Showing papers in "The New England Journal of Medicine in 1973"
TL;DR: The frequencies of 24 HL-A antigens were examined in patients with ankylosing spondylitis, 119 with rheumatoid arthritis, and 66 with gout, finding no significant deviation from control frequen...
Abstract: The frequencies of 24 HL-A antigens were examined in 40 patients with ankylosing spondylitis, 119 with rheumatoid arthritis, and 66 with gout. No significant deviation from control frequen...
1,271 citations
TL;DR: Deficiency of γ-aminobutyric acid, a possible inhibitory synaptic transmitter in brain, might produce the symptoms characteristic of Huntington's chorea.
Abstract: Amino acids and related compounds were measured in various regions of brain obtained at autopsy from eight neurologically normal persons, one patient with Parkinson's disease, and eight patients with Huntington's chorea. γ-Aminobutyric acid (GABA) and homocarnosine, a related dipeptide, were reduced in the substantia nlgra, putamen-globus-pallidus, and caudate nucleus of the choreic patients, as compared to the normal subjects and the patient with Parkinsonism. Glycerophosphoethanolamine concentration was elevated in these three regions of choreic brain. Deficiency of γ-aminobutyric acid, a possible inhibitory synaptic transmitter in brain, might produce the symptoms characteristic of Huntington's chorea. Such a deficiency could result from reduced activity of the enzyme glutamic acid decarboxylase, or might reflect a decrease in the number of neurons that normally utilize γ-aminobutyric acid as a transmitter.
849 citations
TL;DR: To investigate the functioning reserve capacity of the exocrine pancreas, the relations of steatorrhea and creatorrhea to lipase and trypsin outputs in 17 patients with chronic pancreatic cancer are studied.
Abstract: To investigate the functioning reserve capacity of the exocrine pancreas, we studied the relations of steatorrhea and creatorrhea to lipase and trypsin outputs in 17 patients with chronic ...
824 citations
TL;DR: The main problems in the care of diabetic patients are ketoacidosis and infections, but since the introduction of insulin therapy, these problems are no longer the main problems.
Abstract: SINCE the introduction of insulin therapy 50 years ago, ketoacidosis and infections are no longer the main problems in the care of diabetic patients. Today, the diabetic patient faces the developme...
771 citations
TL;DR: In six of seven patients, herpes-simplex virus was recovered from trigeminal ganglions obtained at autopsy from unselected cadavers less than 12 hours after death and maintained in culture for up to two weeks after death.
Abstract: In six of seven patients, herpes-simplex virus was recovered from trigeminal ganglions obtained at autopsy from unselected cadavers less than 12 hours after death and maintained in culture for 10 to 45 days. The virus was not obtained from similarly handled cultures of trigeminal nerve or root from the same patients. The identity of the virus was confirmed by fluorescent-antibody and neutralization tests and by electron microscopy. The results indicate that herpes-simplex virus is present in a high proportion of human trigeminal ganglions and suggest this as a possible site of latent virus causing recurrent oral infection.
655 citations
TL;DR: Physiologic responses to intravenously administered theophylline were determined in nine hospitalized asthmatic subjects and continuous improvement in vital capacity and first-second forced expiratory volume was observed over the plasma range of theophyLLine concentration.
Abstract: Physiologic responses to intravenously administered theophylline were determined in nine hospitalized asthmatic subjects. In each patient incremental theophylline plasma concentration plateaus were attained at which pulmonary-function changes related to drug administration were examined. Continuous improvement in vital capacity and first-second forced expiratory volume was observed over the plasma range of theophylline concentration of 5 to 20 mg per liter. The improvement varied directly with the logarithm of the plasma concentration. A safe and effective dosage regimen for intravenous theophylline can be based on these observations. After a loading dose of aminophylline, 5.6 mg per kilogram given intravenously, 0.9 mg per kilogram per hour can be given as a maintenance dose. This amount will result in a plasma theophylline concentration of approximately 10 mg per liter for 95 per cent of patients and in recovery from some 30 to 40 per cent of reversible pulmonary-airway obstruction. (N Engl J M...
639 citations
TL;DR: Coronary arteriography should be attempted, if possible, during clinical attacks of pain in patients with Prinzmetal angina, even those who have a focal atherosclerotic obstruction may have additional distal coronary arterial spasm.
