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Showing papers by "Mayo Clinic published in 1981"


Journal ArticleDOI
TL;DR: Bone mineral density was measured in vivo at the lumbar spine (predominantly trabecular bone) by dual photon absorptiometry and at the midradius (greater than 95% cortical bone) and distal radius (75% cortical and 25% trabECular bone), by single photon absorptioniometry as mentioned in this paper.
Abstract: Patterns of bone loss in the axial and the appendicular skeleton were studied in 185 normal volunteers (105 women and 82 men; age range, 20--89 yr) and in 76 women and 9 men with vertebral fractures due to osteoporosis. Bone mineral density was measured in vivo at the lumbar spine (predominantly trabecular bone) by dual photon absorptiometry and at the midradius (greater than 95% cortical bone) and distal radius (75% cortical and 25% trabecular bone) by single photon absorptiometry. In normal women, bone diminution from the vertebrae began in young adulthood and was linear. In the appendicular skeleton, bone diminution did not occur until age 50 yr, was accelerated from aged 51 to 65 yr, and then decelerated somewhat after age 65 yr. Overall bone diminution throughout life was 47% for the vertebrae, 30% for the midradius, and 39% for the distal radius. In normal men, vertebral and appendicular bone diminution with aging was minimal or insignificant. Mean bone mineral density was lower in patients with osteoporosis than in age- and sex-matched normal subjects at all three scanning sites, although spinal measurements discriminated best; however, there was considerable overlap. By age 65 yr, half of the normal women (and by age 85 yr, virtually all of them) had vertebral bone mineral density values below the 90th percentile of women with vertebral fractures and, thus, might be considered to have asymptomatic osteoporosis. For men, the degree of overlap was less. The data suggest that disproportionate loss of trabecular bone from the axial skeleton is a distinguishing characteristic of spinal osteoporosis.

1,167 citations


Journal ArticleDOI
TL;DR: The motion needed to perform essential daily activities is obtainable with a successful total elbow arthroplasty and may be used for the determination of disability impairment, to determine the optimum position for elbow splinting or arthrodesis, and to assist in the design of elbow prostheses.
Abstract: We studied thirty-three normal patients, eighteen women and fifteen men, for normal motion and the amount of elbow motion required for fifteen activities of daily living. The amounts of elbow flexion and forearm rotation (pronation and supination) were measured simultaneously by means of an electrogoniometer. Activities of dressing and hygiene require elbow positioning from about 140 degrees of flexion needed to reach the occiput to 15 degrees of flexion required to tie a shoe. Most of these activities are performed with the forearm in zero to 50 degrees of supination. Other activities of daily living (such as eating, using a telephone, or opening a door) are accomplished with arcs of motion of varying magnitudes. Most of the activities of daily living that were studied in this project can be accomplished with 100 degrees of elbow flexion (from 30 to 130 degrees) and 100 degrees of forearm rotation (50 degrees of pronation and 50 degrees of supination). Clinical Relevance: These data, not previously recorded, may be used to provide an objective basis for the determination of disability impairment, to determine the optimum position for elbow splinting or arthrodesis, and to assist in the design of elbow prostheses. The motion needed to perform essential daily activities is obtainable with a successful total elbow arthroplasty.

1,164 citations


Journal ArticleDOI
15 Oct 1981-Cancer
TL;DR: One‐hundred‐ninety‐four eligible and evaluable patients with histologically confirmed locally unresectable adenocarcinoma of the pancreas were randomly assigned to therapy with high‐dose radiation therapy alone, to moderate‐dose (4000 rads) radiation + 5‐fluorouracil (5‐FU), and to high‐ dose radiation plus 5‐FU.
Abstract: One-hundred-ninety-four eligible and evaluable patients with histologically confirmed locally unresectable adenocarcinoma of the pancreas were randomly assigned to therapy with high-dose (6000 rads) radiation therapy alone, to moderate-dose (4000 rads) radiation + 5-fluorouracil (5-FU), and to high-dose radiation plus 5-FU. Median survival with radiation alone was only 51/2 months from date of diagnosis. Both 5-FU-containing treatment regimens produced a highly significant survival improvement when compared with radiation alone. Forty percent of patients treated with the combined regimens were still living at one year compared with 10% of patients treated with radiation only. Survival differences between 4000 rads plus 5-FU and 6000 rads plus 5-FU were not significant with an overall median survival of ten months. Significant prognostic variables, in addition to treatment, were pretreatment performance status and pretreatment CEA level.

