Walter Reed General Hospital Research Articles

New congenital myopathy with crystalline intranuclear inclusions.

THE varieties of congenital myopathy include muscular glycogenosis, megaconial and pleoconial myopathies, congenital muscular dystrophy, central core disease, benign congenital hypotonia, and nemaline myopathy. 1 The purpose of this communication is to report an infant dying with a congenital myopathy which was characterized by a morphologic feature not previously described in any known case. Skeletal muscle from this patient contained numerous eosinophilic intranuclear crystalline inclusions which were seen on routine hematoxylin and eosin stained sections. Special stains and electron microscopic examination revealed additional smaller crystals within the sarcoplasm and occasionally arising from Zbands. Report of a Case The patient, a 2-week-old white girl, was admitted to Walter Reed General Hospital on Nov 7, 1967. She was the product of a normal pregnancy, labor, and delivery and was born to a 21-year-old gravida 1, para 0, healthy woman. At birth the infant had spontaneous respirations but was lethargic, hypotonic, and had

The patient equivalence of the RANDO phantom for cobalt gamma rays.

The RANDO2 “average man” or “average woman” phantoms are especially designed for use in connection with radiation dosimetry studies. The construction of the phantom, which has been discussed in detail in the literature (1, 2), consists of a special thermosetting synthetic rubber which is molded around a natural human skeleton. Lungs are simulated with a special foam reported to have a density of 0.32. During the past three years a RANDO “average man” phantom has been in use at Walter Reed General Hospital in the development of a number of special dosimetry technics using 60Co gamma rays and 2 MVp x rays. In all of these studies the exposure in the phantom was measured with film or miniature ionization chambers. In the application of the measurements to treatment planning we have assumed that the phantom was “patient equivalent,” i.e., that an exposure at a depth and in any particular anatomical site in the phantom would accurately predict the exposure under similar conditions in the patient. This assumpti...

The Frowning Sign Multiple Forehead Furrows In Peptic Ulcer

<h3>To the Editor:—</h3> Frowning is produced by contraction of the corrugator supercilii muscle. This muscle arises from the lowest point of the frontal bone where it joins the bones of the nose and runs obliquely upwards inserts into the skin under the eyebrows. Its action lowers and brings together the eyebrows so that vertical furrows are formed on the forehead.¹ One of us (T.A.W.) has had the impression that chronic duodenal ulcer patients have an increased number of vertical furrows on the forehead. William Shakespeare may have made the original observation, as quoth by Othello, Act III, scene 3, "I have a pain upon my forehead here." This study was undertaken to test the validity of such an impression. <h3>Material and Methods:—</h3> Two hundred patients from the gastroenterology and general medicine services at the Walter Reed General Hospital and 200 male veterans are included in this study. One hundred

The frowning sign. Multiple forehead furrows in peptic ulcer.

To the Editor:— Frowning is produced by contraction of the corrugator supercilii muscle. This muscle arises from the lowest point of the frontal bone where it joins the bones of the nose and runs obliquely upwards inserts into the skin under the eyebrows. Its action lowers and brings together the eyebrows so that vertical furrows are formed on the forehead. 1 One of us (T.A.W.) has had the impression that chronic duodenal ulcer patients have an increased number of vertical furrows on the forehead. William Shakespeare may have made the original observation, as quoth by Othello, Act III, scene 3, I have a pain upon my forehead here. This study was undertaken to test the validity of such an impression. Material and Methods:— Two hundred patients from the gastroenterology and general medicine services at the Walter Reed General Hospital and 200 male veterans are included in this study. One hundred

Schizophrenic symptom change with rehospitalization.

EXCEPT for case studies, most of the literature in which specific signs and symptoms are empirically associated with a diagnosis of "schizophrenia" or "schizophrenic reaction" consists of reports of cross-sectional data associated with a single hospitalization. Relatively little systematic attention has been paid to the consistency of schizophrenic symptoms over time and over multiple hospitalizations. The purpose of this study is to examine the presenting complaints, signs and symptoms, which required two hospitalizations of the same group of patients over a two-year period. Each individual's symptoms and diagnosis on an index hospitalization are compared with those on readmission. <h3>Subjects and Methods</h3> Subjects were drawn from the total group of 403 enlisted men discharged from the Psychiatry Service of Walter Reed General Hospital with a final diagnosis of schizophrenic reaction during the period of February 1962 to May 1963.

