JAMA

Twiss, J. Russell; Gillette, Lee

doi: 10.1001/jama.1959.03000290001001pmid: 13630749

Forty-six patients were selected for further study after routine cholecystography had failed to give satisfactory visualization of the gallbladder or bile ducts. When oral cholangiography was carried out in this group, there was visualization of the gallbladder or of the common bile duct with stones in 23 patients, visualization of the gallbladder without stones in 12, and no visualization in 11. Of these 11, 8 were operated on and were found to have obstructed cystic ducts. Three of these had acute cholecystitis, with gangrene in one. Nine patients were spared an operation when oral cholangiography demonstrated normal function and absence of stones in the gallbladder. Resort to oral cholangiography is therefore to be recommended when routine cholecystography fails to give decisive results, for it gives 65% additional visualization as compared to only 5 to 10% additional visualization with the double dose method.

Knights, Edwin M.; Brush, James S.; Schroeder, John

doi: 10.1001/jama.1959.03000290005002pmid: 13630750

A test paper has been devised for use in quick examination of large numbers of people to detect increased concentrations of chloride in the sweat. The paper is impregnated with silver chromate, which is red. Upon contact with a solution of sodium chloride the red color is replaced by the white color of silver chloride. The paper was found easy to prepare, store, and apply, and after use it could be kept with the records of the case. Used in 91 healthy subjects and 9 patients known to have cystic fibrosis of the pancreas, it gave 3+ reactions with all the latter group. False-positive results were obtained in some children with fever or under emotional stress. Relatively strong (2+) reactions were obtained in some parents of children with cystic fibrosis, which is known to be inheritable.

Woldman, Edward E.; Fishman, David; Segal, Abraham J.

doi: 10.1001/jama.1959.03000290007003pmid: 13630751

The possibility that fibrosis of the pancreas might be related in some way to disease of the liver was explored in a study of material from 1,000 consecutive autopsies. Among these, 778 were free from disease of the liver; in the remaining 222 there was either fatty infiltration or cirrhosis or both. Fibrosis of the pancreas was present in 234 cases and absent in 766. There were 156 cases in which fibrosis of the pancreas was present together with involvement of the liver. This indicates a high degree of association between the two conditions.

Redleaf, Paul D.; Fadell, Edward J.

doi: 10.1001/jama.1959.03000290010004pmid: 13630752

Blood samples for bacteriological study were obtained from 101 obstetrical patients immediately after delivery of the placenta, and again on the morning of the first postpartum day, in order to observe the frequency of bacteremia during labor. Four of the samples at the end of labor yielded bacterial growth, one organism being a coagulase-positive staphylococcus. Eleven of the samples obtained next day yielded growth, one organism being an alpha-hemolytic streptococcus. Thus, only two potentially pathogenic organisms were found, but the hazard of bacteremia in connection with labor was seen to be real. Patients believed to be susceptible to recurrent subacute bacterial endocarditis appear to need the same protection during parturition as is needed by similar patients during dental extractions, tonsillectomies, and urologic procedures. Prophylaxis with antibiotics is therefore justified in such cases.

Friedman, Meyer; Rosenman, Ray H.

doi: 10.1001/jama.1959.03000290012005pmid: 13630753

Three groups of men, selected solely according to the behavior pattern which they habitually manifested in their work, were compared with respect to their serum cholesterol levels, clotting times, presence of clinical coronary disease, and presence of arcus senilis. A group (A) of 83 men were chosen as manifesting an intense, sustained drive for achievement and as being continually involved in competition and deadlines, both at work and in their avocations. In this group the serum cholesterol level, the frequency of arcus senilis, and the incidence of coronary artery disease were much higher than in a group (B) of 83 men who manifested the opposite sort of behavior pattern and a group (C) of 46 unemployed blind men selected as manifesting a chronic state of insecurity and anxiety. Clinical coronary artery disease was seven times more frequent in group A than in group B or group C. Analysis of factors other than the overt behavior pattern described indicated that this pattern per se was largely responsible for the striking differences found.

