Showing papers by "Oregon Health & Science University published in 1975"
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
76,181 citations
TL;DR: Pseudomonas aeruginosa toxin (PA toxin) inhibits protein synthesis in a reticulocyte cell-free system as discussed by the authors, which results in a block at an elongation step of polypeptide assembly.
Abstract: Pseudomonas aeruginosa toxin (PA toxin) inhibits protein synthesis in a reticulocyte cell-free system. The inhibition requires NAD and results in a block at an elongation step of polypeptide assembly. PA toxin was found to act like diphtheria toxin fragment A. Both toxins catalyze the transfer of radioactivity from nicotinamide(U-14-C)adenine dinucleotide ((14-C)NAD) into covalent linkage with the 100,000 dalton elongation (EF-2) protein. Furthermore, in the presence of a limiting amount of EF-2, excess toxin, and (14-C)NAD, the two toxins were non-additive in the amount of label transferred to EF-3. Unlike free fragment A of diphtheria toxin, the enzymatic activity of PA toxin is heat labile and neutralizable with antibody to PA toxin but not with antibody to fragment A. Although PA and diphtheria toxins have different cellular specificities and molecular properties and produce different clinical symptoms, their intracellular mechanisms of action appear to be identical.
615 citations
TL;DR: It appears that cardiac abnormalities are a consistent manifestation of Marfan's Syndrome and that ultrasound is a more sensitive indicator of these abnormalities in such patients than auscultation or phonocardiography.
Abstract: Echocardiographic and phonocardiographic findings in 35 patients with Marfan's Syndrome and ten patients without Marfan's or other clinically apparent connective tissue disorders but with angiographic and echocardiographic evidence of mitral prolapse are reported and compared. Echocardiography revealed aortic root dilatation and/or mitral valve prolapse in 97% of the patients with Marfan's Syndrome. Aortic root dilatation was found in 60% of this group (74% of males, 33% of females) while mitral valve prolapse was found in 91% (87% of males, 100% of females). The incidence of aortic dilatation and mitral prolapse in patients with Marfan's syndrome was essentially equal in children and adults of the same sex. None of the nine adults or one child with mitral prolapse but without evidence of Marfan's Syndrome or other clinically apparent connective tissue disorder had aortic root enlargement. Ausculatory examination and phnocardiography revealed abnormalities in 54% of the patients with Marfan's Syndrome. Aortic regurgitation was found in 23% of this group (35% of males, 0% of females) while mitral regurgitation and/or mitral clicks were found in 46% (39% of males, 58% of females). Aortic regurgitation was much more frequent in adult males with Marfan's Syndrome (7/14, 50%) than male children (1/9, 11%), while the incidence of abnormal mitral sounds was essentially the same in adults (33% of males, 60% of females) and children (43% of males, 57% of females) of the same sex with Marfan's Syndrome. Abnormal mitral sounds were more frequent in patients without Marfan's who had mitral prolapse (90%) than in those with Marfan's (46%). It appears that cardiac abnormalities are a consistent manifestation of Marfan's Syndrome and that ultrasound is a more sensitive indicator of these abnormalities in such patients than ausculation or phonocardiography.
223 citations
TL;DR: Several lines of evidence suggest that globin messenger ribonucleic acid requires "activation" before it can be utilized and that a messenger activation step of protein synthesis initiation is rate-limiting in this cell-free system.
202 citations
TL;DR: Isobutyl 2-cyanoacrylate delivered selectively in small doses produced immediate occlusion of the injected arteries in dogs without significant undesired sequelae and in one patient, pelvic hemorrhage was promptly stopped by a similar technique.
Abstract: Isobutyl 2-cyanoacrylate (IBC) delivered selectively in small doses produced immediate occlusion of the injected arteries in dogs without significant undesired sequelae. In one patient, pelvic hemorrhage was promptly stopped by a similar technique. In another patient, who was on chronic renal dialysis and judged too ill for nephrectomy, IBC occluded both renal arteries and terminated a life-threatening renal protein loss.
150 citations
TL;DR: It is concluded that subjective analysis has a significant error rate and that reproducibility and accuracy of analysis of left ventriculograms require objective analysis.
