JAMA : the journal of the American Medical Association
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Case Reports
Disseminated North American blastomycosis. Occurrence with clinical manifestations of adrenal insufficiency.
Adrenal involvement in cases of disseminated North American blastomycosis occurs frequently, but clinically substantive adrenal insufficiency is rare. An unusual case of disseminated blastomycosis with clinical manifestations of adrenal insufficiency was found. One should be alert to the symptoms of adrenal insufficiency that may develop in patients with disseminated mycoses.
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Steady-state plasma tricyclic antidepressant levels were determined in 65 patients undergoing treatment for depression with either amitriptyline hydrochloride or nortriptyline hydrochloride to determine if common factors such as age, race, sex, or smoking status were predictors of steady-state drug levels that have been shown to vary up to 36-fold. Evaluation of these factors did not disclose differences in the rate of demethylation of amitriptyline to nortriptyline, or steady-state tricyclic levels in the amitriptyline-treated patients. ⋯ Black patients had significantly higher (50%) nortriptyline plasma levels than did white patients, which may explain the more rapid response to tricyclic treatment demonstrated in blacks. Decreased rates of nortriptyline metabolism in blacks can result in increased side effects and treatment failure if the therapeutic plasma range is exceeded.
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We compared a sample of 200 patients who filed a claim of malpractice or negligence against a large urban teaching hospital and its physicians, with a randomly drawn sample of 549 patients who had never filed a claim against the hospital. The two groups were compared on distributions by race, religion, occupation, age, and sex. ⋯ Claimants were significantly older than nonclaimants (P less than .05). Women filed a statistically nonsignificant greater number of claims than men did (P greater than .20).
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Estrogen treatment of postmenopausal women is effective in relieving the symptoms of vasomotor instability and urogenital atrophy; estrogen treatment is effective in preventing accelerated bone loss and osteoporosis in young women following castration, but in postmenopausal women aging is a more important determinant of accelerated bone loss than is decreased estrogen secretion. Low-dose estrogen treatment of postmenopausal women neither prevents nor increases the risk of arteriosclerotic cardiovascular disease or cerebral vascular disease. It cannot be definitively established that estrogen treatment of postmenopausal women causes an increased incidence of breast tumors, but it is clear that such treatment does not prevent these tumors. It is established that estrogen treatment of postmenopausal women increases the risk ratio of endometrial carcinoma.