SUMMER DIARRHEA IN THE SAN JOAQUIN VALLEY

In laboratory, epidemiologic and clinical studies of 85 patients with diarrhea admitted to the General Hospital of Fresno County and the San Joaquin County Hospital during part of the summer of 1949 the following features were noted:1. Cultures were positive for Shigella in about 45 per cent of the cases in the San Joaquin County Hospital and in about 15 per cent of those in the Fresno County Hospital.2. In 80 per cent of cases in which there was gross blood in the stools before the third day of hospitalization, Shigella grew on cultures. No gross blood was noted in 27 per cent of cases in which Shigella was demonstrated.3. The cases in which Shigella was demonstrated did not differ greatly from the others with regard to fever, leukocytosis, or response to therapy.4. Salmonella organisms were not grown on cultures in any case.5. Most of the patients were infants younger than one year of age.6. Poor socio-economic and hygienic conditions characterized the households from which these county hospital patients came.7. Household follow-up studies indicated that there had been one or more instances of diarrhea among household associates of approximately half the hospitalized patients at some time during the month prior to admission.     

The establishment and operation of a Nerve Block Clinic; one year's experience at the Los Angeles County Hospital

The Anesthesia Department at the Los Angeles County Hospital established a Nerve Block Clinic for the purpose of alleviating pain and providing helpful information for diagnosis in a number of diseases. During the first year of operation of this Nerve Block Clinic, over one thousand injections were made. The patients who received the injections were referred to the Nerve Block Clinic by staff members who had been apprised of the services offered.     

THE ESTABLISHMENT AND OPERATION OF A NERVE BLOCK CLINIC—One Year's Experience at the Los Angeles County Hospital

The Anesthesia Department at the Los Angeles County Hospital established a Nerve Block Clinic for the purpose of alleviating pain and providing helpful information for diagnosis in a number of diseases.During the first year of operation of this Nerve Block Clinic, over one thousand injections were made. The patients who received the injections were referred to the Nerve Block Clinic by staff members who had been apprised of the services offered.     

DISEASES AND DEATHS—A Summary of Data from the Los Angeles County General Hospital, 1918 to 1948—Part I

Classification of the 2,557,035 diagnoses made in 1,168,139 different patients at the Los Angeles County General Hospital in the period 1918-48 has been compiled according to the new International List of Causes of Diseases and Death. Similar tabulation of the 377,776 diagnoses made in the 112,409 patients who died while in the hospital reflects the fatality rates associated with these diagnoses. Striking differences are shown in the incidence and fatality rates in the various conditions and great changes have occurred in both during this time. Defects and sources of error in these data are recognized, but they offer a wealth of valuable material for further study and interpretation.     

Diseases and deaths; a summary of data from the Los Angeles County General Hospital, 1918 to 1948

Classification of the 2,557,035 diagnoses made in 1,168,139 different patients at the Los Angeles County General Hospital in the period 1918-48 has been compiled according to the new International List of Causes of Diseases and Death. Similar tabulation of the 377,776 diagnoses made in the 112,409 patients who died while in the hospital reflects the fatality rates associated with these diagnoses. Striking differences are shown in the incidence and fatality rates in the various conditions and great changes have occurred in both during this time. Defects and sources of error in these data are recognized, but they offer a wealth of valuable material for further study and interpretation.     

Gorski Kotar--an endemic region for primary gastric non-hodgkin lymphoma?

