JAMA

Moersch, Herman J.

doi: 10.1001/jama.1952.02930170001001pmid: 14917531

The expectoration of blood is always an alarming experience for the patient and a matter of grave concern to the attending physician, because it may be the warning of serious disease. There is probably no symptom other than severe and acute pain that will stimulate a patient to seek medical aid as promptly as loss of blood for the first time from an unexplained source. When such bleeding occurs from the respiratory tract, the possibility of its being due to pulmonary tuberculosis or carcinoma of the lung is promptly suggested. It is unfortunate, indeed, that the severity of the bleeding is no guide as to the presence or absence of these diseases. It is imperative, therefore, that the patient with a history of hemoptysis have the benefit of thorough investigation to determine the cause of the bleeding. It is essential first to determine that the bleeding does not originate from

Binkley, George E.; Sunderland, Douglas A.; Miller, Charles J.; Stearns, Maus; Deddish, Michael R.

doi: 10.1001/jama.1952.02930170005002pmid: 14917532

One of the more difficult problems facing proctologists, abdominal surgeons, and pathologists is the question of proper treatment for adenomas in which carcinomas have arisen that have not yet invaded the muscular bowel wall. The decision must be made as to whether it is safe to treat these lesions by local removal or whether a radical resection should be performed immediately. In this paper, we hope to settle this problem at least partially. In 1948, Scarborough and Klein1 reported a study of 458 patients with polypoid disease of the colon and rectum. In this series there were six pedunculate adenomas of the colon for which bowel resection had been performed and in which areas of invasive carcinoma were found. Although there was no invasion of the pedicle in any case, there were regional lymph node metastases in three of the operative specimens. This report raised the question as to

Emmett, John L.; Alverez-Ierena, J. Jose; McDonald, John R.

doi: 10.1001/jama.1952.02930170010003pmid: 14917533

There has been much discussion in the urological and pathological literature regarding the unilateral, abnormally small kidney. Many confusing terms have arisen to describe it, such as atrophic kidney, contracted kidney, atrophic pyelonephritis, congenital hypoplasia, infantile kidney, aplastic kidney, and agenesia. Some statements in the literature tend to leave one with the impression that these various terms describe separate clinical and pathological entities that may be distinguished easily clinically, urographically, or by gross or microscopic examination. The two descriptive terms that have become most widely used are "chronic atrophic pyelonephritis" and "congenital hypoplasia." Contrary to general opinion, it has been our impression that it is usually difficult, if not impossible, to distinguish these two entities, if in reality two such separate entities actually exist. A cursory review of the literature will reveal the great confusion that exists on this subject. Most standard American textbooks on urology base their classification and

Kobak, Alfred J.; Fields, Charles; Fitzgerald, James E.

doi: 10.1001/jama.1952.02930170018004pmid: 14917534

The low cervical cesarian section may be safely employed in the presence of sepsis. This statement is supported by 140 consecutive transperitoneal cesarian sections without a fatality in patients who were either potentially or actually infected. This has been accomplished by the addition of modern chemotherapy. TRANSPERITONEAL CESARIAN SECTION VERSUS EXTRAPERITONEAL CESARIAN SECTION Prior to the advent of modern antibacterial therapy a succession of cesarian section techniques was developed. Each supplanted the previous ones, and all made claims of superiority in minimizing postoperative sepsis. The cesarian hysterectomy, for purposes of preventing or controlling postoperative sepsis, has lost most of its adherents. A substantial number of physicians still prefer the extraperitoneal cesarian techniques when infection threatens or is actually present. Almost simultaneous with the current revival of the extraperitoneal operations came the availability of effective chemotherapy. Sulfonamides and penicillin and other more recent antibiotics were found to be highly efficient, when

Hansen, Arild E.

doi: 10.1001/jama.1952.02930170021005pmid: 14917535

The fundamental cause of rheumatic fever remains obscure; nevertheless, progress is being made in conquering this disease, a leading killer of school age children and a leading cause of cardiac crippling in youth and young adults. The significant observation1 that active rheumatic involvement may be "nipped in the bud" by the early administration of corticotropin (ACTH) or cortisone places even greater responsibility on the practicing physician. Practically all children acutely ill with rheumatic fever are first seen in the home or the office; hence the path is clear—every physician who sees children in his everyday practice must be thoroughly familiar with all clinical aspects of acute rheumatic fever and must be constantly on the alert for its occurrence. MANIFESTATIONS The first objective is to become increasingly familiar with the early manifestations of the disorder. Few diseases approach rheumatic fever with respect to variety as well as variability in intensity

Miller, Joseph M.; Long, Perrin H.; Stafford, Edward S.

