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Biomedical subjects

A L Komaroff

Publications and source records attributed to A L Komaroff.

At least 73 records · Page 4Linked to original sources
PubMed1990

High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice.

We administered a standardized history questionnaire and performed a tender point examination on 27 patients with debilitating fatigue of at least 6 months duration, seen in a primary care practice, as well as on 20 patients with fibromyalgia. Sixteen of the 27 patients with chronic fatigue met the full criteria for the working case definition of chronic fatigue syndrome (CFS). Eight patients with chronic fatigue denied having any current persistent, diffuse musculoskeletal pain, and their tender point scores were similar to those in 10 normal control subjects. In contrast, 19 patients with chronic fatigue (70%) had persistent, diffuse musculoskeletal pain. The results of their tender point examinations were similar to those of the patients with fibromyalgia. Thus, the majority of these patients with debilitating chronic fatigue, including those who met criteria for CFS, met the historical and tender point diagnostic criteria for fibromyalgia. The presence of current musculoskeletal pain will identify those CFS patients who have fibromyalgia.

Adult↗
PubMed1989

The expense of testing in a teaching hospital: the predominant role of high-cost tests.

We analyzed all 32,206 tests ordered in a random sample of 1,000 patients admitted to a teaching hospital. The analysis examined costs instead of charges, included professional costs in addition to hospital costs, and considered the effect of combining tests that are ordered as a panel (e.g., cardiac enzymes) or as part of a procedure (e.g., bronchoscopy). High-cost tests (costing more than $100) accounted for only 4 percent of the total number of tests ordered, but for nearly 50 percent of total test costs. The pattern varied by clinical service: high-cost tests accounted for 31, 47, and 51 percents of total test costs on the obstetrics, medicine, and surgery services, respectively. It would seem to be efficient to concentrate on the use of high-cost tests in attempting to foster cost-effective use of diagnostic technologies.

Boston↗
PubMed1989

Indirect costs for medical education. Is there a July phenomenon?

Medicare currently pays for "indirect costs" of medical education to support the higher costs of care in teaching hospitals. To investigate whether indirect costs are higher earlier in the training year when house officers might be less efficient--the "July phenomenon"--we compared utilization by 1251 patients hospitalized during July and August with 1338 patients hospitalized during April and May from 1982 through 1984 at Brigham and Women's Hospital, Boston, Mass. These included all patients in the 10 most prevalent medical and surgical diagnosis related groups. Using analysis of covariance to correct for age, sex, diagnosis related group, urgency of admission, temporal change, and mortality, we found no differences in length of stay, total charges, or categories of ancillary charges. These results suggest that there is no substantial increase in the cost of care early in the training year; there was no evidence of a "July phenomenon."

Ancillary Services, Hospital↗
PubMed1989

The chronic fatigue syndrome: definition, current studies and lessons for fibromyalgia research.

Chronic fatigue syndrome (CFS) is characterized by chronic, debilitating fatigue lasting greater than 6 months. Frequent chronic and recurrent findings include fever, pharyngitis, myalgias, adenopathy, arthralgias, difficulties in cognition and disorders of mood. In the majority of patients, the illness starts suddenly with an acute, "flu-like" illness. The following laboratory abnormalities are seen with some frequency, although none are seen in all patients: lymphocytosis, atypical lymphocytosis, monocytosis, elevation of hepatocellular enzymes, low levels of antinuclear antibodies, varying levels of antithyroid antibodies, partial hypergammaglobulinemia, elevated CD4:CD8 ratio, decreased cytolytic activity of natural killer cells, and low levels of immune complexes. Clinical and serologic studies suggest an association of CFS with all of the human herpesviruses, particularly Epstein-Barr virus (EBV) and the recently discovered human B lymphotropic virus (HBLV) or human herpesvirus 6; neither EBV nor HBLV has yet been shown to play a causal role in the illness. Preliminary evidence suggests that many of these features of CFS also are seen in patients with fibromyalgia.

Fatigue Syndrome, Chronic↗
PubMed1988

Chronic fatigue syndromes: relationship to chronic viral infections.

