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Showing papers by "Mayo Clinic published in 1973"


Journal ArticleDOI
01 Aug 1973-Cancer
TL;DR: Most of the chondrosarcoma‐like tumors of the base of the skull have a paradoxically indolent course and assessment of long‐term survival patients indicated that extensive surgical resection combined with irradiation offers the best palliation and prolongation of life.
Abstract: Special attention was given to chordomas and all cartilaginous tumors at the base of the skull during a study of the clinical and pathologic data on 155 chordomas (76 sacrococcygeal, 55 spheno-occipital, and 24 vertebral) seen at the Mayo Clinic. Attention also was drawn to a histologically separate group of spheno-occipital chordolmas which comprised one third of the tumors in this location and was associated with a surprisingly better prognosis. These tumors, which may bear a striking histologic resemblance to chondrosarcomas or chondromas, had clinical and roentgenologic features that convinced us of their kinship to ordinary chordomas and led us to designate them as “chondroid” chordomas. When these were excluded from the cartilaginous tumors of the base of the skull, there remained only four such tumors, all chondrosarcomas, in the files of the Mayo Clinic. Thus most of the chondrosarcoma-like tumors of the base of the skull have a paradoxically indolent course. Assessment of long-term survival patients indicated that extensive surgical resection combined with irradiation offers the best palliation and prolongation of life.

566 citations


Journal ArticleDOI
02 Mar 1973-Science
TL;DR: The present case represents the first recognized instance of carnitine deficiency in human skeletal muscle, in a rare myopathy muscle fibers contained myriad lipid-filled vacuoles.
Abstract: In a rare myopathy muscle fibers contained myriad lipid-filled vacuoles. Homogenates of the patient's muscle oxidized fatty acids more slowly than normal (11 controls). Addition of carnitine increased the oxidation rate with the patient's muscle to the level attained by the controls with carnitine. In five separate muscle samples from the patient the mean carnitine level was less than 20 percent of that observed in 42 controls. Carnitine palmityl transferase and palmityl thiokinase levels in the patient's muscles were not depressed. The present case represents the first recognized instance of carnitine deficiency in human skeletal muscle.

459 citations


Journal ArticleDOI
01 Jul 1973-Stroke
TL;DR: The EEG is a valuable monitoring technique that indicates when a shunt is required and informs the surgeon of the state of cerebral function not only during occlusion but also throughout the entire operative procedure.
Abstract: Over a 16-month period 121 endarterectomies performed under a carefully controlled level of general anesthesia (halothane-nitrous) were monitored by cerebral blood flow (GBF) measurements determined from intraarterially injected 133Xe and by continuous electroencephalograms (EEG). Details concerning our surgical, anesthetic, EEG, and blood flow technique have been previously reported and will not be discussed in detail here (1). This report will be limited to those 25 cases in which the EEG showed major focal changes within 3 min after carotid clamping. An internal shunt was inserted within 2 to 10 min after the development of focal EEG changes, and in all cases the major changes resolved by 3 min after shunting. In a few cases an additional 4 min was required for minor residual asymmetries to resolve.

452 citations


Journal ArticleDOI
Mark B. Coventry1
TL;DR: In seventy-one patients with degenerative arthritis and sixteen with quiescent rheumatoid arthritis, proximal tibial or femoral osteotomy was performed for varus or valgus deformity, with good or fair results in all but three cases in each group.
Abstract: In seventy-one patients with degenerative arthritis and sixteen with quiescent rheumatoid arthritis, proximal tibial or femoral osteotomy was performed for varus or valgus deformity. The correction needed was gauged in standing roentgenograms. After one to nine years, the patients with either form of arthritis had good or fair results in all but three cases in each group, gauged mostly by relief of pain, since the range of motion did not change. The results tended to be better in patients with lesser degrees of arthrosis.