Abstract: A woman with Prinzmetal angina displayed spontaneous attacks of myocardial ischemia characterized by severe chest pain, hypotension, inferior-wall ST-segment elevation and transient complete heart block. Coronary arteriography during several fully developed spontaneously occurring attacks demonstrated spasm of a right coronary artery that appeared to be anatomically normal. The site, extent and degree of obstruction varied during individual attacks. Immediately after an attack subsided the coronary artery appeared normal. These observations suggest that coronary arteriography should be attempted, if possible, during clinical attacks of pain in patients with Prinzmetal angina. Even those who have a focal atherosclerotic obstruction may have additional distal coronary arterial spasm. Spasm beyond a proximal obstruction may preclude the use of saphenous-vein bypass therapy alone. Coronary arterial vasodilators may be an important additional therapeutic measure.
607 citations
TL;DR: A large number of children in the United States may experience six to eight acute respiratory illnesses per year, many of which, including pneumonia, are undiagnosed and treatable.
Abstract: RESPIRATORY infections are the major cause of morbidity due to acute illnesses in the United States.1 Children may experience six to eight acute respiratory illnesses per year,2 3 4 many of which, ...
595 citations
TL;DR: Aryl hydrocarbon hydroxylase is an inducible, membrane-bound enzyme involved in the metabolism of chemical carcinogens and in cultured human lymphocytes there is genetic variation.
Abstract: Aryl hydrocarbon hydroxylase is an inducible, membrane-bound enzyme involved in the metabolism of chemical carcinogens. In cultured human lymphocytes there is genetic variation. The normal...
581 citations
579 citations
TL;DR: Patients with cardiogenic shock were treated with the intra-aortic counterpulsating balloon in 10 institutions according to a common protocol, and clinical and physiologic problems were found.
Abstract: Eighty-seven patients with cardiogenic shock were treated with the intra-aortic counterpulsating balloon in 10 institutions according to a common protocol. Clinical and physiologic respons...
TL;DR: It is difficult to rule out the possibility that the presence of HSV2 or of antigens is not an independent event unrelated to the cancer, and it is possible that frequent or constant antigenic stimulation occurs in at least some cases of recurrent herpetic infections.
Abstract: PIP: Herpes-simplex virus 1 (HSV1) and 2 can cause recurrent infection in man and in nonhuman species localized on a specific area of the body, such as face, cornea, or genitals. The origin of the virus responsible for a recurrent infection is not usually apparent. Some possible sources of virus can be exogenous infection, endogenous infection from another site of the body, chronic, continuous viral multiplication around the site of involvement, and persistence of the virus at the site of the recurrent infection. No definite information is yet available regarding the mechanism by which HSV1 or HSV2 persists and it is triggered to multiply, or regarding the cells that harbor the virus. It is possible that frequent or constant antigenic stimulation occurs in at least some cases of recurrent herpetic infections. The role of antibodies and of interferon in host resistance to HSV remains to be elucidated. Several recent studies have shown the association of more than a dozen herpes viruses with cancer in man and various animals; for example with limphoma, and with squamous cell carcinoma of the lip and cancer of the cervix. Genital HSV infections and cervical cancer were first linked when it was noted that women with genital herpes had a high frequency of cervical dysplasia and cancer. The results of new seroepidemiologic studies on this subject are still difficult to evaluate. Inocculation of HSV2 in laboratory animals has resulted in sarcomas, but it has never been possible to prove that the virus caused the tumors, since no HSV antigens could be detected in the tumors. However, herpesvirus antigens have been demonstrated by immunofluorescent technics in exfoliated cervical cells obtained from women with dysplasia, carcinoma in situ, and invasive carcinoma. In the absence of other kinds of data, it is difficult to rule out the possibility that the presence of HSV2 or of antigens is not an independent event unrelated to the cancer.
TL;DR: Primary biliary cirrhosis was formerly diagnosed only in its late, icteric stage, and one or more laparotomies had usually been performed to treat it.
Abstract: PRIMARY biliary cirrhosis1 , 2 (chronic nonsuppurative destructive cholangitis)3 was formerly diagnosed only in its late, icteric stage. One or more laparotomies had usually been performed to exclu...
TL;DR: Altered lung mechanics appear to result from persistent airflow obstruction residing in peripheral airways that is not sufficient to induce symptoms at rest but compromises pulmonary function and may serve as a base for future recurrent episodes of asthma.
