Proceedings of the Boston Society of Natural History.

Mode of access: Internet.

Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial

Serotonin reuptake inhibitors and cognitive-behavior therapy (CBT) are considered first-line treatments for obsessive-compulsive disorder (OCD). However, little is known about their modulatory effects on regional brain morphology in OCD patients. We sought to document structural brain abnormalities in treatment-naive OCD patients and to determine the effects of pharmacological and cognitive-behavioral treatments on regional brain volumes. Treatment-naive patients with OCD (n = 38) underwent structural magnetic resonance imaging scan before and after a 12-week randomized clinical trial with either fluoxetine or group CBT. Matched-healthy controls (n = 36) were also scanned at baseline. Voxel-based morphometry was used to compare regional gray matter (GM) volumes of regions of interest (ROIs) placed in the orbitofrontal, anterior cingulate and temporolimbic cortices, striatum, and thalamus. Treatment-naive OCD patients presented smaller GM volume in the left putamen, bilateral medial orbitofrontal, and left anterior cingulate cortices than did controls (p<0.05, corrected for multiple comparisons). After treatment with either fluoxetine or CBT (n = 26), GM volume abnormalities in the left putamen were no longer detectable relative to controls. ROI-based within-group comparisons revealed that GM volume in the left putamen significantly increased (p<0.012) in fluoxetine-treated patients (n = 13), whereas no significant GM volume changes were observed in CBT-treated patients (n = 13). This study supports the involvement of orbitofronto/cingulo-striatal loops in the pathophysiology of OCD and suggests that fluoxetine and CBT may have distinct neurobiological mechanisms of action. Neuropsychopharmacology (2012) 37, 734-745; doi: 10.1038/npp.2011.250; published online 26 October 2011

Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease

The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone.

Efficacy and Safety of Natalizumab in Crohn’s Disease Patients Treated at 6 Boston Academic Hospitals

BACKGROUND: Despite trials demonstrating its efficacy, many physicians harbor concerns regarding the use of natalizumab in the treatment of patients with refractory Crohn's disease (CD). The purpose of this study was to perform a descriptive analysis of a series of CD patients not currently enrolled in a clinical trial. METHODS: A retrospective case review of patients treated with natalizumab at 6 sites in Massachusetts: Boston Medical Center, Beth Israel Deaconess Medical Center, Brigham & Women's Hospital, Lahey Clinic, Massachusetts General Hospital, and UMass Medical Center. RESULTS: Data on 69 CD patients on natalizumab were collected. At the start of treatment, patients' disease duration was 12 years. A high proportion of patients were women (68%), presented with perianal disease (65%) and upper gastrointestinal tract involvement (14%). Prior nonbiologic therapies were steroids (96%), thiopurines (94%), antibiotics (74%), methotrexate (58%), and at least two anti-tumor necrosis factor agent failures (81%). Sixty-nine percent (44 of 64 patients) with available medical evaluation had a partial or complete clinical response. Loss of response was 13% after an average of 1 year of treatment. Adverse events were infusion reactions, headaches, fever, and infections. No case of progressive multifocal leukoencephalopathy was observed. CONCLUSIONS: In our clinical experience outside the context of a clinical trial, natalizumab is largely reserved for CD patients with extensive ileocolonic disease who have failed conventional immunosuppressants and of at least 2 anti-tumor necrosis factor agents. This drug is, however, well tolerated and offers significant clinical improvement for more than a year in one-third of these difficult-to-treat CD patients.

Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process*

The Connecticut State Medical Society (CSMS) reviews and accredits the continuing medical education (CME) programs offered by Connecticut's hospitals. As part of the survey process, the CSMS assesses the quality of the hospitals' libraries. In 1987, the CSMS adopted the Medical Library Association's (MLA's) “Minimum Standards for Health Sciences Libraries in Hospitals.” In 1990, professional librarians were added to the survey team and, later, to the CSMS CME Committee. Librarians participating in this effort are recruited from the membership of the Connecticut Association of Health Sciences Librarians (CAHSL). The positive results of having a qualified librarian on the survey team and the invaluable impact of adherence to the MLA standards are outlined. As a direct result of this process, hospitals throughout the state have added staffing, increased space, and added funding for resources during an era of cutbacks. Some hospital libraries have been able to maintain a healthy status quo, while others have had proposed cuts reconsidered by administrators for fear of losing valuable CME accreditation status. Creating a relationship with an accrediting agency is one method by which hospital librarians elsewhere may strengthen their efforts to ensure adequate library resources in an era of downsizing. In addition, this collaboration has provided a new and important role for librarians to play on an accreditation team.

Account book of Benjamin Gale, 1740-1748 (inclusive)

Ledger containing lists of patient names and payments to Dr. Benjamin Gale (1715-1790) of Killingworth (now Clinton), Connecticut, primarily in 1743. Entries mostly included charges for "sundry" items and visits to patients by Gale, who accepted both cash and payment-in-kind.

Student lectures notes on chemistry and materia medica, and medical recipes, of Lyman Spalding, 1795-1799 (inclusive)

Contains notes taken by Harvard student Lyman Spalding during eleven chemistry lectures delivered by Harvard Professor Aaron Dexter (1750-1829) in the fall of 1795 and recipes prepared and used by Spalding in his medical practice in 1797. The recipes include elixir vitriol, containing liquor, Jamaica pepper, cinnamon, and ginger, and an electuary for a cough, containing oxymel squills (sea onion in honey), licorice, antimonium tartaricum potash (a compound of the chemical element antimony and a potassium-containing salt), and opium. The volume also contains writings about chemistry by Spalding, some of which appear transcribed from published sources, in undated entries, and a diary entry from 1799 regarding an experiment with water.

