Showing papers in "The New England Journal of Medicine in 1974"
TL;DR: The survival experience of 39 patients receiving long-term regular hemodialysis in Seattle since 1960 was studied with particular reference to mortality and morbidity from arteriosclerotic...
Abstract: The survival experience of 39 patients receiving long-term regular hemodialysis in Seattle since 1960 was studied with particular reference to mortality and morbidity from arteriosclerotic cardiovascular complications. Mean age (± 1 S.D.) was 37.0 ± 9.5 years for the group at the start of dialysis. Mean duration of treatment was 6.5 years (range, one to 13). Overall mortality was 56.4 per cent at the end of the 13-year follow-up period, and 14 of 23 deaths could be attributed to arteriosclerotic complications: myocardial infarction was responsible for eight, strokes for three, and refractory congestive heart failure for three deaths. The incidence of these complications was many times higher than for normal and hypertensive groups of comparable age, and similar to rates found in Type 2 hyperlipoproteinemia. These results indicate that accelerated atherosclerosis is a major risk to long-term survivors on maintenance hemodialysis. (N Engl J Med 290:697–701, 1974)
1,748 citations
TL;DR: Oral administration of a photoactive drug, 8-methoxypsoralen (methoxsalen), followed by exposure to a high-intensity, longwave ultraviolet-light system resulted in complete clearing of generalized psoriasis in 21 patients.
Abstract: Oral administration of a photoactive drug, 8-methoxypsoralen (methoxsalen), followed by exposure to a high-intensity, longwave ultraviolet-light system resulted in complete clearing of generalized psoriasis in 21 patients. In 16 of these cases, a paired comparison showed methoxsalen followed by longwave ultraviolet light to be more effective than conventional ultraviolet light. 8-Methoxypsoralen followed by exposure to longwave ultraviolet light has previously been shown to inhibit epidermal DNA synthesis; this may be its mechanism of action in psoriasis, a disorder characterized by an accelerated cell cycle and rate of DNA synthesis. The term photochemotherapy is used to emphasize the point that the effect on epidermal proliferation and the therapeutic response require the interaction of light and drug. (N Engl J Med 291:1207–1211, 1974)
1,245 citations
TL;DR: Measurements of serum ferritin were correlated with other hematologic laboratory indexes in 250 hospitalized subjects with anemia or disorders in iron metabolism.
Abstract: Measurements of serum ferritin were correlated with other hematologic laboratory indexes in 250 hospitalized subjects with anemia or disorders in iron metabolism. A geometric mean value of 4 ng per milliliter was found in 32 patients with uncomplicated iron-deficiency anemia, and one of 2930 ng per milliliter in 23 with iron overload. Among subjects with anemia from causes otherthan iron deficiency, the mean serum ferritin level was increased to 180 ng per milliliter (geometric mean in normal controls, 59 ng per milliliter, with a 95 per cent confidence range of 12 to 300 ng per milliliter), presumably reflecting the transport of red-cell iron to stores. The wide range of values found was shown to be related primarily to the magnitude of body iron stores in each case as evaluated by bone-marrow hemosiderin. In addition, however, inflammation, liver disease and increased red-cell turnover were shown to elevate the serum ferritin concentration to a degree disproportionate to that of iron stores. (N...
921 citations
TL;DR: It is postulated that this respiratory bronchiolitis observed in the lungs of young smokers is a precursor of centriacinar emphysema and may be responsible for the subtle functional abnormalities observed in young smokers.
Abstract: The lungs of young smokers and controls of comparable age from a population of sudden non-hospital deaths were systematically studied to determine the relation between cigarette smoking and pathologic changes in peripheral airways. The characteristic lesion observed was a respiratory bronchiolitis associated with clusters of pigmented alveolar macrophages and was present in the lungs of all smokers studied but rarely seen in nonsmokers (p<0.002). The lungs of smokers also showed small but significant increases in mural inflammatory cells and denuded epithelium in the membranous bronchioles as compared to controls (p<0.05). We postulate that this respiratory bronchiolitis is a precursor of centriacinar emphysema and may be responsible for the subtle functional abnormalities observed in young smokers. (N Engl J Med 291: 755–758, 1974)
914 citations
TL;DR: The data suggest that heightened platelet function is associated with the thrombotic complications and accelerated atherogenesis of Type II hyperlipoproteinemia.
