White Adult Patients Research Articles

How Accurate Is Spirometry at Predicting Restrictive Pulmonary Impairment?

To determine the accuracy with which spirometric measurements of FVC and expiratory flow rates can diagnose the presence of a restrictive impairment. The pulmonary function tests of 1,831 consecutive white adult patients who had undergone both spirometry and lung volume measurements on the same visit over a 2-year period were analyzed. The probability of restrictive pulmonary impairment, defined as a reduced total lung capacity (TLC) below the lower limit of the 95% confidence interval, was determined for each of several categoric classifications of the spirometric data, and additionally for each of several interval levels of the FVC and the FEV1/FVC ratio. A large clinical laboratory in a university teaching hospital using quality-assured and standardized spirometry and lung volume measurement techniques according to American Thoracic Society standards. Two hundred twenty-five of 1,831 patients (12.3%) had a restrictive defect. The positive predictive value of spirometry for predicting restriction was relatively low; of 470 patients with a low FVC on spirometry, only 41% had restriction confirmed on lung volume measurements. When the analysis was confined to the 264 patients with a restrictive pattern on spirometry (ie, low FVC and normal or above normal FEV1/FVC ratio), the positive predictive value was 58%. Conversely, spirometry had a very favorable negative predictive value; only 2.4% of patients (32 of 1,361) with a normal vital capacity (VC) on spirometry had a restrictive defect by TLC measurement. The probability of a restrictive defect was directly and linearly related to the degree of reduction of FVC when the FVC was < 80% of predicted (p = 6.002). Combining the FVC and the FEV1/FVC ratio improved the predictive ability of spirometry; for all values of FVC < 80% of the predicted amount, the likelihood of restrictive disease increased as the FEV1/FVC ratio increased. Spirometry is very useful at excluding a restrictive defect. When the VC is within the normal range, the probability of a restrictive defect is < 3%, and unless restrictive lung disease is suspected a priori, measurement of lung volumes can be avoided. However, spirometry is not able to accurately predict lung restriction; < 60% of patients with a classical spirometric restrictive pattern had pulmonary restriction confirmed on lung volume measurements. For these patients, measurement of the TLC is needed to confirm a true restrictive defect.

Human leukocyte antigen-C genes and susceptibility to primary sclerosing cholangitis.

Genetic susceptibility to primary sclerosing cholangitis (PSC) is associated with the extended HLA A1-B8-DR3 haplotype and also with the DRB3*0101-DRB1*0301-DQA1*0103-DQB1*0603 haplotype. However, very few studies have considered the role of HLA C which lies between HLA A and B, is highly polymorphic, and encodes proteins which play an important role in immunoregulation and in disease susceptibility. Traditional assignment of HLA Cw antigens by serology is both inaccurate and unreliable, with a high error rate. The aim of this study was to characterize the distribution of HLA C alleles in a large group of patients with primary sclerosing cholangitis by using a recently developed polymerase chain reaction-based genotyping technique. Ninety-three white adult patients of northern European origin with well characterized PSC and 100 geographically and racially matched controls were studied. HLA C and HLA DRB1 alleles were assigned by polymerase chain reaction-based genotyping, HLA A and B antigens by standard microlymphocytotoxicity test and extended haplotypes were constructed according to known patterns of linkage disequilibrium. The Cw*07 gene was found in 67.7% of patients versus 54% of controls (P = .051, OR = 1.79). This increase was a result of inheritance of the Cw*0701 allele which was found in 51.6% of patients compared with 34% of controls (P = .013, OR = 2.07). There were no significant differences in the frequencies of any of the other Cw alleles including the Cw*07 group: Cw*0702, Cw*0703, and Cw*0704. HLA-encoded genetic susceptibility to PSC is associated with the HLA Cw*0701 allele, but the association is weak and may simply reflect linkage disequilibrium with the HLA B8-DR3 haplotype. These findings indicate that the telomeric limit of HLA-encoded susceptibility to primary sclerosing cholangitis lies close to the HLA C locus.

Reports by patients and dermatologists of skin cancer preventive services provided in dermatology offices.

