Showing papers by "Mayo Clinic published in 1994"
TL;DR: Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot.
Abstract: Four rating systems were developed by the American Orthopaedic Foot and Ankle Society to provide a standard method of reporting clinical status of the ankle and foot. The systems incorporate both subjective and objective factors into numerical scales to describe function, alignment, and pain.
4,130 citations
TL;DR: The adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization was assessed, the factors that influenced whether analgesia was adequate were studied, and the effects of inadequate analgesia on the patients' perception of pain relief and functional status were determined.
Abstract: Background and Methods Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status. Results Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percen...
2,002 citations
TL;DR: A protracted infusion of fluorouracil during pelvic irradiation improved the effect of combined-treatment postoperative adjuvant therapy in patients with high-risk rectal cancer.
Abstract: Background The combination of radiation therapy and chemotherapy with fluorouracil plus semustine after surgery has been established as an effective approach to decreasing the risk of tumor relapse and improving survival in patients with rectal cancer who are at high risk for relapse or death. We sought to determine whether the efficacy of chemotherapy could be improved by administering fluorouracil by protracted infusion throughout the duration of radiation therapy and whether the omission of semustine would reduce the toxicity and delayed complications of chemotherapy without decreasing its antitumor efficacy. Methods Six hundred sixty patients with TNM stage II or III rectal cancer received intermittent bolus injections or protracted venous infusions of fluorouracil during postoperative radiation to the pelvis. They also received systemic chemotherapy with semustine plus fluorouracil or with fluorouracil alone in a higher dose, both before and after the pelvic irradiation. Results With a median follow-...
1,091 citations
TL;DR: At last follow-up 90% of population-based patients were asymptomatic or only midly incapacitated due to cervical radiculopathy, and a combination of radicular pain and sensory deficit, and objective muscle weakness were predictors of a decision to operate.
Abstract: An epidemiological survey of cervical radiculopathy in Rochester, Minnesota, 1976-90, through the records-linkage system of the Mayo Clinic ascertained 561 patients (332 males and 229 females). Ages ranged from 13 to 91 years; the mean age +/- SD was 47.6 +/- 13.1 years for males and 48.2 +/- 13.8 years for females. A history of physical exertion or trauma preceding the onset of symptoms occurred in only 14.8% of cases. A past history of lumbar radiculopathy was present in 41%. The median duration of symptoms prior to diagnosis was 15 days. A monoradiculopathy involving C7 nerve root was the most frequent, followed by C6. A confirmed disc protrusion was responsible for cervical radiculopathy in 21.9% of patients; 68.4% were related to spondylosis, disc or both. During the median duration of follow-up of 4.9 years, recurrence of the condition occurred in 31.7%, and 26% underwent surgery for cervical radiculopathy. A combination of radicular pain and sensory deficit, and objective muscle weakness were predictors of a decision to operate. At last follow-up 90% of our population-based patients were asymptomatic or only midly incapacitated due to cervical radiculopathy. The average annual age-adjusted incidence rates per 100,000 population for cervical radiculopathy in Rochester were 83.2 for the total, 107.3 for males and 63.5 for females. The age-specific annual incidence rate per 100,000 population reached a peak of 202.9 for the age group 50-54 years.
814 citations
TL;DR: The PDAI provides simple, objective, and quantitative criteria for pouch inflammation after IPAA and is more sensitive than prior scoring systems.
674 citations
TL;DR: Radiosurgery is effective in controlling solitary brain metastases with low morbidity and further study is needed to better define optimum treatment parameters for radiosurgery.
