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In 30 years of follow-up of 5,209 participants in the Framingham Study, 193 men and 183 women developed atrial fibrillation (AF). Among this group, "lone" AF occurred in 32 men and 11 women free of coronary heart disease, congestive heart failure, rheumatic heart disease, and hypertensive cardiovascular disease. To determine the characteristics and prognosis of lone AF, each case was matched to controls in the remaining Framingham sample. Comparisons indicated that levels of several risk factors associated with coronary heart disease were similar between the two groups. Atrial fibrillation cases, however, had significantly higher rates of preexisting nonspecific T- or ST-wave abnormalities and intraventricular block as determined by electrocardiograms. Follow-up for new cardiovascular events indicated similar rates of coronary heart disease and congestive heart failure, but the rate of strokes was significantly greater in the lone AF group. Findings suggest that subjects with lone AF, despite similar cardiovascular risk profiles to normal controls, have a distinct preponderance of preexisting electrocardiographic abnormalities. Furthermore, contrary to general belief, lone AF is not a benign condition; it has a serious prognosis, indicating a greater need for detection and treatment.(JAMA 1985;254:3449-3453)

The epidemiology of varicose veins was examined in 3,822 adults in the Framingham Study. Findings indicate that the incidence of varicose veins is higher among women than men, with no clear age differences. Compared to women without varicose veins, women with varicose veins were more often obese (p < .01), had lower levels of physical activity (p < .001) and higher systolic blood pressure (p < .001), and were older at menopause (p < .001). Women who reported spending eight or more hours in an average day in sedentary activities (sitting or standing) also had a significantly higher incidence of varicose veins than those who spent four or fewer hours a day in such activities (p < .05). For men, varicose veins coexisted with lower levels of physical activity (p < .05) and higher smoking rates (p < .05). While men and women with varicose veins had a higher incidence of atherosclerotic cardiovascular disease than those without varicose veins, only the excess risk of coronary heart disease in women was statistically significant (p < .05). However, this finding was not significant after controlling for body mass and systolic blood pressure. These results suggest that increased physical activity and weight control may help prevent varicose veins among adults at high risk, and reduce the overall risk of atherosclerotic cardiovascular disease as well.

We treated 60 patients with cisplatin-based combination chemotherapy before definitive surgery and/or radiation. All had squamous cell tumors of the head and neck, stages II to IV, M0. Twelve patients (20%) achieved a complete remission after chemotherapy. Eight of these patients showed no histologic evidence of residual disease after biopsy or surgery. Definitive local therapy with surgery and/or radiation was carried out on almost all patients regardless of the extent of the response to preceding chemotherapy. Chemotherapy-induced complete responders have had an improved survival rate in comparison with patients achieving a partial response or less. The extent of primary tumor correlates inversely with a complete response to chemotherapy.

While no unanimity of opinion exists regarding the risk to physical health from smoking marihuana, we have seen four cases that demonstrate clearly that intravenous usage is hazardous. The severity of the multisystemic involvement is dose-related. On initial examination, signs of most severe overdosage included fulminant gastroenteritis, hypoalbuminemia, toxic hepatitis confirmed by serial biopsy, acute renal failure, electrolyte disturbances, leukocytosis, anemia, and a relative thrombocytopenia. In three patients who shared a common needle, gingivostomatitis also developed.(JAMA 233:351-354, 1975)

A group of 75 institutionalized elderly patients was studied to determine the relationship of involuntary relocation to life adjustment in a nursing home. Data were collected by means of medical records and structured questionnaire. Patients who had experienced enforced relocation from other institutions expressed greater life dissatisfaction than those who had relocated voluntarily from their own home environment. For the group in general, life dissatisfaction was correlated with financial dependence, poor health, and limited social participation. Length of stay in the institution was not related to life satisfaction. The evidence suggests that involuntary placement, multiple moves, disruption of social networks, and financial dependence may contribute to life dissatisfaction among institutionalized elderly.

One hundred and fourteen chronically-ill patients six months after discharge from a general hospital revealed a high readmission rate (34.2%), a high utilization of hospital services, out-patient clinics, and family practitioners reflecting the problem of chronically-ill old people. The study of compliance with physician's recommendations showed that 42.1% of all patients interviewed did not comply with one or more recommendations. The reasons for not complying with the orders were related to the deficiencies of community health and social agencies, the patient's attitude or understanding of the instructions, the cost of drugs, and other factors. The lack of compliance was associated with marital status, education, income, and severity of disease.