Temporal trends (1973-1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope?

OBJECTIVE: The incidence and mortality related to esophageal adenocarcinoma (EAC) has been rising in the United States. Meanwhile, the number of diagnostic and therapeutic procedures has increased in number and improved technologically. However, the impact of these advances on the survival of EAC in clinical practice remains unknown. METHODS: Patients with histologically proven EAC between 1973 and 1997 were identified in registries of the Surveillance, Epidemiology, and End Results database, and analyzed in 5-yr time periods. The observed and relative survival rates were calculated. The joint influence of the time of diagnosis, stage and grade of cancer, demographic features, surgical therapy, and radiotherapy were assessed in Cox proportional hazard survival analyses. RESULTS: Between 1973 and 1997, we identified 4835 patients with EAC. The 1-yr and 5-yr observed survival rates increased from 34% and 5% during 1973-1977 to 44% and 13% during 1993-1997 (p < 0.05). In the Cox survival analysis, the more recent year of diagnosis, early stage of tumor, younger age at presentation, receiving radiotherapy or surgery were independent predictors of reduced risk of mortality. The proportion of patients with in situ EAC and those with local spread increased progressively from 0.3% and 17.7% in 1973-1977 to 2.3% and 25.3%, respectively, in 1993-1997 (p < 0.05). The proportion of patients receiving radiation therapy either before or after surgery has increased from 7% in 1973-1977 to 16% in 1993-1997 (p < 0.05). CONCLUSIONS: The short- and long-term survival of patients with EAC has improved slightly in the United States over the past 25 yr. Some of the improvement may be related to an increase in the number of younger patients, and in cases with in situ and localized cancers. However, the overall survival of patients with EAC remains dismal.     

National study of internal medicine manpower: III. Subspecialty fellowship training 1976-1977.

Questionnaire II of the National Study of Internal Medicine Manpower was directed to all of the 1502 subspecialty training programs in the United States and Puerto Rico. The overall response rate was 86%. For the years 1972-1973 through 1976-1977 the number of fellows in subspecialty training grew at an average rate of 10.6% per year, or one and one-half times greater than the growth rate of 7.2% in the number of first-year residents in training for the same time period. In 1976-1977 there were 5826 fellows in subspecialty fellowship training, of whom 26% were foreign medical graduates. Stipends for subspecialty fellows in 1976-1977 amounted to $90 million, 40% of which was derived from direct federal funds and 33% from hospital revenues. Most of the subspecialty fellowship programs were in large teaching hospitals, which are closely affiliated with the nation's medical schools. The 1976-1977 professional activities of former subspecialty trainees who had finished their training between 1972 and 1976 were distributed roughly in thirds between research-teaching, teaching-practice, and practice. We discuss public policy implications of the data.     

Oxygen Transport by the Red Cell: Effects of Chronic Hemodialysis

Ten patients undergoing chronic hemodialysisfor end-stage renal disease were studied inorder to determine the acute effects of hemodialysis on the metabolic function of theerythrocyte in anemic uremic patients. Priorto hemodialysis there was a mean red cell massdeficit of 148 g Hb/sq m. The affinity ofhemoglobin for oxygen was decreased, and thiswas associated with an increase in intraerythrocytic levels of 2,3-DPG and ATP. The plasmaphosphorus levels were also increased in thepredialysis period. Following 5-6 hr of hemodialysis the affinity of hemoglobin for oxygenand the intraerythrocytic levels of 2,3-DPGwere unchanged from the predialysis valuesdespite a significant reduction in plasma phosphorus levels and a significant increase inboth whole blood and intraerythrocytic pH.

From these data we conclude that the maintenance of the red cell’s decreased oxygenaffinity resulted from the increase in intraerythrocytic pH which maintained the intraerythrocytic levels of 2,3-DPG despite a reduction in plasma phosphorus. The reduction inplasma phosphorus was primarily reflected in adecrease in red cell ATP.

Submitted on March 12, 1973 Revised on May 22, 1973 Accepted on June 18, 1973     

Reappraisal of lignocaine therapy in management of myocardial infarction.

