Abstract:
OBJECTIVE:To assess the accuracy of Histoplasma capsulatum variety capsulatum polysaccharide antigen testing for the identification of histoplasmosis relapse in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN:A retrospective study using stored specimens. SETTING:A referral center and several private hospitals. PATIENTS:Twenty episodes of histoplasmosis relapse were evaluated in 17 patients with AIDS from November 1987 to August 1990. Controls included 30 patients with AIDS and histoplasmosis who did not have a relapse during maintenance therapy and who were initially tested during the same week as the patients with relapse. A second control group included seven patients with AIDS and histoplasmosis who were evaluated for relapse on 23 occasions; relapse, however, was excluded on each occasion. MEASUREMENTS:To avoid interassay variability, specimens were tested for H.c. var. capsulatum polysaccharide antigen with the same radioimmunoassay. MAIN OUTCOME MEASURE:The change in the H.c. var. capsulatum polysaccharide antigen level during successful as opposed to unsuccessful maintenance therapy for the prevention of histoplasmosis relapse. MAIN RESULTS:For the 20 episodes of relapse (17 patients), H.c. var. capsulatum antigen levels increased by at least 2 radioimmunoassay units in 12 of 14 serum specimens tested (85.7%; 95% Cl, 57.2% to 98.2%) and in 17 of 18 urine specimens tested (94.4%; Cl, 72.7% to 99.9%). Antigen levels increased in the urine or serum in 1 of 83 specimens (1.2%; CI, 0.03% to 6.6%) obtained on 56 occasions (1.8%; CI, 0.04% to 9.6%) from controls (specificity, 98.2%; CI, 90.4% to 99.96%). In three cases of relapse, antigen levels increased before clinical relapse, antigen levels increased before clinical relapse was suspected. Complement fixation titers increased by at least 2 dilutions in 4 of 11 cases (36.4%; CI, 10.9% to 69.2%) but in 0 of 9 control patients (CI, 0% to 28.3%). CONCLUSION:An increase in H.c. var. capsulatum polysaccharide antigen levels of 2 units or more strongly suggests histoplasmosis relapse. The presence of increasing titers of anti-H.c. var. capsulatum antibodies by complement fixation is less accurate for the diagnosis of relapse.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Wheat LJ,Connolly-Stringfield P,Blair R,Connolly K,Garringer T,Katz BPdoi
10.7326/0003-4819-115-12-936subject
Has Abstractpub_date
1991-12-15 00:00:00pages
936-41issue
12eissn
0003-4819issn
1539-3704journal_volume
115pub_type
杂志文章abstract:OBJECTIVE:To assess factors related to consensus among community physicians regarding appropriate screening intervals for eight cancer screening procedures for which guidelines have been published. DESIGN:Interviews were conducted with a national random sample of 3436 physicians in family practice, internal medicine, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-120-7-199404010-00012
更新日期:1994-04-01 00:00:00
abstract:OBJECTIVE:To describe the effects of human immunodeficiency virus (HIV) infection on the serologic manifestations and response to treatment of syphilis in intravenous drug users. DESIGN:Cohort study of intravenous drug users. SETTING:Medical clinic in a hospital-based methadone maintenance treatment program in New Yo...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-118-5-199303010-00005
更新日期:1993-03-01 00:00:00
abstract:OBJECTIVE:To assess the efficacy and toxicity of moricizine in treating patients with serious ventricular arrhythmias and inducible sustained ventricular tachycardia. DESIGN:Uncontrolled clinical trial. SETTING:The intensive care and telemetry units of Northwestern Memorial Hospital, St. Francis Hospital and Medical ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-5-375
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care. OBJECTIVE:To compare the care received at retail clinics for 3 acute conditions with that received at other care settings. D...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-151-5-200909010-00006
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND:Some physicians seem to be willing to sanction deception of insurance companies. Little is known about public attitudes regarding this practice. OBJECTIVE:To assess public attitudes regarding physician deception of insurance companies. DESIGN:Cross-sectional survey using clinical vignettes. SETTING:Philad...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-138-6-200303180-00011
更新日期:2003-03-18 00:00:00
abstract:BACKGROUND:Screening for hereditary hemochromatosis is traditionally done by using serum iron studies. However, mutation analysis of the hemochromatosis-associated HFE gene has recently become available. OBJECTIVE:To compare the cost-effectiveness of no screening with four screening strategies that incorporate HFE gen...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-132-4-200002150-00003
更新日期:2000-02-15 00:00:00
