Showing papers by "Mayo Clinic published in 1978"
TL;DR: Staging of liver biopsy specimens from patients with chronic non-suppurative destructive cholangitis (CNDC) has become an important part of clinical studies that are currently done in many centers, and methods based on uniform criteria that are applicable to all specimens and are easily reproducible are suggested.
Abstract: Staging of liver biopsy specimens from patients with chronic non-suppurative destructive cholangitis (CNDC or syndrome of primary biliary cirrhosis) has become an important part of clinical studies that are currently done in many centers. Therefore, staging methods should be based on uniform criteria that are applicable to all specimens and are easily reproducible. Most pathologists staging CNDC use the system proposed by Scheuer and modified slightly by Popper and Schaffner; and generally these methods serve well. But the features relied upon as characteristic of the earlier phases of CNDC (namely, inflammatory destruction of intrahepatic bile ducts and proliferation of ductules) are not always present in biopsy specimens from early cases, and occasionally they coexist with more advanced lesions, such as bridging necrosis. We suggest a new staging system, based on our experience with 219 individual biopsy specimens from 101 patients with well established CNDC. Our proposed criteria are: stage I — portal hepatitis; stage II — periportal hepatitis; stage III — septal fibrosis or bridging necrosis, or both; and stage IV — cirrhosis. In most instances, we found these features easy to recognize, and one or another of them was always present. Intra-observer and interobserver variations were small. Experience with the proposed staging system indicates that stages III and IV are encountered 3 or 4 times as commonly as stages I and II. Incidence of inflammatory bile duct destruction seemed to vary little from stages I to II. Cholestasis and positive copper stains were most common in stages III and IV.
675 citations
TL;DR: An adjunct, polyquarternary amines, specifically Polybrene, that greatly reduces or eliminates this problem of automatic spinning-cup sequenators being incapable of approaching the carboxy terminus of a peptide.
412 citations
TL;DR: The two groups were similar except that the outpatient group had a higher percentage of patients with hepatitis-cirrhosis and a lower percentage with neoplasia when compared with the inpatient group.
409 citations
TL;DR: The localization of calcium was studied with the von Kössa method, with alizarin red, and with glyoxalbis-(O-hydroxyanil) in serial, fresh-frozen sections of 114 biopsy specimens, suggesting that intracellular calcium overloading may be an important mechanism of muscle fiber degeneration.
Abstract: Ultrastructural studies have shown plasmalemmal defects in a proportion of non-necrotic muscle fibers in Duchenne dystrophy, suggesting that intracellular calcium overloading may be an important mechanism of muscle fiber degeneration. To investigate this assumption, we studied the localization of calcium with the von Kossa method, with alizarin red, and with glyoxalbis-(o-hydroxyanil) in serial, fresh-frozen sections of 114 biopsy specimens. The biopsy material included Duchenne dystrophy (24 cases), other dystrophies (27 cases), inflammatory myopathies (47 cases), and normal controls (11 cases). Counted in each specimen were every muscle fiber, the so-called large-dark fibers, and all calcium-positive fibers. Separate counts were made of the large-dark, necrotic, and other types of calcium-positive fibers. In Duchenne dystrophy, non-nectotic calcium-positive fibers occurred with a mean frequency of 4.83 percent. For all other groups, the corresponding value was 0.57 percent, with a range of 0.21 percent (normals) to 1.76 percent (scleroderma), p less than 0.001. Large-dark fibers were 12 times more common in Duchenne dystrophy than in all other cases. Forty-three percent of the fibers were calcium-positive in Duchenne dystrophy, whereas calcium-positive large-dark fibers were extremely rare in the other cases.
401 citations
TL;DR: The colon has a surprisingly large capacity to absorb fluid; this capacity is reduced by chenodeoxycholate and is overwhelmed if fluid enters the cecum rapidly.
366 citations
TL;DR: The preliminary conclusion is that elective node dissection is not beneficial in management of melanoma, and disease progression was advanced significantly by age of the patient and by invasiveness and thickness of the melanoma.