Abstract: To compare the degree of bronchial obstruction and the clinical manifestations of asthma, we correlated lung mechanics with subjective complaints and physical findings in 22 patients during acute attacks of bronchospasm, and serially during therapy. Only the sign of retraction of the sternocleidomastoid muscle consistently identified those who had severe impairment of pulmonary function; dyspnea and wheezing did not. Regardless of the initial presentation of the patients, when they became asymptomatic, the overall mechanical function of their lungs ranged between 40 and 50 per cent of predicted normal values. When they were without signs of asthma, lung function was only 60 to 70 per cent of predicted values. These abnormalities appear to result from persistent airflow obstruction residing in peripheral airways that is not sufficient to induce symptoms at rest but compromises pulmonary function and may serve as a base for future recurrent episodes of asthma.
TL;DR: The action of furosemide in the treatment of pulmonary congestion is immediate and is not related to its diuretic properties, since marked changes in venous capacitance accompany this phenomenon, which is only later supplemented by the increase in urine output and electrolyte excretion.
Abstract: Furosemide, 0.5 to 1.0 mg per kilogram intravenously, was given to 20 patients with left ventricular failure after acute myocardial infarction. Within five to 15 minutes, average left ventricular filling pressure fell from 20.4 to 14.8 mm Hg, accompanied by a 52 per cent increase in mean calf venous capacitance. During the same period there was no physiologically important change in either urine output or heart rate, blood pressure and cardiac output. Peak increase in urine flow (from mean of 0.82 to 4.0 ml per minute) occurred at 30 minutes, and peak natriuretic effect at 60 minutes. Thus, the action of furosemide in the treatment of pulmonary congestion is immediate and is not related to its diuretic properties. Rather, the prompt fall in left ventricular filling pressure probably is primarily vascular in origin, since marked changes in venous capacitance accompany this phenomenon, which is only later supplemented by the increase in urine output and electrolyte excretion. (N Engl J Med 288:1087...
TL;DR: It is useful to assess the expected sodium decrease for a given glucose level, because deviations from such a predicted value establish the diagnosis of hyponatremia or hypernatremia that may require therapy in addition to correction of the hyperglycemia.
Abstract: FOR at least 1/4 century clinicians have recognized that hyperglycemia depresses serum sodium concentration.1 Since glucose is largely restricted to extracellular fluid, an increase in its concentration moves water out of cells, causing dilution of extracellular solute. It is useful to assess the expected sodium decrease for a given glucose level, because deviations from such a predicted value establish the diagnosis of hyponatremia or hypernatremia that may require therapy in addition to correction of the hyperglycemia. Most clinicians use the rule of thumb that there is a 2.8 mEq per liter decrease in serum sodium for every 100 mg per . . .
TL;DR: After careful consideration of each of these 43 infants, parents and physicians in a group decision concluded that prognosis for meaningful life was extremely poor or hopeless, and therefore rejected further treatment.
Abstract: Of 299 consecutive deaths occurring in a special-care nursery, 43 (14 per cent) were related to withholding treatment. In this group were 15 with multiple anomalies, eight with trisomy, eight with cardiopulmonary disease, seven with meningomyelocele, three with other central-nervous-system disorders, and two with short-bowel syndrome. After careful consideration of each of these 43 infants, parents and physicians in a group decision concluded that prognosis for meaningful life was extremely poor or hopeless, and therefore rejected further treatment. The awesome finality of these decisions, combined with a potential for error in prognosis, made the choice agonizing for families and health professionals. Nevertheless, the issue has to be faced, for not to decide is an arbitrary and potentially devastating decision of default.(N Engl J Med 289:890–894, 1973)
TL;DR: Reintroduction of a therapeutic dose of salicylazosulfapyridine was achieved by an initially small dose, which was then gradually increased, and this method could be continued in 26 out of 28 patients who exhibited side effects.
Abstract: Most of the toxic symptoms ascribed to salicylazosulfapyridine can be related to high serum concentrations of total sulfapyridine (>50 μg per milliliter). No such correlation is observed with serum concentrations of salicylazosulfapyridine, sulfapyridine metabolites or the other metabolite of salicylazosulfapyridine, 5-aminosalicylic acid. The majority of 28 patients with side effects were taking 4 g or more of salicylazosulfapyridine per day, and most of them were slow acetylator phenotypes. The sulfapyridine-related toxic symptoms can be overcome if salicylazosulfapyridine is stopped temporarily or reduced in dosage. By this method, the therapy could be continued in 26 out of 28 patients who exhibited side effects. A decrease in serum total sulfapyridine concentration coincided with the improvement of the symptoms. Reintroduction of a therapeutic dose of salicylazosulfapyridine was achieved by an initially small dose, which was then gradually increased. Regular blood examination in patients dur...