440 citations


Journal ArticleDOI
01 Jan 1973-Stroke
TL;DR: All patients in the population of Rochester, Minnesota, who had stroke during the period 1955 through 1969 are identified and the course and survival of patients who have had stroke are determined.
Abstract: This study has attempted to identify all patients in the population of Rochester, Minnesota, who had stroke during the period 1955 through 1969, and to determine the course and survival of patients who have had stroke. Cerebral infarction from all causes, including embolic infarction, accounted for 79% of all strokes. Intracerebral hemorrhage accounted for 10% of the cases, and subarachnoid hemorrhage accounted for 6%. The average annual incidence rate for the 15 years of the study was 164 per 100,000 population per year. The rates for all strokes and for cerebral infarction were significantly higher for men than for women, except in the youngest age group. After the end of an earlier study, 1945 through 1954, the average annual incidence rate for all strokes decreased in each succeeding five-year interval and reached 141 during the period 1965 through 1969. The decrease in rates is apparent for all strokes and for cerebral infarction, and is more apparent for women than for men. The prevalence rate on Ja...

370 citations



Journal ArticleDOI
TL;DR: This paper compares the infantile, childhood and adult cases of acid maltase deficiency and considers the diagnostic methods.
Abstract: P o m p e ’ i n 1932 described generalized glycogenosis as a disease fatal in infancy. However, the recognition of acid maltase deficiency (AMD) in this disease by Hers’ in 1963 has led to the diagnosis of less severely affected cases (cases cited in Discussion). In these patients, symptoms may occur after infancy and the prognosis is better, The late-onset form of the disease may simulate, and is often misdiagnosed as, other myopathies. This paper compares the infantile, childhood and adult cases of AMD and considers the diagnostic methods.

246 citations


Journal ArticleDOI
TL;DR: Microspheres of different sizes, 125I-labeled antipyrine (I-Ap), and 42KCl or 86RbCl were injected into the aortic inflow of isolated, Langendorff, perfused, nonworking dogs hearts, and the deposition of 42K and that of I-Ap were essentially similar in three hearts over a large range of regional variation.
Abstract: Microspheres of different sizes, '-"'I-labeled antipyrine (I-Ap), and 4 -KCl or 86 RbCl were injected into the aortic inflow of isolated, Langendorff, perfused, nonworking dogs hearts at blood flows of 1.3-4.8 ml/min g~'. After 15 seconds to 5 minutes, the left ventricle was sectioned into about 300 ordered pieces, and the amount of each tracer was determined. For all tracers, the relative density of deposition was generally higher in the endocardial region, except in one heart in which the aortic pressure and the total coronary flow were low. The deposition of ^-K and that of I-Ap were essentially similar in three hearts over a large range of regional variation. This finding suggests either that both tracers were distributed in proportion to flow or that a small diminution in relative density of deposition of 42 K in high-flow regions due to lower transcapillary extraction was quantitatively similar to a decrease in the residual fraction of I-Ap in these same regions due to faster washout in the first 15—30 seconds after injection. Large microspheres were deposited preferentially in regions of high flow, exaggerating the apparent heterogeneity of regional flows. The distribution of the smaller microspheres was closer to that for I-Ap or 42 K.

227 citations


Journal ArticleDOI
TL;DR: The authors suggest that anesthetics such as thiopental diminish energy requirements of the brain only by reducing its function and hence can provide cerebral protection only when the extent of hypoxia is insufficient to abolish function.
Abstract: The effects of thiopental on rates of cerebral ATP depletion and lactate accumulation in dogs anesthetized with N2O during two different circumstances of impaired oxygen delivery were examined. In ten dogs, five with and five without prior thiopental (13 mg/kg), acute hemorrhagic shock (mean arteria

207 citations


Journal ArticleDOI
TL;DR: Prophylactic anticoagulation with sodium warfarin was used after 1,950 of 2,012 consecutive total hip arthroplasties, beginning on the fifth postoperative day, and there were no fatal complications resulting from antICOagulation.
Abstract: Prophylactic anticoagulation with sodium warfarin was used after 1,950 of 2,012 consecutive total hip arthroplasties, beginning on the fifth postoperative day. No anticoagulative was used after the remaining procedures. The rate of fatal pulmonary embolism in the group treated with anticoagulants was 0.05 per cent, and in the group not treated with anticoagulants, 3.4 per cent. There were nineteen serious bleeding problems in the anticoagulated group, six of which necessitated surgery. There were also two deep infections associated with wound hematomas which resolved satisfactorily with treatment. There were no fatal complications resulting from anticoagulation.