Abstract: In order to determine the reproducibility of analyses of left ventriculograms, 35 cineangiograms were evaluated by four observers, two using standard quantitative techniques to determine ventricular volumes and a newly devised quantitative system to evaluate wall motion and two others using only visual inspection of the angiograms. Objective analysis repeated by the same observer correlated well for end-diastolic and end-systolic volumes and ejection fraction (r = .98, .99, respectively) and only one of 105 (1%) wall segments were identified differently. Variability in assessments increased when comparisons were made with a second objective observer. Correlation coefficients for the three volumetric parameters were .93, .98, and .95 and there was disagreement in the assessment of 8% of wall segments. Wide variability was present between an objective and two subjective observers in analyses of end-diastolic volumes (r = .63, .64). Regional wall motion was assessed differently in 19% and 27% of segments, respectively. Though the correlation of objectively and subjectively determined ejection fractions was much better than the correlation for volume (r = .92, .84), it was not as good as the correlation between two objective observers. Occasional errors of clinical significance occurred. We conclude that subjective analysis has a significant error rate and that reproducibility and accuracy of analysis of left ventriculograms require objective analysis.
144 citations
TL;DR: Results suggest that enterotoxigenic Es.
Abstract: A search for intestinal enterotoxigenic Escherichia coli was made in 59 Apache children hospitalized with 64 episodes of acute diarrhea. Esch. coli isolates from acute-phase and convalescent-phase specimens of small-bowel fluid and stool were tested in three currently recognized models: the adult-rabbit ileal loop; infant rabbit; and the adrenal-cell assay. Enterotoxigenic strains were isolated from 10 children during acute diarrheal episodes (16 per cent); none were isolated from convalescent-phase specimens. None of 64 "enteropathogenic" serotypes of Esch. coli from 43 children with diarrhea, however, caused fluid production in the ileal-loop model. These results suggest that enterotoxigenic Esch. coli may be the cause of considerable diarrhea in this population and that the term "enteropathogenic" as applied to serotypes of Esch. coli needs to be redefined.(N Engl J Med 292:1041–1045, 1975)
139 citations
TL;DR: Left ventricular wall motion abnormalities and ejection fraction improved in some coronary artery disease patients following nitroglycerin, although the mechanism for this is unknown; however, ventriculography before and after nitrogoglyin may be of potential usefulness for identifying areas of reversible wallMotion abnormalities.
Abstract: Coronary artery disease patients frequently have left ventricular wall motion abnormalities. Though nitroglycerin is commonly used in ischemic heart disease, its effects on wall motion abnormalities is unknown. In this study we have evaluated the effects of nitroglycerin on wall motion abnormalities and on ejection fraction in 25 patients. Sixteen had coronary artery disease (greater than 70% luminal narrowing). Six had no evidence of heart disease and three had congestive cardiomyopathies with normal coronary arteries. Left ventricular angiography was performed prior to and six minutes after administration of 0.4 mg of sublingual nitroglycerin. Twelve of the 16 coronary artery disease patients had wall motion abnormalities, and in seven of these, segmental wall motion improved after nitroglycerin. In five, all motion did not change. The initial heart rate, left ventricular systolic and end-diastolic pressure, and left ventricular end-diastolic volumes were not different for those whose wall motion improved versus those whose did not. The increase in the former and fall in the latter three hemodynamic parameters were significant (P less than 0.01) and similar for the two groups. In those whose wall motion abnormalities improved after nitroglycerin, ejection fraction (mean plus or minus se) increased significantly (P less than 0.05), from 0.47 plus or minus 0.025 to 0.62 plus or minus 0.046. In those without improvement, the ejection fraction went from 0.55 plus or minus 0.056 to 0.58 plus or minus 0.051 (NS). Three patients with congestive cardiomyopathy showed no improvement in ventricular wall motion or ejection fraction after nitroglycerin. Left ventricular wall motion abnormalities and ejection fraction improved in some coronary artery disease patients following nitroglycerin. The mechanism for this is unknown; however, ventriculography before and after nitroglycerin may be of potential usefulness for identifying areas of reversible wall motion abnormalities.
119 citations
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TL;DR: The total incidence of therapeutic complications was similar in the two groups, but was more severe in the streptokinase treated patients.
Abstract: Heparin or streptokinase was administered in a prospective randomized fashion to 50 patients with phlebographically confirmed venous thrombosis of the extremities of 14 days or less duration. A total of 49 patients completed the investigative protocol with 26 receiving heparin and 23 receiving streptokinase. All patients were evaluated with sequential phlebograms. Complete thrombolysis with restoration of venous valve function occurred in one of 26 patients receiving heparin and in six of 23 patients receiving streptokinase. Fifty per cent of the patients treated with streptokinase with a total duration of symptoms of three days or less achieved complete lysis. The total incidence of therapeutic complications was similar in the two groups, but was more severe in the streptokinase treated patients.
91 citations
TL;DR: Most of the individual values for selenium in human milk fell within the narrow range of 0.007 to 0.033 ppm Se, yet there was evidence for geographic variations in the seenium content of milk collected from the various cities.