Abstract: Purpose : A multi-institutional experience in radiosurgery for solitary brain metastases was combined to identify factors associated with safety, efficacy, tumor control, and survival. Materials and Methods : A review of 116 patients with solitary brain metastases who underwent gamma knife stereotactic radiosurgery at five institutions was performed. The median follow-up was 7 months following radiosurgery and 12 months following diagnosis. Minimum tumor doses varied from 8–30 Gy (mean, 17.5 Gy). Forty-five patients failed prior radiotherapy and 71 had no prior brain irradiation. Fifty-one patients had radiosurgery alone and 65 underwent combined radiosurgery with fractionated large-field radiotherapy (mean dose, 33.8 Gy). Results : Median survival was 11 months after radiosurgery and 20 months after diagnosis. Follow-up documented local tumor control in 99 patients (85%), tumor recurrence in 17 (15%), and documented radiation necrosis in one (1%). The 2-year actuarial tumor control rate was 67 ± 8%. Tumor histology affected survival (better for breast cancer, p = .004) and local control (better for melanoma and renal cell, p = .0003) in multivariate analyses. Combined fractionated radiotherapy and radiosurgery improved local control (p = .0111), but not survival in multivariate testing. Conclusion : Radiosurgery is effective in controlling solitary brain metastases with low morbidity. Further study is needed to better define optimum treatment parameters for radiosurgery.
663 citations
TL;DR: There are two distinct forms of idiopathic chronic pancreatitis, both of which have initially and thereafter a long course of severe pain but slowly develop morphological and functional pancreatic damage, whereas patients with late-onset pancreatitis have a mild and often a painless course.
645 citations
TL;DR: Patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity and survival rates at 10 and 15 years compare favorably with those of an age-matched control group.
644 citations
TL;DR: The data show a strong correlation between disease phenotype and the nature and position of theRET mutation, suggesting that a simple, constitutive activation of the RET tyrosine kinase is unlikely to explain the events leading to MEN 2A and FMTC.
Abstract: We have analysed 118 families with inherited medullary thyroid carcinoma (MTC) for mutations of the RET proto-oncogene. These included cases of multiple endocrine neoplasia types 2A (MEN 2A) and 2B (MEN 2B) and familial MTC (FMTC). Mutations at one of 5 cysteines in the extracellular domain were found in 97% of patients with MEN 2A and 86% with FMTC but not in MEN 2B patients or normal controls. 84% of the MEN2A mutations affected codon 634. MEN 2A patients with a Cys634 to Arg substitution had a greater risk of developing parathyroid disease than those with other codon 634 mutations. Our data show a strong correlation between disease phenotype and the nature and position of the RET mutation, suggesting that a simple, constitutive activation of the RET tyrosine kinase is unlikely to explain the events leading to MEN 2A and FMTC.
614 citations
TL;DR: The present study establishes for the first time that the elevation of plasma ET in severe human CHF represents principally elevation of big-ET, characteristic of severe CHF and not asymptomatic or mild CHF.
Abstract: BACKGROUNDAlthough recent investigations report the elevation of plasma endothelin (ET) in congestive heart failure (CHF), it remains unclear if this elevation is that of the biologically active peptide ET-1 or of its precursor big-ET. Furthermore, it is unclear if such elevation is associated with increased myocardial ET and if the molecular form from cardiac tissue is altered ET. Last, it remains to be established whether circulating ET is increased at the earliest stage of CHF in patients with asymptomatic left ventricular dysfunction and correlates with the magnitude of ventricular dysfunction.METHODS AND RESULTSThe present study was designed to investigate concentrations and molecular forms of ET in plasma and cardiac tissue in healthy subjects and CHF patients with New York Heart Association (NYHA) class I through IV using cardiac radionuclide angiogram, cardiac myocardial biopsy, radioimmunoassay, gel permeation chromatography (GPC), and immunohistochemical staining (IHCS). Plasma ET was increased ...
602 citations
TL;DR: The results suggest that surgical treatment should be considered early, even in the absence of severe symptoms, in patients with severe mitral regurgitation, before left ventricular dysfunction occurs, and echocardiographic EF remained the best predictor of late survival, even when combined withleft ventricular angiographic variables.
