JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of propranolol and hydrochlorothiazide for thr initial treatment of hypertension. I. Results of short-term titration with emphasis on racial differences in response. Veterans Administration Cooperative Study Group on Antihypertensive agents.
We compared hydrochlorothiazide and propranolol hydrochloride for monotherapy of hypertension by a double-blind study of 683 men who were titrated to less than 90 mm Hg diastolic BP or to 640 mg of propranolol or 200 mg of hydrochlorothiazide. Propranolol reduced systolic BP from 146.0 +/- 14.4 (SD) to 134.8 +/- 16.3 mm Hg and diastolic BP from 101.6 +/- 4.6 to 90.5 +/- 7.5 mm Hg. Hydrochlorothiazide lowered both systolic BP more effectively from 146.5 +/- 15.8 to 128.8 +/- 12.2 mm Hg and diastolic BP from 101.3 +/- 4.5 to 89.4 +/- 6.5 mm Hg. ⋯ In blacks treated with hydrochlorothiazide, 71.3% achieved diastolic BP of less than 90 mm Hg, v 53.5% with propranolol. There was no racial difference in dose response to propranolol, but blacks required much less hydrochlorothiazide to achieve control. We conclude that in this short-term study propranolol was as efficacious as hydrochlorothiazide in whites, but the latter was more effective than propranolol in blacks.
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We studied four wrestling tournaments that totaled 1,049 participants of grade school, high school, and college age levels. Two clearly serious injuries occurred: a wrist fracture and an elbow dislocation. Knee and ankle sprains of mild to moderate severity were the most common diagnoses. ⋯ Thirty-nine percent of all injuries were because of aggravation of old injuries. Thus, rehabilitation after injury is believed to be an important preventive measure. These findings suggest that, although most injuries in wrestling are not severe, attendance at tournaments by medically trained personnel is warranted.
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Comparative Study
Malignant melanoma in black American and white American populations. A comparative review.
Malignant melanoma, a type of cancer that accounts for 1% to 3% of all malignant neoplasms in 20 times more frequent in the American white than black population. During a computer-aided retrospective chart review of more than 2,500 patients with melanoma being followed up at the Duke University Comprehensive Cancer Center, 31 blacks have been identified. Primary lesions of the foot were predominant in blacks with melanoma, and a high percentage of these were classified pathologically as acral lentiginous primary lesions. ⋯ Five-year survival for the total black population was 23%. Blacks had a significantly worse prognosis than the white population when a comparison with the total group was made that was controlled for sex, age, site of primary lesion, stage of disease at presentation, and Clark level of primary melanoma lesion. This emphasizes the aggressive nature of this disease in the American black.
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Case Reports
Fatal cardiac tamponade. Occurrence with other complications after left internal jugular vein catheterization.
A case of fatal cardiac tamponade caused by superior vena cava perforation complicating left internal jugular vein catheterization and infusion is reported. Two cases of nonfatal combined hydromediastinum and hydrothorax as a result of the left-sided approach are discussed. Unexplained hypotension with venous distention in a patient with a central venous catheter should immediately raise the possibility of cardiac tamponade. Avoidance of the left internal jugular vein approach, the use of flexible catheter materials, and localization of the catheter tip above the pericardial reflection will lessen the complications caused by placement of central venous lines.