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17 December 2002 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.

Survival in 1901 Boston Smallpox Epidemic Was Predicted by Age, Severity of Disease, and Vaccination Status

An analysis of case records of 243 patients admitted to a Boston smallpox hospital between 1901 and 1903 found that the very young and very old, those who had not been vaccinated, and those with the most severe disease were least likely to survive (History of Medicine, p. 993). [This article is the subject of a video news release; call for times and coordinates.]

Study Finds Echinacea Had No Effect on Cold Symptoms

A study of 148 healthy college students who acquired colds naturally found no differences in the length of the colds or severity of symptoms between those who took the herb echinacea and those who took a placebo, or dummy pill (Article, p. 939). Researchers used a mixture of unrefined echinacea herb and root. An editorial writer says that despite the widespread use and many anecdotal reports of the benefits of echinacea, definitive scientific evidence on its effects will be hard to come by because different preparations have different compositions. Also, no one yet knows the herb's active ingredients or how they work.

Liver Failure in United States Most Often Caused by Drug Reactions

A prospective study of 308 patients with acute liver failure admitted to one of 17 special liver-care centers found that failure was caused most often by medication reactions, with acetaminophen overdose the single most common cause (Article, p. 947). Earlier studies have suggested that hepatitis was the most common cause. Acute liver failure, in which the liver deteriorates over a period of days or weeks, is a relatively rare condition, with about 2,000 U.S. cases each year. Overall survival in this study was 67 percent (about one-third of the patients died), with 132 patients surviving without liver transplantation. The authors say this study shows how rapidly the disease progresses, the importance of early transfer to intensive care settings, and the need to better predict outcomes so that transplantation is reserved for those who cannot survive without it.

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