Abstract: Platelet function was studied in 17 patients with Type II hyperlipoproteinemia. As compared with 26 normal subjects, platelets from patients with the Type II syndrome aggregated in response to 1/25 the mean concentration of epinephrine, one third the concentration of collagen, and one third the concentration of ADP. Total nucleotide release was increased from four to six fold with all aggregating agents. However, release of platelet factors 3 and 4, platelet adhesiveness and clot retraction were all normal in patients with Type II hyperlipoproteinemia. In contrast, platelets from 11 patients with Type IV hyperlipoproteinemia showed normal sensitivity to ADP and collagen, normal nucleotide release and normal release of 14C serotonin. The data suggest that heightened platelet function is associated with the thrombotic complications and accelerated atherogenesis of Type II hyperlipoproteinemia. (N Engl J Med 290:434–438, 1974)
658 citations
TL;DR: Total parenteral nutrition can be employed with an acceptable risk, provided catheter care is according to protocol, and catheters used with strict aseptic technic were complicated by a sepsis rate of 3 per cent as compared to one of 20 per cent when breaks in the protocol were observed.
Abstract: The complications related to central venous catheters for total parenteral nutrition were prospectively evaluated in 200 patients. Catheter sepsis was defined as an episode of sepsis, for which no anatomic locus could be identified, that resolved on removal of the catheter. The insertion of 355 catheters for 4492 days led to complications involving 4 per cent of the catheters and 6 per cent of the patients. Catheter sepsis was associated with 7 per cent of catheters and occurred in 11 per cent of patients. Eight cases of superior-vena-cava thrombosis and three of pulmonary embolism were found in 34 autopsied patients. Catheters used with strict aseptic technic were complicated by a sepsis rate of 3 per cent as compared to one of 20 per cent when breaks in the protocol were observed (p = 0.01). Thus, total parenteral nutrition can be employed with an acceptable risk, provided catheter care is according to protocol. (N Engl J Med 290:757–761, 1974)
651 citations
631 citations
TL;DR: It is suggested that osteolytic bone lesions and hypercalcemia in Myeloma are due to the secretion of a soluble factor by myeloma cells that in turn stimulates osteoclastic bone resorption in organ culture.
Abstract: In an effort to describe the mechanism of bone erosion in patients with multiple myeloma, supernatant fluids from the short-term cultures of bone marrow aspirated from seven patients with myeloma were examined. Six contained a factor that stimulated osteoclastic bone resorption (calcium release greater than controls) in organ culture. This factor was biologically and chemically similar to osteoclast-activating factor, a mediator produced by phytohemagglutinin-activated normal peripheral blood leukocytes. Cultures of bone-marrow cells obtained from seven other patients with a variety of hematologic disorders did not produce a stimulator of bone resorption. Morphologic examination of autopsy and biopsy samples of bone from 37 patients with myeloma showed osteoclasts on bone-resorbing surfaces adjacent to areas of heavy myeloma-cell infiltration. It is suggested that osteolytic bone lesions and hypercalcemia in myeloma are due to the secretion of a soluble factor by myeloma cells that in turn stimul...
630 citations
TL;DR: The findings suggest that acute pancreatitis associated with gallstone disease is frequently caused by transient blockage of the ampulla of Vater by migrating gallstones.
Abstract: Stools were screened for gallstones in 36 patients with acute pancreatitis associated with gallstones. These patients had typical clinical evidence of pancreatitis with transiently elevated serum amylase and bilirubin concentrations. Another 36 patients with gallstones but without acute pancreatitis served as controls. Gallstones were found in the feces of 34 out of 36 patients with pancreatitis, but in only three out of the 36 control cases. In the former group, the finding was usually preceded by a relief of the symptoms and a rapid decrease of serum amylase and bilirubin concentrations. The calculi found in the stools and those found in the biliary tracts of the patients at operation were identical as determined by gross inspection and chemical analysis. These findings suggest that acute pancreatitis associated with gallstone disease is frequently caused by transient blockage of the ampulla of Vater by migrating gallstones. (N Engl J Med 290:484–487, 1974)
575 citations
Journal Article•
567 citations
TL;DR: Treatment with spiramycin during pregnancy reduced the overall frequency of the fetal infections but not of overt disease, and Mothers with antibodies before they became pregnant had no infected infants.