TL;DR: A follow-up study of 449 patients with Crohn's enteritis, enterocolitis or colitis showed the incidence of colonorectal cancer to be 20 times greater in these cases than in a control population.
Abstract: A follow-up study of 449 patients with Crohn's enteritis, enterocolitis or colitis showed the incidence of colonorectal cancer to be 20 times greater in these cases than in a control population. Life-table methods were used for analysis, and complete follow-up observation was achieved in 442 (98.4 per cent) of the patients. (N Engl J Med 289:1099–1103, 1973)
TL;DR: Two sisters at risk for hereditary medullary carcinoma and having small but progressive increases of serum calcitonin in response to calcium infusion underwent thyroidectomy and showed signs of following thyroidectomy protocol.
Abstract: Two sisters at risk for hereditary medullary carcinoma and having small but progressive increases of serum calcitonin in response to calcium infusion underwent thyroidectomy. The thyroid glands were studied for C-cell distribution. Middle and upper portions of the lateral thyroid lobes showed marked increases and clustering of calcitonin-containing cells in comparison with normal thyroid glands. Elevated calcitonin content (670 to 4100 Medical Research Council mU per gram), as compared to similar regions in normal thyroid tissue (<0.6 to 50.0 Medical Research Council mU per gram), correlated precisely with the cytologic localization. Histologic characteristics of the cells had the appearance of a preinvasive hyperplastic process. A third case from another kindred was studied with similar findings. C-cells thus appear to be distributed inhomogeneously in normal human thyroid tissue; an early change in persons destined to development of hereditary tumors of these cells is a multicentric, but anatom...
TL;DR: One patient judged clinically and biochemically to have ovarian failure regained normal ovarian function 10 months after cessation of cyclophosphamide therapy.
Abstract: Twenty-two women receiving cyclophosphamide for either progressive glomerulonephritis (20) or rheumatoid arthritis (two) were studied to define more closely the nature of menstrual abnormalities known to occur with this drug. The patients were studied by assay of urinary estrogens and total gonadotrophins and, when possible, by ovarian biopsy. Seventeen patients had definite or probable ovarian failure after cyclophosphamide. No patient on whom ovarian biopsy was performed showed normal follicular maturation, and ova were seen in only two. One patient judged clinically and biochemically to have ovarian failure regained normal ovarian function 10 months after cessation of cyclophosphamide therapy. (N Engl J Med 289:1159–1162, 1973)
TL;DR: Analysis of indexes of renal function suggested more rapid recovery from acute renal failure in patients treated with renal-failure fluid, and survival differences were more apparent in higher-risk patients.
Abstract: The effect of intravenous essential l-amino acids and hypertonic glucose ("renal-failure fluid") in the treatment of acute renal failure was evaluated in a prospective, double-blind clinical trial. The population of 53 adult patients had sustained a presumable renal insult within 10 days before inclusion in the study. The control group was treated with glucose alone. The two groups were adequately randomized for age, renal diagnosis and renal dysfunction at the time of the study. Twenty-one of 28 patients receiving renal-failure fluid, as compared with 11 of 25 given glucose alone, recovered from these episodes of acute renal failure (p = 0.02). These survival differences were more apparent in higher-risk patients, including those with oliguric acute renal failure, requiring dialysis, and those in whom pneumonia, generalized sepsis or major gastrointestinal hemorrhage developed. Analysis of indexes of renal function suggested more rapid recovery from acute renal failure in patients treated with r...
TL;DR: Requirements of vitamin D2, vitamin D3, 25-hydroxyv Vitamin D3 and 1α,25-dihydroxyvitamin D3 were studied in five patients with vitamin-D-dependent rickets, a recessively inherited form of v...
Abstract: Requirements of vitamin D2, vitamin D3, 25-hydroxyvitamin D3 and 1α,25-dihydroxyvitamin D3 were studied in five patients with vitamin-D-dependent rickets, a recessively inherited form of v...
TL;DR: Clinically important bleeding was not increased in heparin-treated surgical patients, though the blood requirement of transfused thromboplastin time was moderately increased for five hours after subcutaneous Heparin injections.