A Long-Term Evaluation of the Postexercise Electrocardiogram in the Prediction of Coronary Artery Disease.

s1 May 1968A Long-Term Evaluation of the Postexercise Electrocardiogram in the Prediction of Coronary Artery Disease.L. F. Parmley, M.D., F.A.C.P., T. W. Mattingly, M.D., F.A.C.P., J. A. Orbison, M.D., F.A.C.P.L. F. Parmley, M.D., F.A.C.P.Search for more papers by this author, T. W. Mattingly, M.D., F.A.C.P.Search for more papers by this author, J. A. Orbison, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-68-5-1160_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn 1952 a prospective study was initated at Walter Reed General Hospital to determine if a postexercise electrocardiogram stress test could detect latent coronary artery disease in the clinically normal individual. A retrospective study following extensive use of this exercise test in preceding years had established the electrocardiogram (EKG) criteria of ST segment straightening and depression of over 0.5 mm as indicative of myocardial ischemia and called "ischemic depression" (ID). T-wave changes and ST segment junctional depression were believed due to other than coronary artery disease and called "nonischemic depression" (NID). Three hundred male Army officers, 100 in each of... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Washington, D. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1968Volume 68, Issue 5Page: 1160-1160KeywordsElectrocardiographyExerciseIschemiaProspective studiesRetrospective studiesStable coronary artery disease Issue Published: 1 May 1968 PDF DownloadLoading ...

A study of survival in 279 cases of Hodgkin's disease.

The series of cases of Hodgkin's treated at Walter Reed General Hospital during the interval between 1949 and 1961 is presented and the results of treatment are analyzed and compared with other series. The limited value of using over-all survival figures to measure success of treatment is demonstrated. Differences in survival by stage evident in this comparison are discussed.In the Walter Reed General Hospital series there was apparent improvement in survival in the early stages when prophylactic areas were irradiated. With the present staging system there may be little value in differentiating between Stage 1 and 11A since survival at 5 and 10 years is the same in each stage. The system proposed at the Symposium on the Radiotherapy of Hodgkin's disease9 recognizes this difficulty and redefines Stage 1 as disease limited to one anatomic region or two contiguous anatomic regions on the same side of the diaphragm.Supervoltage equipment has made it possible to irradiate larger volumes of tissue to ...

Anaphylactoid reaction to intravenously administered fluorescein.

FLUORESCEIN, administered intravenously, has been discussed frequently in the current ophthalmologic literature. However, no mention has been made of serious adverse drug reactions, and for that reason, this case is being reported. 1-7 Report of a Case The patient is a 30-year-old white man, a physician, with a childhood history of hay fever. He has also had allergic reactions in the past that have been manifested by partial respiratory obstruction and pruritus of the middle ear and oropharynx. These occurred after he ate ripe cantaloupe, cucumber, or watermelon. The patient now avoids these foods and has had no allergic reactions since 1962. For one week prior to admission to the hospital, the patient had uniocular metamorphopsia. He was seen at the Walter Reed General Hospital Eye Clinic, and a diagnosis was made of detachment of the posterior vitreous with wrinkling of the internal limiting membrane of the retina of his

Limited value of lymphanigography in Hodgkin's disease.

The following generalizations are commonly accepted as forming the basis for rational therapy in Hodgkin's disease: (a) cure depends on the deliverance of an adequate dose of radiation to all involved tissues; (b) retroperitoneal extensions of apparently localized disease may be clinically silent; (c) lymphangiography will demonstrate clinically silent retroperitoneal extensions in a large percentage of cases (2–5, 7–9); (d) lymphangiography is mandatory for defining the proper treatment volume in curative therapy of Hodgkin's disease (4, 5, 7–9). A review of the lymphangiograms in 71 cases of Hodgkin's disease at Walter Reed General Hospital does not confirm statements c and d, however, but suggests that lymphangiography may be of little practical value in determining proper therapy. Since 1962, more than 250 lymphangiographic examinations have been performed at Walter Reed, over 100 in patients with proved Hodgkin's disease. Of these studies, 71 were available for review and met the criteria for inclusi...

Ewing's sarcoma: case against surgery.

Thirty cases of Ewing's sarcoma have been treated at Walter Reed General Hospital since 1949. A review of this experience and that of others has failed to reveal any valid reason for a heroic surgical attack. Removal of limbs and other portions of the body has become a needless surgical exercise. Radiation therapy regularly controls the lesion and is the most effective agent for palliation of metastasis. Supervoltage radiation is the treatment of choice in all cases.

