Showing papers by "Mayo Clinic published in 1971"
TL;DR: The clinicopathologic findings in ninety cases of carotid body tumors seen at the Mayo Clinic from 1931 through 1966 are compared with those in 500 reported cases in the literature, finding that Group 3 tumors are usually large and incarcerate the carotids.
Abstract: The clinicopathologic findings in ninety cases of carotid body tumors seen at the Mayo Clinic from 1931 through 1966 are compared with those in 500 reported cases in the literature. In the ninety cases reviewed here, there were sixty-two men and twenty-eight women. In twenty cases surgery had been performed elsewhere; seventy patients were operated on here, with total excision in forty-nine, including one patient with bilateral tumors. The over-all surgical mortality rate was 5.7 per cent, usually related to carotid arterial damage or ligation. There were no tumor recurrences, although cervical node metastasis was noted in one patient and spinal metastasis in another. A classification was suggested for future surgical cases. Group 1 tumors are relatively small and minimally attached to the carotid vessels. Surgical excision usually can be carried out without difficulty. Group 2 tumors are usually larger and show moderate arterial attachment. These tumors are amenable to careful surgical removal. Group 3 tumors are usually large and incarcerate the carotids. Here the tumor must be approached with great care and vessel replacement should be considered.
663 citations
TL;DR: The rapid deterioration of most of the patients after operation was determined by, and characteristic of, the anaplastic portion of the tumor and indicated the need for radical treatment at the earliest practicable date.
Abstract: Of 370 well-differentiated chondrosarcomas, 33 had dedifferentiated zones of fibrosarcoma or osteogenic sarcoma. The clinical characteristics, including long preoperative duration of symptoms, age distribution of patients, and skeletal localization, and certain roentgenographic features correlated well with the chondrosarcomatous component of these tumors. The rapid deterioration of most of the patients after operation was determined by, and characteristic of, the anaplastic portion of the tumor and indicated the need for radical treatment at the earliest practicable date.
371 citations
TL;DR: Increased bacterial deconjugation of bile acids was agsessed by measuring 14 CO 2 specific activity of breath samples taken at intervals after a meal containing cholyl-glycine-l- 14 C (glycocholic acid).
312 citations
TL;DR: There is no evidence of abnormality of function of the peripheral nerve or muscle fibers themselves that might explain the muscle weakness in the myasthenic syndrome, and the different processes involved in neuromuscular transmission have been presented in detail.
Abstract: About a decade ago Lambert and coworkers26 described the characteristics of neuromuscular transmission in the myasthenic syndrome sometimes associated with bronchogenic carcinoma, and subsequent studies have shown that the neuromuscular transmission defect in this syndrome has clinical and electromyographic findings quite different from those in classical myasthenia gravis.26,7”3,25,32.~ The main symptoms in the myasthenic syndrome are weakness and easy fatigability of proximal muscles of the limbs. In contrast to myasthenia gravis, ocular or bulbar muscle involvement is not a prominent feature of the syndrome, but respiratory insufficiency may occasionally occur in severely ill patients. Cholinesterase inhibitors usually have only a slight beneficial effect compared to the effect of these drugs in myasthenia gravis. As in myasthenia gravis, there is no evidence of abnormality of function of the peripheral nerve or muscle fibers themselves that might explain the muscle weakness in the myasthenic syndrome.26,23.25*30 However, on stimulation of motor nerves, there is a characteristic pattern of responses in the muscles that is of value in the diagnosis of this syndrome and in differentiating it from myasthenia gravis in clinical electromyographic examinations. In patients with the myasthenic syndrome there is usually in rested muscle a pronounced depression of the muscle response to a supramaximal stimulus applied to the motor nerve. At low rates of repetitive nerve stimulation, there may be a further transient decrease of the response, but with repetitive nerve stimulation at rates above lO/sec, there is a marked increase in the responses. On the other hand, in patients with myasthenia gravis, there is usually only a small depression of the response to a single nerve stimulus in rested muscle. When the nerve is stimulated repetitively, there is usually a decrease in the response at high and low rates of stimulation. At this conference, the different processes involved in neuromuscular transmission have been presented in detail. Let us recapitulate very briefly. At the resting neuromuscular junction, small amounts of ACh are continuously being liberated from the motor nerve terminal in the form of multimolecular units, generally called ACh quanta or ACh packages. If a microelectrode is inserted into the muscle fiber at the end-plate region, the increase in membrane permeability caused by these small amounts of ACh can be recorded as miniature end-plate potentials (MEPP) , which are usually about 1 mV in amplitude, much less than is required to trigger an action potential in the muscle fiber. They occur at random intervals with spontaneous frequencies at most neuromuscular junctions in vertebrates of about l/sec. Their frequency increases greatly if the nerve
298 citations
TL;DR: In 50 patients with chronic active liver disease, observer and sampling error in histologically evaluating hepatitis and cirrhosis after blind-needle biopsy of the liver was assessed from coded tissue was small, indicating that a single needle biopsy accurately reflects the type and degree of inflammation and necrosis in adjacent areas of the Liver.