Abstract: Of 378 pregnant women with high initial toxoplasma antibody titers or seroconversion during pregnancy, 183 acquired the infection during pregnancy, a rate of 6.3 per 100 pregnancies. There were 11 abortions; seven infants were stillborn or died. Toxoplasmosis occurred in 59 of the nonaborted offspring. Among these, two died, and seven had severe disease with cerebral and ocular involvement. Of the remaining 50, 11 had mild, and 39 had subclinical illness. Severe disease was noted only when maternal infections were acquired during the first two trimesters. Later acquisition resulted in subclinical or no fetal infections. Parasites were isolated from the placentas of 25 per cent of those who acquired toxoplasma during pregnancy. Treatment with spiramycin during pregnancy reduced the overall frequency of the fetal infections but not of overt disease. Mothers with antibodies before they became pregnant had no infected infants.
TL;DR: Strict adherence to aseptic care of closed sterile drainage systems can be expected to reduce rates of hospital-acquired, catheter-associated bacteriuria.
Abstract: Of 405 hospitalized patients with temporary closed sterile urinary-catheter drainage, 95 (23 per cent) acquired bacteriuria. The risk was significantly greater for patients who were female, elderly or critically ill (p<0.005 for each with appropriate comparison group). The patients who received systemic antimicrobial agents acquired bacteriuria less frequently than the patients who did not (16 versus 32 per cent —p<0.001). However, the apparent protective effect of antimicrobials occurred only during the first four days in which catheterization was in progress. Breaks in the closed drainage system or improper care of the drainage bag occurred frequently (121 of 405 systems studied) and predisposed to bacteriuria. Bacterial contamination of the drainage bag preceded onset of bacteriuria in 18 per cent of cases. Strict adherence to aseptic care of closed sterile drainage systems can be expected to reduce rates of hospital-acquired, catheter-associated bacteriuria. (N Engl J Med 291:215–219, 1974)
TL;DR: The demonstration of markedly deficient dihydrotestosterone formation in slices of perineal skin, epididymis and phallus, is compatible with the fact that dihydotestosterone is the fetal hormone responsible for male differentiation of the external genitalia, iscompatible with the idea that androgen resistance in this syndrome is different from that in other androgen-resistant states.
Abstract: Two 46 XY siblings with familial incomplete male pseudohermaphroditism, Type 2, inherited as an apparent autosomal recessive trait, were investigated. The phenotype was distinctive in that male wolffian-duct structures (epididymis, vas deferens and seminal vesicles) were present whereas tissues derived from the urogenital sinus and from the anlage of the external genitalia were female in character. Studies of estrogen and androgen dynamics revealed normal male blood testosterone and estrogen levels, production rates and interconversions. The normal blood luteinizing hormone level and normal estrogen production rate suggest that androgen resistance in this syndrome is different from that in other androgen-resistant states. The demonstration of markedly deficient dihydrotestosterone formation in slices of perineal skin, epididymis and phallus, considered with the fact that dihydrotestosterone is the fetal hormone responsible for male differentiation of the external genitalia, is compatible with the...
TL;DR: The leukocyte count may prove valuable in the routine assessment of risk of myocardial infarction and may account for about two thirds of the relation of the count toinfarction.
Abstract: The multiphasic-examination findings of 464 persons in whom a first myocardial infarction later developed were compared with those of two control groups, one matched for age, sex and race (ordinary controls), and the other matched in addition for standard coronary risk factors (risk controls). The total leukocyte count, measured, on the average, 16.8 months before the myocardial infarction, was strikingly related to development of infarction. The mean leukocyte count in cases was significantly higher (p<0.001) than in either control group. Ascending from lowest to highest quartile in the cases and ordinary controls the increase in risk of myocardial infarction associated with the leukocyte count was similar to that found for cholesterol and blood pressure. Cigarette smoking, which was strongly related to the leukocyte count, may account for about two thirds of the relation of the count to infarction. The leukocyte count may prove valuable in the routine assessment of risk of myocardial infarction...
TL;DR: Examination of 77 strains of Escherichia coli from the cerebrospinal fluid of neonates with meningitis revealed 65 (84 per cent) with the capsular (K1) polysaccharide.
Abstract: Examination of 77 strains of Escherichia coli from the cerebrospinal fluid of neonates with meningitis revealed 65 (84 per cent) with the capsular (K1) polysaccharide The Esch coli K1 ca
TL;DR: IndometHacin Indomethacin (Indocin), although very different chemically from phenylbutazone, shares much of its therapeutic spectrum and has proved at least in vitro to be a very potent anti-inflam...
Abstract: Indomethacin Indomethacin (Indocin), although very different chemically from phenylbutazone, shares much of its therapeutic spectrum. It has proved at least in vitro to be a very potent anti-inflam...
