Abstract: THE growth of solid neoplasms is always accompanied by neovascularization. This new capillary growth is even more vigorous and continuous than a similar outgrowth of capillary sprouts observed in f...
9,874 citations
TL;DR: The natural history of congestive heart failure was studied over a 16-year period in 5192 persons initially free of the disease, finding that in almost every five-year age group, from 30 to 62 years, the incidence rate was greater for men than for women.
Abstract: The natural history of congestive heart failure was studied over a 16-year period in 5192 persons initially free of the disease. Over this period, overt evidence of congestive heart failur...
3,143 citations
TL;DR: It is argued the cause-and-effect relationship between in utero exposure to diethylstilbestrol and incidence of vaginal adenocarcinoma among young women and a ban of such diet supplementation of human foodstuffs is called for.
Abstract: Herbst, Ulfelder and Poskanzer1 were the first to notice a high correlation between adenocarcinoma of the vagina in adolescent girls and prior maternal ingestion of diethylstilbestrol. This is a stunning observation. It is supported by five more cases described in this issue by Greenwald et al. In a previous editorial2 Langmuir discussed some clinical and scientific implications of this discovery. Further speculations are now warranted. Neither Herbst nor Greenwald studied a large number of mothers with repeated bleeding or previous pregnancy loss who did not receive stilbestrol. This omission is irrelevant, however, because of the extreme rarity of adenocarcinoma of . . .
2,438 citations
TL;DR: The association between treatment of the mothers with estrogen diethylstilbestrol during the pregnancies and the development of adenocarcinoma of the vagina in the girls is highly significant and non-significant factors include maternal age at time of birth smoking in parents intrauterine x-ray exposure and breast feeding.
Abstract: Although cancer of the vagina is rare and occurs principally in women over age 50 in the form of epidermoid carcinoma 8 girls (15-22) between 1966 and 1969 with adenocarcinoma of the vagina (clear-cell or endometrial) were seen at 2 Boston hospitals. The 4 controls (female) for each case were born within 5 days of the patient and on the same type of service (ward or private). The association between treatment of the mothers (7 or 8) with estrogen diethylstilbestrol during the pregnancies and the development of adenocarcinoma of the vagina in the girls is highly significant (p less than 0.00001). All 7 mothers began therapy in the first trimester and received either a constant dose administered to term or a continually increasing dose given almost to term. Other factors with lower levels of significance are maternal bleeding in the study pregnancy (p less than 0.05) and any prior pregnancy loss (p less than 0.01). Non-significant factors include maternal age at time of birth smoking in parents intrauterine x-ray exposure and breast feeding.
2,267 citations
TL;DR: In this paper, a continuous positive airway pressure was applied to 20 infants severely ill with idiopathic respiratory-distress syndrome (IRS) to lower the inspired oxygen within 12 hours.
Abstract: We applied a continuous positive airway pressure to 20 infants (birth weight 930 to 3800 g) severely ill with the idiopathic respiratory-distress syndrome. They breathed spontaneously. Pressure, up to 12 mm of mercury, was delivered through an endotracheal tube to 18 infants and via a pressure chamber around the infant's head to two. Arterial oxygen tension rose in all, permitting us to lower the inspired oxygen an average of 37.5 per cent within 12 hours. Minute ventilation decreased with increased continuous positive airway pressure, but this had little effect on arterial carbon dioxide tension, pH, arterial blood pressure and lung compliance. Sixteen infants survived, including seven of 10 weighing less than 1500 g at birth.
1,093 citations
TL;DR: Baroreceptor-induced slowing of heart rate in normal subjects was shown to be mediated by the parasympathetic nervous system since it could be abolished with atropine.