abstract:Background:Little is known about whether insurance expansion affects the location and type of emergency department (ED) use. Understanding these changes can inform state-level decisions about the Medicaid expansion under the Patient Protection and Affordable Care Act (ACA). Objective:To investigate the effect of the 2...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/M16-0086
更新日期:2017-02-07 00:00:00
abstract::Many investigations consider the presence of e antigen (HBeAg) valuable in predicting which patients with acute hepatitis B are at risk of remaining infected and developing chronic liver disease. We tested this hypothesis in a retrospective study of serial samples from patients undergoing long-term hemodialysis. We fo...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-3-310
更新日期:1978-09-01 00:00:00
abstract:BACKGROUND:Elevated blood pressure (BP) is the largest contributing risk factor to all-cause and cardiovascular mortality. PURPOSE:To update a systematic review on the benefits and harms of screening for high BP in adults and to summarize evidence on rescreening intervals and diagnostic and predictive accuracy of diff...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M14-1539
更新日期:2015-02-03 00:00:00
abstract:BACKGROUND:Medical students may be at high risk for occupational exposures to blood. OBJECTIVE:To measure the frequency of medical students' exposure to infectious body substances, to identify factors that affect the probability of such exposure, and to suggest targets for the prevention of such exposure. DESIGN:Revi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-130-1-199901050-00009
更新日期:1999-01-05 00:00:00
abstract::In 1984, both the United Kingdom and the United States received recommendations from panels of experts specifically convened to consider the merits of Depo-Provera (depot medroxyprogesterone acetate [DMPA]) as a long-term contraceptive agent. This study compares the final reports written by these panels. We explore wh...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-106-6-886
更新日期:1987-06-01 00:00:00
abstract:BACKGROUND:Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates. OBJECTIVE:To examine the relationships among intention to lose weight, weight loss, and all-cause mortality. DESIGN:Prospective cohort study using a pr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-138-5-200303040-00007
更新日期:2003-03-04 00:00:00
abstract::The relation of menopause to cardiovascular disease incidence was examined in women less than 55 years old from the cohort of 2873 women in the initial Framingham examination. Although the number of person-years of experience during the 20 years of observation was nearly the same for premenopausal and postmenopausal s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-85-4-447
更新日期:1976-10-01 00:00:00
abstract::Physicians treating patients with chronic rheumatoid arthritis spend a considerable amount of time dealing with the psychological and social aspects of the disease. The patients' reaction to the disease can be related to age, experience, personality, and environment at work and at home. Common problems include loss of...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-3-344
更新日期:1982-03-01 00:00:00
abstract:STUDY OBJECTIVE:To critically assess original studies evaluating the role of preoperative pulmonary function testing in predicting postoperative outcomes. DESIGN:MEDLINE search of English-language articles from 1966 to 1987 using the following medical subjects headings respiratory function tests, lung, lung diseases, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-112-10-763
更新日期:1990-05-15 00:00:00
abstract::The observations that have provided the foundation of the sodium hypothesis of human hypertension are reviewed. Clinical observations made over 125 years ago initiated an investigative effort that has encompassed epidemiologic data, development of salt-related experimental models, and elucidation of theoretical mechan...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-5-720
更新日期:1983-05-01 00:00:00
abstract::A case of a patient with metastatic cancer raises the issues of patient refusal of treatment, euthanasia, and unintended side effects of therapy. For each management dilemma, there are relevant ethical and legal considerations, justifications, and conclusions. In addition, psychological and social influences on the de...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:
更新日期:1980-01-01 00:00:00
abstract:DESCRIPTION:Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for peripheral artery disease (PAD). METHODS:The USPSTF reviewed the evidence on the use of resting ankle-brachial index (ABI) as a screening test for PAD or as a risk predictor for cardiovascular disease (CVD). The...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:10.7326/0003-4819-159-5-201309030-00008
更新日期:2013-09-03 00:00:00