TL;DR: In all volunteers receiving 40 mg of prednisone or 1.2 g of aspirin, impaired adherence developed, suggesting that glucocorticoids and salicylates may affect adherence in vivo by inducing an inhibitor.
Abstract: A simple, rapid, in vitro assay was developed to study granulocyte adherence, an important component of the inflammatory reaction. Heparinized whole blood is filtered through nylon fiber packed in Pasteur pipettes, and the percentage of granulocytes adhering is calculated. Test variability from morning to evening, before and after meals, and on successive days is less than 10 per cent. In vitro exposure of whole blood to ethanol concentrations varying from 100 to 1000 mg per 100 ml caused a dose-dependent, significant inhibition of adherence (16–87 per cent, p<0.05), but incubation with sodium salicylate (5 to 50 mg per 100 ml) or hydrocortisone sodium succinate (500 to 3000 μg per 100 ml) had no effect. In all volunteers receiving 40 mg of prednisone or 1.2 g of aspirin, impaired adherence developed, suggesting that glucocorticoids and salicylates may affect adherence in vivo by inducing an inhibitor. The anti-inflammatory effect of salicylates, hydrocortisone and ethanol may be secondary to the...
TL;DR: It is indicated that systemic (adjuvant) chemotherapy delays relapse and may provide defiency to patients with osteogenic sarcoma with follow-up periods of two to 23 months.
Abstract: Twenty consecutive patients with osteogenic sarcoma without visible metastases received adjuvant chemotherapy starting three weeks after local treatment of the primary tumor with operation or radiation. Adjuvant chemotherapy consisted of intravenous vincristine followed in 30 minutes by a six-hour infusion of methotrexate. Two hours later citrovorum factor was administered every six hours for 12 doses. Such treatment courses were given at three-week intervals. Ninety-eight patients referred to this center between 1950 and June, 1972, served as controls. The incidence of pulmonary metastases was significantly reduced by adjuvant chemotherapy to two as opposed to the expected 12.2 cases. Nineteen of the 20 patients treated with the adjuvant chemotherapy are surviving with follow-up periods of two to 23 months. Only six of 212 courses of treatment were associated with myelosuppression or stomatitis. These observations indicate that systemic (adjuvant) chemotherapy delays relapse and may provide defi...
TL;DR: Initially rapid post-defibrillation heart rates and atrial fibrillation or sinus tachycardia were associated with good survival in contrast to slow rates and idioventricular or junctional rhythms.
Abstract: The subsequent course of 301 subjects with prehospital ventricular fibrillation detected by rescue units was analyzed. Defibrillation was successful in 199. Of these patients, 98 died before admission; of 101 who were hospitalized, 59 died in the hospital, and 42 were discharged alive. Initially rapid post-defibrillation heart rates and atrial fibrillation or sinus tachycardia were associated with good survival in contrast to slow rates and idioventricular or junctional rhythms. Among hospitalized patients ventricular fibrillation or ventricular tachycardia recurred in 57 per cent and in most within 24 hours. Acute myocardial infarction was diagnosed in 35 per cent, and ischemia alone (predominantly of the anterior wall) in 32 per cent. In 17 per cent no acute myocardial changes evolved. Congestive heart failure occurred in 63 per cent, cardiogenic shock in 25 per cent, and pulmonary complications in 42 per cent. Of the 42 who were discharged, 60 per cent returned to pre-arrest status; 28 per cen...
TL;DR: A randomized controlled trial was conducted to assess the effects of substituting nurse practitioners for physicians in primary-care practice, and the quality of care rendered seemed similar, as assessed by a quantitative "indicator-condition" approach.
Abstract: From July, 1971, to July, 1972, in a large suburban Ontario practice of two family physicians, a randomized controlled trial was conducted to assess the effects of substituting nurse pract...
TL;DR: Rhabdomyolysis with myoglobinuria from nontraumatic causes was the sole identifiable explanation for acute renal failure in 15 patients during a three-year period.
Abstract: Rhabdomyolysis with myoglobinuria from nontraumatic causes was the sole identifiable explanation for acute renal failure in 15 patients during a three-year period. Myoglobinuria resulted from myopathies, seizures, prolonged coma, strenuous exercise and viral illness. It was invariably accompanied by a triad of orthotolidin-positive urine, pigmented granular casts in the sediment, and marked elevation of serum creatine phosphokinase levels. In addition, myoglobinuric acute renal failure was often accompanied by an unusually rapid increase in serum levels of creatinine, potassium and inorganic phosphate. Six patients had hypocalcemia (levels of ≤ 7 mg/100 ml) early in the course of acute renal failure; in three of these hypercalcemia developed in the diuretic phase. This hypercalcemia may be unique for myoglobinuric acute renal failure, perhaps as a result of deposition and resorption of calcium phosphate salts in tissues. Nontraumatic myoglobinuria with acute renal failure is a relatively common d...