999 citations


Journal ArticleDOI
TL;DR: Between 1960 and 1973, a total of 104 patients at the Mayo Clinic had a diagnosis of idiopathic dilated cardiomyopathy on the basis of clinical and angiographic criteria; these patients were followed up for 6 to 20 years.
Abstract: Between 1960 and 1973, a total of 104 patients at the Mayo Clinic had a diagnosis of idiopathic dilated cardiomyopathy on the basis of clinical and angiographic criteria; these patients were followed up for 6 to 20 years. Twenty-one percent of the patients had a history of excessive consumption of alcohol, 20 percent had had a severe influenza-like syndrome within 60 days before the appearance of cardiac manifestations and 8 percent had had rheumatic fever without involvement of cardiac valves several years before; thus, possible etiologic risk factors of infectious-immunologic type may be important. Eighty patients (77 percent) had an accelerated course to death, with two thirds of the deaths occurring within the first 2 years. Twenty-four patients (23 percent) survived, and 18 of them had clinical improvement and a normal or reduced heart size. Univariate analysis at the time of diagnosis revealed three factors that were highly predictive (p less than 0.01) of the clinical course: age, cardiothoracic ratio on chest roentgenography and cardiac index. Systemic emboli occurred in 18 percent of the patients who did not receive anticoagulant therapy and in none of those who did; thus, anticoagulant agents should probably be prescribed unless their use is contraindicated.

899 citations


Journal ArticleDOI
TL;DR: The clinical and histological appearance of type II collagen arthritis in the mouse indicates that it may be a good animal model for the investigation of various immunogenetic traits in rheumatoid arthritis.
Abstract: A model of arthritis was established by the injection of type II collagen into mice. Only mice bearing the H-2q haplotype were susceptible to the disease. Susceptibility was further mapped by the use of recombinant strains on the Iq locus. Type II collagen arthritis was observed in the (resistant X susceptible) F1 cross. Mice strains were designated high, intermediate, or low responders with respect to the anti-type II antibody levels measured by radioimmunoassay. Arthritis-susceptible strains were all classified as high antibody responders. The clinical and histological appearance of type II collagen arthritis in the mouse indicates that it may be a good animal model for the investigation of various immunogenetic traits in rheumatoid arthritis.

702 citations


Journal ArticleDOI
Kai Nan An1, F.C. Hui1, Bernard F. Morrey1, Ronald L. Linscheid1, Edmund Y. S. Chao1 
TL;DR: Serial cross-sectional anatomy analysis was used to obtain the centroid and thus the moment arms of each of the muscles along the upper arm and at the elbow joint, and physiological cross-sections were calculated.

588 citations


Journal ArticleDOI
TL;DR: TMA-DPH, a cationic analogue of diphenylhexatriene (DPH), has photophysical properties that are generally similar to those of DPH, and should prove useful in the study of the dynamics of phospholipid monolayers, e.g., in native or reconstituted lipoproteins.
Abstract: 1-[4-(Trimethylamino)phenyl]-6-phenylhexa-1,3,5-triene (TMA-DPH), a cationic analogue of diphenylhexatriene (DPH), has photophysical properties that are generally similar to those of DPH. In solution the fluorescence lifetime (tau) of TMA-DPH is short (less than 1.5 ns), but tau increases to approximately 7 ns when the probe is embedded in lipid bilayers at temperatures less than the thermal transition temperature (Tc) of the lipid. The cationic charge ensures that the probe is anchored at the lipid-water interface, most likely with the DPH moiety intercalated between the upper portions of the fatty acyl chains. The profiles of changes in steady-state anisotropies (rss) and limiting hindered anisotropies (r infinity) are similar for both TMA-DPH and DPH embedded in lipid bilayers, but r infinity values for TMA-DPH even at T much greater than Tc are generally greater than 0.14, e.g., at 35 degrees C in 1,2-dimyristoylglycero-3-phosphocholine (DMPC) (cf. 0.03 for DPH in DMPC at 35 degrees C). Electrostatic interactions of the cationic probe with head groups of phospholipids do not appear to significantly influence the apparent dynamics of the probe. TMA-DPH should prove useful in the study of the dynamics of phospholipid monolayers, e.g., in native or reconstituted lipoproteins.