204 citations



Journal ArticleDOI
TL;DR: The Merkel cell penetrates the epidermis in fetal life and functions as a specific, slowly adapting, sensory touch receptor that is capable of living in union with neural and epithelial cells.

Journal ArticleDOI
TL;DR: A rapid, sensitive, specific, and valid radioimmunoassay for conjugated cholyl bile acids has been developed and should be useful for assessing hepatic function in health and disease.

Charles G. Moertel1
01 Jan 1973
TL;DR: For example, this article showed that 5-Fluorouracil (5-FU) provides only infrequent, incomplete, and fleeting antitumor effects, which are probably more than counterbalanced by its gastrointestinal, mucocutaneous, and hematologic anti-host effects.
Abstract: Although advanced gastrointestinal cancer is the most commonplace problem encountered by the medical oncologist, this group of diseases has proved exceedingly resistant to past chemotherapy efforts. 5-Fluorouracil (5-FU), accepted by some as standard treatment, has provided only infrequent, incomplete, and fleeting antitumor effects, which are probably more than counterbalanced by its gastrointestinal, mucocutaneous, and hematologic antihost effects. There is no evidence that any manipulation of route or schedule of administration provides any improvement in the therapeutic ratio of 5-FU. There is no evidence that this drug contributes to patient survival when used at any stage of any type of gastrointestinal carcinoma. The search for alternative single drugs to 5-FU has been disappointing. The nitrosoureas and Mitomycin C produce occasional regressions, but they do not match the meager effectiveness of 5-FU; and they, in addition, present the difficult problem of cumulative bone marrow suppression. Recent trials with combination regimens have given some indication that the long stalemate in chemotherapy of gastrointestinal cancer may be breaking. Substantial improvements in frequency of tumor regression have been recorded for gastric carcinoma with combinations of 5-FU and BCNU, 5-FU and methyl CCNU, and 5-FU, Mitomycin C, and cytosine arabinoside; for colorectal carcinoma, with the combination of 5-FU, methyl CCNU, and vincristine; and for carcinoid tumors and islet cell carcinomas, with the combination of 5-FU and Streptozotocin. There are also suggestions that such combination chemotherapy with response rates in the 30 to 50% range may produce increased survival when compared to the untreated patient and patients treated with single-drug regimens. While the accomplishments of chemotherapy for the gastrointestinal cancer patient remain less than spectacular there is nevertheless realistic hope that a respectable contribution can now be made to multidisciplinary efforts applied at a stage of disease with minimal tumor burden.

Journal ArticleDOI
07 Sep 1973-Science
TL;DR: Frequency distributions of serum enzyme values in both children and adults suggest the existence of two populations with regard to serum activity of this enzyme.
Abstract: Dopamine-β-hydroxylase activity is released into the blood with catecholamines from the adrenal medulla and sympathetic nerves. This enzyme activity has been measured in the blood of 317 normal children and 227 normal adults. A significant sibling-sibling correlation of serum dopamine-β-hydroxylase values was found in the 94 sibling pairs tested. Frequency distributions of serum enzyme values in both children and adults suggest the existence of two populations with regard to serum activity of this enzyme.

Journal ArticleDOI
Claude D. Arnaud1
TL;DR: The presence of hyperparathyroidism in early renal failure was first suggested by the data of Friis, Hahnemann and Weeke which showed that serum phosphate was lower in patients with small decreases in glomerular filtration rate (GFR).

