Radioiodine and the treatment of hyperthyroidism: the early history.

Little was known about iodine metabolism in the mid-1930s, but when Saul Hertz and his chief, J. Howard Means, at the Massachusetts General Hospital (MGH) realized in 1936 that radioiodine could be made and used as a tracer, they arranged with physicists Robley Evans and Arthur Roberts at the Massachusetts Institute of Technology (MIT) to make the short-lived 128I and study its physiology in rabbits. By 1938, they showed that the rabbit's thyroid gland rapidly took up 128I, especially when there was only a little non-radioactive iodine present.

Transcutaneous partial oxygen pressure changes following skew flap and Burgess-type below-knee amputations.

Objective: To evaluate the degree of flap hypoxia following different types of below-knee amputations.

Design: Prospective preoperative and postoperative measurements of transcutaneous partial oxygen pressure (TcPo2) at the site of amputation in 10 consecutive patients who underwent a Burgess-type below-knee amputation (group 1) and in 10 consecutive patients who underwent a skew flap amputation (group 2).

Setting: An academic, tertiary care Veterans Affairs medical center.

Tuberculosis then and now: a personal perspective on the last 50 years.

Rates of death from tuberculosis in the United States decreased from 194 per 100,000 persons in 1900 to 40 per 100,000 persons in 1945, in part because the epidemic of tuberculosis in the western world was running its course and in part because of public health initiatives and improved socioeconomic conditions. In 1945, 63,000 persons died of tuberculosis and 115,000 new cases of the disease emerged. Streptomycin and para-aminosalicylic acid had just been discovered; the discovery of isoniazid followed, in 1952.

Alterations in pharmacodynamics of anxiolytics in abstinent alcoholic men: subjective responses, abuse liability, and electroencephalographic effects of alprazolam, diazepam, and buspirone.

Subjective responses, including those associated with abuse liability and changes in frontal electroencephalographic activity, were assessed in abstinent alcoholic men and control subjects after administration of alprazolam, diazepam, buspirone, and placebo. Plasma concentrations of alprazolam, diazepam, and desmethyldiazepam also were determined. Abuse liability scales were elevated for alcoholic participants above control levels after alprazolam and diazepam.

High prevalence of chronic gastrointestinal symptoms in a National Guard Unit of Persian Gulf veterans.

Objectives: To determine the prevalence and spectrum of GI complaints in a group of Persian Gulf veterans (PGV) and to compare these data to a group of veterans (controls) from the same unit who were not deployed to the Persian Gulf region.

Methods: A 68-item survey was distributed to 136 members of a single National Guard Unit. The survey asked the veterans to rate the frequency of GI symptoms before, during, and after the Persian Gulf war had concluded.

Study of etiologic relationship of arterial atherosclerosis to corporal veno-occlusive dysfunction in the rabbit.

Purpose: The aim of this study was to explore the possible etiologic relationship of hypercholesterolemia and atherosclerosis to corporal veno-occlusive dysfunction.

Materials And Methods: In the New Zealand White rabbit, the competence of the corporal veno-occlusive mechanism was examined at various intervals after exposure to control diet, high cholesterol diet, or aortoiliac atherosclerosis.

Results: Initially, all animals showed normal erectile function and corporal veno-occlusion.

Measures of prefrontal dysfunction after closed head injury.

Tasks sensitive to frontal lobe dysfunction (delayed response, delayed alternation, object alternation, and Wisconsin Card Sort) were administered to 20 patients with post-acute closed-head injury (CHI). Time since injury varied (6 to 280 months; mean, 48 months), as did length of coma (2 hr to 120 days; mean, 38 days). Compared to normal controls, CHI patients showed no deficits on delayed response tasks, but were impaired on delayed alternation, object alternation, and the Wisconsin Card Sort Test.

The total costs of drug therapy for rheumatoid arthritis. A model based on costs of drug, monitoring, and toxicity.

Objective: We created a model to estimate the total medication costs of treating patients with rheumatoid arthritis with 6 second-line agents for the first 6 months of treatment.

Methods: Drug costs were obtained from a survey of pharmacies; monitoring costs were calculated from utilization information obtained in a survey of rheumatologists; toxicity costs were obtained using decision trees to represent the evaluation and treatment of potential toxicities. Monitoring and toxicity costs were estimated using costs from the Boston University Medical Center or, for hospitalizations, using appropriate diagnosis-related group categories.

Inability to perform bicycle ergometry predicts increased morbidity and mortality after lung resection.