doi: 10.1001/jama.1952.02930170025006pmid: 14917536

Streptokinase and streptodornase are useful topical adjuncts in the surgical treatment of certain acute and chronic diseases. The properties of these compounds and the results of treatment have been reported in detail elsewhere.1 Streptokinase is a catalytic agent acting on a fibrin-lysing system present in the euglobulin fraction of human blood. The agent activates the fibrin-lysing system, which causes liquefaction of fibrin. Streptokinase also inhibits the change of fibrinogen to fibrin. Tests of streptokinase for protein give positive results. The substance is rendered inert by trypsin and activated papain, does not act upon casein, peptone, or gelatin, and can be isolated from the dissolved fibrin clot after completion of liquefaction. Streptokinase is antigenic, and an antikinase may develop in human beings as the result of antecedent hemolytic streptococcic infection or prolonged treatment with streptokinase. Streptodornase is an enzyme having the capacity to hydrolyze desoxyribose nucleoprotein. Kunitz2 has described

Gray, Seymour J.; Reifenstein, Robert W.; Benson, John A.; Young, J. C. Gordon

doi: 10.1001/jama.1952.02930170029007pmid: 14917537

The purpose of this communication is to report our experiences over a period of 2 years with the use of corticotropin (ACTH) and cortisone in a selected group of patients with ulcerative colitis. Studies were directed to determine the effectiveness of hormone therapy in inducing a remission in the disease. The possibility of sustaining the remission by long-term maintenance therapy and repeated courses of hormone treatment was investigated. Corticotropin therapy was begun in the first patient of this series (O. D.) on Oct. 2, 1949. The use of corticotropin in ulcerative colitis is predicated on its effectiveness in reducing the extensive inflammatory tissue reaction that characterizes the disease and in diminishing the systemic and toxic manifestations of infection. Hormonal inhibition of fibroblastic proliferation with the possible prevention of fibrosis and stricture formation were additional indications. The dramatic increase in appetite and sense of well-being, which often characterize the administration of

Bader, Mortimer; Bader, Richard; Friedberg, Charles K.

doi: 10.1001/jama.1952.62930170001008pmid: 14917538

The recovery rate of patients with subacute bacterial endocarditis has increased progressively, but death from incomplete eradication of the infection or from complications of the disease still occurs in 20% to 30% of the patients.1 It seems appropriate, therefore, that in every fatal case a careful scrutiny be made into the possible causes of failure, in the hope that the knowledge thus obtained may further improve the effectiveness of treatment. The accompanying report deals with a patient who was admitted four times to the hospital for the treatment of the original episode of subacute bacterial endocarditis and, subsequently, for relapses following apparently adequate courses of treatment. An analysis was made to determine why this patient died despite the use of various antibiotics, singly and in combination, and despite large doses of those antibiotics, apparently adequate according to careful bacteriologic and sensitivity studies. REPORT OF A CASE A 56-year-old man

Downing, John Godwin

doi: 10.1001/jama.1952.62930170004008apmid: 14917539

A 71-year-old man, who has been a barber for 40 years, stopped work in August, 1950, because of dermatitis of the right hand. While he was cutting hair, short bristles would frequently irritate the second interspace of his right hand. Gradually, a rash appeared at this area and spread over the hand and forearm. Examination on Sept. 25, 1950, showed marked erythema, edema, and vesiculation of the fingers of both hands. The patient said he had had no eruption elsewhere. This dermatitis responded to soothing treatment in three weeks. The patient then admitted having an ulcer on his right ankle, which had not responded to treatment by a vascular surgeon, and he requested therapy. The ulcer healed on Nov. 7. His right hand had remained well; however, a small, red, pouting sinus was seen at the right second interspace. Protruding from this sinus was a small hair; in fact, the

Laszlo, Daniel; Schilling, Albert; Bellin, Judith; Gottesman, Estelle D.; Schulman, Cyril A.

doi: 10.1001/jama.1952.62930170005009pmid: 14917540

In the past decade, hormonal therapy has been advocated in the palliative management of patients with metastatic breast carcinoma1; reports of temporary palliation have been published from many centers,2 and a wide discrepancy between the incidence of subjective and objective improvement has been noted. In a preceding paper,3a it was pointed out that metabolic studies are an important aid in defining the course of malignant disease, in gaging the effect of therapeutic agents, and in studying their mode of action. The mineral metabolism of patients with active osteolysis has been characterized by elevated urinary calcium and phosphorus excretions and negative balances.3 At times, excessive rates of demineralization exceed the ability of the kidneys to excrete calcium, resulting in hypercalcemia.3a Conversely, patients with osteoblastic metastases have characteristically subnormal urinary calcium excretion and a tendency to maximal calcium retention.4 On occasion, patients with osteolytic metastases may spontaneously