Showing papers by "Mayo Clinic published in 1972"
TL;DR: It is concluded that ligamentous injury along with scaphoid fracture is probably necessary if dorsiflexion instability is to develop and is associated with ulnar displacement of the carpus as is seen in rheumatoid arthritis or after loss of the distal end of the ulna.
Abstract: The scaphoid is a mechanical link that stabilizes the intercarpal joint during motions of the wrist. Without this stability the proximal carpal row acts as an unsupported intercalated link in a three-link system and zigzag collapse occurs with axial loading. A deformity with dorsiflexion of the lunate within the linkage (dorsiflexion instability) occurs commonly after scaphoid fracture and scapholunate dissociation. When dissociation occurs the scaphoid assumes a vertical position, that is, the angle formed by the longitudinal axes of the scaphoid and the lunate approaches a right angle. Rupture of the distal attachments of the palmar radiocarpal ligament and of the scapholunate ligament appears to induce dissociation. It is therefore concluded that ligamentous injury along with scaphoid fracture is probably necessary if dorsiflexion instability is to develop.
Palmar flexion instability characterized by palmar flexion of the lunate within the wrist linkage appears to be associated with ulnar displacement of the carpus as is seen in rheumatoid arthritis or after loss of the distal end of the ulna. This position may be normal in a small percentage of patients. The direction of the intercarpal collapse is related to the location of the pressure of the head of the capitate against the concave surface of the lunate, that is, whether this pressure is dorsal or palmar to the plane of the radiolunate fulcrum on the proximal convex surface of the lunate. The direction of the collapse is also related to the normal oblique path of motion (rotation and sliding) of the capitate during ulnar and radial deviation and is intimately controlled by the geometric configuration of the bones and the resultant of forces on the carpus. These forces are determined by the strength, direction, and leverage of the musculotendinous units, which cross the joints of the wrist complex.
908 citations
TL;DR: A prospective, controlled, double blind, randomized trial of treatments for severe chronic active liver disease, involving 63 consecutive patients chosen by predefined criteria, showed that 20 mg of prednisone daily or a combination of 10 mg of Prednisone and 50 mg of azathioprine daily was superior to 100 mg of Azathiopine daily or placebo.
675 citations
529 citations
TL;DR: Evidence is provided that a major cause of diarrhea in patients with ileal resection was the increased passage of bile acids into the colon, and a therapeutic program is described to treat this syndrome.
477 citations
TL;DR: These studies support the contention that this form of neuropathy is a clinical entity with, in most cases, a fairly typical pattern of symptoms and signs and the overall prognosis is excellent despite the severity and extent of the lesion.
Abstract: A clinical analysis of 99 patients with brachial plexus neuropathy (BPN) and the outcome of 84 of these patients are presented. The disease may involve the upper, the lower, or the entire plexus; the involvement may be complete or incomplete, and it may often be bilateral. Although the etiologic factor or factors remain unknown, our studies support the contention that this form of neuropathy is a clinical entity with, in most cases, a fairly typical pattern of symptoms and signs. The overall prognosis is excellent despite the severity and extent of the lesion. There is no apparent difference in the clinical aspects and recovery rates between patients who had antecedent immunizations and those who did not. While improvement may begin in one to two months, complete functional recovery may not be achieved for up to three years or longer in some cases.
465 citations
346 citations
TL;DR: Patients with fibrohistiocytic tumors that microscopically had a bizarre and often malignant appearance do present a definite histologic range with recognizable transitions from the atypical through the malignant forms.