Abstract: In 50 patients with chronic active liver disease, observer and sampling error in histologically evaluating hepatitis and cirrhosis after blind-needle biopsy of the liver was assessed from coded tissue. This was done by repeated readings of the same specimens by the same pathologist, by sequential biopsies from the same patients with cirrhosis, and by multiple simultaneous biopsies from adjacent areas of the liver. Observer error was small. The consistency of grading the individual histologic characteristics of hepatitis was 90%, and the reproducibility of the degree of either hepatitis or cirrhosis was 94%. Sampling error was also trivial in hepatitis, indicating that a single needle biopsy accurately reflects the type and degree of inflammation and necrosis in adjacent areas of the liver. By contrast, sampling error was of considerable magnitude when the presence of cirrhosis in patients known to have the lesion was sought, since confirmation by simultaneous or sequential biopsies was made in only 33% of the cases.
261 citations
TL;DR: No tumors occurred during the first two decades of life of patients with osteogenic sarcoma of the somatic soft tissue in the present series, in contrast to those primary in bone in which the peak incidence is in the second decade.
Abstract: Twenty-six cases of osteogenic sarcoma of the somatic soft tissue were found during a review of more than 2,100 somatic soft-tissue sarcomas in the files of the Mayo Clinic. These cases bring the total reported in the English literature through 1968 to 94. In the present series, no tumors occurred during the first two decades of life, in contrast to those primary in bone in which the peak incidence is in the second decade. Twenty-four tumors were found in the limbs and limb girdles, and two in the retroperitoneum. The spectrum of histologic patterns as described for osteogenic sarcoma in bone was applied to establish the diagnosis. Five tumors were subtyped as chondroblastic, 10 as fibroblastic, and 11 as osteoblastic; all were poorly differentiated. Sarcomas with benign osseous or chondromatous metaplasia, mixed mesenchymal sarcomas, pseudo-malignant tumors of soft parts (niyositis ossificans), and parosteal osteogenic sarcomas were excluded. In the series, 21 patients had died. Of the 5 living patients, only 2 are long-term survivors (8 and 12 years). The average survival period was between 3 and 4 years, although 3 patients died with recurrent or mctastatic disease 7, 9, and 14 years after initial treatment. No histologic difference could be detected between tumors with a rapid clinical course and those with a prolonged course.
240 citations
TL;DR: The object of this study was to see what, if any, fine structure correlates there might be in external intercostal muscle motor end plates to the clearly established physiologic defects.
Abstract: A small miniature end-plate potential, attributed to small quantum size, is found in myasthenia gravis (MG).13 In the myasthenic syndrome (MS) (LambertEaton syndrome), the miniature end-plate potential amplitude is normal but the quantum content of the end-plate potential is The object of this study was to see what, if any, fine structure correlates there might be in external intercostal muscle motor end plates to the clearly established physiologic defects. Sixty-eight motor end plates from 18 cases of MG and 42 end plates from 9 cases of MS were examined by electron microscopy. Thirty-two end plates obtained from 12 nonweak subjects undergoing thoracotomy served as controls. The results of in vitro microelectrode studies on aliquots of biopsy specimens from these patients are included in the paper by Lambert and Elmqvist for this ~onference .~ CLINICAL DATA
225 citations
TL;DR: An important exception has been vaccination against smallpox which does induce solid though temporary resistance to infection, and presumably as the result of systematic vaccination, endemic smallpox has disappeared from large areas.
