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Fever, infection, or both occurred at some time during hospitalization in 67% of patients on a referral spinal cord injury service. A single cause of fever was generally found, with urinary tract and soft-tissue infections predominating; these responded well to appropriate management. In contrast, spinal cord injury patients on other services seen in consultation by the infectious disease service had far more complicated and advanced disease. Multiple infections were diagnosed in the majority of these patients, with urinary tract and decubitus ulcers predominating. Complicating osteomyelitis was present in more than half of those who had infected decubitus ulcers. In both groups of patients, diagnosis required careful attention to physical and laboratory examination because multiple potentially infected areas could be identified and because usual symptoms were sometimes masked by altered sensation. (JAMA1982;248:66-70)

PROSPECTIVE studies, of which the Albany Cardio;vascular Health Center study is typical, have confirmed or identified abtout a dozen characteristics which to varying degreeis are associated with an increased incidence of cardiovascular disease (1-8). Such studies, however, are enormously expensive in terms oif both service and research. An increasingly interested and informed public is now putting great preissure on health agencies to mount effeltive progra.ms toward prevention of heart disease. It is accordingly desirable to develop methods to identify and serially re-evaluate susceptible groups and, if possible, individual members of such groups. In 1961 we developed such a procedure by having nonmedical personnel conduct diagnostic examinations during the, period between the regular biennial medical appraisals o-f the Cardiovascular Health Center population of men. This procedure, carried out by appropriately trained personnel and evaluated against the basic program, convinced us that complete and reliable information on cardiovascular risk fac,tors can be obtained efficiently, economically, and with high acceptajbility by the participant. Therefore, we decided to extend this operation to a mu6h larger group comprised of both mien and women.

Various analogues and isomers of levothyroxin have been shown to be considerably less calorigenic than the naturally occurring hormone, though they retain its lipid-lowering properties. The purpose of this study was to measure the effect of one of these isomers, dextro-triiodothyronine, on the serum lipid levels of 23 patients with ischemic heart disease and with cholesterol levels exceeding 300 mg.%. Cholesterol, triglycerides, and phospholipids were measured in all patients at intervals during the 40 weeks of this study. In doses of 1.5 to 2 mg. daily dextro-triiodothyronine was able to produce effective and prolonged reduction of all 3 lipids. In spite of the absence of evidence of hyperthyroidism in all patients receiving this drug, 8 of the 23 experienced increased severity or frequency of angina pectoris. The frequency and seriousness of this side effect precludes the general use of this drug in patients with ischemic heart disease, but additional analogues of this nature should be sought and studied.