Abstract: BACKGROUNDLeft ventricular dysfunction is a frequent cause of death after successful surgical repair of mitral regurgitation. The role of preoperative echocardiographic left ventricular variables in the prediction of postoperative survival and thus their clinical implications remain uncertain.METHODS AND RESULTSThe survival of 409 patients operated on between 1980 and 1989 for pure, isolated, organic mitral regurgitation and with a preoperative echocardiogram (within 6 months of operation) was analyzed. The overall survival was 75% at 5 years (90% of expected), 58% at 10 years (88% of expected), and 44% at 12 years (73% of expected). Operative mortality was 6.6% and markedly improved from 1980 to 1984 (10.7%) to 1985 to 1989 (3.7%). Multivariate analysis showed that age (P = .0003), date of operation (P = .003), and functional class (P = .016) but not left ventricular function were predictors of operative mortality. In the most recent period (1985 to 1989), operative mortality was 12.3% in patients age 75...
01 Jan 1994
TL;DR: FNA biopsy is a safe, simple, reliable, and cost-effective means of detecting benign nodules and the role of levothyroxine therapy remains uncertain and is not recommended until compelling data are available.
Abstract: Background The efficacy of fine-needle aspiration (FNA) biopsy and its role in the management of a nodular goiter are clearly established The accuracy of cytologic diagnosis approaches 95% Findings FNA biopsy is a reasonable approach to thyroid nodules; it has decreased costs substantially because it facilitates selection of patients who need to undergo surgical excision Selecting patients for operation on the basis of results of FNA biopsy has more than doubled the yield of carcinoma The limitations of cytologic examination, nondiagnostic results, and cellular follicular neoplasms should be remembered but need not negate continued use of FNA biopsy Negative (benign) and positive (malignant) cytologic results are conclusive; careful clinical follow-up of benign nodules and surgical excision of malignant nodules are recommended Nondiagnostic results are inconclusive; further evaluation by repeated FNA biopsy, ultrasound-guided biopsy, or radionuclide scanning is necessary Suspicious cytologic results are also inconclusive and are associated with a 20% chance of malignant involvement; surgical treatment is necessary for clarification The role of levothyroxine therapy remains uncertain and is not recommended until compelling data are available Conclusion FNA biopsy is a safe, simple, reliable, and cost-effective means of detecting benign nodules FNA biopsy, not thyroid scanning or ultrasonography, is the preferred initial diagnostic test in all patients with thyroid nodules
Pennsylvania State University1, Australian National University2, University of Leeds3, University of California, Davis4, Children's National Medical Center5, Uniformed Services University of the Health Sciences6, Wake Forest University7, Drexel University8, University of Massachusetts Medical School9, Mayo Clinic10
TL;DR: The malignant hyperthermia clinical grading scale is recommended for use as an aid to the objective definition of this disease and may improve malignanthyperthermia research by allowing comparisons among well-defined groups of patients.
Abstract: Background:The diagnosis of an acute malignant hyperthermia reaction by clinical criteria can be difficult because of the nonspecific nature and variable incidence of many of the clinical signs and laboratory findings. Development of a standardized means for estimating the qualitative likelihood of
TL;DR: Analysis of 84 human X chromosomes for the presence of interrupting AGG trinucleotides within the CGG repeat tract of the FMR1 gene revealed that most alleles possess two interspersed AGGs and that the longest tract of uninterrupted CGG repeats is usually found at the 3′ end.
Abstract: Analysis of 84 human X chromosomes for the presence of interrupting AGG trinucleotides within the CGG repeat tract of the FMR1 gene revealed that most alleles possess two interspersed AGGs and that the longest tract of uninterrupted CGG repeats is usually found at the 3' end. Variation in the length of the repeat appears polar. Alleles containing between 34 and 55 repeats, with documented unstable transmissions, were shown to have lost one or both AGG interruptions. These comparisons define an instability threshold of 34-38 uninterrupted CGG repeats. Analysis of premutation alleles in Fragile X syndrome carriers reveals that 70% of these alleles contain a single AGG interruption. These data suggest that the loss of an AGG is an important mutational event in the generation of unstable alleles predisposed to the Fragile X syndrome.