497 citations


Journal ArticleDOI
TL;DR: In a series of 506 patients with renal cell carcinoma survival was analyzed in terms of pathologic stage, histologic grade, and a combination of stage and grade, data reveal that stage, grade and the combination are important prognostic indicators.

470 citations


Journal ArticleDOI
TL;DR: In the patient with intussusception of the small intestine, an associated primary malignancy is uncommon and initial reduction, followed by limited surgical resection, is the preferred treatment.
Abstract: Controversy concerning the appropriate surgical management of intussusception in the adult prompted review of the Mayo Clinic's experience with this uncommon entity. During the last 23 years, 48 patients had documented intussusception: 24 instances of intussusception originating in the small intestine and 24 instances of intussusception originating in the colon. Two-thirds of the colonic intussusceptions were associated with primary carcinoma of the colon. Only one-third of the intussusceptions of the small intestine were harbingers of malignancy, and 70% of these lesions were metastatic. Because of these findings, we advocate resection of intussusceptions of the colon without initial surgical reduction, in order to minimize the operative manipulation of a potential malignancy. In the patient with intussusception of the small intestine, an associated primary malignancy is uncommon. Initial reduction, followed by limited surgical resection, is the preferred treatment. Surgical resection without reduction is favored only when an underlying primary malignancy is clinically suspected.

372 citations


01 Jun 1981
TL;DR: It is found that eosinophil granule constituents are released into the bronchi in asthma and that measurement of sputum MBP may be useful in identifying asthma.
Abstract: The eosinophil granule major basic protein (MBP) is toxic to parasites and mammalian cells. Because eosinophilia is characteristic of asthma, we tested the effect of MBP on bronchi and assayed sputa for this protein. We found that MBP damaged bronchial epithelium in vitro and produced changes that mimicked those in asthma. Radioimmunoassay of sputa from 100 consecutive patients with respiratory diseases revealed MBP levels above 0.1 mug/ml in 13 patients, and 11 of these had asthma. In 15 patient hospitalized for asthma, MBP levels of sputum were markedly elevated. Treatment with bronchodilators and glucocorticoids caused an increase peak expiratory flow rate, a reduction in blood eosinophils, and a decrease in the serum and sputum levels of MBP. The results indicate that eosinophil granule constituents are released into the bronchi in asthma and that measurement of sputum MBP may be useful in identifying asthma. The possibility that the eosinophil damages bronchial epithelium in asthma is discussed.

358 citations


01 Jul 1981
TL;DR: It is of particular interest to note that of the six benign cases resulting from thrombosis of the superior vena cava, three were due to the use of central venous catheters, and Physicians should be aware of this association.
Abstract: The Mayo Clinic experience with superior vena cava obstruction during the last 20 years was reviewed. The diagnosis of superior vena cava obstruction is often made at the bedside. Typical symptoms include suffusion, dyspnea, cough, and, less commonly, pain, syncope, dysphagia, and hemoptysis. The most important physical findings are the increased collateral veins covering the anterior chest wall and the dilated neck veins with edema of the face, arms, and chest. The chest x-ray film usually shows widening of the superior mediastinum. Of our 86 cases of superior vena cava obstruction, 67 (78%) were due to malignancy and 19 (22%) to benign causes. The cause of obstruction is usually established by bronchoscopy, open lung biopsy, or biopsy of the superficial lymph node. Radiotherapy remains the standard approach for the treatment of superior vena cava obstruction due to malignant disease. It is of particular interest to note that of the six benign cases resulting from thrombosis of the superior vena cava, three were due to the use of central venous catheters. Physicians should be aware of this association.