Abstract: To define the state of the parasympathetic nervous system in heart failure, parasympathetic blockade with atropine was induced after adrenergic blockade with propranolol in 12 normal subjects and in nine patients with heart disease. Atropine elevated heart rate by 55 ± 9 per cent in normal subjects, but by only 23 ± 8 per cent in patients with heart disease (p less than 0.05). In 23 control subjects and 22 patients, transient elevations in arterial pressure were produced by intravenous injections of phenylephrine, and successive R-R intervals were plotted as a function of systolic pressure. The slowing of heart rate per unit rise in systolic arterial pressure averaged 16.0 ±1.8 msec per millimeter of mercury in normal subjects but only 3.70 ± 0.8 msec per millimeter of mercury in the patients (p less than 0.001). Baroreceptor-induced slowing of heart rate in normal subjects was shown to be mediated by the parasympathetic nervous system since it could be abolished with atropine. These findings poi...
963 citations
TL;DR: The increase in proportions of glycohemoglobin in diabetes mellitus appears to be another example of increased glycoproteins in this disorder.
Abstract: An increase in a minor hemoglobin component closely resembling hemoglobin AIc in which one or more hexoses are bound to the beta-polypeptide chains was observed in a previous study of diabetic patients In the present study the proportions of chromatographically rapid (fast) minor components of hemoglobin, 75 to 80 per cent of which is accounted for by hemoglobin AIc, were quantified by a modified Chromatographic method in 20 normal and 100 diabetic subjects Mean values for the proportions of fast hemoglobin components (glycohemoglobin) in diabetes showed a nearly twofold increase over values found in normal subjects The increased proportions of these fast components did not appear to be related to the age of the patients, or to the duration, therapy or complications of diabetes The increase in proportions of glycohemoglobin in diabetes mellitus appears to be another example of increased glycoproteins in this disorder
860 citations
TL;DR: The mean chemotactic index in 31 patients with diabetes mellitus was significantly less than that in 31 matched controls, and it is suggested that this defect in the chemotaxis of diabetic leukocytes could contribute to increased infections in these patients.
Abstract: With a new in vitro method of measuring the chemotaxis of polymorphonuclear leukocytes from peripheral blood, a chemotactic index was calculated. The mean chemotactic index in 31 patients with diabetes mellitus was significantly less (p less than 0.0005) than that in 31 matched controls. The defect in chemotaxis could not be correlated with plasma insulin, plasma glucose, serum carbon dioxide and blood urea nitrogen values, or with any therapeutic agents. Incubation of the leukocytes from 11 normals with glucose in concentrations of 300 to 900 mg per 100 ml did not alter indexes. The defect in chemotaxis of the diabetic leukocyte was corrected by incubation of the cells with insulin in concentrations of 100 μU to 10 mU per milliliter. Insulin with phenol was less effective than insulin without preservative. Insulin was ineffective in the absence of glucose. It is suggested that this defect in the chemotaxis of diabetic leukocytes could contribute to increased infections in these patients.
694 citations
TL;DR: Combination carbenicillin and gentamicin is of value as initial antibiotic therapy for suspected Ps.
Abstract: Seventy-five acutely ill, febrile patients with cancer and granulocytopenia were treated empirically with a combination of carbenicillin and gentamicin for presumed bacterial infection. Cultures taken before the initiation of antibiotics subsequently documented the presence of infection in 48 of these patients, of whom 21 were shown to have Pseudomonas aeruginosa infections. Fourteen of these patients with pseudomonas infections had complete improvement, three improved temporarily but later died of infection, two had no improvement, and two could not be evaluated. This antibiotic combination was less promising for the infections caused by other gram-negative bacteria, especially klebsiella. Superinfection occurred in eight patients. Combination carbenicillin and gentamicin is of value as initial antibiotic therapy for suspected Ps. aeruginosa infection in granulocytopenic patients with cancer but only after careful examination and extensive culturing.
667 citations
TL;DR: It is shown that cardiogenic shock is associated with extensive loss of left ventricular myocardium due to new and frequently old infarcts as well, and a sharp reduction in coronary perfusion pressure could explain this combination of findings.