To learn how often patients receive skin cancer preventive services in dermatologists' offices. Survey of dermatology patients and dermatologists. Dermatology practices of full-and part-time faculty at a midwestern medical school. Patients were randomly selected from clinical sessions of 11 dermatologists. Of 200 patients enrolled, 162 (81%) responded to the survey. Ten (91%) of the dermatologists responded, and 4 additional dermatologists from the faculty were also surveyed. Patients' and dermatologists' reports of the provision of skin cancer prevention counseling and screening for skin cancer. Most patients (93%) had been informed about the risks of sun exposure, but for only 27% was a dermatologist the main source of information. Although 76% of patients had seen a dermatologist at least twice in the last 5 years, only 34% reported that they had ever received a total-body screening examination for skin cancer. Most patients (55%) would like to learn more about skin cancer prevention, and responded that they would learn best from a brochure (43%) or from a dermatologist (42%). All dermatologists believed that some skin cancer preventive services should be provided to each patient, but they varied widely in the proportion of their white adult patients to whom they provided such services. For example, with respect to counseling about sunscreens, the same number of dermatologists (4 [29%]) responded that they counsel 25% or less of their patients, and more than 75% of their patients. There is wide variation in how often skin cancer preventive services are provided in dermatologists' offices.

Strong association of dermatomyositis-specific Mi-2 autoantibodies with a tryptophan at position 9 of the HLA-DR beta chain.

To characterize the clinical and immunogenetic features of patients with Mi-2 autoantibodies. Eighteen adult white patients with Mi-2 antibodies were clinically characterized and compared with 41 Mi-2-negative dermatomyositis (DM) patients. HLA class I and class II typing for DRB alleles was done by microcytotoxicity assay and for DQA and DQB alleles by polymerase chain reaction-based oligotyping. Seventeen of the 18 Mi-2-positive patients had DM. Symptoms of scleroderma, lung involvement, and arthritis were less common in this group than in the Mi-2-negative DM patients; the V-sign rash and nailfold involvement were found more frequently. Mi-2 antibodies were strongly associated with HLA-DR7 (88% versus 24% in healthy controls), HLA-DQA1*0201 (86% versus 23%), and DR7 "homozygosity" (31% versus 0%). A tryptophan residue at position 9 of the HLA-DR beta chain was present in all Mi-2-positive patients (100% versus 62%; homozygous in 81% versus 15%). Our results reemphasize the specificity of Mi-2 antibodies for DM, and extend previous reports that Mi-2 antibody production is associated with certain HLA class II antigens. We propose beta 9-Trp as a candidate epitope on the HLA-DR beta chain as a prerequisite for this type of autoimmune response.

The validity of the prediction of soft tissue profile changes after LeFort I osteotomy using the dentofacial planner (computer software)

The purpose of this study was to examine the validity of the prediction of soft tissue changes after LeFort I osteotomy with the DentoFacial Planner (DFP) (computer software). The preoperative and postoperative lateral cephalograms of 21 white adult orthodontic patients (10 males and 11 females) who underwent only LeFort I osteotomy as part of their overall treatment were digitized. A coordinate system of X and Y axes were used to assess the amount and direction of movement of the maxilla. The SN + 7° was the X axis, and a perpendicular to this plane from nasion was the Y axis. The sample was divided into two groups depending on the amount of forward movement of the maxilla. More than 2 mm of anterior placement of the maxilla comprised the advancement group (13 patients) and less than 2 mm comprised the impaction group (8 patients). The selection criteria for the sample were (1) before and after cephalograms taken with lips in repose and in centric occlusion; (2) all preoperative records taken almost immediately before surgery; (3) postoperative records taken at least 6 months after surgery and checked by regional superimposition of the preoperative and postoperative lateral cephalograms onto the maxilla and the mandible. No tooth movement occurred between the time the records were taken. The following soft tissue landmarks were examined: pronasale, subnasale, stomion superior, middle upper lip, stomion inferior, middle lower lip, labrale inferior, labiomental fold, and pogonion. The results indicate that for some of these landmarks the amount and direction of soft tissue changes differed between the DFP prediction and the actual surgical changes by LeFort I osteotomy. Differences between actual and predicted changes may be partially attributed to the variability of surgical procedures of previous studies that provided the data for the DFP computer software. (A M J O RTHOD D ENTOFAC O RTHOP 1994;105:241-9.)