Abstract: To determine whether immediate or delayed lymphadenectomy is more beneficial than none in cases of localized (stage I) melanoma, we undertook in 1972 a prospective randomized study. Patients with midline trunk lesions were excluded as well as patients with lesions situated directly over the node-bearing area. In addition, because of the low risk of metastasis, the protocol was changed to exclude level 2 lesions. Of the 173 patients studied, 63 were randomized to no lymphadenectomy, 56 to delayed (3 months) lymphadenectomy, and 54 to immediate lymphadenectomy. None of these regimens differed significantly from the others in its effect on length of survival or interval to metastasis. And of the 110 patients who underwent elective lymphadenectomy, 103 were without nodal involvement. Our preliminary conclusion is that elective node dissection is not beneficial in management of melanoma. However, disease progression was advanced significantly by age of the patient (greater than 60 years) and by invasiveness (level 4 or 5) and thickness (greater than 1.5 mm) of the melanoma.
347 citations
TL;DR: A review of tumors from 60 patients with localized pleural mesothelioma seems to justify separation into benign and malignant variants, and no single clinical feature allowed preoperative predictability concerning benignity or malignancy.
328 citations
TL;DR: Nonpathologic factors Influencing Brainstem Auditory Evoked Potentials and their consequences are studied in detail in the context of EEG research.
Abstract: (1978). Nonpathologic Factors Influencing Brainstem Auditory Evoked Potentials. American Journal of EEG Technology: Vol. 18, No. 4, pp. 177-209.
302 citations
TL;DR: The prognosis was uniformly poor in patients presenting with the primary and secondary lesion together, regardless of the mode of therapy, and an operation for the metastatic lesion seemed to offer the best results in patients who presented with the solitary metastaticLesion after nephrectomy.
277 citations
TL;DR: Xanthogranulomatous pyelonephritis did not recur but in some patients bacteriuria continued or hypertension developed, and a correct preoperative diagnosis was made in only 1 instance.
258 citations
TL;DR: From 1950 through 1974, a total of 108 cases of primary intestinal leiomyosarcoma were seen at the Mayo Clinic, and most of these uncommon tumors occurred in the fifth and sixth decades of life, and more of them in men than in women (2.6:1).
Abstract: From 1950 through 1974, a total of 108 cases of primary intestinal leiomyosarcoma were seen at the Mayo Clinic. Most of these uncommon tumors occurred in the fifth and sixth decades of life, and more of them in men than in women (2.6:1). There were 73% in the small bowel, 25% in the large bowel, and 2% in the anus. Gastrointestinal bleeding and pain were the two most common signs at presentation, and they led to surgical exploration in all cases where they appeared. By the time surgery was performed, only 48% of the tumors could be resected with hope of cure. Within that group of cases, 50% of the patients survived 5 years, but only 35% survived 10 years, late recurrence being common. The histologic grade of the tumor affected survival strongly. Lack of recognition of the high late recurrence rate probably led to erroneous early optimism in prognosis.
TL;DR: Baclofen has been clearly shown to exert an antinociceptive effect at the spinal level, in addition to its previously suggested supraspinal action, and may be compared with a similar dual site of action of morphine.
TL;DR: Systems for automatic assessment of cutaneous touch‐pressure, vibratory, and thermal sensation have been developed and may be used to detect and validate abnormalities of sensation in neurological disease and in persons at risk from new medications or from industrial toxins.
Abstract: Systems for automatic assessment of cutaneous touch-pressure, vibratory, and thermal sensation have been developed. These systems use stimuli which are quantified and reproducible, a two-alternative forced-choice technique, and programmed steps to test, score, and report. If normal responses from series of healthy persons have been measured, percentile values specific for test, site, age, and sex can be determined. Abnormality, as in neurological disease, can then be defined as the response which has a value greater than that of the 95th (or other) percentile. These systems may be used to detect and validate abnormalities of sensation in neurological disease and in persons at risk from new medications or from industrial toxins, and to monitor worsening or improvement of sensation in follow-up of a patient or in evaluation of therapeutic regimens.
TL;DR: A retrospective review of 55 patients with post-traumatic radioscapholunate ligament disruption suggests that rupture of this ligament can be treated successfully if certain guidelines are followed and results after ligament reconstruction have ranged from good to fair.