Abstract: The amount of left ventricular myocardium destroyed by recent and old infarcts in patients with acute myocardial infarction with and without cardiogenic shock was compared in hearts obtained at autopsy. All 20 patients with, and only one of 14 without, shock had lost 40 per cent or more of the left ventricle. The remainder lost 35 per cent or less. These results indicate that cardiogenic shock is associated with extensive loss of left ventricular myocardium due to new and frequently old infarcts as well. In five cases the new infarct was small as compared to the total amount of myocardial destruction. Patients with cardiogenic shock consistently showed marginal extension of the recent infarct (unlike those not in shock) and focal areas of necrosis throughout both left and right ventricles. Similar focal lesions were encountered in a third series of 20 patients with shock from other causes. A sharp reduction in coronary perfusion pressure could explain this combination of findings, which indicate ...
656 citations
TL;DR: A fascinating picture emerges of agents that may infect by diverse natural or iatrogenic routes, with man at risk from time of conception, although the spectrum of disease known to be produced by the CMV continues to expand.
Abstract: Epidemiologic Aspects Distribution of CMV Surveys of unselected newborn infants in four cities in the United States and England indicate that some 1 per cent enter the world with an active infectio...
TL;DR: Two Escherichia coli strains isolated in Vietnam from American soldiers with diarrhea and acute "colitis" were examined for virulence in both in vitro and in vivo experimental models.
Abstract: Two Escherichia coli strains isolated in Vietnam from American soldiers with diarrhea and acute "colitis" were examined for virulence in both in vitro and in vivo experimental models. Their biologic properties were compared with those of an enterotoxin-producing Esch. coli strain implicated in disease of swine as well as with those of four other Esch. coli and a virulent shigella strain. The two Vietnam strains produced an enterotoxin in a rabbit ileal-loop model and in volunteers caused a diarrheal syndrome resembling that of cholera. Two nontoxigenic Esch. coli strains gave evidence of penetrating epithelial cells in laboratory models and caused a shigella-like illness in man characterized by dysentery, tenesmus, urgency, hyperpyrexia and hypotension with systemic toxemia. Thus, strains of Esch. coli can cause disease in man by at least two mechanisms: elaboration of a cholera-like enterotoxin; and shigella-like intestinal epithelial penetration.
TL;DR: In this article, the serum or plasma of 674 patients was studied by means of a radioimmunoassay that detects on carcinoembryonic antigen (CEA) an antigenic site exposed at low ionic strength.
Abstract: The serum or plasma of 674 patients was studied by means of a radioimmunoassay that detects on carcinoembryonic antigen (CEA) an antigenic site exposed at low ionic strength. Serum specimens from 11 of 299 patients hospitalized for various illnesses other than neoplastic disease had elevated levels of antigen. Subsequently, two of these patients were found to have previously undetected entodermally derived adenocarcinoma. Elevated levels of CEA were observed in serum specimens from 87 of 101 patients with known colonic adenocarcinoma, 30 of 45 patients with breast carcinoma, 26 of 35 patients with lung carcinoma and 20 of 51 patients with prostatic carcinoma. Since serum from patients with both entodermally and nonentodermally-derived carcinoma had elevated levels of CEA an antigenic site common to several tumors appears to exist on CEA.
TL;DR: An actuarial analysis of the long-term survival of 396 children suffering from ulcerative colitis showed that survival rates were 78, 58, 39 and 27 per cent at 10, 20, 30 and 43 years, respectively.
Abstract: An actuarial analysis of the long-term survival of 396 children suffering from ulcerative colitis showed that survival rates were 78, 58, 39 and 27 per cent at 10, 20, 30 and 43 years, respectively. The death rate was 20 per cent per decade. The risk of the development of cancer was also 20 per cent per decade for those at risk, but this began after the first 10 years of ulcerative colitis. Among patients suffering from ulcerative colitis involving the entire colon, the death rate was higher, and the risk of cancer greater than among those who had disease limited to the rectum at the time of diagnosis. For 40 of these patients who underwent proctocolectomy the long-term survival rate apparently was improved after an initially higher risk in the first year after operation.