Abstract: Data were collected on the selenium concentration in human mature milk from a total of 241 subjects who resided in or near cities located in 17 states across the United State. The overall mean value for the selenium content of mature human milk was 0.018 ppm Se. Most of the individual values for selenium in human milk fell within the narrow range of 0.007 to 0.033 ppm Se, yet there was evidence for geographic variations in the selenium content of milk collected from the various cities.
75 citations
TL;DR: In hepatorenal patients, intra-arterial infusion of subpresor doses of dopamine hydrochloride improved the angiographic appearance of the renal cortical vasculatrue and the cortical blood flow rate.
Abstract: Functional renal failure accompanying advanced cirrhosis of the liver carries a grave prognosis. Seven patients with the hepatorenal syndrome and five patients with decompensated cirrhosis of the liver without renal failure were studied by the xenon Xe 133 washout technique. Mean renal blood flow and its cortical component were decreased in both groups compared to normal transplant donors, but to a significantly greater degree in hepatorenal syndrome. In hepatorenal patients, intra-arterial infusion of subpressor doses of dopamine hydrochloride improved the angiographic appearance of the renal cortical vasculature and the cortical blood flow rate. Urine flow rate and glomerular filtration rate did not consistently improve with 12- to 24-hour intravenous infusions, although two patients survived, temporally related to the study. These patients had shown signs of liver function recovery.
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TL;DR: Twenty-five patients with Raynaud's phenomenon, including 20 with associated diseases and five with primary RaynaUD's disease, were evaluated with sequential determinations of digital temperature recovery time after cold exposure and magnification hand arteriography before and aftercold exposure and before and before intra-arterial reserpine.
TL;DR: Therapeutic techniques explored in animals include intravascular tamponade of gastric coronary vein and the nonsurgical creation of intrahepatic portacaval shunts, both of promise in the future management of massive gastrointestinal bleeding from varices.
Abstract: More than five years of clinical and animal experience with the use of a transjugular approach to the liver, biliary system, and portal circulation is reviewed. It has been of clinical value in connection with hepatic manometry and venography, liver biopsy, and cholangiography. Satisfactory hepatic manometry and venography were achieved by the transjugular approach in all 47 cases where attempted; diagnostic liver specimens were obtained in 71 of 83 patients (86 percent); and cholangiography was successful in 48 of 52 patients with enlarged intrahepatic ducts (92 percent). No complications occurred with these studies. In animals, transjugular catheterization was used as a means for portal, mesenteric, and pancreatic venography. These procedures are ready for diagnostic clinical use. Therapeutic techniques explored in animals include intravascular tamponade of gastric coronary vein and the nonsurgical creation of intrahepatic portacaval shunts, both of promise in the future management of massive gastrointe...
TL;DR: Five infants with intractable congestive heart failure due to ostium secundum atrial septal defect (ASD) are presented and all survived ASD closure and are doing well.
TL;DR: The achieved results show the anatomical feasibility of this approach and give good perspective for development of a clinical method for percutaneous intravascular tamponade of the bleeding gastroesophageal varices in cirrhotics.
Abstract: Experimental catheter obstruction of the left gastric (coronary) vein was explored in 10 dogs. Using a transjugular approach, the liver was punctured and the portal vein catheterized. Coaxially introduced catheters were then used to catheterize selectively and produce an intravascular obstruction (tamponade) of the gastric coronary vein. Ballon catheters were used for a temporary occlusion. Injection of a tissue adhesive, isobutyl 2-cyanoacrylate, was used for a definitive obliteration. The achieved results show the anatomical feasibility of this approach and give good perspective for development of a clinical method for percutaneous intravascular tamponade of the bleeding gastroesophageal varices in cirrhotics.
TL;DR: Patch testing indicates the general relationship between the structure of pyrimidine compounds and their antigenic cross reactivity, and four cases of allergic contact dermatitis from idoxuridine, sensitized by both eye and skin applications are reported.
Abstract: Idoxuridine has been used for many years in the treatment of herpex simplex infections of the eye. Use of the drug for herpes simplex infection of the skin is increasing. Ophthalmologists have noted occasional conjunctival and corneal irritant reactions, but no true delayed cutaneous hypersensitivity has been verified. We report four cases of allergic contact dermatitis from idoxuridine, sensitized by both eye and skin applications. Cross reactivity to brominated and chlorinated, but not fluorinated, pyrimidine analogues is noted. Extensive patch testing indicates the general relationship between the structure of pyrimidine compounds and their antigenic cross reactivity. ( Arch Dermatol 111:1581-1584, 1975)
01 Sep 1975
TL;DR: The results and previous clinical experience suggest that the selective infusions of vasopressin into arteries supplying the liver can be used for short-term vasoconstrictive therapy of acute gastrointestinal bleeding in patients without liver damage.