Abstract: This study concerns 65 patients with fibrohistiocytic tumors that microscopically had a bizarre and often malignant appearance. Four histologic types were recognized: atypical fibrous histiocytoma (18 tumors), malignant fibrous histiocytoma (33 tumors), malignant histiocytoma (seven tumors), and epithelioid sarcoma (seven tumors). Twenty-one of the tumors (18 malignant) evolved from the superficial tissues and 44 (29 malignant) from the deep soft tissues. Local recurrences were noted in 73% of the patients treated by local excision. Metastases occurred in 19 patients (regional lymph nodes in 13 instances and lungs in 14 instances). Five-year survival rates were 90% for the group with atypical fibrous histiocytoma, 64% for the group with malignant fibrous histiocytoma, 50% for the group with malignant histiocytoma, and 100% for the group with epithelioid sarcoma; the 10-year survival rates were 80%, 38%, 0%, and 80%, respectively. Although everyone may not agree with the concept of tissue histiocyte origin, the lesions do present a definite histologic range with recognizable transitions from the atypical through the malignant forms.
314 citations
TL;DR: The tumor may respond favorably to radiation therapy, which should be employed only for surgically inaccessible tumors, and it may be curative; the one metastasizing benign chondroblastoma that was documented is a pathologic rarity.
Abstract: Chondroblastoma is a benign bone tumor arising most often in the epiphyses of long bones. Nearly 90% occurred in patients between the ages of 5 and 25 years, but tumors were found in later adulthood and even in old age. A few chondroblastomas were predominantly cystic, and some contained zones that were indistinguishable microscopically from aneurysmal bone cysts. Conservative surgical removal, nearly always effective, should be thorough so as to minimize the risk of the occasional troublesome recurrence. Late sarcomatous change has been reported in a few cases whether radiation therapy was employed or not. Atypical sarcomas, especially chondrosarcomas, mimic chondroblastoma in rare instances, but there is no convincing evidence for a primarily malignant chondroblastoma. The one metastasizing benign chondroblastoma that was documented is a pathologic rarity. The tumor may respond favorably to radiation therapy, which should be employed only for surgically inaccessible tumors, and it may be curative.
312 citations
TL;DR: It is believed that this technique should be utilized as a salvage procedure only in those infrequent cases in which posterolateral grafting is inadvisable because of infection or unusally extensive scarring.
Abstract: A consecutive series of eighty-three patients treated with anterior interbody disc excision and bone-grafting has been presented. A good clinical result was achieved by only 36 per cent of the patients and roentgenographic evidence of fusion at all levels grafted occurred in only 56 per cent. A one-level grafting procedure gave a better chance of fusion (68 per cent) and the lumbosacral interspace became solid slightly more frequently than more cephalad interspaces. Postoperative cast immobilization significantly improved the fusion rate.
We concluded that the reported differences in success with this technique are attributable chiefly to the interpretation of clinical and roentgenographic factors by different authors and to the type of patients selected for this procedure. We believe that this technique should be utilized as a salvage procedure only in those infrequent cases in which posterolateral grafting is inadvisable because of infection or unusally extensive scarring.
291 citations
TL;DR: Nearly all strains were resistant to kanamycin and gentamicin, although moderate activity to both drugs was noted with Fusobacterium sp.
Abstract: The minimal inhibitory concentrations of 601 clinical isolates of anaerobic bacteria to 10 different antimicrobial agents were determined by an agar-dilution technique. Nearly all strains were resistant to kanamycin and gentamicin, although moderate activity to both drugs was noted with Fusobacterium sp., anaerobic cocci, some strains of Bacteroides melaninogenicus , and nonsporeforming gram-positive bacilli. Chloramphenicol at 12.5 μg/ml inhibited all but three of the strains tested. Tetracycline at 6.25 μg/ml had high activity against all groups tested, with the exception that only 39% of strains of Bacteroides fragilis were inhibited at this concentration. Excluding certain species of Bacteroides , the majority of anaerobes were inhibited by penicillin at 3.1 μg/ml or less and by cephalothin at 12.5 μg/ml or less. Lincomycin at 6.2 μg/ml or less was active against nearly all strains. Erythromycin at a concentration of 3.1 μg/ml was active against B. fragilis ; however, erythromycin was less active against the other groups. Most of the minimal inhibitory concentrations of lincomycin exceeded those of clindamycin by fourfold. Rifampin inhibited virtually all strains at 3.1 μg/ml.