Primary gastric non Hodgkin lymphoma (PGNHL) is a distinct group of extranodal lymphomas with interesting geographical distribution and variable prevalence in different countries. We analysed epidemiological data of our patients with PGNHL in Primorsko-goranska County. Clinical data of 30 patients with PGNHL diagnosed and treated in Clinical Hospital Center of Rijeka, Croatia between January 1995 and December 2005 were prospectively analyzed. We used statistical analysis (t-test, chi2-test) for small groups. Out of 30 pts with PGNHL, 19 were born in Primorsko-goranska County, part of Croatia situated by the Adriatic sea which consists of three regions: City of Rijeka, Islands and Gorski Kotar. 6 of 19 patients (31.6%) were originally from Gorski Kotar which made incidence rate of PGNHL in Gorski Kotar 7 times higher than in other two regions. Many authors emphasized that relative frequency of PGNHL is very variable in various countries and regions. Geographical distribution of our patients was very surprising because Gorski Kotar is the region with lowest number of citizens, rural area without any known pollutants, and ecologically one of the most preserved microsystem in this part of Croatia. Gorski Kotar is known to be an endemic region for multiple sclerosis and lyme borreliosis. Is it for PGNHL too?     

Bacterial meningitis and other diseases affecting the meninges; a review of 349 cases

Three hundred and forty-nine cases of disease affecting the meninges were observed at the San Bernardino County Charity Hospital in an eight year period.A total of 29 patients with meningococcal, H. influenzae and pneumococcal meningitis were treated. There were four deaths, of which three occurred during the first 24 hours in the hospital. Of 22 cases of unclassified meningitis, four probably were tuberculous, four probably were meningococcal and two probably were of virus origin. Under present treatment programs the differentiation between viral and bacterial meningitides is difficult and it is possible, therefore, that the reported incidence of the two groups may not represent the facts. Of 22 cases of unclassified meningitis, 12 had no specific characteristics which would permit a clinical diagnosis. One of the patients died. Of 70 cases of clinical meningitis, the infecting organism was identified in 69 per cent. Meningococcal meningitis made up only 17 per cent of 70 cases of purulent meningitis observed between July 1, 1945, and July 1, 1948.     

BACTERIAL MENINGITIS AND OTHER DISEASES AFFECTING THE MENINGES—A Review of 349 Cases

Three hundred and forty-nine cases of disease affecting the meninges were observed at the San Bernardino County Charity Hospital in an eight year period.A total of 29 patients with meningococcal, H. influenzae and pneumococcal meningitis were treated. There were four deaths, of which three occurred during the first 24 hours in the hospital.Of 22 cases of unclassified meningitis, four probably were tuberculous, four probably were meningococcal and two probably were of virus origin.Under present treatment programs the differentiation between viral and bacterial meningitides is difficult and it is possible, therefore, that the reported incidence of the two groups may not represent the facts.Of 22 cases of unclassified meningitis, 12 had no specific characteristics which would permit a clinical diagnosis. One of the patients died.Of 70 cases of clinical meningitis, the infecting organism was identified in 69 per cent.Meningococcal meningitis made up only 17 per cent of 70 cases of purulent meningitis observed between July 1, 1945, and July 1, 1948.     

FEMORAL NECK FRACTURES IN THE AGED

Clinical data were reviewed on 99 patients with 102 fractures of the femoral neck on the Orthopedic Service of the San Diego County General Hospital. All were elderly. Twenty-one were dead within two month of the time the fracture was reduced and 36 within a year. In 14 cases the fracture was impacted or undisplaced; there was only one of these in which the fracture did not unite following treatment, and that was for iatrogenic reasons. Sixty-one per cent of the displaced fractures healed; only 32 per cent of the total number of patients with displaced femoral neck fractures walked again.     

Antibiotics in management of staphylococcal endocarditis; with special reference to increasing bacterial resistance

Eighteen patients with staphylococcal endocarditis were observed at the Los Angeles County Hospital over a 3-year period (1947-49, inclusive). Twelve died. Bacterial sensitivity studies were carried out in 15 of the cases, and there was resistance to penicillin in ten. Aureomycin was effective in two cases of Staphylococcus aureus endocarditis in which there was no response to penicillin therapy. In one case of Staphylococcus aureus endocarditis the organism was resistant to penicillin and developed increasing resistance to aureomycin.     

A single-bottle blood culture system: evaluation and comparison with two other systems.