TL;DR: The syndrome of congenital deafness, syncopal episodes, long QT interval on the electrocardiogram and sudden death, and ventricular dysrhythmias have been well described.
Abstract: THE syndrome of congenital deafness, syncopal episodes, long QT interval on the electrocardiogram and sudden death has been well described.1 2 3 Recently, ventricular dysrhythmias have been documen...
TL;DR: A combined cytochemical and electrophoretic study indicates that this tartrate-resistant enzyme activity represents isoenzyme 5 may be used as the marker enzyme to diagnose leukemic reticuloendotheliosis and to trace the origin of the "reticulum cells" ("hairy cells") in the reticulendothelial system.
Abstract: Acid phosphatase activity in the reticulum cells of leukemic reticuloendotheliosis is quantitatively and qualitatively different from that in the lymphosarcoma cells of lymphosarcoma and in lymphocytes of chronic lymphocytic leukemia. Enzyme activity in the reticulum cells is strong and tartrate resistant, whereas that in the lymphoid cells of the other two diseases is very weak and is inhibited by tartrate. A combined cytochemical and electrophoretic study indicates that this tartrate-resistant enzyme activity represents isoenzyme 5. It is present almost exclusively in the reticulum cells and not in other hemic cells in leukemic reticuloendotheliosis. It is not present in the lymphoid cells in lymphosarcoma or chronic lymphocytic leukemia. It may be used as the marker enzyme to diagnose leukemic reticuloendotheliosis and to trace the origin of the "reticulum cells" ("hairy cells") in the reticuloendothelial system.
TL;DR: If a person is subjected to progressively increasing work loads, there is a linear relation between work load and oxygen uptake until the maximal oxygen uptake is reached.
Abstract: KNOWLEDGE of how oxygen is transported from the ambient air to the tissue cells of the body is essential to an understanding of the mechanisms by which the body adapts to the oxygen demands of muscular exercise. The requirement of oxygen by the various tissue cells of the body is met by the combined cardiovascular and pulmonary systems, which function as a unit termed the oxygen transport system of the body. If a person is subjected to progressively increasing work loads, there is a linear relation between work load and oxygen uptake until the maximal oxygen uptake is reached. Heavier . . .
TL;DR: Systemic lupus erythematosus is a disease characterized by several immunologic abnormalities, and the association between histocompatibility loci and susceptibility to certain diseases may be mediated by histoc Compatible immune response genes analogous to such associations demonstrated in mice.
Abstract: Systemic lupus erythematosus is a disease characterized by several immunologic abnormalities. We determined the HL-A antigens of 40 patients by a standard lymphocyte cytotoxicity test. Specificity HL-A8 was present in 33 per cent, and W15 (LND) in 40 per cent of the patients, as compared to control population frequencies of 16 per cent (p less than 0.025) and 10 per cent (p less than 0.0005), respectively. Nineteen other HL-A antigens did not differ significantly between patients and the control population, and no unusually frequent phenotypes were observed. The association between histocompatibility loci and susceptibility to certain diseases may be mediated by histocompatibility-linked immune response genes analogous to such associations demonstrated in mice. Other possible mechanisms for this association are that histocompatibility antigens represent specific receptor sites for attachment of a virus and that "cross-tolerance" enables viral antigens to mimic certain histocompatibility antigens.
TL;DR: In neither the asymptomatic nor the symptomatic groups of patients could any effect of hiatus hernia be found, and the rationale for surgical repair of pause hernia in patients with gastroesophageal reflux must be questioned.
Abstract: To measure the effect of a sliding (concentric) hiatus hernia on gastroesophageal sphincter competence, 75 patients were studied: 25 patients without esophageal symptoms and without hiatus hernia (Group A); 25 patients without esophageal symptoms but with hiatus hernia (Group B); and 25 patients with symptoms of severe gastroesophageal reflux, with or without a hiatus hernia (Group C). In Group C, 12 patients had a hiatus hernia, and 13 did not. Symptomatic patients were readily separated from asymptomatic ones both by a weaker base-line sphincter strength and by decreased sphincteric response to the stimulus of an increase in intraabdominal pressure. However, in neither the asymptomatic nor the symptomatic groups of patients could any effect of hiatus hernia be found. A hiatus hernia apparently has no effect on gastroesophageal sphincter competence. The rationale for surgical repair of hiatus hernia in patients with gastroesophageal reflux must therefore be questioned.