Abstract: Specific immunization has long been a basic tool in medical practice and in local, state, national and international public health. However, the protection afforded by such immunization has been largely limited to the persons immunized because: 1) the usual sources of infection are extra-human (tetanus, yellow fever); 2) spread is primarily by indirect means (typhoid); or 3) those immunized may remain at least partially susceptible to infection and, hence, continue as potential links in the future spread of agents transmitted by contact (diphtheria, pertussis, Salk-type inactivated polio vaccine). An important exception has been vaccination against smallpox which does induce solid though temporary resistance to infection. Presumably as the result of systematic vaccination, endemic smallpox has disappeared from large areas
214 citations
TL;DR: Sixty‐nine cases of bone tumors of vascular origin, excluding cases of lymphangiomas and massive osteolysis, were found in a complete review of the surgical files of the Mayo Clinic, and the most important indicator of prognosis was the grade of anaplasia.
Abstract: Sixty‐nine cases of bone tumors of vascular origin, excluding cases of lymphangiomas and massive osteolysis, were found in a complete review of the surgical files of the Mayo Clinic. There were 56 hemangiomas, and these often produced roentgenologic diagnostic problems. Most were easily managed surgically, although some vertebral hemangiomas required radiation therapy. There were known multicentric lesions in only 2 of the 56 cases. Hemangiopericytomas accounted for 4 of the 69 cases. In these 4, the clinical courses were characteristically unpredictable. There were 9 hemangioendotheliomas. These 9 were added to 13 cases in which specimens were submitted for review. In 6 of the 22 cases, there was multifocal involvement. In this group of 22 cases, it was impractical to differentiate a separate group and designate it as angiosarcoma. Half of the 22 patients died, 1 of known unrelated disease. Surgical extirpation, when possible, and irradiation of lesions incompletely excised or surgically inaccessible seem logical principles in treatment. In these cases of hemangioendotheliomas, the most important indicator of prognosis was the grade of anaplasia.
202 citations
TL;DR: The ratio of the cholesterol-solubilizing agents in bile—bile acids plus lecithin—to cholesterol was significantly increased by the administration of chenodeoxycholic acid and significantly decreased by administering clofibrate plus cholic acid.
197 citations
TL;DR: Gastric lipase probably contributes to digestion of milk triglyceride in infants, as well as to hydrolysis of administered medium chain triglyceride, especially in children with decreased pancreatic lipase concentrations.
TL;DR: Hyperemia, or “luxury perfusion,” manifested by red venous blood, appears to be related to failure of cerebral tissue to utilize available oxygen as well as to “reactive” hyperemian flow in regions previously ischemic.
Abstract: Correlative studies of cortical blood flow measured by the 85Kr washout technique and observations of the cortical blood vessels of 10 squirrel monkeys subjected to temporary occlusion of the middle cerebral artery are described. During occlusion, cortical blood flow in core areas of ischemia decreased to 0.12 to 0.90 ml/g/min (20 to 50% of preocclusion values) and became pressure dependent with failure of autoregulation. After release of the occluding clip, cortical blood flow was restored. Correlation between degree of vascular reaction judged by observation of the cortex and degree of hyperemia as determined by cortical blood flow was poor. There was incomplete correlation between the degree of hyperemia and the degree of preceding ischemia. Hyperemia, or "luxury perfusion," manifested by red venous blood, appears to be related to failure of cerebral tissue to utilize available oxygen as well as to "reactive" hyperemia, or supernormal blood flow, in regions previously ischemic. There was no demonstrabl...
TL;DR: One antiserum prepared with T3-HSA is highly specific for L-T3 and was useful in a final dilution of 1:1000 to 1:4000 and was sufficiently sensitive to measure 50 pg of unlabeled T3 per assay tube.