Acute Renal Failure Associated with Heat Stress and Physical Exertion.

Excerpt Eight cases of acute renal failure associated with heat stress and physical exercise were treated at the Walter Reed General Hospital between 1960 and 1966. All of the cases occurred during...

Treatment and prognosis in Wilms' tumor. A study of 51 cases with special reference to the role of actinomycin D.

A total of 51 patients with Wilms' tumor have been treated at Walter Reed General Hospital in 16 years. The 2-year survival rate was 44% and the 3-year survival rate 42%. Most patients had nephrectomy followed by postoperative irradiation. Patients treated after 1960 received actinomycin D either in the immediate postoperative period in conjunction with irradiation or subsequently when metastases developed. The addition of actinomycin D has not influenced the cure rate. However, the methods of treatment selection and the total number of cases prohibits proper staistical analysis. In addition, the immediate use of actinomycin D in the postoperative period along with irradiation has not prolonged survival. When actinomycin D has been reserved for subsequent use for later metastases or recurrent tumor there appears to be a definite increase in survival time. Both radiation therapy alone and combined with actinomycin D has been quite effective in controlling lung metastases. The complications of irradiation and actinomycin D in the treatment of Wilms' tumor have been briefly reviewed and found to be minimal in the present series.

Pheochromocytoma of the Bladder

PHEOCHROMOCYTOMAS, having originated from chromaffin tissue, are most frequently associated with the adrenal glands, but may be located in any area along the fetal route of this tissue.¹The protean origin of these tumors has been recognized by Rosenheim,²who has stated that 10% of the pheochromocytomas are bilateral and 10% ectopic. Although 19 cases of pheochromocytoma originating in the urinary bladder have been previously reported,^3-5only 3 have been diagnosed and located preoperatively.^6-8This report emphasizes the techniques of preoperative diagnosis of such a tumor. <h3>Report of a Case</h3> A 34-year-old married white woman was referred to Walter Reed General Hospital with a tentative diagnosis of a pheochromocytoma of the urethra. The patient stated that for a ten-year period, urination was frequently associated with a cataclysmic experience. Upon voiding, the patient experienced "a hurting and throbbing all over as if her blood vessels were going

Intensive Care Unit Opens for Shock Patients

A single-bed intensive treatment unit for the study and care of patients with refractory shock opened recently at Walter Reed General Hospital. The unit, which has its own computers for data reduction, is the first in an armed forces or government medical facility, according to Col Robert M. Hardaway, III, MC, USA. An eight-channel recorder makes continuous displays of the patient's arterial, pulmonary and peripheral blood pressure, cardiac output, skin and rectal temperature, as well as other parameters. The bed is built on a scale which computes the patient's weight to the gram. Radiolucent straps facilitate fluoroscopy without moving the patient. The specially constructed image intensifier is another feature of the unit. It may be used at bedside without shielding or darkening of the room for positioning pulmonary artery catheters and other purposes. From past experience, it is known that an average of one shock patient per week fails to

A Method of Adenectomy and Breast Reconstruction for Benign Disease

Washington, D. C. * Formerly Chief Resident, Plastic Surgery Service, Walter Reed General Hospital, Washington, D. C., and presently United States Army Fellow in Plastic Surgery, Barnes Hospital, St. Louis, Missouri. † Assistant Chief, Plastic Surgery Service, Walter Reed General Hospital, Washington, D. C.

A Method of Adenectomy and Breast Reconstruction for Benign Disease

Washington, D. C. * Formerly Chief Resident, Plastic Surgery Service, Walter Reed General Hospital, Washington, D. C., and presently United States Army Fellow in Plastic Surgery, Barnes Hospital, St. Louis, Missouri. † Assistant Chief, Plastic Surgery Service, Walter Reed General Hospital, Washington, D. C.

Pituitary adenomas: concepts based on twelve years' experience at Walter Reed General Hospital.