abstract::A patient with familial Mediterranean fever and amyloidosis who received a cadaver renal transplant 6 1/2 years ago was studied to determine the relation of the serum precursor of secondary amyloid (SAA) to the clinical course and to the deposition of amyloid in the transplant. Amyloid fibrils extracted from the patie...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-87-1-31
更新日期:1977-07-01 00:00:00
abstract:OBJECTIVE:To determine the necessity of posteroanterior chest roentgenography for the identification of pneumothorax and other complications after thoracentesis. DESIGN:Prospective cohort study. SETTING:Tertiary care teaching hospital. PATIENTS:67 men and 43 women (mean age +/- SD, 62.4 +/- 13.2 years). Exclusion cr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-9-199605010-00005
更新日期:1996-05-01 00:00:00
abstract::Endomyocardial biopsy was done 119 times in 98 patients receiving doxorubicin therapy once every 3 weeks and 41 times in 27 patients receiving doxorubicin therapy weekly. Factors contributing to the degree of anthracycline-induced endomyocardial injury were evaluated. Neither age, sex, type of malignancy, concomitant ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-6-745
更新日期:1983-12-01 00:00:00
abstract::Increasingly, interventions aimed at improving care are likely to use such technologies as machine learning and artificial intelligence. However, health care has been relatively late to adopt them. This article provides clinical examples in which machine learning and artificial intelligence are already in use in healt...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M19-0872
更新日期:2020-06-02 00:00:00
abstract::In recent years there has been increasing attention to the appropriate interpretation of a clinical study. One special concern has been the difficulty inherent in interpreting studies that were not statistically significant: Was the sample size sufficient to detect a clinically important effect if, in fact, it existed...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-99-2-248
更新日期:1983-08-01 00:00:00
abstract::During the early 1990s, the U.S. government addressed the issue of providing universal health care to all its citizens. Although this issue has not been completely resolved, centralization of electronic data and sharing of health care information among insurers and providers have been pursued. The emergence of electro...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-127-8_part_2-199710151-00050
更新日期:1997-10-15 00:00:00
abstract:OBJECTIVE:To determine whether self-assessment of purified protein derivative of tuberculin (PPD) skin test reactions, done using a simple two-choice approach, is an effective screening method for tuberculosis. DESIGN:Double-blind comparison between self-assessments and trained professional readings of PPD skin test r...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-125-4-199608150-00004
更新日期:1996-08-15 00:00:00
abstract::Chinese herbal medicine (CHM) formulas are the major components of traditional Chinese medicine (TCM) interventions. The general reporting quality of randomized controlled trials (RCTs) of CHM formulas is disappointing, although CONSORT (Consolidated Standards of Reporting Trials) Statement extensions for herbal medic...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M16-2977
更新日期:2017-06-27 00:00:00
abstract:BACKGROUND:Reviews have compared the efficacy and tolerability of newer second-generation antidepressants with those of placebo or older treatments, but comparative evidence for use of second-generation antidepressants to treat major depressive disorder has not been evaluated. PURPOSE:To systematically evaluate compar...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/0003-4819-143-6-200509200-00006
更新日期:2005-09-20 00:00:00
abstract:STUDY OBJECTIVE:To assess the effects of dopamine, which has an inotropic effect on the myocardium and increases renal and splanchnic blood flow, on diaphragmatic contraction. DESIGN AND PATIENTS:We studied the changes in transdiaphragmatic pressure during electrical bilateral supramaximal stimulation of the phrenic n...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-110-1-17
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:To determine the efficacy and safety of fluconazole treatment of coccidioidal meningitis. DESIGN:Uncontrolled clinical trial. SETTING:Four university-based treatment centers in California, Arizona, and Texas. Most therapy was conducted without hospitalization. PATIENTS:Fifty consecutive patients with activ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-119-1-199307010-00005
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:Primary prevention of Alzheimer disease and other types of dementia (all-cause dementia) is an important public health goal. Evidence to date is insufficient to recommend any lifestyle change to prevent or delay the onset of dementia. OBJECTIVE:To assess the association between objectively measured midlife ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-158-3-201302050-00005
更新日期:2013-02-05 00:00:00