Abstract: The free acid form of L-triiodothyronine was coupled to HSA, BSA or RSA using carbodiimide. The conjugates contained 11–17 moles of T3 per mole of protein. Rabbits were immunized separately with each conjugate. Antibodies against T3 were obtained in all animals after 6 weeks of immunization. One antiserum prepared with T3-HSA was studied in detail using a radioimmunoassay procedure. It was useful in a final dilution of 1:1000 to 1:4000 and was sufficiently sensitive to measure 50 pg of unlabeled T3 per assay tube. The ability of 30 tyrosine and thyronine derivatives to compete with T3 for binding to antibody were investigated to assess the specificity of the assay. Antibody recognition involved the following structural requirements: two phenolic rings; a 3′ iodine; 4′ hydroxyl group and a 5′ hydrogen. Alterations in the alanine side chain reduced antibody recognition, but to a much smaller extent than changes in the structure of the phenolic rings. Thus, the antiserum is highly specific for L-T3 ...
TL;DR: This paper found a heterogeneous group of systemic diseases (15 to 26 cases) associated with necrotizing angiitis and showed that the immunoglobulins and complement staining were related to distribution of histologic changes but not to the severity of such changes.
Abstract: We found a heterogeneous group of systemic diseases (15 to 26 cases) associated with necrotizing angiitis. Patterns of dermal vessel immunofluorescence were related to specific clinical and histopathologic lesions in 15 of 26 cases of necrotizing angiitis, in 4 cases of livedo vasculitis, and in 3 cases of facial granuloma. The immunoglobulins and complement staining were related to the distribution of histologic changes but not to the severity of such changes. Staining of β 1 -C/β 1 -A globulin in diseased dermal vessels superimposed IgG and IgM in seven of 15 biopsies. One or more serum immunoglobulins were altered (± 2 SD) in 15 of 22 patients with necrotizing angiitis. Globulins in perivascular spaces occurred more frequently in association with elevated serum immunoglobulins.
TL;DR: The predictive value of significant lateralization of renal venous renin activity with respect to the results of surgical treatment of renovascular hypertension was assessed in 60 patients followed up postoperatively for 6 to 30 months as mentioned in this paper.
Abstract: The predictive value of significant lateralization of renal venous renin activity (ratio of 1.5 or greater between the value from the affected or more severely affected kidney and the value from the contralateral kidney) with respect to the results of surgical treatment of renovascular hypertension was assessed in 60 patients followed up postoperatively for 6 to 30 months. Studies of renal venous renin activity in 26 patients with normal levels of sodium intake disclosed lateralization in 8 (all in improved condition after surgery) and non-lateralization in 18 (17 in improved and 1 in unimproved condition after surgery). Results were correctly predicted in 9 patients (35 percent). Studies in 41 patients with reduced sodium intake showed lateralization in 33 (all in improved condition) and nonlateralization in 8 (4 in improved and 4 in unimproved condition after surgery). Results were correctly predicted in 37 patients (90 percent). Seven patients were studied on both regimens. Sodium depletion increased the sensitivity of the renal venous renin activity measurement for determining a functionally significant presser kidney in renovascular hypertension.
TL;DR: Serum immunoreactive parathyroid hormone (IPTH) is normal in patients with X-linked hypophosphatemic rickets who are not treated with phosphate salts and endogenous IPTH does not influence the existing defect in tubular reabsorption of phosphate in male patients.
Abstract: Serum immunoreactive parathyroid hormone(IPTH) is normal in patients with X-linked hypophosphatemic rickets who are not treated with phosphate salts. Phosphate raises IPTH in these patients. Endogenous IPTH does not influence the existing defect in tubular reabsorption of phosphate in male patients.
TL;DR: The survival rate of patients with diffuse, malignant mesothelioma of the pleura was low, and 28 of the 37 patients had died, with an average survival of 18 months from the onset of symptoms for those with the tubulopapillary type, eight months for Those with the fibrous type, and seven months forThose with the bimorphic malignancies.
TL;DR: The effect of EHDP in man is to produce morphologic osteomalacia, based on studies in experimental animals and patients who had primary osteoporosis.
TL;DR: Myelomonocytic leukemia, the authors' preferred designation for leukemia involving two or more marrow cell lines, is currently the most common type of leukemia seen at the Mayo Clinic and was preceded in 41 patients by a preleukemic phase of variable duration.