Adenomas of the pituitary gland constitute a significant portion of intraeraniM neoplasms. In the past sixty years a large body of knowledge has been accumulated regarding their clinical and pathologic features. Age and sex incidence, tumor morphology, common signs and symptoms, have been defined through the study of series of patients, and have become part of the generally accepted body of medical knouTledge. Nevertheless, despite the frequency with which these neoplasms are encountered, and despite the considerable number of reports concerned with patients with pi tui tary adenomas, their management remains controversial. The decision for either surgery and irradiation, alone or in some combination, or no t reatment at all, depends on the experience and prejudices of the attending physician, and does not follow a universally accepted formula. In every instance, our own included, a decision for or against a form of therapy has been made based upon retrospective analysis of an uncontrolled series of selected eases. In presenting this report, we hope to serve a two-fold purpose. First, an a t tempt will be made to add to the collected knowledge, and emphasize some of the less commonly appreciated characteristics of these neoplasms. Secondly, we wish to present our views regarding the management of the pi tui tary adenoma suspect.

RANGE OF DIFFICULTY OF FOUR HARVARD PHONETICALLY BALANCED WORD LISTS.

The LaryngoscopeVolume 75, Issue 2 p. 289-296 Article Range of difficulty of four harvard phonetically balanced word lists Kenneth S. Burke A.B., Kenneth S. Burke A.B. Washington, D. C. Research Psychologist, Bioacoustics Section, Army Audlology and Speech Center, Walter Reed General Hospital, Walter Reed Army Medical Center, Washington 12, D. C.Search for more papers by this authorR. Edwin Shutts Ph.D., R. Edwin Shutts Ph.D. Washington, D. C. Assistant Director, Army Audiology and Speech Center, Walter Reed General Hospital, Walter Reed Army Medical Center, Washington 12, D. C.Search for more papers by this authorWilliam P. King M.D., William P. King M.D. Washington, D. C. Former Director, Army Audiology and Speech Center, Walter Reed General Hospital, Walter Reed Army Medical Center, Washington 12, D. C. Currently in private practice, Corpus Christi, Texas.Search for more papers by this author Kenneth S. Burke A.B., Kenneth S. Burke A.B. Washington, D. C. Research Psychologist, Bioacoustics Section, Army Audlology and Speech Center, Walter Reed General Hospital, Walter Reed Army Medical Center, Washington 12, D. C.Search for more papers by this authorR. Edwin Shutts Ph.D., R. Edwin Shutts Ph.D. Washington, D. C. Assistant Director, Army Audiology and Speech Center, Walter Reed General Hospital, Walter Reed Army Medical Center, Washington 12, D. C.Search for more papers by this authorWilliam P. King M.D., William P. King M.D. Washington, D. C. Former Director, Army Audiology and Speech Center, Walter Reed General Hospital, Walter Reed Army Medical Center, Washington 12, D. C. Currently in private practice, Corpus Christi, Texas.Search for more papers by this author First published: February 1965 https://doi.org/10.1288/00005537-196502000-00008Citations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume75, Issue2February 1965Pages 289-296 RelatedInformation

CARPAL TUNNEL SYNDROME AS MANIFESTATION OF SARCOIDOSIS.

The median nerve is vulnerable to compression as it passes through the rigid carpal tunnel, posterior to the transverse carpal ligament, and anterior to the flexor tendons. Hematomata, edema, urate deposits, granulomata, or fractures within this carpal tunnel have been incriminated as a cause of compression. Paresthesias in the distribution of the median nerve to the hand with ultimate atrophy of the involved muscles may occur. Previous reports have related such an entity to a variety of otherwise unrelated systemic diseases. Rheumatoid arthritis, diabetes mellitus, thyroid adenomas, myxedema, gout, multiple myeloma, acromegaly, and lymphomatous diseases have been etiologically related to a coexistent carpal tunnel syndrome. 1,2,5 Sarcoidosis, however, has not been mentioned previously. Two patients with probable sarcoidosis who had an associated bilateral median nerve compression will be described. Report of Cases Case 1. —A 45-year-old Caucasian male was admitted to Walter Reed General Hospital in February, 1961, with a

EFFECT OF POTASSIUM IN RESTORING MYOCARDIAL RESPONSE TO A SUBTHRESHOLD CARDIAC PACEMAKER.

IMPLANTED cardiac pacemakers may become exhausted and no longer produce myocardial response. Pharmacologic means were used in this study to restore responsiveness to partially exhausted pacemakers in 2 patients with complete heart block. Case Reports Case 1. A 69-year-old woman had been asymptomatic for 20 months after implantation of a cardiac pacemaker for complete heart block and Adams-Stokes attacks. However, 2 weeks before admission, she noted a slower heart rate and after 2 syncopal episodes was returned to Walter Reed General Hospital. An electrocardiogram revealed complete heart block, with idioventricular rhythm. The ventricle responded to the implanted pacemaker only when . . .