摘要:

The current level of the gonorrhea epidemic supports the need for additional measures for gonorrhea control. In the absence of evidence that prophylactic availability enhances promiscuity, a strong case can be made for venereal disease prophylaxis. This paper reviews the efficacy and acceptability of prophylactic techniques. In the military, acceptability and efficacy have been demonstrated for systemic antibiotics, and probably a postcoital prophylactic kit. These measures are either inappropriate or unavailable for general civilian use. The condom and vaginal spermicides offer promise of partial protection; further studies of efficacy and utilization are needed.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Six patients with symptomatic osseous Paget's disease were treated with a four-day course of mithramycin (25µg/kg/day). The effects of treatment on the plasma calcium, phosphorus, parathyroid hormone, and the urinary fractional clearance of calcium and phosphorus were studied. Mithramycin produced significant hypocalcemia and hypophosphatemia, and also significantly and simultaneously increased the plasma parathyroid hormone concentration. Despite the increase in parathyroid hormone, the hypocalcemia persisted because of the probable blocking effect which mithramycin exerted on the osteoclasts. The physiological response of the kidney to the elevated plasma parathyroid hormone appeared to be well preserved, as evidenced by the decreased fractional excretion of calcium and the increased fractional excretion of phosphorus in the urine; however, the fall in the clearance of calcium could be the result of the decreased filtered load.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

This report describes three patients with a prolonged bleeding time and reduced platelet retention on glass beads, two of the three established criteria for conventional von Willebrand's disease (vWd). However, the third standard, the diminution of factor VIII, was replaced by a decrease of factor IX or XI in the first two instances, respectively, and combined factor VIII and IX deficiency was present in the last patient. These associations suggest that the vW (bleeding time/platelet retention) factor is not necessarily homogeneous, may not be dependent on a single genetic determinant, and may be present in a molecular complex composed not only of factor VIII but of other blood clotting proteins as well. Although simulating classic vW, these homologues may more appropriately be called von Willebrand syndromes. Finally, unusual as they may be, their clinical recognition is important to insure that such patients receive not only factor VIII concentrates in treatment since these materials do not contain factors IX and XI and may not even be a suitable source of platelet retention factor under these modified circumstances.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The site and rate of entry of insulin into the body may affect its metabolic actions. This study tested for the first time in man the hypothesis that the mode of action of endogenous insulin differs from peripherally injected insulin. In 11 nondiabetic and six diabetic patients we compared the effects on peripheral glucose utilization (PGU) and degree of hypoglycemia of the following: (1) glucagon-free insulin rapidly injected and slowly infused into the portal circulation via percutaneous splenic puncture; (2) peripheral intravenous insulin; (3) peripheral intravenous sodium tolbutamide. The arteriovenous glucose difference (A-V) and (A-V)/A ratios were calculated as parameters for measuring PGU. In nondiabetics our experiments showed: (1) similar magnitudes of hypoglycemia for insulin given by both routes, and (2) a significantly smaller (A-V)/A and therefore PGU, after the intraportal route, particularly after a slow infusion. Intravenous tolbutamide produced marked hypoglycemia and a small PGU comparable to that of slow intraportal infusion of insulin. In diabetics, results were similar. These findings suggest that, compared to the action of peripherally administered insulin, intraportally injected exogenous insulin or tolbutamideinduced endogenous insulin has a greater hepatic and a lesser peripheral effect on glucose metabolism.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Radioimmunoassay determinations of calcitonin from blood samples obtained by selective venous catheterization have demonstrated a large peripheral to thyroid vein gradient for this hormone in both normocalcemic and hypercalcemic persons. These findings indicate that in fasting humans the thyroid gland maintains peripheral levels of calcitonin by actively secreting the hormone, and are consistent with the suggestion that the role of plasma calcitonin is of physiologic significance.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