Abstract: Myelomonocytic leukemia, our preferred designation for leukemia involving two or more marrow cell lines, is currently the most common type of leukemia seen at the Mayo Clinic. In an attempt to clarify the clinical picture and natural course of this myeloproliferative disorder, 132 patients first seen between 1955 and 1959 were studied. The disease, which usually had its onset after 50 years of age, was preceded in 41 patients by a preleukemic phase of variable duration. At the onset of overt leukemia, predominant involvement was of the erythrocytic and megakaryocytic compartments; during this phase the hematologic findings often suggested vitamin B12 or folate deficiency. As the disease evolved, it resembled acute granulocytic or monocytic leukemia or a mixture of these. The course, which was variable and unpredictable, ranged from a few weeks to several years.
TL;DR: The “2-step” exercise test provides an imperfect though independent means for predicting the presence and extent of significant coronary artery disease in the individual patient, and abnormal results on this test may suggest an associated abnormal rise in left ventricular filling pressure during exercise.
Abstract: Postexercise electrocardiograms were related to coronary arteriograms in 100 cases and were correlated with left ventricular hemodynamics at rest and during mild exercise in 78 of these cases. The incidence and degree of exercise-induced “ischemie” S-T segment depression increased significantly with increasing extent of coronary artery disease. A criterion for abnormality of 0.5 mm or greater S-T depression offered a specificity of true negative responses of 83 percent and a sensitivity of true positive responses of 63 percent. A criterion of 1.0 mm or greater S-T depression produced a specificity of 100 percent but at the expense of a reduced sensitivity of 35 percent true positive responses. Left ventricular end-diastolic pressure was the only hemodynamic index that correlated with either the extent of coronary artery disease or the degree of exercise-induced S-T segment depression. Patients with S-T segment depression of 1.0 mm or greater had significantly greater values for left ventricular end-diastolic pressure, both at rest and during exercise, than did patients with lesser degrees of S-T depression. The “2-step” exercise test provides an imperfect though independent means for predicting the presence and extent of significant coronary artery disease in the individual patient, and abnormal results on this test may suggest an associated abnormal rise in left ventricular filling pressure during exercise.
TL;DR: The Analytab system of 20 biochemical tests for identification of Enterobacteriaceae was evaluated in parallel with conventional tests on 128 Enterobacteriaiaceae, 5 Aeromonas, and 1 Yersinia enterocolitica and showed almost complete agreement.
Abstract: The Analytab system of 20 biochemical tests for identification of Enterobacteriaceae was evaluated in parallel with conventional tests on 128 Enterobacteriaceae, 5 Aeromonas, and 1 Yersinia enterocolitica. The results of tests for H2S and indole production, citrate utilization, lysine and ornithine decarboxylase, arginine dihydrolase, nitrate reduction, β-galactosidase, and fermentation of arabinose, rhamnose, mannitol, and glucose showed almost complete agreement between the two systems. Eighty-eight per cent of Enterobacteriaceae were correctly speciated with the Analytab system; on repeat testing with heavier inocula of organisms failing to ferment glucose initially, the proportion of Enterobacteriaceae correctly speciated became 93%.
TL;DR: A 15-year follow-up of 140 patients who had transient cerebral ischemic attacks and were first seen at the Mayo Clinic for this complaint in 1950 through 1954 is reported, finding that patients who were 65 or older at their first attack had a survival similar to that of the standard population.
Abstract: A 15-year follow-up of 140 patients who had transient cerebral ischemic attacks and were first seen at the Mayo Clinic for this complaint in 1950 through 1954 is reported. There was no significant difference in mortality related to sex or location of residence. Patients hypertensive at onset of symptoms had no significant increase in mortality compared to normotensive patients but the survival trend favored normotensive patients. Probability of surviving 15 years was significantly less than expected for patients less than 65 years old. Patients who were 65 or older at their first attack had a survival similar to that of the standard population. The difference between the expected and observed 15-year survivals for patients with primarily motor symptoms was about the same as that difference for patients with primarily sensory symptoms. Information concerning stroke occurrence was incomplete but 37% of local residents are known to have had a stroke, a higher rate than expected. Among patients who died during this study, 50% died of a cardiac cause and 36% died of a stroke.