Chronic fatigue syndrome (CFS) is a newly-recognized clinical entity characterized by chronic, debilitating fatigue lasting longer than six months. Common associated findings are chronic and recurrent fever, pharyngitis, myalgias, adenopathy, arthralgias, difficulties in cognition and disorders of mood. In the majority of patients, the illness starts suddenly with an acute, 'flu-like' illness. The following abnormalities are seen with some frequency although none are seen in all patients: lymphocytosis, atypical lymphocytosis, monocytosis, elevation of hepatocellular enzymes, low levels of antinuclear antibodies, low levels of immune complexes. Clinical and serologic studies suggest an association of CFS with all of the human herpesviruses, particularly Epstein-Barr virus (EBV) and the recently-discovered human B-lymphotropic virus (HBLV) or human herpesvirus-6; neither EBV nor HBLV has yet been shown to play a causal role in the illness.

Chronic Disease↗
PubMed1988

Chronic fatigue syndrome: a working case definition.

The chronic Epstein-Barr virus syndrome is a poorly defined symptom complex characterized primarily by chronic or recurrent debilitating fatigue and various combinations of other symptoms, including sore throat, lymph node pain and tenderness, headache, myalgia, and arthralgias. Although the syndrome has received recent attention, and has been diagnosed in many patients, the chronic Epstein-Barr virus syndrome has not been defined consistently. Despite the name of the syndrome, both the diagnostic value of Epstein-Barr virus serologic tests and the proposed causal relationship between Epstein-Barr virus infection and patients who have been diagnosed with the chronic Epstein-Barr virus syndrome remain doubtful. We propose a new name for the chronic Epstein-Barr virus syndrome--the chronic fatigue syndrome--that more accurately describes this symptom complex as a syndrome of unknown cause characterized primarily by chronic fatigue. We also present a working definition for the chronic fatigue syndrome designed to improve the comparability and reproducibility of clinical research and epidemiologic studies, and to provide a rational basis for evaluating patients who have chronic fatigue of undetermined cause.

Chronic Disease↗
PubMed1988

"Chronic Epstein-Barr virus infection" syndrome and polymyalgia rheumatica.

Twenty-three patients with polymyalgia rheumatica (PMR) followed in an academic rheumatology practice frequently reported symptoms commonly found in the recently described "chronic fatigue syndrome" or "chronic Epstein-Barr infection syndrome." These symptoms persisted for months after treatment had reduced the severity of the myalgias and lowered the sedimentation rate: periodically disabling fatigue (33%), recurrent pharyngitis (30%), sleep disorder (65%) and arthralgias (70%). However, antibody titers to Epstein-Barr virus in the patients with PMR were not significantly different from those in age and sex matched control subjects.

Aged↗
PubMed1987

Phenotypic and functional deficiency of natural killer cells in patients with chronic fatigue syndrome.

Natural killer (NK)3 cells are large granular lymphocytes that appear to play a significant role in the host's defense against viral infection. We performed an extensive phenotypic and functional characterization of NK cells on 41 patients with the chronic fatigue syndrome (CFS), or "chronic active Epstein-Barr virus infection" syndrome, and on 23 age- and sex-matched asymptomatic control subjects in an attempt to further characterize this illness. These studies demonstrated that a majority of patients with CFS have low numbers of NKH1+T3- lymphocytes, a population that represents the great majority of NK cells in normal individuals. CFS patients had normal numbers of NKH1+T3+ lymphocytes, a population that represents a relatively small fraction of NK cells in normal individuals. When tested for cytotoxicity against a variety of different target cells, patients with CFS consistently demonstrated low levels of killing. After activation of cytolytic activity with recombinant interleukin 2, patients were able to display increased killing against K562 but most patients remained unable to lyse Epstein-Barr virus-infected B cell targets. Additional cytotoxicity experiments were carried out utilizing anti-T3 monoclonal antibody to block killing by NKH1+T3+ cells. These experiments indicated that the NK cell that appears to be responsible for much of the functional activity remaining in patients with CFS belongs to the NKH1+T3+ subset, which under normal circumstances represents only approximately 20% of the NK cell population.

Antibodies, Viral↗