Abstract: A retrospective review of 55 patients with post-traumatic radioscapholunate ligament disruption suggests that rupture of this ligament can be treated successfully if certain guidelines are followed. If the rupture is seen within 4 weeks, an anatomic reduction maintained in plaster for 8 weeks leads to good results. Ligament ruptures that cannot be held in reduction or that are diagnosed after 4 weeks do poorly with immobilization only. Results after ligament reconstruction have ranged from good to fair but appear to have been sufficiently successful to warrant continued trial rather than resort to arthrodesis, proximal row carpectomy, or similar reconstructive procedures. Patients with degenerative joint disease associated with radioscapholunate rupture are not candidates for ligament reconstruction. Radial styloidectomy or some variety of wrist arthrodesis or wrist arthoplasty should be considered in these instances.
TL;DR: It is concluded that the decreased plateau size of the spontaneous electrical cycles generated by the gastric smooth muscle cells and the diminished sensitivity of the cells to appropriate contractile stimuli caused this patient's gastric retention.
TL;DR: Among patients with carotid TIA who received anticoagulants, the net probability of stroke was slightly but not significantly lower than in untreated patients, and the difference favoring treated patients with vertebral‐basilar TIA was significant starting at three months.
Abstract: A population of 199 patients from Rochester, MN, was followed from the time of their first carotid or vertebralbasilar transient ischemic attack(TIA). Patients treated with anticoagulants had no significant difference in survival from untreated patients. Among patients with carotid TIA who received anticoagulants, the net probability of stroke was slightly but not significantly lower than in untreated patients. The difference favoring treated patients with vertebral-basilar TIA was significant starting at three months.
The rate of intracranial hemorrhage was higher among all patients receiving anticoagulant treatment than among untreated patients and was significantly higher among those 55 to 74 years old. Almost all the hemorrhages occurred after a year or more of anticoagulant treatment and in patients more than 65 years old.
Patients with high diastolic blood pressure had a significantly higher net probability of stroke than did patients with lower blood pressure and those receiving antihypertensive drugs. By implication, treatment of hypertension was effective in preventing stroke in patients with TIA.
Linear discriminant analysis and actuarial analysis indicated that diastolic blood pressure and anticoagulant therapy were the only factors that influenced stroke occurrence. There was no suggestion that previous myocardial infarction, angina pectoris, valvular heart disease, cardiac arrhythmia, or congestive heart failure–individually or in combination–influenced the occurrence of stroke or survival.
01 Oct 1978
TL;DR: These guidelines are developed on the basis of a review of the literature on anticoagulant, antiplatelet, and surgical treatment, supplemented by personal experience, for the management of patients with transient ischemic attacks.
Abstract: On the basis of a review of the literature on anticoagulant, antiplatelet, and surgical treatment, supplemented by our personal experience, we have developed guidelines for the management of patients with transient ischemic attacks (TIA). 1. The majority of patients with vertebral-basilar TIA are treated medically. 2. If a skilled surgeon and an experienced angiographer are available, patients with typical carotid TIA who are suitable medical risks should have angiography followed by carotid endarterectomy if an appropriate lesion is found. 3. Nonoperated patients with TIA of less than 2 months' duration are treated with 3 months of warfarin therapy (unless contraindicated) before treatment with aspirin is begun. 4. Nonoperated patients with continuing TIA of 2 or more months' duration are treated with aspirin unless there has been a recent increase in the frequency, duration, or severity of TIA. Under these circumstances, warfarin therapy is advised for 3 months before aspirin is started. Aspirin therapy should be continued until the patient has been free of TIA for 1 year. 5. No treatment is advised for nonoperated patients whose last episode of TIA was longer than 12 months ago.
TL;DR: Interwave latency prolongations that were abnormal relative to an age‐matched normal population were seen in patients with both spontaneous and induced hypothermia, and these abnormalities disappeared after rewarming to normothermia.
Abstract: Latency measurements between three potentials (waves I, III, and IV/V) of the human brainstem auditory response can allow early detection of certain posterior fossa lesions. The diagnostic use of these interwave latencies requires knowledge of what factors may prolong them in the absence of disease. Hypothermia appears to be one such factor--in 5 neurologically and audiometrically normal patients, mean esophageal temperatures as high as 34.5 degrees C resulted in prolongations of central auditory conduction time. Interwave latency prolongations that were abnormal relative to an age-matched normal population were seen at 32.1 degrees +/- 0.3 degrees C in patients with both spontaneous and induced hypothermia, and these abnormalities disappeared after rewarming to normothermia. Hypothermia often accompanies intoxication and coma and should therefore be considered when brainstem auditory response abnormalities are being interpreted in these two clinical conditions.