TL;DR: Arterial inflow to and venous outflow from the vascularly isolated splanchnic region were measured simultaneously by using cannulating electromagnetic square-wave flow transducers in 25 anesthetized dogs with intact abdomens to study the translocation of blood during hemorrhage and under these circumstances blood moved out of the splan Schnic circulation at a fairly constant rate.
Abstract: Arterial inflow to and venous outflow from the vascularly isolated splanchnic region were measured simultaneously by using cannulating electromagnetic square-wave flow transducers in 25 anesthetized dogs with intact abdomens. Change in splanchnic blood volume (SBV) was calculated as the instantaneous difference between inflow and outflow. Addition of the respective increases and decreases in SBV induced by changing carotid sinus pressure from the control value (mean, 136 mm Hg) to 200 or to 40 mm Hg gave an average total volume of 93 ml of blood (SD, ±21.7) that could be mobilized reflexly from the splanchnic circulation, Electrical stimulation (15 v, 2 cps, 3 msec duration) of the left thoracic splanchnic nerve for 2 to 10 minutes decreased SBV by 159 ml of blood (SD, ±84). These mean values represent 32 and 48%, respectively, of the calculated total SBV. In both situations the translocation of blood was rapid, 50% of the total change in splanchnic blood flow and SBV occurring within 30 seconds. During a 2-minute hemorrhage (7.2 ml/kg), a mean volume of 56 ml of blood (SD, ±16) was mobilized from the splanchnic region. This represented 54% of the total volume bled. Under these circumstances, blood moved out of the splanchnic circulation at a fairly constant rate.
TL;DR: It is concluded that droperidol is a potent cerebral vasoconstrictor, that this effect dominates when it is given in combination with fentanyl, that hypocapnia causes little further reduction in c.b.f., and that the reduction produced by Innovar is not accompanied by alterations in normal cerebral metabolic pathways.
Abstract: The effects of droperidol and fentanyl given individually and in combination (Innovar) on the rate of cerebral oxygen consumption (CMRo,) and cerebral blood flow (c.b.f.) were studied in dogs anaesthetized with nitrous oxide (70 percent) and oxygen. Fentanyl (0.006 mg/kg) decreased both the CMRo, and the c.b.f. (mean decreases at 15 minutes were 18 per cent and 47 percent, respectively). The duration of effect was approximately 30 minutes. Droperidol (0.3 mg/kg) produced a decrease of 40 per cent in c.b.f. due primarily to a 30-40 per cent increase in cerebrovascular resistance, and this effect persisted for the period of observation (60 minutes). No significant change in CMRo, occurred after droperidol was administered. With the combination drug (Innovar), the effects were partially additive. After 15 minutes, CMRo, had decreased 23 per cent; c.b.f. had decreased 50 per cent; and cerebral vascular resistance had increased 85 per cent. After 30 minutes, the effects of Innovar were indistinguishable from those of droperidol alone. No significant changes occurred in the rate of cerebral glucose consumption or the oxygen-glucose index. The effect of increased and decreased Paooj on c.bi. after Innovar was compared widi that observed during halothane anaesthesia. With halothane, hypercapnia (Pacoi=60 tnm Hg) increased c.b.f. 40 per cent and hypocapnia (Pace = 20 mm Hg) decreased c.b.f. 40 per cent. Innovar at normocapnia reduced the c.b.f. 65 per cent. With hypercapnia, the c.bi. doubled, but with hypocapnia, little further reduction in c.b.f. occurred. It is concluded that droperidol is a potent cerebral vasoconstrictor, that this effect dominates when it is given in combination with fentanyl, that hypocapnia causes little further reduction in c.b.f., and that the reduction in c.bi. produced by Innovar is not accompanied by alterations in normal cerebral metabolic pathways
TL;DR: The colon is relatively impermeable to urea, urea from the circulation is hydrolysed more readily than that in the lumen, colonic urease activity, although bacterial, has a mucosal or juxtamucosal location, and ammonia generated from ureolysis passes to the circulation rather than theLumen of the colon by nonionic and simple ionic diffusion.