The opinions and actions of physicians during a malpractice insurance crisis.
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Biomedical subjects
Publications and source records attributed to H Freeman.
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A syndrome consisting of an apical systolic click and late systolic murmur appeared over a period of three months in a patient with acromegaly. Levels of growth hormone were highest during this interval. As a result of group D streptococcal endocarditis three months later, the patient sustained cerebral embolism and acquired free mitral regurgitation from ruptured chordae tendineae. During follow-up over 18 months, neither the level of growth hormone nor the degree of mitral regurgitation changed significantly.
An 18-year-old white Canadian male patient with paroxysmal nocturnal hemoglobinuria and refractory marrow failure received a marrow infusion from his normal identical twin brother without prior ablation of the patient's marrow by drugs or irradiation. After 2 years of follow-up, the patient is well with no evidence of clinical disease or significant hematological abnormality. The results suggest that normal marrow stem cells can have a selective advantage over the abnormal paroxysmall nocturnal hemoglobinuria clone.
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The presentation of symptoms, laboratory findings and possible precipitating factors are reviewed in an 18-year-old patient with the onset of typical paroxysmal nocturnal hemoglobinuria. The opportunity was taken to study the physiology in his normal identical twin sibling who showed no hematological abnormalities on exhaustive studies, including photoscanning of the erythrocytes. These observations strengthen the evidence that PNH is an acquired disease with no basic measurable abnormalities of a hereditary or genetic nature.
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