Journal ArticleDOI
TL;DR: Since there was no statistically significant difference in efficacy and since tamoxifen was less toxic, tamoxIFen appears to be the preferred agent.
Abstract: Before the introduction of tamoxifen, diethylstilbestrol (DES) was widely considered to be the hormonal treatment of choice in postmenopausal women with advanced breast cancer. We performed a randomized clinical trial of these two agents to determine their relative efficacy and toxicity. The trial involved 143 evaluable patients, of whom 99 had received no prior systemic therapy and 44 had received previous chemotherapy. The regression rates (complete plus partial) were higher in patients receiving DES (41 per cent) than in those receiving tamoxifen (33 per cent), but not significantly so (P = 0.37). In patients who had had no prior systemic therapy, the rates were 44 per cent and 38 per cent, respectively (P = 0.55), and in those who had had previous chemotherapy, 32 per cent vs. 23 per cent (P = 0.50). Analysis of the time until treatment failure for the two treatment groups showed no significant difference (medians: DES, 142 days; tamoxifen, 171 days). Toxicity was greater in patients receiving DES; nine of 74 patients (12 per cent) discontinued therapy solely because of adverse reactions. Since there was no statistically significant difference in efficacy and since tamoxifen was less toxic, tamoxifen appears to be the preferred agent.

Journal ArticleDOI
TL;DR: The survival of patients classified T1 N0 M0 (91% alive at 2 years and 80% at 5 years) is so good that it seems unlikely that adjuvant therapy in this group could demonstrate improved survival, and age at operation, sex, and extent of operation were important determinants of survival.

Journal ArticleDOI
TL;DR: The recognition of strikingly similar morphologic features in many liver specimens from patients with either PSC or CUC or both suggests that the causes of these conditions are closely related.

Journal ArticleDOI
TL;DR: Analysis of the frequency and type of various sensory symptoms was helpful in distinguishing between acquired and inherited neuropathies.
Abstract: Intensive evaluation of 205 cases of undiagnosed neuropathy in a center with special approaches and facilities permitted classification of 76% of the patients. Inherited disorders accounted for 42% of the series, 21% of the patients were shown to have inflammatory-demyelinating polyradiculoneuropathy, and 13% had neuropathies associated with other disorders. A considerable improvement in diagnosis was possible from evaluation of the kin of the patients with undiagnosed neuropathy. Analysis of the frequency and type of various sensory symptoms also was helpful in distinguishing between acquired and inherited neuropathies.

Journal ArticleDOI
TL;DR: During the five years from 1973 through 1977, eighty Mayo and Coonrad total elbow arthroplasties were performed in seventy-two patients at the Mayo Clinic, and the range of motion was superior to that provided by any other procedure currently available.
Abstract: During the five years from 1973 through 1977, eighty Mayo and Coonrad total elbow arthroplasties were performed in seventy-two patients at the Mayo Clinic. Follow-up after at least two years (average, four years) revealed that the results were good in 60 per cent, fair in 16 per cent, and poor in 24 per cent. Pain was a major symptom in 80 per cent of the elbows preoperatively but in only 3 per cent postoperatively. At follow-up, motion had increased: extension-flexion by 10 degrees (average range, 29 to 131 degrees of flexion) and forearm rotation by 26 degrees (average range, 61 degrees of pronation to 59 degrees of supination). Excluding eleven prostheses with loosening for which revision was necessary, there were forty-four complications (55 per cent) after eighty procedures. Of these forty-four complications, eleven were ulnar neuropathies (two permanent and nine transient); four were wound-healing problems; ten, significant triceps weakness; eleven, intraoperative fractures of the medial or lateral supracondylar bone column; seven, deep infections; and one was an ulnar fracture. Although the complication rate was very high, most of the complications occurred during the early years of the study. Follow-up revealed twenty-nine elbows with radiolucency around the components: in twenty-five about the humeral and in four about the ulnar component. Revisions were performed in nineteen (24 per cent) of the eighty elbows: in eleven because of loosening, in seven because of deep infection, and in one because of ankylosis. Intraoperative supracondylar fracture and defective cementing of the prosthesis were important factors contributing to prosthetic loosening. When the arthroplasty was successful, the relief of pain was dramatic, stability was excellent, and the range of motion was superior to that provided by any other procedure currently available.