TL;DR: It is evident that the LLSF approach uses the relevance information effectively within human decisions of categorization and retrieval, and achieves a semantic mapping of free texts to their representations in an indexing language.
Abstract: A unified model for text categorization and text retrieval is introduced. We use a training set of manually categorized documents to learn word-category associations, and use these associations to predict the categories of arbitrary documents. Similarly, we use a training set of queries and their related documents to obtain empirical associations between query words and indexing terms of documents, and use these associations to predict the related documents of arbitrary queries. A Linear Least Squares Fit (LLSF) technique is employed to estimate the likelihood of these associations. Document collections from the MEDLINE database and Mayo patient records are used for studies on the effectiveness of our approach, and on how much the effectiveness depends on the choices of training data, indexing language, word-weighting scheme, and morphological canonicalization. Alternative methods are also tested on these data collections for comparison. It is evident that the LLSF approach uses the relevance information effectively within human decisions of categorization and retrieval, and achieves a semantic mapping of free texts to their representations in an indexing language. Such a semantic mapping lead to a significant improvement in categorization and retrieval, compared to alternative approaches.
TL;DR: UDCA was extraordinarily safe and well tolerated, and its use was associated with delayed progression of the disease as defined in this study, however, the lack of effects on symptoms, histology, and the need for liver transplantation or survival indicate that further evaluation is necessary.
TL;DR: Although dissections in multiple cervical vessels are common at presentation, after the first month the risk of recurrent dissection is only about 1 percent per year.
Abstract: Background Spontaneous dissection of the internal carotid and vertebral arteries is increasingly recognized as a cause of ischemic stroke in young people. An underlying arteriopathy is often suspected in the pathogenesis of such dissection, but the frequency of recurrent dissection is unknown. Methods We describe the long-term follow-up of 200 consecutive patients (104 women and 96 men) with spontaneous cervical-artery dissections evaluated at the Mayo Clinic between 1970 and 1990. All diagnoses were confirmed by angiography. Results The mean age of the patients was 44.9 years (range, 16 to 76). Internal carotid arteries were affected in 150 patients, vertebral arteries in 37, and both in 13. Multivessel dissections were present in 28 percent of the patients. The mean follow-up was 7.4 years. Recurrent dissection occurred only in arteries not previously involved by dissection. A recurrent arterial dissection developed in 16 patients (8 percent) -- within a month after the initial dissection in 4 patients ...
01 Aug 1994
TL;DR: The simplicity of the model, the high recall-precision rates, and the efficient computation together make ExpNet preferable as a practical solution for real-world applications.
Abstract: Expert Network (ExpNet) is our new approach to automatic categorization and retrieval of natural language texts. We use a training set of texts with expert-assigned categories to construct a network which approximately reflects the conditional probabilities of categories given a text. The input nodes of the network are words in the training texts, the nodes on the intermediate level are the training texts, and the output nodes are categories. The links between nodes are computed based on statistics of the word distribution and the category distribution over the training set. ExpNet is used for relevance ranking of candidate categories of an arbitrary text in the case of text categorization, and for relevance ranking of documents via categories in the case of text retrieval. We have evaluated ExpNet in categorization and retrieval on a document collection of the MEDLINE database, and observed a performance in recall and precision comparable to the Linear Least Squares Fit (LLSF) mapping method, and significantly better than other methods tested. Computationally, ExpNet has an O(N 1og N) time complexity which is much more efficient than the cubic complexity of the LLSF method. The simplicity of the model, the high recall-precision rates, and the efficient computation together make ExpNet preferable as a practical solution for real-world applications.
TL;DR: In patients with the clinical diagnosis of dilated cardiomyopathy, markers of diastolic dysfunction correlated strongly with congestive symptoms, whereas variables of systolic function were the strongest predictors of survival.