The use of lignocaine in the prevention of ventricular fibrillation among patients admitted to a coronary care unit has been reviewed over the 12-year period 1967 to 1978 inclusive. The practice of suppressing warning ventricular ectopic activity has gradually been abandoned with the result that whereas in 1967 to 1968 33 per cent of all patients received lignocaine therapy, in 1972 to 1973 the number had fallen to 15 per cent, and in 1977 to 1978 to 4 per cent. The incidence of ventricular fibrillation was not significantly changed at 9.1, 7.7, and 7.8 per cent, respectively. Approximately 80 per cent of all patients suffering ventricular fibrillation within the coronary care unit were initially resuscitated and approximately 50 per cent survived hospital admission. Death was rarely a result of recurrent ventricular fibrillation and for the most part took the form of pump failure or late unexpected death. Experience suggests that the use of lignocaine to suppress ventricular ectopic activity observed in the first few hours of admission to hospital with acute myocardial infarction has no therapeutic value.     

Can automated haematology analysers discriminate thalassaemia from iron deficiency?

The use of automated analysers in population screening for beta-thalassaemia has been a matter of controversy. The new fully automated haematology analyser Sysmex E-5000 (Toa Medical Electronics Co. Ltd) facilitates the discrimination of heterozygous thalassaemia from iron deficiency anaemia. In addition to haemoglobin, mean corpuscular haemoglobin and mean corpuscular volume, the red cell size-distribution width is measured. In patients with hypochromic microcytic red cells, the Sysmex data have been evaluated and compared with the indices described by England and Fraser [Lancet i, pp. 449-452, 1973], Mentzer [Lancet i, p. 882, 1973] and by Shine and Lal [Lancet i, pp. 692-694, 1977]. For the detection of beta-thalassaemia trait, the size-distribution width is superior to the previously described indices. The sensitivity is 79%, the specificity 95% and the predictive value for a positive test 94%.     

Sequential serum complement (C3) and immunoglobulin levels in shock/trauma patients developing acute fulminant systemic sepsis

The complement system has been implicated in the physiopathology of septic shock. Since infection is a major cause of death in trauma patients, we examined daily serum C3 and immunoglobulin levels in all victims of major trauma during a 3-month interval. Sixteen patients developed acute systemic sepsis 3-15 days after admission. For all variables the lowest values occurred shortly after hospital admission, during or just after fluid resuscitation. Thereafter, the serum C3 and immunoglobulin concentrations gradually returned to the normal ranges, despite the onset of fulminant systemic sepsis. Except for IgM, the occurrence of hypotension during sepsis did not affect the recovery patterns of the measured variables. In the five patients experiencing hypotension, serum IgM dropped transiently but resumed its normalization trend after the restoration of adequate perfusion pressure. In the three nonsurvivors there was no reduction in the serum C3 or immunoglobulin levels prior to death. These data do not support a role for C3 or the immunoglobulins in the pathogenesis of acute fulminant clinical sepsis. On the contrary, the behavior of these substances during severe sepsis is more consistent with protective host defense functions.     

1951-2014年辽宁省疟疾流行特征

目的 了解1951-2014年辽宁省疟疾流行趋势和特征,为制定有效的控制对策提供依据。 方法 对1951-2014年辽宁省各市、县上报的疟疾疫情数据进行流行病学分析。 结果 1951-2014年每年均有疟疾病例报告,1953、1962年和1973年是3个发病高峰年,发病率分别为136.67/10万、256.81/10万和35.89/10万;发病人数分别为27 862、65 460人和11 523人;1977年之后每年发病率均在1/10万以下;患者职业于1951-1980年以农民为主,1981-2014年以工人、农民、劳务输出人员为主。 结论 辽宁省经历了疟疾暴发流行到基本消除的过程,开展长期疫情监测防止二代病例出现将是下一步的工作方向。     

Equine influenza in Chile (1963-1992): a possible human case

In Chile equine influenza has been strongly related to continental epizootics. First outbreak was described in 1963; main outbreaks were reported in 1977, 1985 and 1992. Equine influenza virus was isolated in three opportunities: H7N7 (A/equi/1/Santiago, Chile/1977); H3N8 (A/equi/2/Santiago, Chile/1985) and H3N8 (A/equi/2/Quillota, Chile/1992). The most serious outbreak was caused by strain H7N7 in 1977. Since 1992 equine influenza has not been reported in our country. In 1973 was described a case of influenza and seroconversion in a human being related with horses suffering a respiratory distress diagnosed as equine influenza; unfortunately the isolated virus was not typed.     