A commercially available single-bottle blood culture system was evaluated at Ben Taub General Hospital, a Harris County District Hospital. Blood cultures from 1010 patients were examined with the Lederle Diagnostics one-bottle blood culture medium-SPS, Columbia broth (E-Vac, Pfizer), and an in-house-prepared brain heart infusion broth with p-aminobenzoic acid (PABA) and 0.1% agar. Of the 1010 patients examined, blood cultures from 211 (20.8%) were positive, yielding a total of 23 different species of microorganisms. Comparison of the results during clinical evaluation, as well as those from simulated blood cultures, showed that the Lederle Diagnostics blood culture bottle was as effective as the in-house-prepared brain heart infusion and commercially available Columbia broths for isolation of aerobes as well as anaerobes. The techniques used in the evaluation and the advantages of a single-bottle culture system are discussed.     

GLUTETHIMIDE—A New Nonbarbiturate Hypnotic

A new anticonvulsant, nonbarbiturate compound, Doriden (ethyl-a-phenyl-glutarimide) was studied for clinical activity as a hypnotic drug in mildly disturbed patients on the acute Psychiatric Service of Los Angeles County General Hospital. It was found to have approximately the same hypnotic activity as pentobarbital in the dosages recommended (1 gm. Doriden=200 mg. pentobarbital).     

ANTIBIOTICS IN MANAGEMENT OF STAPHYLOCOCCAL ENDOCARDITIS—With Special Reference to Increasing Bacterial Resistance

Eighteen patients with staphylococcal endocarditis were observed at the Los Angeles County Hospital over a 3-year period (1947-49, inclusive). Twelve died.Bacterial sensitivity studies were carried out in 15 of the cases, and there was resistance to penicillin in ten.Aureomycin was effective in two cases of Staphylococcus aureus endocarditis in which there was no response to penicillin therapy.In one case of Staphylococcus aureus endocarditis the organism was resistant to penicillin and developed increasing resistance to aureomycin.     

Glutethimide,a new nonbarbiturate hypnotic

A new anticonvulsant, nonbarbiturate compound, Doriden (ethyl-a-phenyl-glutarimide) was studied for clinical activity as a hypnotic drug in mildly disturbed patients on the acute Psychiatric Service of Los Angeles County General Hospital. It was found to have approximately the same hypnotic activity as pentobarbital in the dosages recommended (1 gm. Doriden=200 mg. pentobarbital).     

A THERAPEUTIC REGIMEN FOR TUBERCULOUS MENINGITIS

The results of treatment of tuberculous meningitis in Highland Alameda County Hospital, since the advent of streptomycin, in 34 cases were: dead, 21 patients, or 61 per cent; alive, 10 patients, or 29 per cent. Three cases were excluded from the ultimate report due to inadequate follow-up. The mean survival time of the ten survivors at the time of report was 35 months, the longest being 74 months.The composite results of treatment elsewhere, as reported in the literature, have been: dead, 892, or 59 per cent; alive, 629, or 41 per cent.The pathogenesis of the disease and the effects of chemotherapy are discussed.A therapeutic regimen for tuberculous meningitis is presented, which has been used at Highland Hospital since INH became established as the most effective component in the combined chemotherapeutic attack on the disease.     

Progression of optic neuritis to multiple sclerosis in the County of Split-Dalmatia, Croatia

