Annals of internal medicine
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Comparative Study
Rectilinear thyroid scanning as a predictor of malignancy.
Rectilinear scan findings were correlated with the surgically documented size, location, and histology of thyroid carcinoma in 67 patients. At the site of the carcinoma, 36 (54%) had hypofunction, associated with a palpable abnormality in all but one patient; 16 (24%) had an abnormality on palpation but not on scanning; 11 (16%) had both a normal clinical examination and a normal scan, associated with a benign abnormality in another part of the thyroid; and four (6%) had a patchy uptake. ⋯ The scan may still be used in evaluating the clinically solitary nodule that is not obviously malignant. However, unless that module is hyperfunctioning, clinical criteria rather than appearance of the scan should contribute most to the decision of whether to treat surgically.
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We studied 270 Saudi Arabs with homozygous sickle cell anemia, using chart review, a register (since 1969), and home visiting in 42 cases. Average follow-up for the total group was 10 years. ⋯ Compared with American or Jamaican blacks, serious complications occurred only 6% to 25% as frequently; leg ulcers did not occur at all; the mortality under age 15 years was 10% as great; mean levels of blood hemoglobin were higher (10 g/dl), reticulocyte count was lower (5% to 6%), and mean fetal hemoglobin (HbF), which was inversely correlated with reticulocytes, was higher (22% to 26.8%). The high HbF is believed to account for the very mild clinical manifestations.
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In an attempt to explain the greater morbidity from essential hypertension in the black as compared with the white race, we evaluated the intrarenal vasculature of 27 patients with hypertension (19 white and 8 black). All patients had mild-to-moderate hypertension (mean arterial pressure, 110 to 125 mm Hg), normal renal function, and minimal target-organ damage. All patients had selective renal angiograms, which were evaluated for arterial nephrosclerosis. ⋯ Black hypertensives had significantly (P less 0.01) more severe nephrosclerosis than the white patients. Renal blood flow was lower (P less than 0.05) in black patients (390 +/- 35 ml/min - m2 body surface area) than white patients (473 +/- 19 ml/min - m2 body surface area). These findings may help to explain racial differences in morbidity and mortality from essential hypertension.