Journal ArticleDOI
TL;DR: All patients with peripheral neuropathy of unknown cause presenting at the authors' institution within 1 year to determine the prevalence of monoclonal serum proteins in this group were surveyed, and 80% of these patients were evaluated, and 10% had a monocolonal serum protein.
Abstract: We attempted to survey with serum protein electrophoresis all patients with peripheral neuropathy of unknown cause presenting at our institution within 1 year to determine the prevalence of monoclonal serum proteins in this group. Eighty-four percent of these patients were evaluated, and 10% of these had a monoclonal serum protein. This figure was statistically different from that obtained in two community studies in the literature. Because these patients often present difficult diagnostic problems, serum protein electrophoresis is necessary in the evaluation of cryptogenic neuropathies.

Journal ArticleDOI
TL;DR: Transmission ultrasound computer-assisted tomography has been developed for detection and diagnosis of cancer in the breast and estimates of sensitivity and specificity are approaching those of X-ray mammography techniques.
Abstract: Transmission ultrasound computer-assisted tomography has been developed for detection and diagnosis of cancer in the breast. Pulses of ultrasound (8 MHz ±3 MHz) are transmitted through the breast in a coronal plane from a plurality of directions. The received signal is processed for arrival time and for changes in amplitude. The measured values for arrival time and attenuation are used in a convolution-back projection reconstruction algorithm to obtain estimates of the two-dimensional distribution of acoustic speed and attenuation within the scanned planes of the breast. Over 1000 images in breasts of approximately 150 patients have been scanned of whom 30 had biopsy proven cancer. Some common characteristics of the reconstructed images which are associated with cancer are 1) increased speed relative to the embedding tissue associated with 2) decreased attenuation in central region of the lesion usually with 3) a ring of higher attenuation at the border of the lesion. Current estimates of sensitivity and specificity of this system for cancer are approaching those of X-ray mammography techniques.

Journal ArticleDOI
TL;DR: Three experiments were performed in which the distribution and rates of synthesis of amino sugar-containing macromolecules in normal and osteoarthritic cartilage from the human femoral head were assessed by biochemical analysis and studies of the incorporation of 3H-glucosamine and 35SO4.
Abstract: Since 1960, numerous studies have supported the thesis that the synthetic activity of articular chondrocytes is increased in osteoarthritis, but several recent reports have challenged this concept. To clarify this problem fully and also to define further the products of this increased synthesis, three experiments were performed in which the distribution and rates of synthesis of amino sugar-containing macromolecules in normal and osteoarthritic cartilage from the human femoral head were assessed by biochemical analysis and studies of the incorporation of 3H-glucosamine and 35SO4. The biochemical data obtained clearly demonstrated the previously noted significant decrease in hexosamine content in osteoarthritic tissue. This decrease was principally due to a diminution in glucosamine concentration and correlated inversely with the severity of the disease process (as measured by a previously described histological-histochemical grading system). Metabolic studies showed a marked increment in the rates of incorporation of 3H-glucosamine into both the glucosamine and the galactosamine fractions of the cartilage. The increased synthesis correlated directly in a non-linear fashion with the severity of the disease. The ratio of the rate of incorporation of 3H-glucosamine into the glucosamine fraction to the rate of its incorporation into the galactosamine fraction was the same in normal and osteoarthritic samples, suggesting that the decline in glucosamine concentration was not related to a qualitative alteration of synthetic activity.


Journal ArticleDOI
Thomas W Bunch1
TL;DR: Longer followup has shown that the group givenprednisone plus azathioprine has improved more with respect to functional disability; this group also requires less prednisone for disease control.
Abstract: Two groups of patients with polymyositis have been followed for approximately 3 years. One group was treated with prednisone alone and the other with prednisone plus azathioprine. Although the polymyositis of both groups has improved, no statistically significant difference was noted at the end of 3 months, as previously reported. Longer followup, however, has shown that the group given prednisone plus azathioprine has improved more with respect to functional disability; this group also requires less prednisone for disease control.

Journal ArticleDOI
TL;DR: No statistical relationship was found between either anatomic success or functional result and the presence of aphakia, demarcation lines, vitreous hemorrhage, detachments of the pars plana epithelium, or predetachment glaucoma being treated.