Abstract: The effect of 5000 U of heparin given subcutaneously three times daily on the frequency of venous thrombosis detected by 125-I-fibrinogen scanning was evaluated in a prospective randomized study of 350 high-risk surgical and medical patients. Heparin treatment reduced the rate of venous thrombosis from 19 of 118 patients (16.1 per cent) to two of 108 (1.9 per cent) treated after elective surgery, from 11 of 23 untreated (48 per cent) to three of 23 (13 per cent) treated after hip fracture, and from nine of 40 (22.5 per cent) to one of 38 (2.6 per cent) treated patients admitted to the hospital for suspected myocardial infarction. Thrombosis occurred in 21.5 per cent of the total of 181 untreated and in 3.6 per cent of 169 heparin-treated patients. The activated partial thromboplastin time was moderately increased for five hours after subcutaneous heparin injections. Clinically important bleeding was not increased in heparin-treated surgical patients, though the blood requirement of transfused pat...
TL;DR: A prospective study of pregnant women revealed cytomegalovirus excretion from urine or cervix in 12 per cent of women, indicating increasing rate of infection with advancing gestation, stable antibody titers and so on.
Abstract: A prospective study of pregnant women revealed cytomegalovirus excretion from urine or cervix in 12 per cent. Increasing rate of infection with advancing gestation, stable antibody titers and absence of viremia suggested localized infection. Infection present at birth was not documented in any infants, but 40 per cent born to mothers excreting cytomegalovirus in cervical secretions near delivery ultimately became infected. The constancy of the intervals from birth to onset of virus excretion and the lack of evidence for postnatal transmission suggest that infection was acquired at delivery. Acquisition and initial replication of virus occurred despite appreciable levels of maternal antibody. The subsequent rise in antibody titers documents recent infection, but in spite of continued antibody production, chronic viral excretion in throat and urine was observed. These data indicate that most infants infected with cytomegalovirus in the perinatal period are asymptomatic, and continuing infection occ...
TL;DR: Observations suggest that the neurotoxicity associated with intrathecal methotrexate may be associated with prophylaxis or treatment of meningeal leukemia.
Abstract: Cerebrospinal-fluid methotrexate concentration was measured in 25 patients receiving intrathecal therapy for prophylaxis or treatment of meningeal leukemia. In 20 patients with no manifestations of neurotoxicity, the mean antifolate value in the cerebrospinal fluid was 1.7 X 10–7 M two days after administration of 12 to 15 mg per square meter of intrathecal methotrexate, and declined thereafter with a half-life of 12 to 18 hours. Five patients with severe neurotoxicity had cerebrospinal-fluid methotrexate concentrations averaging 13.8 times higher than the mean, and these concentrations were consistently higher than the range of antifolate values in the asymptomatic patients. One patient with values 20 to 100 times greater than the mean in asymptomatic patients sustained a fatal myelopathy, and in another, with an apparent antifolate half-life of 48 hours, irreversible neurologic sequelae developed. These observations suggest that the neurotoxicity associated with intrathecal methotrexate may be ...
TL;DR: By evaluation of the diagnostic, therapeutic, and follow-up processes of the set of tracers and the outcome of treatment, it is possible to assess the quality of routine care provided in a health-care system.
Abstract: A set of specific health problems — called tracers — were selected by a set of criteria. The tracers include otitis media and associated hearing loss, visual disorders, iron-deficiency ane...
TL;DR: It is firmly established that androgens stimulate erythropoiesis, and the role of sex hormones on the red cell, hemoglobin and hematocrit is explored.
Abstract: SINCE early investigations exploring the role of sex hormones on the red cell, hemoglobin and hematocrit,1 , 2 numerous reports have now firmly established that androgens stimulate erythropoiesis. ...
TL;DR: In this article, the effect of intravenous administration of glucocerebrosidase isolated from human placenta was investigated in two patients with Gaucher's disease who are deficient in this enzyme.
Abstract: The effect of intravenous administration of glucocerebrosidase isolated from human placenta was investigated in two patients with Gaucher's disease who are deficient in this enzyme. The first received one injection of 1.5 x 106 units of glucocerebrosidase, and the second an injection of 1.65 x 106 units on two successive days. Liver biopsies were obtained before and 24 hours after injection of enzyme. Glucocerebroside in the liver of the first patient decreased from 702 to 519 μg per gram wet weight and from 1634 to 1214 μg per gram in the second after infusion of glucocerebrosidase. The quantity of glucocerebroside in erythrocytes of the two patients before infusion was 7.4 and 6.2 μg per milliliter of cells respectively and 2.9 and 2.6 μg per milliliter of cells 72 hours afterward. These findings indicate that exogenous glucocerebrosidase causes definite decreases in the quantity of accumulated lipid in patients with Gaucher's disease. (N Engl J Med 291:989–993, 1974)