Endemic aminoglycoside resistance in gram-negative bacilli: epidemiology and mechanisms

Isolates of gentamicin-resistant gram-negative bacilli from clinical specimens peaked at nine to 10 per month in 1973-1974. Instituting barrier-type precautions during 1974-1977 was associated with a sustained 87% reduction in resistant Enterobacteriaceae. The number of resistant Pseudomonadaceae fell temporarily by 28%, paralleling gentamicin usage. During an endemic 15-month period in 1976-1977 nonenzymatically mediated resistant Pseudomonas aeruginosa often emerged after aminoglycoside therapy in patients who had prior carriage of sensitive strains of the same serotype (P = 0.002); this resistance was associated with wound or sputum isolates (P = 0.003). Resistant Enterobacteriaceae more often demonstrated the converse, that is, spread of urinary tract isolates with enzymatically mediated resistance from patients not on aminoglycoside therapy. These findings suggest that control measures to minimize occurrence of resistant bacilli include barrier-type precautions for patients with resistant Enterobacteriaceae, evaluation of transfers and readmissions as a source of resistant organisms, and reduction of aminoglycoside use to decrease the selection of nonenzymatic resistance.     

Internistische Intensivmedizin in Österreich

The first Austrian internal intensive care unit was established in 1971 at the Medical University Clinic in Vienna. Most intensive care units evolved from coronary care units in the following years. At the beginning mostly patients with heart disease and intoxication, respectively with mono-organ failure were admitted to the units. In the last 20 years the main cause of admission has been sepsis and multiorgan failure. Despite an increase in disease severity with an increase in ventilator days and use of extracorporeal therapies, mortality has not changed. At the same time as the first ICU was established, a scientific society of internal intensive care medicine was founded. From the beginning, there was a close relationship with the German Society of Internal Intensive Care Medicine. The first joint meeting was realized in Vienna in 1973. From that time, all meetings were organized as a common meeting in Germany or Austria. In addition to these meetings, the Vienna Intensive Care Days have been organized yearly in Vienna since 1982.     

First 24-h Sardjito Cardiovascular Intensive Care (SCIENCE) admission risk score to predict mortality in cardiovascular intensive care unit (CICU)

Background and objectivesThe application of prognostic scoring systems to identify risk of death within 24 h of CICU admission has significant consequences for clinical decision-making. Previous score of parameters collected after 24 h was considered too late to predict mortality. As a result, we attempted to develop a CICU admission risk score to predict hospital mortality using indicators collected within 24 h.MethodsData were obtained from SCIENCE registry from January 1, 2021 to December 21, 2021. Outcomes of 657 patients (mean age 58.91 ± 12.8 years) were recorded retrospectively. Demography, risk factors, comorbidities, vital signs, laboratory and echocardiography data at 24-h of patient admitted to CICU were analysed by multivariate logistic regression to create two models of scoring system (probability and cut-off model) to predict in-hospital mortality of any cause.ResultsFrom a total of 657 patients, the hospital mortality was 15%. The significant predictors of mortality were male, acute heart failure, hemodynamic instability, pneumonia, baseline creatinine ≥1.5 mg/dL, TAPSE <17 mm, and the use of mechanical ventilator within first 24-h of CICU admission. Based on Receiver Operating Characteristic (ROC) curve analysis a cut off of ≥3 is considered to be a high risk of in-hospital mortality (sensitivity 75% and specificity 65%).ConclusionThe initial 24-h SCIENCE admission risk rating system can be used to predict in-hospital mortality in patients admitted to the CICU with a high degree of sensitivity and specificity,     

Outcome after episodes of hypothermia

A retrospective study was made of all patients aged over 65 years with hypothermia discharged from or dying in the Victoria Infirmary, Glasgow in the years 1977-81. Full follow-up data were obtained on 81 of the 91 patients identified. Patients were divided into cases of primary and secondary hypothermia. There were no significant differences between the two groups in initial mortality mean age on admission or mean temperature on admission, but there was a highly significant (P less than 0.001) difference in long-term outcome: the 3-year mortality in patients who survived the index admission was 100% in the primary group and 24% in the secondary group.     