Journal ArticleDOI
TL;DR: The epidemiology of pelvic fractures was investigated in Rochester, Minnesota, residents during the decade 1968 to 1977, and moderate trauma was responsible for the increase in pelvic fracture incidence with age in the high-risk population of postmenopausal women.
Abstract: The epidemiology of pelvic fractures was investigated in Rochester, Minnesota, residents during the decade 1968 to 1977. The overall incidence was 37 per 100,000 person-years, substantially higher than previous population-based studies would indicate. The incidence increased markedly with age in both sexes, and was greater for women than men at all ages over 35, reaching a maximum incidence of 446.3 per 100,000 person-years in women 85 or older. Half of all pelvic fractures were attributed to moderate trauma, usually a fall from standing height, 95% of which were minor (Type I or II). Moderate trauma was responsible for the increase in pelvic fracture incidence with age in the high-risk population of postmenopausal women. A large proportion of both men and women with moderate trauma fractures had some evidence of preexisting osteoporosis.

Journal ArticleDOI
07 May 1981-Nature
TL;DR: It is reported that SRif-28 and SRIF-25 are more potent thanSRIF-14 in the inhibition of insulin release, but that SR IF-14 preferentially inhibits glucagon release, indicating that their differential release may be physiologically important.
Abstract: The widely occurring1–3 tetradecapeptide somatostatin (SRIF-14) has been variously implicated4–8 as a neurotransmitter, a neurohormone, a cybernin (local regulatory factor) and a hormone. In the first isolation of SRIF-14 from hypothalamic extracts9,10 and subsequent extracts of other tissues11–15, peptides of higher molecular weight but with similar activity have been noted. Recently two such peptides have been characterized as the 28-amino acid SRIF-28 (from porcine gastro-intestinal tract16 and porcine and ovine hypothalamus17,18) and the 25-amino acid SRIF-25 (from ovine hypothalamus17), each of which consists of an N–terminal extension of SRIF-14. We now report that SRIF-28 and SRIF-25 are more potent than SRIF-14 in the inhibition of insulin release, but that SRIF-14 preferentially inhibits glucagon release. This suggests that SRIF-28 and SRIF-25 are not mere biosynthetic precursors of SRIF-14 and that their differential release may be physiologically important.

Journal ArticleDOI
TL;DR: In histograms prepared from seven cases of amyotrophic lateral sclerosis (ALS), the Cl and Al peaks were decreased selectively and severely, providing evidence for alpha, but not gamma, motor neuron vulnerability.
Abstract: The diameter histograms of cell bodies (cytons) in motor neuron columns at the L5 segment of the spinal cord of adult man reproducibly yield three peaks of increasing height: small (Cs), intermediate (Ci), and large (Cl). Histograms of L5 myelinated axons obtained from the ventral root have two peaks of increasing height: intermediate (Ai) and large (Al). In histograms prepared from seven cases of amyotrophic lateral sclerosis (ALS), the Cl and Al peaks were decreased selectively and severely. This provides evidence for alpha, but not gamma, motor neuron vulnerability. The Cl peak of spinal ganglion neurons and the Al peak of dorsal roots were significantly reduced in number, without a concomitant increase in Ci, Cs, and Ai peaks. This, plus earlier reports of abnormal cutaneous sensation thresholds, abnormal rates of fiber degeneration in cutaneous nerves, and dorsal column demyelination, provides evidence that large afferent neurons are affected in ALS, but to a lesser degree than alpha motor neurons.

Journal ArticleDOI
TL;DR: The results indicate that eos inophil granule proteins circulate in blood covalently bound to serum proteins, and that elevated concentrations of serum MBP are present in some diseases associated with eosinophilia.
Abstract: A radioimmunoassay was established for the human eosinophil granule major basic protein (MBP). The mean level of MBP in sera from 105 normal control patients was 454 ng/ml, whereas in a sample of 188 patients with various forms of diseases, including the hypereosinophilic syndrome, levels as high as 14,000 ng/ml were measured. Serum levels of MBP did not correlate with eosinophil counts in normal subjects, but a positive correlation was seen in patients with eosinophilia; the patients with eosinophil counts greater than 350/mm3 generally showed increased levels of MBP. Many patients with skin disease and normal eosinophil counts had elevated levels of serum MBP. Monomer MBP has a molecular weight of 9,300, but in sera of patients with eosinophilia, the MBP activity was of high molecular weight, greater than 50,000. Analyses of serum by Sephadex G-200 and by electrofocusing suggest that MBP is not simply polymerized, but rather is bound to a larger carrier molecule. Monomeric MBP can be isolated from serum by reduction of serum with dithiothreitol, alkylation with iodoacetamide, and acidification to pH 2 followed by fractionation on Sephadex G-50 at pH 2. Under these conditions, up to 80% of the MBP emerges in monomeric form. The results indicate that eosinophil granule proteins circulate in blood covalently bound to serum proteins, and that elevated concentrations of serum MBP are present in some diseases associated with eosinophilia.