In light of new techniques for measuring circulating thyroid hormones and for studying the thyroid gland, we present our experience with 35 patients with solitary autonomous nodules of the thyroid to define more precisely the clinical course of patients with this disorder. The patients ranged in age from 19 to 80 years and 31 of the 35 were female. Younger patients were generally euthyroid and sought attention because of a thyroid mass; virtually all older patients were hyperthyroid. Eighteen had obvious clinical features of hyperthyroidism and 5 over age 70 had apathetic hyperthyroidism; all 5 of the elderly and 13 of the 18 under age 70 had elevated thyroxine (T4) and triiodothyronine (T3) levels. Isolated elevation of T3and elevated basal metabolic rate were observed in 5 previously untreated clinically hyperthyroid young patients. In each of these, thyroid uptake of131I was not suppressible with exogenous T3and BMR was elevated in those tested. Two elderly patients, who had previously been treated for conventional hyperthyroidism with radioactive iodine, had T3toxicosis when hyperthyroidism recurred. There was a strong positive correlation between the age of the patient, the size of the nodule and the thyroid functional state. The mean area of the nodules projected on131I rectilinear scan for euthyroid patients was 5.1 cm2. The mean area of the nodules in hyperthyroid subjects was significantly higher, 13.4 cm2in patients with T3toxicosis and 19.3 cm2in subjects with conventional hyperthyroidism. Progression from a euthyroid state to hyperthyroidism was observed in four patients. One of these became thyrotoxic within days after an injection of iodinated contrast medium. Spontaneous resolution of nodules occurred in two patients.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The clinical and hematological features of 100 patients with sickle cell anemia are reviewed. The heart was enlarged and a murmur was heard in nearly 80 per cent of patients. Pneumonia and pulmonary infarction occurred in 43 per cent and 12 per cent of patients, respectively. Musculoskeletal involvement included the hand-foot syndrome (15 per cent), leg ulcers (55 per cent), aseptic necrosis of bone (11 per cent), and osteomyelitis (4 per cent). Symptoms and signs related to the gastrointestinal system included jaundice (55 per cent), hepatomegaly (50 per cent), splenomegaly (23 per cent), hepatitis (11 per cent) and gallstones (9 per cent). Three patients underwent cholecystectomy and three patients had their spleens removed. Pyelonephritis occurred in 17 patients, priapism in five and hematuria in seven. Nineteen women had 39 pregnancies, of which 35 resulted in the birth of healthy infants. At least 328 painful crises occurred in 73 patients. There were also 13 hemolytic crises, eight sequestration crises, and five aplastic crises. A trial of alkali therapy in 33 crises in children failed to produce beneficial effects greater than hydration and analgesics alone as used in the control group. Laboratory findings in the 100 patients were comparable to those previously reported in the literature. The renal concentrating defect in most patients was confirmed. There were six deaths: hepatic coma secondary to post-transfusion hepatitis, thrombosis of inferior vena cava, congestive heart failure, exsanguination from erosion of the pancreaticoduodenal artery, extensive bronchopneumonia, and pulmonary infarction.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The effects of self-monitoring of blood pressure on the control of hypertension were examined in this study. Failure of patients to comply with treatment is presumably attributable in part to the fact that hypertension usually is asymptomatic until complications develop. Self-monitoring might make visible an otherwise asymptomatic condition, and thereby increase motivation. One hundred hypertensive patients beginning outpatient treatment were randomly assigned to experimental and control groups. Subjects were given a sphygmomanometer and instructed in its use. Both groups were given similar antihypertensive medications. After six months of treatment, mean systolic pressure was significantly lower (11.4 mm Hg, p<0.05) in the experimental than in the control subjects. However, the mean baseline systolic pressure in the control group was 3.9 mm Hg less than that of the experimental group. If this value is subtracted from the difference between the last mean systolic pressures in the two groups, the 7.5 mm Hg difference is seen as a very modest effect of self-monitoring. Diastolic blood pressure was insignificantly lower for experimental subjects. Compared to the potent effectiveness of drugs in reducing blood pressure, self-monitoring was of little value.

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:1975

数据来源: OVID