Abstract: BACKGROUNDDilated cardiomyopathy is an important cause of morbidity and mortality among patients with congestive heart failure. Hemodynamic and prognostic characterization are critical in guiding selection of medical and surgical therapies.METHODS AND RESULTSA cohort of 102 patients with the clinical diagnosis of dilated cardiomyopathy who underwent echocardiographic examination between 1986 and 1990 was identified and followed up through July 1, 1991. Patients with moderate or severe symptoms had lower indices of systolic function and greater left atrial and right ventricular dilation. Mitral inflow Doppler signals were characterized by a restrictive left ventricular filling pattern. In multivariate logistic regression analysis, deceleration time, ejection fraction, and peak E velocity were independently associated with symptom status. Over a mean follow-up of 36 months, 35 patients died. Kaplan-Meier estimated survival at 1, 2, and 4 years was 84%, 73%, and 61%, respectively, and was significantly poore...
TL;DR: This data indicates that megestrol acetate can ameliorate hot flashes in women with a history of breast cancer and in men who have undergone androgen-deprivation therapy for prostate cancer, who have experienced bothersome hot flashes.
Abstract: Background Vasomotor hot flashes are a common symptom in women during menopause and in men who have undergone androgen-deprivation therapy for prostate cancer. Although treatment with estrogens in women and androgens in men can attenuate these symptoms, these hormones may be contraindicated in women with breast cancer and in men with prostate cancer. Pilot trials have suggested that the progestational agent megestrol acetate can ameliorate hot flashes in both groups of patients. Methods The patients included 97 women with a history of breast cancer and 66 men with prostate cancer who had undergone androgen-deprivation therapy. All patients had experienced bothersome hot flashes (median number per day at base line, 6.1 for the women and 8.4 for the men). After a one-week pretreatment observation period, the patients received megestrol acetate (20 mg twice daily) for four weeks, followed by placebo for four weeks, or vice versa in a double-blind manner as determined by pretreatment randomization. The patien...
TL;DR: It is concluded that Gβγ is a primary regulator of IK.ACh activity and plays a major role in this pathway through muscarinic receptor binding and activation of pertussis-toxin-sensitive G proteins.
Abstract: Acetylcholine activates inwardly rectifying potassium channels (IK.ACh) in the heart through muscarinic receptor binding and activation of pertussis-toxin-sensitive G proteins. Experiments showing that only the beta gamma-subunit (G beta gamma) activates IK.ACh (ref. 4) were challenged by reports that only the activated alpha-subunit (G alpha) was effective. Here we examine IK.ACh regulation using purified brain and recombinant G-protein subunits. Six recombinant G beta gamma-subunits activated IK.ACh with apparent half-maximal activation concentrations of 3-30 nM. Activation of IK.ACh by recombinant G alpha-GTP gamma S was observed, but this was probably due to release of GTP gamma S from the protein. Importantly, IK.ACh activity elicited by GTP gamma S was inhibited by purified brain and recombinant G alpha-GDP, suggesting that native G beta gamma plays a major role in this pathway. We conclude that G beta gamma is a primary regulator of IK.ACh activity.
01 Jun 1994
TL;DR: The initial results suggest that this questionnaire is valid and should be applicable in population-based studies to assess gastroesophageal reflux disease.
Abstract: for outpatients, 0.70 [interquartile range, 0.59 to 0.81]; median Œ for population sample, 0.70 [interquartile range, 0.60 to 0.81]) and validity (median Œ, 0.62 [interquartile range, 0.49 to 0.74]) were acceptable. • Conclusion: Our initial results suggest that this questionnaire is valid and should be applicable in population-based studies to assess gastroesophageal reflux disease. (Mayo Clin Proc 1994; 69:539-547)
TL;DR: Considerable additional research is needed in order to fully understand both normal lipolytic regulation and the abnormalities of lipolysis which accompany pathological conditions.