TL;DR: It is tentatively concluded that the addition of dipyridamole to a program of anticoagulation reduces the frequency of postoperative arterial emboli originating on prosthetic cardiac valves in patients who can tolerate the drug.
Abstract: Either dipyridamole, a vasodilator known to reduce platelate adhesiveness and aggregation, or a placebo was given in a daily dose of 400 mg as a random, blind trial to 70 patients who had undergone prosthetic cardiac-valve replacement. Patients in both groups were given anticoagulation with warfarin sodium. Of 36 patients in the placebo group followed for 557 months systemic arterial embolism occurred in 17 per cent. Twenty-seven patients in the dipyridamole group followed for 393 months gave no clinical evidence of arterial embolism. Dipyridamole was discontinued shortly after surgery in seven patients, and these were followed for 110 months. In two of them cerebral emboli developed six months after treatment was discontinued. It is tentatively concluded that the addition of dipyridamole to a program of anticoagulation reduces the frequency of postoperative arterial emboli originating on prosthetic cardiac valves in patients who can tolerate the drug.
TL;DR: The binding of DPH by plasma proteins from azotemic patients appears to be decreased, probably owing to a change in the binding proteins.
Abstract: The protein binding of diphenylhydantoin (DPH) and desmethylimipramine (DMI) was measured in plasma from azotemic and uremic patients by an Ultrafiltration technic. DPH binding was decreased in uremic plasma. The impairment of binding was strongly correlated (p less than 0.001) to the degree of azotemia and degree of physical disability of the patients but weakly correlated (p less than 0.05) to their concentrations of serum proteins. DMI binding was almost normal. Dialysis of normal and uremic plasma in tap water or hemodialysis solution did not alter the DPH binding. The binding of DPH by plasma proteins from azotemic patients appears to be decreased, probably owing to a change in the binding proteins. The possibility of alteration of drug binding by pathologic states should be considered when total plasma concentrations of protein-bound drugs are measured and the values used to establish or modify drug-dosage regimens.
TL;DR: (First of Two Parts)* "Ischaemicheart disease, or coronary heart disease, has reached enormous proportions, striking more and more at younger subjects, and will result in coming years in the greate...
Abstract: (First of Two Parts)* "Ischaemic heart disease, or coronary heart disease, has reached enormous proportions, striking more and more at younger subjects. It will result in coming years in the greatest epidemic mankind has faced unless we are able to reverse the trend by concentrated research into its cause and prevention."1 "We are again in the age of the great pandemics. Our plague is cardiovascular."2 THESE words express the gravity of the current epidemic of coronary disease in many economically advanced countries. Felton and Cole estimate that all cardiovascular diseases accounted for 12 per cent of the time lost by . . .
TL;DR: Fungal septicemia was not related to steroid therapy or immunologic deficiency, however, a correlation with prolonged intravenous catheterization was found, and Candida albicans was the causative microbial species in eight patients.
Abstract: Thirty-three patients with fungal septicemia at the University of Minnesota Hospital were seen during an 18-month period, January, 1968, through August, 1969. Twenty-two of these 33 patients (67 per cent) had received parenteral hyperalimentation for severe gastrointestinal dysfunction. Fungal septicemia was not related to steroid therapy or immunologic deficiency i te patiets receiing hyperalimentation. However, a correlation with prolonged intravenous catheterization was found. More recently, during a prospective study of all patients receiving parenteral hyperalimentation, septicemia complicated the course of therapy in 13 of 49. In eight of these patients, Candida albicans was the causative microbial species.
TL;DR: These findings confirm the association between stilbestrol therapy of the mother during pregnancy and adenocarcinoma in young women and provide additional information on dose and time relations.