Long-term course of lipoprotein lipase (LPL) deficiency due to homozygous LPL(Arita) in a patient with recurrent pancreatitis, retained glucose tolerance, and atherosclerosis

CONTEXT: Lipoprotein lipase (LPL) deficiency is a rare autosomal recessive disorder caused by LPL gene mutation and is characterized by severe hyperchylomicronemia. Patients with LPL deficiency suffer from the frequent recurrence of acute pancreatitis, but the underlying mechanisms are not fully understood. CASE REPORT: A 22-yr-old male Japanese patient with severe hyperchylomicronemia was admitted to our hospital in 1973. He had no consanguinity and no family history of hyperlipidemia. He was genetically diagnosed as LPL deficiency (homozygous for LPL(Arita)) with no LPL mass or activity in postheparin plasma. He has experienced recurrent acute pancreatitis 22 times during our 31-yr clinical follow-up, but no pancreatic pseudocyst, irregularity of the pancreatic duct, or abnormal pancreatic calcification was observed in computed tomography. Moreover, his pancreatic endocrine function, as assessed by the oral glucose tolerance test, has preserved more than 30 yr. Although he was a current smoker, no clinically significant atherosclerotic lesion had been observed. CONCLUSIONS: From the long-term observation of this patient, we propose that LPL deficiency is not invariably associated with high mortality and that even with repeated episodes of acute pancreatitis, pancreatic function may be slow to decline.     

Hospital admission rates of diabetic children

Summary In 1973 a children's diabetic clinic was established in Oxford. An analysis has been made of the effects this has had on the pattern of emergency admissions classified as severe hyperglycaemia (A), moderate hyperglycaemia (B) and hypoglycaemia (C). A comparison of the admission rate per diabetic year over the four years before and the three years after the children's clinic was established showed a significant decrease in admission rate for all hyperglycaemic admissions (p<0.05). This decrease was shown to be mainly due to a reduction in admissions with severe hyperglycaemia (A) (p<0.01), there being no significant change in admission rate for moderate hyperglycaemia (B). There was no significant change in admission rate for hypoglycaemia (C).     

1977例急性、亚急性、慢加急性肝衰竭患者的病因与转归分析

目的 探讨急性肝衰竭(ALF)、亚急性肝衰竭(SALF)、慢加急性肝衰竭(ACLF)的病因. 方法回顾性总结1977例肝衰竭患者的临床资料,对病因、年龄、性别、转归等方面进行比较分析.结果 ALF的前三位病因是:HEV感染(33.96%)、HBV感染(13.21%)与药物性肝病(9.43%);SALF为药物性肝病(31.53%)、HEV感染(16.22%)、HBV感染(9.91%);ACLF为HBV感染(90.29%)、洒精性肝病(2.65%)、HBV与HEV重叠感染(2.26%).常见嗜肝病毒感染者占90.09%(1781例),其中单HBV感染占92.93%(1655例).在HBV感染者中(1655例),26～55岁患者占77.10%(1276例).2005-2007年酒精性肝衰竭患者39例,占酒精性病因患者的81.25%(48例);2006-2007年药物性肝衰竭共23例,占药物性病因的56.10%(41例).除药物性肝损伤外,其他病因均男性多于女性.三类肝衰竭总治愈,好转率为35.56%,HEV感染性肝衰竭的治愈,好转率高于药物性肝衰竭(x2=4.42,P<0.05),其他组间差异无统计学意义.结论 不同类型肝衰竭主要病因不同;HBV感染居肝衰竭病因之首,酒精性、药物性肝衰竭呈上升趋势;HEV感染性肝衰竭治愈、好转率相对较高.     