267 citations
TL;DR: MODD was a measure of the blood glucose changes resulting from day-to-day variation in response to therapy that was kept as constant as possible and decreased when therapy was deliberately intensified through the use of four daily injections of short-acting insulin.
Abstract: Differences between paired blood glucose values during two successive 24-h periods of continuous blood glucose analysis were investigated during 22 studies in seven unstable diabetics, three stable diabetics, and three normal subjects. The absolute means (without regard to sign) of daily differences (MODD) were high in unstable diabetics (36.6 to 158.1 mg/100 ml), intermediate in stable diabetics (10.2 to 35.1 mg/100 ml), and low in normals (6.2 to 8.2 mg/100 ml). MODD was a measure of the blood glucose changes resulting from day-to-day variation in response to therapy that was kept as constant as possible. When therapy was deliberately intensified through the use of four daily injections of short-acting insulin, MODD decreased in five of six such experiments. In two diabetics retested at intervals of 5 to 7 months without change in insulin regimen, MODD values remained similar. MODD quantifies another characteristic of blood glucose behaviour, the between-day variability; this is an important complement of the mean amplitude of glycaemic excursions (MAGE, a measure of within-day variability) and of the mean blood glucose concentration, MBG (the overall level of glycaemia during the variability measurements).
TL;DR: The presence of 45,X cell lines in the bone marrow or peripheral blood of aging males should be recognized as a common event, and the finding should not be considered evidence for the presence of a specific disease state.
Abstract: Direct bone marrow chromosome studies were carried out on 165 males, 3 months to 94 years of age. Forty-one males were found to have 45,X cell lines in their bone marrow. The number of males exhibiting Y chromosome loss correlated with age, but the degree of Y chromosome loss did not correlate with age. The loss of Y chromosome appears to be a permanent event. The longest follow-up period in this study was 13 months. The incidence of 45,X cell lines in the bone marrow is much greater than that in peripheral blood leukocyte cultures. The presence of 45,X cell lines in the bone marrow or peripheral blood of aging males should be recognized as a common event, and the finding should not be considered evidence for the presence of a specific disease state.
TL;DR: Early recognition of the lesion and prompt radical ablative surgery seem to offer the best chance for survival in patients with postmastectomy lymphedema.
Abstract: Data from 23 cases of lymphangiosarcoma associated with chronic lymphedema seen at the Mayo Clinic and 163 cases from the world literature are reviewed. The available information in 162 cases of postmastectomy lymphedematous lymphangiosarcoma revealed that the lesion occurred at an average age of 63.9 years (range 44 to 84 years) and an average of 10 years 3 months after mastectomy. Fifty per cent of the 129 patients eligible for follow-up were dead within 19 months after treatment, and only 11 patients have survived 5 years or more. Amputation gave a slightly better prognosis than did radiation therapy. Of 24 patients (two from the Mayo Clinic) with lymphangiosarcoma and non-postmastectomy lymphedema, 12 (50%) were dead within 34 months after treatment. Only two of the patients were long-term survivors (5 and 15 years), and both were treated by amputation. Early recognition of the lesion and prompt radical ablative surgery seem to offer the best chance for survival.
TL;DR: The persistence of normal IPTH concentration despite elevated serum total and ionized calcium values suggests an abnormality of the receptor mechanism for the calcium ion control of the secretion of parathormone by the parathyroid glands.
TL;DR: The lesion is somewhat more aggressive and considerably more likely to recur in young patients, but adequate local resection nearly always can forestall such recurrence.
Abstract: A study of 76 chondromyxoid fibromas affirms that it is a benign tumor, apparently of cartilaginous derivation, that is most likely to occur in adolescents and young adults. Although a wide skeletal distribution has been observed, the lesion most often affects major limb bones, especially the tibia. The characteristic but somewhat complex histologic range of this lesion, coupled with its benign appearance on roentgenograms, allows ready distinction from other tumors, most importantly chondrosarcoma. The lesion is somewhat more aggressive and considerably more likely to recur in young patients, but adequate local resection nearly always can forestall such recurrence. Malignant transformation is extremely improbable.