The ability to successfully exercise has been used to assess the cardiopulmonary risk of thoracotomy for lung cancer. Because of musculoskeletal, neurologic, peripheral vascular, or behavioral problems, not all patients presenting for pulmonary resection are capable of exercising. Using a multifactorial cardiopulmonary risk index (CPRI) consisting of a cardiac risk index (CRI) and a pulmonary risk index, we studied 74 patients (60 capable of exercising and 14 incapable of exercising) who underwent thoracotomy for lung cancer resection.

Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons.

Background: Low serum thyrotropin concentrations are a sensitive indicator of hyperthyroidism but can also occur in persons who have no clinical manifestations of the disorder. We studied whether low serum thyrotropin concentrations in clinically euthyroid older persons are a risk factor for subsequent atrial fibrillation.

Methods: We studied 2007 persons (814 men and 1193 women) 60 years of age or older who did not have atrial fibrillation in order to determine the frequency of this arrhythmia during a 10-year follow-up period.

Comparison of a standard and a sensitive thromboplastin in monitoring low intensity oral anticoagulant therapy.

The greater precision in prothrombin time monitoring obtained using thromboplastins with low international sensitivity index (ISI) values are believed to result in improved patient care. The authors conducted a blinded prospective study of 84 random patients on low-intensity warfarin therapy who were monitored with either a sensitive (ISI, 1.3) or standard (ISI, 1.

Non-Hodgkin's lymphoma can mimic renal adenocarcinoma with inferior vena caval involvement.

Genitourinary involvement in both Hodgkin's and non-Hodgkin's lymphomas is common and can be confused with other benign and malignant urologic conditions. While lymphoma commonly produces vascular and ureteral encasement, intraluminal vascular involvement is rare. Indeed, there are no previous reports of renal lymphoma with tumor thrombus extending into both the renal vein and inferior vena cava.

A clinical study monitoring low-intensity anticoagulant therapy with a standard-sensitivity thromboplastin.

The ability of the prothrombin time to measure the anticoagulant effect of warfarin sodium varies depending on the particular tissue thromboplastin used in performing the test. Based on studies using sensitive thromboplastins, lower therapeutic ranges of anticoagulation are recommended. The adequacy of monitoring therapy in this lower range with the relatively insensitive thromboplastins commonly used in North America is unestablished.

Bronchial stump disruption following inadvertent right mainstem intubation 9 years after pneumonectomy.

An 82-year-old man, with a history of right pneumonectomy 9 years prior to admission, was emergently intubated for respiratory failure resulting from rapid atrial fibrillation and congestive heart failure. Postintubation chest radiograph demonstrated the tube to be in the right bronchial stump. Over the next 48 hours gas exchange remained poor, endotracheal suctioning produced copious serosanguinous secretions, and chest radiographs showed increasing air, with air fluid levels, in the previously opacified right hemithorax.

Acute effects of indomethacin on the disposition of a potassium load.

We examined the effects of acute indomethacin administration on the disposition of a potassium load in anesthetized rats. In response to the potassium load, indomethacin-treated animals had greater plasma potassium concentrations and smaller increases in fractional excretion of potassium than did vehicle-treated rats, but there was no change in urine flow rate. Findings were consistent with indomethacin-induced impairment of renal potassium excretion.

A model for multidisciplinary data collection for cervical metastasis.

A system for multidisciplinary data collection for metastatic neck disease is discussed. Information from 87 neck dissections and 3218 lymph nodes is reported to illustrate the strength of the model. Clinical (endoscopic) assessment under general anesthesia, surgical assessment during the neck dissection, and radiographic (computed tomographic scan) assessment were compared with the pathological evaluation.

Community-acquired acute renal failure.

Acute renal failure usually occurs during hospitalization, but may also be present on admission to the hospital. To define the causes and outcomes of community-acquired acute renal failure, we undertook a prospective study of patients admitted to the hospital with acute elevations in serum creatinine concentrations. Over a 17-month period, all admission serum creatinine determinations were screened for patients with values greater than 177 mumol/L (2 mg/dL).

Impaired myocardial function in spontaneously hypertensive rats with heart failure.

We have observed that many spontaneously hypertensive rats (SHR) between the ages of 18 and 24 mo develop findings suggestive of heart failure, including pleural and pericardial effusions, left atrial thrombi, and right ventricular hypertrophy. Isolated left ventricular papillary muscle function was studied in these animals (SHR-F), in age-matched SHRs without evidence of heart failure (SHR-NF), and in nonhypertensive controls (WKY). Preparations from SHR-F showed depression of active tension development (3.

Interpretation of urinary flow rates.

The uroflow examination is the most accurate, physiologic, and noninvasive method of assessing bladder outflow obstruction. The examiner must be aware of the errors that may arise from problems inherent in the uroflowmeter, in the patient (such as psychological inhibition), or in bladder physiology (such as the influence of intravesical volume). Additional tests such as pressure-flow studies or simple cystometry are required in certain cases.