The aim of this study was to determine the incidence of monosymptomatic optic neuritis (MON) and progression of MON to multiple sclerosis (MS) from the Mediterranean region of southern Europe in the County of Split-Dalmatia, Croatia during the 11 years period from 1991 to 2001. This study was made retrospectively on the 87 cases (59 female, aged 25.9 +/- 11.3 and 28 male aged 29.9 +/- 9.2) of MON, which were treated at the Department of Ophthalmology and Department of Neurology, Split, University Hospital, from January 1991 to December 2001. In each case the diagnosis was confirmed by a chart review and cases were ascribed to the data of admittance at hospital. The annual incidence of MON was 1.9 per 100,000 (95% CI, 0.4-3.5). The incidence among males was 1.2 (95% CI, 0-2.9) cases / 100,000 per year and 2.5 (95% CI, 0.1-4.9) among females. A significant seasonal variations in the incidence of MON was not found (chi2 = 6.81, p = 0.08). MS developed in 20 of 87 patients (22.9%) and median time was 25 (SE 8) months, (95% CI, 9-41) after the MON onset. After two years 12.6% of patients with MON developed MS, 20.6% after 5 years and 22.9% after 10 years. MS was slightly but not significantly more frequent in women than in men (chi2 = 0.72, p = 0.3). In conclusion, the progression of MON to MS in the County of Split-Dalmatia, Croatia was at a relatively moderate frequency.     

Diseases and deaths; a statistical survey of 40,130 autopsies at the Los Angeles County General Hospital, 1918 to 1948. II

The 215,468 diagnoses recorded in 40,130 autopsies on patients treated at the Los Angeles County General Hospital during the 30 years between 1918 and 1948 were reviewed and tabulated. The primary causes of death as determined by the pathologists in these cases were recorded and the incidence of death from each disease in relation to the number of cases in which each occurred was computed. The age, sex and race distribution of patients examined postmortem and the incidence and fatality rates from various pathological conditions changed greatly during the period, owing to many factors, among them changes in elements of the population served by the hospital, an increasing incidence of older patients, and medical triumph over some formerly formidable diseases.     

2006-2010 年北京延庆县肺结核病发现与治疗转归

目的:评估北京延庆县肺结核病发现与治疗转归情况.方法:运用描述性统计方法,分析2006～2010年北京延庆县肺结核流行病学监测数据,主要探讨肺结核发现以及治疗转归的特点.结果:2006～2010年我县查痰率为94.65％,阳性检出率为36.70％.5年间全县共登记活动性肺结核患者1058例,登记率呈上升趋势;新登涂阳肺结核患者中治愈298例,平均治愈率为88.17％,治愈率呈逐年升高的趋势.结论:我县肺结核防治工作取得了显著成绩,但是仍然存在一些问题,有待进一步完善.     

DISEASES AND DEATHS—A Statistical Survey of 40,130 Autopsies at the Los Angeles County General Hospital, 1918 to 1948—Part II

The 215,468 diagnoses recorded in 40,130 autopsies on patients treated at the Los Angeles County General Hospital during the 30 years between 1918 and 1948 were reviewed and tabulated. The primary causes of death as determined by the pathologists in these cases were recorded and the incidence of death from each disease in relation to the number of cases in which each occurred was computed. The age, sex and race distribution of patients examined postmortem and the incidence and fatality rates from various pathological conditions changed greatly during the period, owing to many factors, among them changes in elements of the population served by the hospital, an increasing incidence of older patients, and medical triumph over some formerly formidable diseases.     

Bleeding Esophageal Varices Due to Occult Cirrhosis of the Liver

The literature on the subject and the records of 40 cases of proven gallstone obstruction in the small intestine observed at the Los Angeles County General Hospital over a 27-year period were reviewed. The incidence of this type of obstruction is about 1.5 per cent of all cases of mechanical intestinal obstruction; and it occurs more often in women than in men-the ratio was 3.7 to 1 in the Los Angeles County General Hospital series. In general, the majority of patients are in the seventh decade of life, although in the present series the age average was well over 70 years. Gallstones large enough to cause intestinal obstruction almost invariably reach the intestinal tract through a fistula between the gallbladder and the duodenum. The symptoms of gallstone obstruction are principally those of mechanical obstruction of the small bowel. The usual site of obstruction is the distal ileum. When gallstones are the cause of obstruction, the symptoms may be intermittent. Surgical operation is the treatment of choice. Exploration should include a complete examination of the intestinal tract to make certain multiple stones are not overlooked, and the right upper quadrant should be palpated for the presence of an acutely inflamed gallbladder or more calculi.