TL;DR: Experience indicates that posterolateral lumbar-spine bone-grafting resulted in a better fusion rate and a greater percentage of good clinical results than those reported for either anterior interbody or strictly posterior bone- grafting techniques.
Abstract: A series of 177 patients who had posterolateral lumbar-spine bone-grafting has been presented. The clinical result was based on reliefof pain, the need for analgesic medication, the restriction of physical activities, and the return to employment. Sixty per cent achieved good results, and 81 per cent satisfactory results (good and fair). A solid fusion based on roentgenographic evaluation was achieved in 80 per cent. There was high correlation between the clinical result and the presence or absence of a solid fusion in all diagnostic categories except spondylolisthesis. For spondylolisthesis, a one-level posterolateral grafting procedure seemed to be more reliable than a two-level procedure. Compensation considerations and a diagnosed psychoneurosis were factors that were identified as predisposing to a poor clinical result. Postoperative immobilization with a plaster body cast did not improve the fusion rate. Our experience indicates that posterolateral lumbar-spine bone-grafting resulted in a better fusion rate and a greater percentage of good clinical results than those reported for either anterior interbody or strictly posterior bone-grafting techniques.
TL;DR: The method uses extension-block splinting (a forearm gauntlet with a dorsal extension along the finger) which allows early active flexion of the proximal interphalangeal joint but prevents extension beyond a predetermined point at which the joint subluxates on dislocates.
Abstract: A closed method is recommended for the treatment of a common injury of the proximal interphalangeal joint, a fracture of the articular surface of the middle phalanx with dorsal dislocation or subluxation. The method uses extension-block splinting (a forearm gauntlet with a dorsal extension along the finger) which allows early active flexion of the proximal interphalangeal joint but prevents extension beyond a predetermined point at which the joint subluxates on dislocates. The method is described and the results in seventeen patients are presented.
TL;DR: It was concluded that there was no significant increase in monoclonal proteins in the population of Thief River Falls and the 1968 socalled epidemic of multiple myeloma in Thief River falls remains unexplained.
TL;DR: The association of primary lymphedema with yellow discoloration of the nails has been termed the “yellow nail syndrome,” and a third manifestation may be otherwise unexplained pleural effusion.
TL;DR: Microinjection of aequorin, a bioluminescent protein sensitive to calcium, into the presynaptic terminal of the squid giant synapse demnonstrated an increase in intracellular calcium ion concentration during repetitive synaptic transmission.
Abstract: Microinjection of aequorin, a bioluminescent protein sensitive tocalcium, into the presynaptic terminal of the squid giant synapse demnonstrated an increase in intracellular calcium ion concentration during repetitive synaptic transmission. Although no light flashes synchronous with individual presynaptic : tion potentials were detected, the results are considered consistent with the hypothesis that entry of calcium into the presynaptic terminal triggers release of e synaptic transmitter substance.
TL;DR: Serial biopsies in a prospective, controlled, double blind, randomized trial of treatment involving 63 patients with predefined clinical and biochemical criteria of severe chronic active liver disease revealed five different histologic patterns of hepatic injury, concluding that the evolution of any lesion is influenced by at least two factors: the original histologic pattern and the therapy applied.
TL;DR: Impaired secretion of cholecystokinin-pancreozymin was identified in patients with nontropical sprue, and was attributed to mucosal damage of the small intestine, and may contribute to steatorrhea in some patients with sprue.
TL;DR: Those patients achieving objective response had a significantly longer survival period than those failing to respond and the greatest proportion of patients presenting with adenocarcinoma of unknown origin to have their primary neoplasms in the pancreas.