Abstract: VAGINAL adenocarcinoma in young women was recently reported by Herbst, Ulfelder and Poskanzer1 as being associated with stilbestrol therapy of the mother during pregnancy. In an accompanying editorial, Dr. Alexander D. Langmuir2 emphasized the scientific and social implications of this observation, and stated the need for confirmatory data. Our findings confirm the association and provide additional information on dose and time relations. The New York State Cancer Registry receives reports of all cancer diagnosed in New York State, exclusive of New York City. During the period 1950 through 1970, five adenocarcinomas of the vagina were reported in women under age . . .
TL;DR: Except in patients with ectopic ACTH syndrome or adrenal carcinoma, appropriate treatment for Cushing's syndrome is appropriate, except in patients that respond metabolically to metyrapone.
Abstract: In 17 years, 108 patients with Cushing's syndrome were treated at Vanderbilt University. Seventeen had adrenal adenoma, 10 adrenal carcinoma, 17 ectopic ACTH syndrome, and 64 Cushing's disease. Surgery for adrenal adenoma was uniformly successful. Three carcinomas were surgically cured, and two patients had remissions; these two and another patient subsequently responded to o.p′DDD. Four cases were not amenable to therapy. No patient with ectopic ACTH syndrome was cured, but some responded metabolically to metyrapone. In Cushing's disease, pituitary irradiation cured 10 of 51 patients and improved 13 without complications. All six unilateral adrenalectomies and two of five subtotal adrenalectomies were unsuccessful, but bilateral adrenalectomy (19 cases) was always curative. After o,p′DDD treatment serum cortisol levels returned to normal, without mineralocorticoid deficiency, in eight patients. Thus, except in patients with ectopic ACTH syndrome or adrenal carcinoma, appropriate treatment for Cu...
TL;DR: To investigate the effects of sleep deprivation on medical interns, an electrocardiographic arrhythmia-detection task and questionnaires assessing mood and subjectively perceived psychophy...
Abstract: To investigate the effects of sleep deprivation on medical interns, an electrocardiographic arrhythmia-detection task and questionnaires assessing mood and subjectively perceived psychophy...
TL;DR: A familial influence on blood pressure can be detected in children, and it is possible that factors responsible for essential hypertension are acquired in childhood.
Abstract: The familial aggregation of blood pressure is well known in adults. To determine if this familial effect is detectable in childhood, blood pressures of 721 children two to 14 years of age were taken in the homes of 190 families. A portable, automated blood-pressure recorder was used, and scores adjusted for age and sex were expressed in standard-deviation units. For both systolic and diastolic pressures, variance of blood-pressure scores was significantly less within families than among all children in this age group (p less than 0.01). Sib-sib and mother-child regression coefficients were 0.34 and 0.16 for systolic pressure and 0.32 and 0.17 for diastolic pressure respectively. The clustering effect was measurable at all levels of blood pressure. Thus, a familial influence on blood pressure can be detected in children, and it is possible that factors responsible for essential hypertension are acquired in childhood.
TL;DR: Myocardial ischemia was more prevalent in patients with than in those without collateral vessels as evidenced by a significantly greater frequency of abnormal post-exercise electrocardiograms and myocardial lactate production.
Abstract: To determine the effect of intercoronary collateral vessels on the clinical features of coronary-artery disease, 61 patients with collateral vessels were compared with 58 patients without arteriographically demonstrable collateral vessels. No significant differences existed between the two groups in level of physical activity, duration of angina, frequency of prior myocardial infarction or prevalence of electrocardiographic, hemodynamic and ventriculographic abnormalities. Myocardial ischemia was more prevalent in patients with than in those without collateral vessels as evidenced by a significantly greater frequency of abnormal post-exercise electrocardiograms and myocardial lactate production. The incidence of acute myocardial infarction during the follow-up period was nearly identical in the two groups. Death was less frequent in patients with than in those without collateral vessels, but this observation did not achieve statistical significance. Thus, although collateral vessels do not necess...