Journal ArticleDOI
TL;DR: All young males with nasal obstruction or nose-bleed (or both) should be suspected of having juvenile angiofibroma and knowledge of the point of origin in the posterior nasal cavity and the natural history of extension of the tumor into the nasal cavity, nasopharynx, sphenoid sinus, pterygomaxillary and infratemporal fossae, and cranial cavity is essential in planning treatment.
Abstract: Summary All young males with nasal obstruction or nose-bleed (or both) should be suspected of having juvenile angiofibroma. This awareness, as well as a good physical examination and history taking, is essential. Plain roentgenograms of the sinus, with submentovertical views, and tomograms should be sufficient adjuncts for diagnosis. Knowledge of the point of origin in the posterior nasal cavity and the natural history of extension of the tumor into the nasal cavity, nasopharynx, sphenoid sinus, pterygomaxillary and infratemporal fossae, and cranial cavity is essential in planning treatment. Angiography for diagnostic purposes should be used only in unusual circumstances. The use of hormones, cryotherapy, carotid ligation, or hypotensive anesthesia probably will not be of any help in controlling hemorrhage at operation. Our experience with patients who have received irradiation and who still had the angiofibroma—with the ever present risk of irradiation [ 15 ] in the preadult patient—has caused us to be skeptical of this modality as a primary form of treatment. However, the radiotherapist is a member of the team managing the treatment of patients with this most difficult tumor. (Figure 9.) All operations presently used to obtain surgical exposure of the angiofibroma and its extension may be inadequate when the tumor bleeds excessively on manipulation. We believe-lateral rhinotomy, in one procedure, allows the surgeon to expose the extensions of the tumor and to remove the tumor from its point of origin in the posterior nasal cavity without disturbing facial growth or causing facial deformity. Intracranial extension indicates advanced disease and is not unusual [ 13, 16 ]. We have successfully removed angiofibromas involving the middle fossa, but four of our patients who died had evidence of intracranial angiofibroma.

Journal ArticleDOI
TL;DR: It is suggested that C18 fatty acids may contribute to diarrhea in states of fat malabsorption by impairing intestinal water absorption and hydration of dietary fats of hydroxy fatty acid may not be essential for this effect.

Journal ArticleDOI
TL;DR: Results support a mechanism in which prothrombin is first cleaved, either by Factor Xa or thrombin, to yield Intermediate 1 from its COOH-terminal region and Intermediate 3 from its NH2-Terminal region, and a mechanism which indicates that the activation proceeds by the sequential cleavage of portions of the NH2 -terminal regions of prothombin and the intermediates.

Journal ArticleDOI
01 Aug 1973-Cancer
TL;DR: A review of 4,286 cases of prostatic adenocarcinoma at the Mayo Clinic showed 55 cases in which lesions were of a distinctive ductal type, eight of which originated from periurethral primary prostatic ducts and had exuberant papillary folds.
Abstract: Clinical and histopathologic features of prostatic ductal adenocarcinomas have been incompletely described. A review of 4,286 cases of prostatic adenocarcinoma (1950 through 1970) at the Mayo Clinic showed 55 cases in which lesions were of a distinctive ductal type. Eight of the 55 lesions originated from periurethral primary prostatic ducts and had exuberant papillary folds. Cystoscopic examination revealed a polypoid and villous or an infiltrative urethral component. The 5-year survival rate (42.8%) was similar to that for the usual acinic adenocarcinomas. Carcinomas originating from secondary ducts had a multi-centric origin and papillary, comedo-like, and cribriform-papillary histopathologic features. The overall 5-year survival rate was 24.2%. Palliative hormone therapy appeared to be less effective in prolonging life in these patients as compared to patients with acinic carcinomas. Bone metastases were osteoblastic, and serum acid phosphatase activities were elevated if metastases were present.

Journal ArticleDOI
TL;DR: The breath test appears to be a useful screening test for the detection of the stagnant loop syndrome and its interpretation is uncertain in patients with ileal dysfunction, since such patients may also have bile acid malabsorption.

Journal ArticleDOI
TL;DR: In carefully selected patients, definite amelioration or long-term relief of existing hypertension may be accomplished by appropriate surgical management; in the severe cases thus managed, the mortality rate appears to be decidedly reduced.
Abstract: Hypertension with atheromatous or fibromuscular renal artery stenosis was studied prospectively in 214 cases for 7 to 14 years. After 3 months or less of medical management proved unsuccessful, 100 patients, were submitted to surgical management. At latest follow-up examination, 84 of these survived and 51 were normotensive without medication. The survivors included 26 of 37 with artheromatous stenosis and 58 of 63 with fibromuscular stenosis. Medical management was continued in the other 114 patients (except for 16 transferred after 6 months to 5 years to surgical care but are not reported on here). Of these 114 patients, 44 had atheromatous disease, of whom 10 were surviving with medication at latest follow-up examination (7 others having been transferred to surgical management); and 70 had fibromuscular stenosis, of whom 49 survived with continuing medication (9 others having been transferred to surgery). At the latest follow-up study (December 1972), 55 of the 214 patients had died. Myocardial infarction, stroke and renal failure were the most common causes of death. Renal artery stenosis may be demonstrated by current angiographic techniques. Functional significance of proved lesions can be determined by renal vein renin activity, differential renal function study or demonstration of a systolic-diastolic or continuous abdominal bruit; and it can be suggested by intravenous urography and isotope renography. In carefully selected patients, definite amelioration or long-term relief of existing hypertension may be accomplished by appropriate surgical management; in the severe cases thus managed, the mortality rate appears to be decidedly reduced.