TL;DR: Both treatments are efficacious in ameliorating neurological deficit in chronic inflammatory demyelinating polyradiculoneuropathy and the frequency and dosage needed to maintain good function could be titrated by assessing the neurological disability score and the summated muscle action potentials at 6‐week intervals.
Abstract: Chronic inflammatory demyelinating polyradiculoneuropathy is a paralytic syndrome, causing considerable disability and even death. In controlled clinical trials, plasma exchange prevented or ameliorated neurological deficits, but the efficacy of immune globulin infusion remains unproved. Also unknown is whether immune globulin infusion is as effective, or more effective, than plasma exchange and what dosages and frequencies are best. In this observer-blinded study, using some objective end points not subject to bias (e.g., summated compound muscle action potential), 20 patients with progressive or static polyneuropathy were randomly assigned to receive either of the two treatments for 6 weeks, followed by a washout period, and then were assigned to receive the other treatment. Plasma exchange (twice a week for 3 weeks then once a week for 3 weeks) and immune globulin infusion (0.4 gm/kg once a week for 3 weeks, then 0.2 gm/kg once a week for the next 3 weeks) were used. End points assessed before and after treatment schedules were neurological disability score; muscle weakness of the neurological disability score; summated compound muscle action potentials of ulnar, median, and peroneal nerves; summated sensory nerve action potentials of ulnar and sural nerves; and vibratory detection threshold of the great toe using CASE IV. Observers were masked as to treatment used. Of 20 patients, 13 received both treatments whereas 4 did not worsen sufficiently to receive the second treatment--1 patient left the study during and 2 after the first treatment to receive unscheduled treatment elsewhere.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: The role of radiation therapy in the occurrence of sarcom in fibrous dysplasia is still controversial and the need for further research into this topic is still unclear.
Abstract: collected in the literature. Most of the descriptions of sarcomas in fibrous dysplasia that are in the literature are single case reports or reports of a few case^.^-'^ The largest series, which includes 15 cases, is that from Memorial Sloan-Kettering Cancer Center, New York.2,20 In 1988, Yabut and coworkers' reported a new case and found 83 cases in a careful review of the literature. The most common of the malignancies was osteosarcoma, followed by fibrosarcoma and chondrosarcoma. The possibility of sarcomatous change in fibrous dysplasia without prior irradiation seems well established, as verified by several reports of documented case~.~~~~'' The role of radiation therapy in the occurrence of sarcoma in fibrous dysplasia is still c~ntroversial.'~~~~' In Huvos' series," only 1 of 15 patients with sarcomas in fibrous dysplasia had received radiation therapy. In the review of the literature by Yabut and coworker^,^ 23 patients had received radiation therapy, 46 had not had prior irradiation, and 14 did not have information available. The purpose of the current study was to review and report our experience with malignancies in fibrous dysplasia. Materials and Methods
TL;DR: PSA, when combined with other variables such as Gleason score and clinical stage, improves the prediction of pathological stage for prostate cancer and should be used to aid in early diagnosis and treatment planning for men with prostate cancer.
TL;DR: Primary progressive MS may differ from relapsing‐remitting MS in MRI lesion frequency, immunogenetic profile, responsiveness to immunosuppressive treatment, and histology.
Abstract: Multiple sclerosis (MS) is the most common idiopathic inflammatory disease of the central nervous system. The distinction between MS and other benign or fulminant inflammatory demyelinating disorders is based on quantitative, rather than qualitative, differences in chronicity and severity. Primary progressive MS may differ from relapsing-remitting MS in MRI lesion frequency, immunogenetic profile, responsiveness to immunosuppressive treatment, and histology. In 60% of patients, MS begins as a relapsing-remitting disease and evolves secondarily into a progressive neurological illness. Life expectancy is not substantially altered in patients with MS, particularly in the early years of the illness. The rate of suicide has been reported to be increased sevenfold in MS patients. Up to 40% of patients with attacks severe enough to render them nonambulatory may not recover. At 15 years from MS onset, 50% of patients are disabled to the point at which they at least require a cane to walk a half block. Early age at onset, female sex, relapsing-remitting course at onset, and perhaps optic neuritis or sensory symptoms at onset and relatively few attacks in the first two years are associated with a favorable course.