TL;DR: Acceptable prosthodontic care for the patient with the acquired maxillary defect should include cautious prosthesis design combined with routine maintenance care to provide comfort, function, cosmetics, and minimal change to the compromised remaining structures.
Abstract: Fabrication of obturator prostheses does not require a special ability to fabricate a prosthesis extension into a defect or an arbitrary extension of a prosthesis into a defect. Fabrication of an obturator prosthesis depends on the application of basic prosthodontic principles that are used in the treatment of patients without maxillary defects. Some principles must be modified because of the defect and the character and position of the remaining structures. The defect, in conjunction with the remaining structures, must be used to provide support, retention, and stability of an obturator prosthesis. If basic prosthodontic principles are applied the size and extension of the obturator will be determined, and the extensive variation so commonly seen in obturators will be minimized. Acceptable prosthodontic care for the patient with the acquired maxillary defect should include cautious prosthesis design combined with routine maintenance care to provide comfort, function, cosmetics, and minimal change to the compromised remaining structures.
TL;DR: It is concluded that intrarenal infusion of adenosine preferentially constricts the afferent arterioles of the superficial cortex and thereby decreases superficial GFR without decreases in glomerular capillary ultrafiltration coefficient.
Abstract: This study evaluates the contributions of pre- and postglomerular resistances and glomerular capillary ultrafiltration coefficient (Kf) in adenosine-induced decreases in glomerular filtration rate (GFR). Experiments were performed on 19 dogs prepared for micropuncture. Whole kidney and superficial nephron functions were measured before and during adenosine infusion (0.1 μmol/min) into the renal artery. Whole kidney GFR decreased from 29.0 ± 1.7 to 23.1 ± 1.6 (SE) ml/min (P< 0.003). Renal plasma flow (RPF) increased slightly from 98 ± 6 to 108 ± 8 ml/min (P< 0.05), resulting in a decreased filtration fraction from 0.30 ± 0.02 to 0.22 ± 0.02. Superficial single nephron GFR and plasma flow decreased from 68.8 ± 5.2 to 39.9 ± 6.4 nl/min (P < 0.001) and from 206 ± 28 to 128 ± 17 nl/min (P < 0.01), respectively. Free flow and stop flow pressures in proximal tubules decreased from 23 ± 1 to 16 ± 1 mm Hg and from 44 ± 1 to 31 ± 2 mm Hg, respectively. Kf was not significantly changed (2.55 ± 0.22 vs. 3.12 ± 0.88 nl/min per mm Hg). The hydrostatic pressures in efferent arterioles decreased from 14 ± 0.6 to 10.4 ± 1.8 mm Hg (P < 0.01). The resistance in the afferent arterioles increased more than 2-fold from 1.38 ± 0.25 to 3.04 ± 0.42 − 1010 dynes - sec - cm\"5 (P < 0.003), whereas efferent arteriolar resistance was only slightly increased from 1.35 ± 0.18 to 1.76 ± 0.17. We conclude that intrarenal infusion of adenosine preferentially constricts the afferent arterioles of the superficial cortex and thereby decreases superficial GFR without decreases in glomerular capillary ultrafiltration coefficient.
TL;DR: The survival associated with oral 5‐Fu alone was significantly shorter than the survival time associated with the remaining 3 treatment programs among both North American and South African patients.
Abstract: One hundred and sixty-eight patients with unresectable primary liver cancer were prospectively studied by members of the Eastern Cooperative Oncology Group. These patients were randomized to receive treatment with oral 5-Fluorouracil (5-Fu), oral 5-Fu plus Streptozotocin, oral 5-Fu plus MethylCCNU or Adriamycin. The single agent treatments (oral 5-Fu and Adriamycin) were associated with less gastrointestinal toxicity than were the oral 5-Fu treatment combinations. A total of 15 partial responses were reported. Adriamycin appears to be the most active agent and responsible for 9 of the 15 responses. No response was seen in any of the 48 patients randomized to oral 5-Fu alone. The survival associated with oral 5-Fu alone was significantly shorter than the survival time associated with the remaining 3 treatment programs among both North American and South African patients. A multivariate model of survival was formulated. Covariates of prognostic significance were treatment, initial performance status and sex. South African black patients had a shorter survival time than North American black patients. Excluding oral 5-Fu from consideration, prognostic variables appeared to dominate any differences between the remaining treatments under study. Cancer 42:2149–2156, 1978.