Journal ArticleDOI
TL;DR: Patients with Stage I epithelial cancer of the ovary treated at the Mayo Clinic from 1950 through 1966 showed that many factors in addition to the stage of the lesion influence survival, including cell type, grade of malignancy, and gross characteristics of theLesion.

Journal ArticleDOI
TL;DR: Nine patients, including four undergoing their first hemodialysis, were observed clinically and by hourly electroencephalographic recordings before, during, and three hours after highly efficient he modialyses during which plasma osmolality was maintained by use of a dialysate with increased concentrations of sodium and chloride.

Journal ArticleDOI
TL;DR: Plasma catecholamines, as determined by a new improved method, are increased in hypothyroidism and decreased in hyperthyroidism.
Abstract: Plasma catecholamines, as determined by a new improved method, are increased in hypothyroidism and decreased in hyperthyroidism. In addition, plasma catecholamine values are inversely correlated with total thyroxine values in hyperthyroidism.


Journal ArticleDOI
TL;DR: Preliminary data indicate that the presence of a positive culture in a hip previously operated on may be significant, even though a deep wound infection may later yield a different organism.
Abstract: This is a study of 658 consecutive total hip arthroplasty procedures in which cultures were taken at surgery. Cultures were positive in 195: 111 occurred in 437 hips that had not been previously operated on and eighty-four in 221 hips that had undergone previous operation. To date, there have been fourteen infections: seven superficial, and seven deep. Preliminary data indicate that the presence of a positive culture in a hip previously operated on may be significant, even though a deep wound infection may later yield a different organism. Organisms belonging to the family Micrococcaceae appear to predominate in deep wound infections.

Journal ArticleDOI
TL;DR: The present study suggests a mechanism for the abnormal myocardial oxygen consumption in pressure overload hypertrophy and relates it to nonphosphorylating mitochondrial respiration linked to calcium transport.
Abstract: Depressed myocardial contractility with paradoxically increased oxygen consumption has been demonstrated in previous studies of pressure overload hypertrophy. To determine whether altered mitochondrial respiration participates in the abnormal energetics of this muscle, right ventricular hypertrophy (RVH) was produced in 12 cats by pulmonary artery banding. A polarographic muscle bath was used to study eight control and eight RVH papillary muscles, and the respiration of mitochondria isolated from these right ventricles was characterized. RVH muscles demonstrated depressed force-velocity and length-tension curves. The myocardial oxygen consumption per gram of peak active tension was increased from 0.65 ± 0.05 nliters/mg beat-1 (control) to 1.10±0.07 nliters/mg beat-1 (RVH) (P<0.001). Abnormal mitochondrial respiration was shown by an increase in the rate of state 4 oxygen consumption from 12.5±0.8 natoms/mg min-1 (control) to 19.9±0.8 natoms/mg min-1 (RVH) (P < 0.001). The altered oxygen cost of active iso...

Journal ArticleDOI
TL;DR: It is proposed that the absence of the gallbladder causes more rapid enterohepatic recycling of bile acids and therefore increased bile acid secretion.
Abstract: After cholecystectomy, bile secretion is continuous and 24-hour bile acid output exceeds that in health. Cholecystokinin-pancreozymin (CCK-PZ) influences neither bile acid secretion nor the bile acid composition of bile after the operation. It is proposed that the absence of the gallbladder causes more rapid enterohepatic recycling of bile acids and therefore increased bile acid secretion. The bile acid composition of bile following cholecystectomy is abnormal for the same reasons. A high proportion of secondary bile acids is present, including several found to be keto bile acids, and this is attributed to increased exposure of the bile acid pool to degradation by intestinal microorganisms.