Abstract: One hundred sixty-two patients with adenocarcinoma of undertermined origin were treated with 213 chemotherapeutic regimens, primarily 5-FU by intensive course. Objective response was obtained with 12% of these regimens and was maintained by a median time of 3.5 months and a mean of 9 months. Regimens producing a response rate of 15% or greater included 5-FU alone, 5-FU in combination with BCNU, and mitomycin C. Those patients achieving objective response had a significantly longer survival period than those failing to respond. Necropsy examinations revealed the greatest proportion of patients presenting with adenocarcinoma of unknown origin to have their primary neoplasms in the pancreas.
TL;DR: It is suggested that inflammatory bowel disease (IBD) results from the establishment of a state of hypersensitivity to antigen(s) of bacteria normally present in the individual's gastrointestinal tract and that the pathologic and clinical features of IBD then result from a predominantly cell-mediated hypersensitivity reaction in the bowel wall.
Abstract: From our studies (1-6) and a review of the literature, we have developed a working hypothesis for the etiology and pathogenesis of nonspeci f ic i n f l a m m a t o r y bowel disease (chronic ulcerative colitis and Crohn 's enterocolitis). This speculation is, first, that inflammatory bowel disease (IBD) results from the establishment of a state of hypersensitivity to antigen(s) of bacteria normally present in the individual's gastrointestinal tract and that the pathologic and clinical features of IBD then result from a predominantly cell-mediated hypersensitivity reaction in the bowel wall, and second, that the gut is the principal immune organ involved. The latter point is important to the concept and is supported by the conclusions of Fichtelius (7), who characterized the gut lymphoid tissue as a first-order central lymphoid organ, and by the work of Clarke (8), among others. How does the state of hypersensitivity become established when, normally (9), there is a mucosal block to the confrontation of the gut lymphoid tissues by bacterial antigen(s) from the lumen? We suggest that it could develop as a result of increased permeability of the gut mucosa, allowing the passage into the bowel wall of macromolecules and nonenteropathic gram-negative bacteria, and their resulting recognition by the gut-associated lymphoid tis-
TL;DR: Inhibition of absorption was reversible even though unconjugated dihydroxy bile acids produced striking structural changes of the jejunal mucosa, and bile acid conjugates caused no significant morphological changes.
TL;DR: Patients with sporadic Duane's retraction syndrome appear to have a significant increase in the number of associated congenital malformations, primarily facial anomalies, ear and hearing anomalies, skeletal deformities, and roentgenographic malforms.
Abstract: Patients with sporadic Duane's retraction syndrome (congenital aberrant innervation) appear to have a significant increase in the number of associated congenital malformations. These are primarily facial anomalies, ear and hearing anomalies, skeletal deformities, and roentgenographic malformations in the upper vertebral column and rib cage. The critical time in embryologic development resulting in these anomalies is the fourth to the eighth week of gestation.
TL;DR: Thirty-four additional cases of Sarcoma developing in previously irradiated bone are documented, bringing the total Mayo Clinic experience in sarcoma appearing after radiation therapy to fifty-five instances.
Abstract: Thirty-four additional cases of sarcoma developing in previously irradiated bone are documented, bringing the total Mayo Clinic experience in sarcoma appearing after radiation therapy to fifty-five instances. The sarcomas arose in normal bone within the radiation treatment field in eleven patients, while they arose in pre-existing bone lesions in sixteen patients. Osteogenic sarcoma and fibrosarcoma were most commonly diagnosed. The outlook in tumors of this nature is poor, the average survival being 1.14 years, with only two long-term survivors. Although a relationship has been established in experimental animals, a direct relationship between exposure to external radiation and the development of sarcoma is not established in man. There is no absolute proof that ionizing radiation caused any of these sarcomas. However, this and other significantly large series add to the mounting circumstantial evidence that the association between ionizing radiation and sarcoma is a real one. It must also be emphasized that this is a rare complication clinically.
TL;DR: It is found that transbronchoscopic lung biopsy has been helpful in the diagnosis of diffuse pulmonary disease and used in patients with diffuse diseases of the lungs.