Mandibular growth in patients with cleft lip and/or cleft palate—the influence of cleft type

A total of 229 adult white patients with cleft lip or palate were evaluated, through cephalometric radiographs, to determine cleft-type influence on mandibular structure and spatial position. The sample includes adult patients with unilateral complete cleft lip and alveolus (n = 50), complete cleft lip and palate (n = 118), and isolated cleft palate (n = 61). A group of 65 subjects with normal occlusion and without cleft lip or palate was used as a control group. All groups were matched according to sex. When compared, the cleft groups and the normal group showed that the mandibular structure was significantly different. The mandible in the cleft groups displayed shorter mandibular ramus and body length, without difference between the cleft types. Mandibular position relative to cranial base was similar in the cleft groups with involvement of the palate, and differed significantly from that observed in the group with cleft lip and alveolus and in the subjects without cleft. Palatal clefts induce a significant downward and backward rotation of the mandible associated with a more obtuse gonial angle. Thus a small mandible is a structural characteristic of all cleft types studied. However, mandibular shape and spatial position are strongly influenced in clefts that involve the palate.

Alpha 1 antitrypsin (PI) phenotypes in two rheumatic diseases: a reappraisal of the association of PI subtypes in rheumatoid arthritis.

alpha 1 Antitrypsin phenotypes were determined by isoelectric focusing in 225 adult white patients with rheumatoid arthritis (RA), 60 patients with severe rheumatoid arthritis (grade III and IV), 17 sibling pairs--HLA identical but discordant for rheumatoid arthritis, and 122 random patients with Sjögren's syndrome. No significant increase in non-M phenotypes was found in either of the groups of patients with RA, but the association between M subvariants was striking. There was a significant increase in M1M2 phenotype and M2 allotype in both the RA and severe RA groups. This increase in M1M2 was also supported by DR4 positive patients with RA compared with DR4 positive siblings without RA. No apparent association of variant phenotype was found in four subgroups of patients with Sjögren's syndrome.

Primary lymphoma of the liver. Ten cases and a review of the literature.

Ten adult white patients (21-75 years old; six women, four men) presented with large cell lymphoma of the liver. Each complained of abdominal pain and/or an abdominal mass, and five had B-symptomatology of weight loss, fever (one patient), and night sweats (three patients). At laparotomy (eight patients) or by computerized tomography, liver-spleen scan and lymphangiogram (two patients with percutaneous liver biopsy only), the liver was the sole site of involvement, although subsequent staging procedures revealed bone marrow involvement in three patients. Initial biopsy interpretation was incorrect in four cases which were diagnosed as poorly differentiated carcinoma. Although uncommon, the differential diagnosis of primary liver lymphoma should be entertained when patients present with solitary (three cases) or multiple (six cases) liver defects, particularly when alpha-fetoprotein and carcinoembryonic antigen levels are normal. One patient had diffuse hepatomegaly. Treatment included biopsy (eight patients) or resection (two patients) followed by combination chemotherapy. All patients are alive from 0 to over 10 years (mean, 2.4; median, 1.8 years): six in complete remission, two with less than 6-months follow-up, and two with recurrent lymphoma. Examination of this group of patients along with 19 cases identified in the literature suggests that this is a more treatable disease than primary liver carcinoma.

Judging whether a patient is white or black by his Draw-A-Person Test.

Summary Attention was directed to the projection of racial characteristics in the Draw-A-Person Test (DAP). DAP protocols from 28 matched black and white adult male patients were presented to 34 untrained and 17 trained judges who were asked to identify race of patient from his DAP. Average correct identification ranged from 53.8% (black judging black, n. s.) to 62.9% (white judging white, t = 6.43, p < .01). White untrained judges were more accurate than black untrained judges (t = 2.43, p < .05). Black judges had more difficulty with black stimuli than with white stimuli, as did trained judges. The modest success achieved by both black and white judges adds minimal evidence to the body image hypothesis. Possible explanations are offered.

Stale, Soft, or Chronic

Editorials1 June 1969Stale, Soft, or ChronicE. J. H.E. J. H.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-70-6-1272 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPhysicians in Rochester, N. Y., have recently provided evidence (1) confirming again that mental and emotional disorders are a sizeable fraction of problems presented by patients. The data were reported by 29 internists and 29 general practitioners from a population of 14,117 white adult patients. The highest rate, 25%, of psychiatric disorders was in women between ages 35 and 54. Men between ages 15 to 24 and 65 to 99 had the lowest rate, 7%. The overall rate was 14%. The rates reported by internists and by general practitioners did not differ. The therapeutic challenge from these patients is implicit...