Changes in hospital admissions across Europe: 1995-2003. Results from the EuroSIDA study

OBJECTIVES: To describe changes in the proportions of patients admitted to hospital and the duration of admission during the month of March between 1995 and 2003 and to describe the factors related to admission for 9802 patients from EuroSIDA, a pan-European, observational cohort study. METHODS: Generalized estimating equations were used to determine changes over time in the proportion of patients admitted and the median duration of admission. Logistic regression was used to determine factors related to admission in March 1995, March 1998 and March 2001. RESULTS: The proportion of patients admitted during March declined from 7.4% in 1995 to 2.6% in 2003. After adjustment, the estimated reduction in the proportion of patients admitted was 5.5% per year [95% confidence interval (CI) 2.5-8.5%; P=0.0004], a 26% reduction. The median duration of hospital admission declined by 58% from 12 days in 1995 [interquartile range (IQR) 5-19 days] to 5 days in 2003 (IQR 3-12 days), a significant decline of 0.7 days per year after adjustment (95% CI 0.5-0.9 days; P=0.031). Patients with a lower CD4 lymphocyte count, and with an AIDS diagnosis made within the 3 months prior to March, all had increased odds of admission during March 1995, 1998 or 2001. In March 2001, patients whose treatment regimen was changed as a consequence of toxicities had increased odds of admission [odds ratio (OR) 2.34; 95% CI 1.26-4.37; P=0.0074]. In addition, patients who were hepatitis C virus-positive during March 2001 (OR 1.66; 95% CI 1.02-2.68; P=0.041) had increased odds of admission. CONCLUSIONS: There has been a considerable decline in both the proportion of patients admitted to hospital and the median duration of the stay. Patients with hepatitis C had increased odds of admission, but there was little evidence of an increase in admissions among patients taking highly active antiretroviral therapy (HAART) associated with serious adverse events, although longer follow up is required.     

A new surgical technique for treatments of left ventricular outflow tract obstructions. Report of a case and reexamination of our experience (author's transl)]

Aortic valvotomy, aortic valve replacement, resection of the subaortic membrane and aortic patch angioplasty do not always provide satisfactory relief of left ventricular outflow tract obstruction. From August 1975 through January 1977, 15 patients underwent creation of a left ventricular vent by means of a Dacron fabric conduit containing a heterograft valve going from the left ventricle to the supraceliac portion of the abdominal aorta (Cooley's point). All patients had valvular, subvalvular, supravalvular aortic stenosis, or combined defects. One patient had severe hemolytic anemia following aortic valve replacement. Eleven of our 15 patients had undergone one or more previous surgical procedures for relief of aortic stenosis. The operative mortality has been one patient. At postoperative catheterization, there was a normalization of pressure gradients, and the blood flow through the conduit was 40% of the cardiac output. An interesting case of supravalvular aortic stenosis associated with stenosis of the vessels of the arch is presented.     

The Beta-Blocker Pooling Project (BBPP): subgroup findings from randomized trials in post infarction patients

The objective of the Beta-Blocker Pooling Project (BBPP) wasto collect and analyse data from the major long-term secondaryprevention trials in order to determine whether there are subsetsof post-infarction patients who benefit to a greater or lesserextent from beta-blocker therapy than the average patient population. One-year all-cause mortality data from nine trials involving13 679 patients were obtained. Overall, mortality was 24% lowerin the beta-blocker group compared to the placebo group. However,there was heterogeneity among the results of the trials, whichtested seven different beta-blockers. Subgroups with high placebogroup mortality (e.g. patients with a history of previous myocardialinfarction (MI), angina pectoris, mechanical or electrical complications,and digitalis usage) seemed to benefit particularly from beta-blockertreatment. These findings were consistent in the nine trials.Patients in the lower risk subgroups also appeared to benefitfrom beta-blockers, but this benefit was smaller in absoluteterms and inconsistent across the trials. There was no evidencethat treatment outcome was related to gender, baseline levelof heart rate or blood pressure, or time of initiation of treatmentafter hospital admission. In conclusion, the Pooling Projectindicates that high risk MI patients, without contraindicationsto beta-blockers, are the prime candidates for long-term therapy,but the lower risk patients may also receive some benefit.     

Modern ideas about organization of services for elderly patients in hospitals and nursing homes in the Netherlands.

The system of nursing homes in the Netherlands, and the advantages of the new department for geriatric assessment in the Municipal Hospital in Amsterdam are discussed. Included are admission and discharge data on 694 patients in the Geriatric Department in 1977, and also a list of the more common diagnoses, classified according to body system and disease.