Journal ArticleDOI
TL;DR: The correlation of survival and ipsilateral tumor recurrence with the type of operation suggests that patients withgrade 2 tumors may benefit from total nephroureterectomy, and the radical procedure seems to be of no benefit to patients with grade 3 or 4 tumors.

Journal ArticleDOI
TL;DR: The clinical features of biclonal gammopathy and its response to therapy are similar to those of monoclonal Gammopathy, and this subject is of importance because of the lack of clinical data in the literature.

Journal ArticleDOI
TL;DR: It is indicated that physiological increments in plasma hGH cause both insulin-like and insulin-antagonistic effects in man and that these actions occur in hepatic as well as extrahepatic tissues.
Abstract: To determine whether increments in circulating GH concentrations within the physiological range would exert insulin-like as well as insulin-antagonistic actions in man and, if so, whether both actions would occur in hepatic and extrahepatic tissues, normal volunteers (n = 6) were infused with human GH (hGH; 100 ng/kg . min) for 6 h along with somatostatin (100 micrograms/h) to suppress insulin, glucagon, and hGH secretion and also with sufficient insulin (100 microU/kg . min) to maintain a constant plasma insulin level. During the final 2 h, glucose (2 mg/kg . min) was infused. In control studies, saline was infused instead of hGH. Infusion of hGH increased plasma hGH to 35 ng/ml. Plasma glucose decreased to 60 +/- 2 mg/dl compared to 67 +/- 1 mg/dl observed in control studies (P less than 0.05); this greater hypoglycemia was due to both greater suppression of hepatic glucose production (P less than 0.05) and greater augmentation of glucose clearance (P less than 0.05). These insulin-like effects of hGH were no longer evident after 2 h. Subsequently, when glucose was infused, plasma glucose increased to 133 +/- 4 mg/dl compared to the 104 +/- 6 mg/dl observed in control studies (P less than 0.01). This greater hyperglycemia was due to both impaired suppression of hepatic glucose production (P less than 0.001) and decreased glucose clearance (P less than 0.01). These results indicate that physiological increments in plasma hGH cause both insulin-like and insulin-antagonistic effects in man and that these actions occur in hepatic as well as extrahepatic tissues. The insulin-like actions of hGH are transient.

Journal ArticleDOI
01 Jun 1981-Diabetes
TL;DR: It is indicated that glucose clearance is not independent of changes in plasma glucose concentration and, thus, use of glucose clearance to evaluate glucose utilization at differing plasma glucose concentrations is not valid.
Abstract: Glucose clearance (glucose utilization divided by plasma glucose) is commonly used to assess glucose utilization under conditions in which plasma glucose concentrations vary. The validity of this practice requires that glucose clearance itself be independent of plasma glucose concentration. The present studies were, therefore, undertaken to determine the relationship between glucose clearance and plasma glucose concentration in man. Using the glucose clamp technique, rates of glucose utilization (measured isotopically with 3-3H-glucose) and glucose clearance were determined in 5 normal volunteers at steady-state plasma glucose concentrations of approximately 60, 95, 130, and 165 mg/dl, while plasma insulin concentrations were maintained constant (approximately 18 microU/ml) by infusion of insulin and somatostatin. Despite virtually identical 0.4 mg X kg-1 X min-1 increments in glucose utilization for each 35-mg/dl increment in plasma glucose, glucose clearance decreased as a function of plasma glucose concentration (r = -0.85, P less than 0.001). These results indicate that glucose clearance is not independent of changes in plasma glucose concentration and, thus, use of glucose clearance to evaluate glucose utilization of differing plasma glucose concentration is not valid. Whether this conclusion also applies to similar use of clearance for other substrates remains to be determined.