Student lecture notes on anatomy and surgery, and medical notes, of Lyman Spalding, 1795

Contains notes taken by Harvard student Lyman Spalding (1775-1821) from lectures on anatomy and surgery delivered by Harvard Professor John Warren (1753-1815) in 1795, as well a section entitled “Medical Observations,” which includes entries on “Vernal Debility,” or diseases occurring in the spring, and lung function. It is unclear if these are Spalding’s own writings or transcriptions from a published work. There is also text transcribed from “Elementa Medicinae,” published in 1780 by Scottish physician John Brown.

Notebook of Moses Appleton, 1794-1837 (inclusive)

Contains notes taken by Moses Appleton (1773-1849) on anatomy lectures delivered at Harvard by John Warren (1753-1815). Other lecture topics included midwifery and surgery. Also includes a transcript of an examination given by Warren to his students on anatomy and surgery, as well as exams given by Harvard Professor Benjamin Waterhouse (1754-1846) and Harvard Professor Aaron Dexter (1750-1829) on the theory and practice of physic, and chemistry, respectively. There are additionally patient case notes and transcriptions of notes and correspondence from physicians Appleton consulted, and a list of operations Appleton performed between 1796 and 1828, primarily repairing dislocated joints and fractured bones. Also includes obituaries of citizens of Waterville, Maine, from 1807 to 1837.

Commonplace book of Moses Appleton, 1791-1815 (inclusive)

Volume containing medicinal recipes, medical notes, poetry, and obituaries written by Dr. Moses Appleton (1773-1849). Many of the recipes were copied from medical texts or other publications. His "cure for the dropsy," taken from the New York Herald, contained stale cider, parsley, horseradish, oxymel squills (sea onion in honey), and juniper berries. For diarrhea, he prescribed a blackberry syrup. Several entries indicate Appleton practiced Thomsonian medicine, an alternative system based on use of botanicals. The medical notes include an account of his treatment of a man with smallpox in 1815, and entries on patients he inoculated with cowpox matter. Another entry dated in 1796 provides instructions from the Massachusetts Humane Society for "treatment to be used with persons apparently dead from drowning," which included blowing tobacco smoke in the victim's lungs and applying warm blankets for several hours. Appleton adds a note questioning whether or not the lungs also should be "often artificially inflated." There is additionally a history of prominent physicians dating from ancient Greece.

Account book of David Townsend, 1774-1791

Account book kept by Dr. David Townsend (1753-1829) that records patients treated, illnesses, and fees charged in Boston, Massachusetts, and neighboring towns from 1774 to 1791. His patients included a number of soldiers and sailors, as well as figures like the French-American writer John Hector St. John (1735-1813). Townsend's treatments typically consisted of delivering cathartics or emetics. For the family of Samuel Appleton, Townsend administered smallpox inoculation in 1776, charging him 4 pounds, 4 shillings. Townsend sometimes recorded the occupation or race of the patient. For example, he attended the delivery of a child of Sappho Henshaw, "black girl," in 1786; in 1787 he attended to an unnamed "black man at [who lived at the] corner of Board Alley" in the North End of Boston. Other patients included John Hancock (1736-1793) and members of Hancock's household, as well as Federalist publisher John Fenno (1751-1798).

Memoranda Medica of John Perkins, 1750-1773 (inclusive)

Contains notes written by Dr. John Perkins (1698-1781) from 1750 to 1773 on physiology, materia medica, and illness, including symptoms, causes, and treatment of conditions like mumps, dysentery, dropsy, and rheumatism. Also includes observations on children and on various bodily functions. There is an index at the end of the volume.

Student notes from medical lectures by Benjamin Rush, undated

The volumes contain student notes on a course of medical lectures given by Dr. Benjamin Rush (1746-1813) while he was Professor of the Institutes of Medicine and Clinical Practice at the University of Pennsylvania Medical School, likely in circa 1800-1813. The notes indicate Rush often referenced the works or teachings of contemporaries such as Scottish physicians William Cullen, John Brown, John Gregory, and Robert Whytt, and Dutch physician Herman Boerhaave. He frequently included anecdotes and case histories of his own patients, as well as those of other doctors, to illustrate his lecture topics. He also advised students to take notes on the lectures after they ended to allow them to focus on what they were hearing. Volume 1 includes notes on: physician conduct during visits to patients; human and animal physiology; voice and speech; the nervous system; the five senses; and faculties of the mind. Volume 2 includes notes on: food, the sources of appetite and thirst, and digestion; the lymphatic system; secretions; excretions; theories of nutrition; differences in the minds and bodies of women and men; reproduction; pathology; a table outlining the stages of disease production; “disease and the origin of moral and natural evil”; contagions; the role of food, drink, and clothing in producing disease; worms; hereditary diseases; predisposition to diseases; proximate causes of diseases; and pulmonary conditions. Volume 3 includes notes on: the pulse; therapeutics, such as emetics, sedatives, and digitalis, and treatment of various illnesses like pulmonary consumption, kidney disease, palsy, and rheumatism; diagnosis and prognosis of fever; treatment of intermitting fever; and epidemics including plague, smallpox, and yellow fever, with an emphasis on the yellow fever outbreaks in Philadelphia in 1793 and 1797.

Winthrop, Robert Charles, 1809-1894, autographed letter signed to James Read Chadwick; Boston, 1 side (3 pages), 1879 January 29

Correspondence regarding the donation of several collections to the Boston Medical Library, including the John Winthrop papers