Ayd, Frank J.

doi: 10.1001/jama.1959.03000290022006pmid: 13630754

Since chlorpromazine strikingly improves the adjustment of many psychiatric patients without being truly curative, administration in many cases must be continued for years. In order to detect possible adverse effects of such prolonged medication, a study was made in 50 patients who took it for two to four years. The total amounts taken by individual patients ranged from 54 to 1,078 Gm. All patients gained weight. No evidence of renal or hepatic dysfunction was found. Amenorrhea occurred in two-fifths of the women, but sometimes menstruation was resumed without interruption or reduction of the dosage. In some patients the white blood cell count dropped as low as 3,000 per cubic millimeter of blood; but it was not necessary to interrupt the medication, because the counts returned to normal while chlorpromazine therapy continued. Three patients manifested photosensitization each year from May to October but were desensitized by repeated limited exposures to the sun. Chlorpromazine enabled these patients to remain outside of the hospital, to work, and to be reasonably comfortable in spite of the persistence of their basic illness.

Richert, Joel H.; Krakaur, Richard B.

doi: 10.1001/jama.1959.03000290028007pmid: 13630755

Two patients with signs and symptoms of chronic pulmonary disease were hospitalized because of the suspicion of tuberculosis. In one a lung biopsy specimen obtained at exploratory thoracotomy was found to contain lesions characteristic of pulmonary schistosomiasis, and ova of Schistosoma mansoni were identified. In the other the ova of S. mansoni were first found in the feces; later the characteristic ova were also found in pseudotubercules in specimens of lung tissue obtained by wedge biopsy. The first patient was treated with a total of 90 cc. of stibophen (Fuadin) injected intramuscularly over a period of 20 days, and the disease was arrested. The other improved after two courses consisting altogether of 95 cc. of stibophen; although he continued to complain of respiratory symptoms he returned to duty. Both had lived in Puerto Rico before entering the U. S. Army.

Geraci, Joseph E.; Weed, Lyle A.; Nichols, Donald R.

doi: 10.1001/jama.1959.03000290032008pmid: 13630756

A study of the diagnostic value of laparotomy was made in 70 patients with febrile states that had lasted longer than two weeks and had been explained by repeated thorough physical and laboratory examinations. In 21 patients exploration of the abdominal cavity revealed malignant disease, and in 10 of these the lesion was a lymphoblastoma. In 15 patients evidence of specific infections was found, and in 5 of these it was tuberculous peritonitis. The surgical intervention entailed little risk. Its dagnostic value in cases of fever of obscure origin was evident.

Hay, Richard C.; Yonezawa, Takeshi; Derrick, William S.

doi: 10.1001/jama.1959.03000290041009pmid: 13630757

Relief from otherwise intractable pain in the lower portions of the body can frequently be afforded by the subarachnoid injection of absolute alcohol. The technique here described is believed to give more predictable results and to cause less of the distressing complications (paralyses, paresthesias, and vesical and intestinal dysfunction) than do older methods. This method, involving the careful positioning of the patient and other precautions to limit the action of the alcohol to the dorsal nerve roots, was applied in 106 patients with hopeless malignant disease. The results were classed as good in 53 and fair in 35. Ten spinal cords were examined at subsequent autopsies, and the most constant finding was demyelinization of the dorsal roots of the spinal nerves. The effects extended peripherally to the dorsal root ganglia and centrally into certain tracts within the cord. The abolition of pain was not always permanent, especially since metastases sometimes appeared in distant parts, but some patients were completely relieved for eight months or more.

Brachfeld, Jonas; Bell, E. Cooper

doi: 10.1001/jama.1959.73000290001010pmid: 13630758

The incidence of serious untoward reactions to meprobamate must be small in view of the widespread use of this drug. The following case is reported because it is believed to represent the first recorded instance of such a reaction to meprobamate. Furthermore, it represents a rare type of reaction to any drug. Report of a Case A 51-year-old woman was admitted on June 23, 1958, to Woman's Hospital, Philadelphia, because of a myocardial infarction. She was treated in the conventional manner with bed rest and bishydroxycoumarin (Dicumarol); in addition, her previous medication with chlorothiazide, 0.5 Gm. daily, and digoxin, 0.5 mg. daily, was continued. Pentobarbital was given nightly, but, starting on July 8, chloral hydrate was substituted. Because of continued restlessness during the day, as well as sleeplessness, therapy with meprobamate, 400 mg. given four times a day, and secobarbital and phenobarbital given at bedtime was started on July 11.