TL;DR: The broad concept of "carcinomatous neuromyopathy" is frequently invoked to explain obscure neurologic symptoms in patients with cancer, but it is also important to realize that neurologic dysfunction may be iatrogenic — i.e., caused by the treatment of cancer.
Abstract: THE incidence of neurologic disorders has been steadily increasing in several neoplastic diseases as recent advances in therapy have lengthened patient survival.1 2 3 The neurologic complications of cancer most frequently result from metastasis to the nervous system or compression of neural structures by extraneural tumor. In addition, an interesting group of nonmetastatic neuromuscular disorders has recently been described,4 , 5 and the broad concept of "carcinomatous neuromyopathy" is frequently invoked to explain obscure neurologic symptoms in patients with cancer.6 However, it is also important to realize that neurologic dysfunction may be iatrogenic — i.e., caused by the treatment of cancer. Radiation myelitis and . . .
TL;DR: A prospective study of 2750 employed men who completed a computer-scored test questionnaire measuring the coronary-prone Type A behavior pattern showed that high scorers had twice the incisive risk of heart attack as low scorers.
Abstract: Prospective study of 2750 employed men who completed a computer-scored test questionnaire measuring the coronary-prone Type A behavior pattern showed that high scorers had twice the incide...
TL;DR: Alterations in Cartilage in Osteoarthritis The morphologic changes in joints affected by osteoarth arthritis were identified in writings of the Hunter brothers over 200 years ago.
Abstract: Alterations in Cartilage in Osteoarthritis The morphologic changes in joints affected by osteoarthritis were identified in writings of the Hunter brothers over 200 years ago.88 Over the intervening...
TL;DR: The data suggest that chronic intensive use of marihuana may produce alterations in male reproductive physiology through central (hypothalamic or pituitary) action.
Abstract: Twenty heterosexual men 18 to 28 years of age who used marihuana at least four days a week for a minimum of six months without use of other drugs during that interval were studied. Mean (± S.E.M.) plasma testosterone — 416 ± 34 ng per 100 ml — was significantly lower in this group than that in the control-group mean — 742 ± 29 ng per 100 ml — for age-matched men who had never used marihuana. Decreased testosterone was dose related. Abstention from marihuana use and stimulation with human chorionic gonadotropin during continued marihuana use produced marked increases in testosterone. Measurements of liver function, circulating gonadotropins, prolactin, Cortisol and thyroxine were within normal limits. Six of 17 men (35 per cent) showed oligospermia, and two men were impotent. The data suggest that chronic intensive use of marihuana may produce alterations in male reproductive physiology through central (hypothalamic or pituitary) action. (N Engl J Med 290:872–874, 1974)
TL;DR: A four-month, double-blind, crossover study of 22 patients with familial Mediterranean fever was undertaken to study the effect of colchicine in decreasing acute attacks of that disease.
Abstract: A four-month, double-blind, crossover study of 22 patients with familial Mediterranean fever was undertaken to study the effect of colchicine in decreasing acute attacks of that disease. T...
TL;DR: Sodium nitroprusside infused in 18 patients with intractable heart failure produced a prompt reduction of left ventricular filling pressure and a rise in cardiac output, suggesting that intracted heart failure may be effectively treated by reduction in impedance toleft ventricular ejection.
Abstract: Sodium nitroprusside infused in 18 patients with intractable heart failure (nine with ischemic heart disease and nine with cardiomyopathy) produced a prompt reduction of left ventricular filling pressure (pulmonary wedge or left ventricular end-diastolic pressure) from an average of 32.2 to 17.2 mm Hg and a rise in cardiac output from an average of 2.98 to 5.2 liters per minute. Mean arterial pressure fell by 15 mm Hg, and heart rate was slightly but significantly slowed. Stroke volume and forward ejection fraction were nearly doubled. Responses were similar in ischemic heart disease and cardiomyopathy. A diuresis and natriuresis accompanied the infusion, and the clinical response was sustained in five patients in whom the drug was continued for 24 to 72 hours. These results suggest that intractable heart failure may be effectively treated by reduction in impedance to left ventricular ejection. (N Engl J Med 291:587–592, 1974)