Statistics for a Diagnostic Model

In recent years, several methods have been proposed for making medical diagnoses by machine (Ledley and Lusted [1959], Crumb and Rupe [1959]). A method devised by Brodman et al. [1959, 1960] has been used to program a high-speed electronic computer for making presumptive medical diagnoses using only information relating to the age, sex, and responses of patients to a standardized health questionnaire. The method assigns patients to none, one, or several of 60 selected disease categories. The 60 diseases most frequently diagnosed by hospital physicians in men and the 60 diseases in women were chosen for study. The method was developed with data referring to 5,929 consecutive adult white patients (2,718 men and 3,211 women) admitted to the outpatient departments of The New York Hospital, a large general hospital, during the 18-month period beginning July 1, 1948. It was tested with data referring to 2,745 consecutive adult white patients (1,280 men and 1,465 women) admitted during the 12-month period beginning January 1, 1956. Each patient's symptoms were elicited through a printed form, the Cornell Medical Index-Health Questionnaire (CMI). The CMI was devised to collect diagnostically important elements of the medical history given by general medical patients, without expenditure of a physician's time. Solely with these data, a physician can often correctly predict which diseases will be found in subsequent examination (Brodman et al. [1951]). Additional data abstracted for analysis from the hospital records include each patient's sex and age, along with the diagnoses made by hospital physicians after eliciting a history and performing physical and laboratory examinations. These diagnoses for the 1948-1949 data were coded according to the U. S. Public Health Service Manual for Coding Causes of Illness [1944] and form the standard against which the method is evaluated.

Dosage requirements of griseofulvin in onychomycosis due to Trichophyton rubrum. I. Preliminary report.

With the introduction of oral griseofulvin¹and the demonstration of its effectiveness in onychomycosis,^2,3a simple oral therapy appeared at hand. Onychomycosis due to the common Trichophyton rubrum organism has long been considered incurable by most dermatologists, there being no reasonable, routinely effective therapy. Early in 1959, when griseofulvin became available to the authors, a study was begun to determine the optimum dosage required to clear nails diseased with Trichophyton rubrum.^*It is the purpose of this preliminary report to outline our experiences to date in the treatment of onychomycosis with griseofulvin. Since February of 1959, we have treated 55 patients. No topical remedies were prescribed during the course of this study. Forty-one adult white patients have been observed for three months or more to form the basis of this report. In all cases the involvement of the nails was characterized by elevation and separation of the nail

The electroencephalogram in the negro: A comparison of electrical activity of the brain in white and negro patients

A group of 396 relatively normal white and negro adult patients were studied electroencephalographically, and the results compared, to determine whether any differences were present. No statistically significant differences were found.

Regional Distribution of Moles and Melanomas

THE RELATIONSHIP of pigmented moles and melanomas has been studied with regard to histogenesis, age of subjects, malignant derivation, etc., but the significance of their proportionate regional distribution has been largely ignored. We consider these clinical facts to be of sufficient interest and, perhaps, importance to justify the presentation of this information by four series of scattergrams showing (a) the pattern of primary melanin distribution when unaffected by sunlight or other melanin-provoking exposure; (b) the distribution of benign pigmented moles in 1,000 white adult patients; (c) the distribution of benign pigmented moles in 840 patients who, with their physicians, were so suspicious of these lesions as to have them removed for microscopical examination, and (d) the regional distribution of 1,225 verified malignant melanomas. From an outpatient diagnostic service, 1,000 adult white patients, who came for other complaints, were carefully examined in order to note and record the character, number, and

Regional distribution of moles and melanomas.

THE RELATIONSHIP of pigmented moles and melanomas has been studied with regard to histogenesis, age of subjects, malignant derivation, etc., but the significance of their proportionate regional distribution has been largely ignored. We consider these clinical facts to be of sufficient interest and, perhaps, importance to justify the presentation of this information by four series of scattergrams showing (a) the pattern of primary melanin distribution when unaffected by sunlight or other melanin-provoking exposure; (b) the distribution of benign pigmented moles in 1,000 white adult patients; (c) the distribution of benign pigmented moles in 840 patients who, with their physicians, were so suspicious of these lesions as to have them removed for microscopical examination, and (d) the regional distribution of 1,225 verified malignant melanomas. From an outpatient diagnostic service, 1,000 adult white patients, who came for other complaints, were carefully examined in order to note and record the character, number, and