TL;DR: In this article, high performance liquid chromatographic separation of the catecholamines epinephrine, norepinephrine, 3,4-dihydroxybenzylamine and dopamine utilizing an isocratic aqueous mobile phase flowing over a bonded octadecylsilane (μBondapak C18) solid phase, with amperometric detection of the eluate.
TL;DR: Late results were more encouraging than were early results and were moderately satisfactory for each method, and improvement in grasp and pinch strength was most predictable for arthrodesis, although wrist motion was diminished.
Abstract: Scaphotrapezial trapezoidal degenerative arthritis as an isolated entity or as a preponderant part of a pantrapezial degenerative process was seen in 49 hands of 34 patients. Pain and weakness were the primary complaints. Point tenderness was present in all but two hands. Significant loss of grasp and pinch strength was noted in 18 hands, and loss of wrist motion occurred in 16 hands. Roentgenographic findings included narrowing of the scaphotrapezial trapezoidal joint space, subarticular cortical sclerosis, and cyst formation. A dorsiflexed position of the scaphoid, with a scapholunate angle of less than 45°, was noted in 38 of the 45 hands. Late collapse of the intercarpal joint with dorsiflexion instability of the lunate also was noted. Twenty-nine hands were treated conservatively by protective splints, corticosteroid injections, and avoidance of exacerbating activities. Surgical treatments consisted of fibrous arthroplasty (four), silicone interposition arthroplasty (six), trapezial replacement arthroplasty (three), arthrodesis (five), joint debridement (one), and trapezial excision (one). Late results were more encouraging than were early results and were moderately satisfactory for each method. Improvement in grasp and pinch strength was most predictable for arthrodesis, although wrist motion was diminished.
TL;DR: A deterministic model is developed to describe a single wave of influenza A in a closed stratified population which selects the optimal vaccine distribution pattern among the various age groups when there is a limited quantity of vaccine available.
Abstract: A deterministic model is developed to describe a single wave of influenza A in a closed stratified population. The model specifies agent characteristics and nonhomogeneous mixing patterns among various age groups in a standardized American community. Attack rates predicted by the model for the Asian and Hong Kong strains of influenza are found to agree with those predicted by a previously described stochastic simulation model. The deterministic model is then coupled with an optimization formulation which selects the optimal vaccine distribution pattern among the various age groups when there is a limited quantity of vaccine available. Optimal vaccine distribution patterns are given. These patterns are found to vary, depending on the particular strain of influenza A modeled, the quantity of vaccine available, and the “cost” structure of the objective function.
TL;DR: An attempt is made to measure the rotatory component of cadaver elbows under passive motion to justify certain noninvasive means to measure three-dimensional angular motion for living subjects.
TL;DR: Patients given melphalan-prednisone were able to continue on treatment for a longer time and to receive larger doses before the code was broken, and survival did not differ significantly between the groups.
TL;DR: The placebo effect of the transcutaneous electrical stimulator is similar to the placebo effect that is noted in other double‐blind studies in which medicationms are used.
Abstract: The placebo effect of transcutaneous electrical stimulation was studied in 93 patients in a double-blind cross-over trial using a genuine stimulator and a placebo machine. Placebo analgesic effects occurred in 32% of trials, as compared with 48% for actual stimulation. The placebo effect of the transcutaneous electrical stimulator is similar to the placebo effect that is noted in other double-blind studies in which medicationms are used.
TL;DR: The lesions were characterized by an aggressive course, with recurrence in 80% of the patients, and metastases in 23%; thus, the importance of recognizing the lesion pathologically is emphasized.
Abstract: A study of 26 emangiopericytomas of the meninges revealed that the histologic appearance—including ultrastructural features—was similar to that of hemangiopericytomas of soft tissues. Both sexes were affected, and occurrence was most frequent in the adult years, with no symptoms specific for the lesions. The lesions were characterized by an aggressive course, with recurrence in 80% of the patients, and metastases in 23%; thus, the importance of recognizing the lesion pathologically is emphasized.