Dr. Jaffee's EDITORIAL (224:897, 1973) makes some interesting observations about the need for a critical appraisal of " `complaint-centered' clinics," and contains some good, old-fashioned common sense about the need for "skillful individual physicians" who will " `treat the person, not the symptom.' " His concern that such clinics might divert patients from the more usual health delivery setting, yet fail to provide any additional benefits is worthy of consideration. Unfortunately, he provides a poorly balanced critique of the complaint-oriented clinics in which he considers only their shortcomings and fails to appreciate the value of the highly organized evaluation (or treatment) that may be conducted in such a setting. For more than three years, we have maintained a "dizziness clinic" at Northwestern University Medical School, designed to organize an approach to the exceedingly complex and extensive series of disorders that lie at the root of the unitary complaint of "dizziness".
Hat sizes—6-3/8 to 7-7/8—seem a peculiar array of fractional numbers with which to identify hats, from small to extra-large, to fit the full range of human heads. These arcane numbers are the diameters in inches of perfect circles whose circumferences match the heads on which the hats fit. You can determine your cranial circumference in inches from your hat size by multiplying by π or in centimeters by multiplying by 7.98.
“Normal” cranial circumference for adults is about 50 to 60 cm (although Nellhaus’ age 18 figures ±2 SD give a somewhat narrower range1), with microcephaly at one end of the range and macrocephaly at the other. This range of normal describes only the capacity of the cranium and not its contents ; not everyone outside the range is abnormal, and not everyone within it has normal brain function. The great French author, Anatole France, who won the Nobel Prize in 1921 for his literary genius, was known to have an extremely small head.
Twenty-three hundred years ago Herophilus understood that the “brain was the organ of mind,” but for centuries exactly how the structure related to the functions was unclear. In the late 18th century, Gall articulated the concept that behavioral functions were related to specific anatomical locations in the brain. Limited (by …
Background: Previous studies have examined the relation between postmenopausal estrogen replacement therapy (ERT) and the risk of Alzheimer disease (AD).The findings have been inconsistent, since some studies have been interpreted as showing a protective effect while others have reported no effect.Objective: To determine whether exposure to ERT is associated with a reduced risk of AD.Design: Population-based nested case-control study.Setting: The United Kingdom-based General Practice Research Database. Patients:The base cohort consisted of women who were recipients of ERT (n = 112 481) and a similar cohort of women who did not use estrogens (n = 108 925).The 2 cohorts were restricted to women born on or before January 1, 1950.From the 2 cohorts, we identified and verified 59 newly diagnosed cases of AD and 221 matched control subjects.Main Outcome Measure: Prior and current use of ERT in cases compared with controls.Results: Among the 59 newly diagnosed cases of AD, 15 (25%) were current estrogen users, while among the controls, 53 (24%) were current users.The adjusted odds ratio comparing all current estrogen recipients with nonrecipients was 1.18 (95% confidence interval, 0.59-2.37).In estrogen users who took the drug for 5 years or longer compared with nonusers, the odds ratio was 1.05 (95% confidence interval, 0.32-3.44).Odds ratios were similar for estrogen recipients who received estrogens alone and recipients who received combined estrogen-progestin treatment. Conclusion:The use of ERT in women after the onset of menopause was not associated with a reduced risk of developing AD.
In Maricopa County, Arizona, most defendants who are found not competent and not restorable (NCNR) are admitted involuntarily to an acute-care inpatient hospital. Many of these patients would most likely not have met the State's usual admission criteria for acute inpatient care had they not been evaluated in relation to a criminal offense. Is this group treated differently from their peers who are not involved in the criminal justice system? We examined records for 293 NCNR admissions, retrospectively, to assess their admission status and the outcomes of their commitment. We compared them to 280 matched cases of patients admitted involuntarily from the community (non-NCNR). The NCNR group met fewer admission criteria and received court-ordered treatment (COT) 22 percent more often than did the non-NCNR patients. The NCNR patients had longer hospital stays despite being found less dangerous to themselves or others than the community sample. Results suggest that NCNR individuals are treated differently from non-NCNR patients.