TL;DR: A population-based, retrospective study to examine the risk of a variety of connective-tissue diseases and other disorders after breast implantation in women in Olmsted County, Minnesota, between January 1, 1964, and December 31, 1991.
Abstract: Background We conducted a population-based, retrospective study to examine the risk of a variety of connective-tissue diseases and other disorders after breast implantation. Methods All women in Olmsted County, Minnesota, who received a breast implant between January 1, 1964, and December 31, 1991 (the case subjects), were studied. For each case subject, two women of the same age (within three years) from the same population who had not received a breast implant and who underwent a medical evaluation within two years of the date of the implantation in the case subject were selected as control subjects. Each woman's inpatient and outpatient medical record was reviewed for the occurrence of various connective-tissue diseases, certain other disorders thought to have an autoimmune pathogenesis (e.g., Hashimoto's thyroiditis), and cancer other than breast cancer, as well as related symptoms and abnormal results of laboratory tests. The case subjects were categorized according to whether they received implants ...
TL;DR: A multiplex PCR assay for detection of the staphylococcal mecA gene (the structural gene for penicillin-binding protein 2a) was compared with agar dilution and disk diffusion susceptibility test methods for identifying methicillin resistance.
Abstract: A multiplex PCR assay for detection of the staphylococcal mecA gene (the structural gene for penicillin-binding protein 2a) was compared with agar dilution and disk diffusion susceptibility test methods for identifying methicillin resistance. The multiplex PCR assay combined two primer sets (mecA and 16S rRNA) in a single reaction. A total of 500 staphylococcal isolates (228 isolates of Staphylococcus aureus and 272 isolates of coagulase-negative staphylococci) from clinical specimens were studied. For S. aureus, 40 of 40 mecA-positive isolates and 4 of 188 mecA-negative isolates were oxacillin resistant (positive and negative predictive values of 100 and 98%, respectively). In 3 of 4 discordant isolates, resistance was due to hyperproduction of beta-lactamase. For coagulase-negative staphylococci, 148 of 159 mecA-positive isolates and 0 of 113 mecA-negative isolates were oxacillin resistant (positive and negative predictive values of 93 and 100%, respectively). Twenty-six isolates were categorized as indeterminate because of the absence of a detectable 16S rRNA product. Four of these 26 isolates contained mecA when retested. The assay is designed to be incorporated into the work flow of the clinical microbiology laboratory and allows for the identification of intrinsic resistance in a timely and reliable manner.
TL;DR: Treatment with fish oil for two years retards the rate at which renal function is lost and the effects of fish oil could prevent immunologic renal injury in patients with IgA nephropathy.
Abstract: Background The n-3 fatty acids in fish oil affect eicosanoid and cytokine production and therefore have the potential to alter renal hemodynamics and inflammation. The effects of fish oil could prevent immunologic renal injury in patients with IgA nephropathy. Methods In a multicenter, placebo-controlled, randomized trial we tested the efficacy of fish oil in patients with IgA nephropathy who had persistent proteinuria. The daily dose of fish oil was 12 g; the placebo was a similar dose of olive oil. Serum creatinine concentrations, elevated in 68 percent of the patients at base line, and creatinine clearance were measured for two years. The primary end point was an increase of 50 percent or more in the serum creatinine concentration at the end of the study. Results Fifty-five patients were assigned to receive fish oil, and 51 to receive placebo. According to Kaplan-Meier estimation, 3 patients (6 percent) in the fish-oil group and 14 (33 percent) in the placebo group had increases of 50 percent or more i...