Abstract: Electromagnetic flow measurement study was performed in 20 anesthetized dogs to evaluate the effect of selective celiac infusion of vasopressin on the hepatic arterial vasculature. Teh hepatic arterial flow showed a biphasic response with an initial decrease followed by a substantial increase in spite of a continued infusion. The left gastric, splenic, and superior mesentric arteries showed a monophasic response with persistent decrease of flow during the whole infusion. The biphasic response of the hepatic arterial flow is thought to be due to autoregulatory dilative action of the liver to a decrease of the portal flow. The results and previous clinical experience suggest that the selective infusions of vasopressin into arteries supplying the liver can be used for short-term vasoconstrictive therapy of acute gastrointestinal bleeding in patients without liver damage. Further experience is necessary to evaluate the safety of prolonged hepatic infusions in patients with liver damage.
TL;DR: Clinical observation that depression is a major risk for individuals given this diagnosis and that the experience of depression by these patients is genuine did support the clinical observation that depressed patients given this diagnoses are genuine.
Abstract: We attempted to validate the DSM-II diagnosis of hysterical personality and the depression often experienced by such patients by comparing mean Minnesota Multiphasic Personality Inventory (MMPI) scores of hysterical personality patients with those of paranoid schizophrenic patients and a group with mixed psychiatric diagnoses. Index patients had significantly higher scores than either control group and could be distinguished on individual scales from the paranoid schizophrenics. However, the mean MMPI profile of hysterical personalities was similar to that of depressed controls. Therefore, the MMPI alone could not differentiate these two groups nor could it confirm or refute the validity of the diagnostic concept of hysterical personality, but it did support the clinical observation that depression is a major risk for individuals given this diagnosis and that the experience of depression by these patients is genuine.
TL;DR: The results suggest that the ventromedial region is not crucial for the inhibitions produced by emotional arousal under experimental conditions, but plays some role in amphetamine anorexia.
Abstract: In rhesus monkeys with knife cuts which disconnected the ventromedial hypothalamus and produced hypothalamic hyperphagia, we have studied a variety of stimuli known to reduce food intake: weight gain, emotionally arousing stimuli, bitter-tasting food, amphetamine, and pre-prandial intragastric infusion of nutrient. We demonstrate that these animals are similar to animals with ventromedial lesions in passing through a "dynamic" phase of overeating and weight gain and then stabilizing their body weight at a new level by reducing their feeding in a "static" phase. These animals are also more sensitive to the inhibitory effects of noise and bad taste in food. They, however, are less sensitive to the anorexic action of amphetamine. These results suggest that the ventromedial region is not crucial for the inhibitions produced by emotional arousal under our experimental conditions, but plays some role in amphetamine anorexia. Amphetamine is likely to have some specific anorexic action beyond its potential for arousal, since the same animals which are sensitive to the inhibitory effects of arousal are also resistant to amphetamine. Finally these hyperphagic animals do not differ from intact controls in the reduction of food intake produced by preloading with intragastric nutrient. This result is not consistent with the concepts that hypothalamic hyperphagia is caused by a disruption of satiety and that the ventromedial hypothalmic region is a crucial "satiety" centre.
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TL;DR: It is concluded that TNP-T4 should be classified among the thymus independent antigens, and in vivo priming with the carrier T4 failed to enhance the subsequent in vitro response to TNP
Abstract: A primary immune response was obtained in vitro to trinitrophenylated bacteriophate T4 (TNP-T4) by using normal BALB/c spleen cells challenged in vitro. The primary response was limited to anti-TNP; we failed to find evidence of a primary anti-T4 response in spleen cell cultures challenged with either TNP-T4 or native T4. In vivo priming with the carrier T4 failed to enhance the subsequent in vitro response to TNP-T4 although such priming sometimes caused suppression of the anti-hapten response. The addition of excess free carrier to spleen cell cultures challenged with TNP-T4 failed to suppress the anti-TNP response. Spleen cells treated with anti-θ plus complement were unaffected in their ability to respond to TNP-T4. We conclude that TNP-T4 should be classified among the thymus independent antigens.
TL;DR: The authors found only a relatively low value for epinephrine renal venography in the diagnosis of hypervascular renal tumors and the early detection of venous extension of hypernephromas.
Abstract: Experience with the use of epinephrine renal venography in 60 patients with various renal disease is reviewed. The technique offers an important supplement to selective arteriography. It is of particular value in the diagnosis of avascular infiltrative tumors of the renal parenchyma and pelvis. Further, it is of value in the detailed demonstration of renal vein thrombosis and in seeking the cause of unexplained gross hematuria. It can also aid in evaluating expansile avascular renal masses and renal parenchymal disease. The authors found only a relatively low value for epinephrine renal venography in the diagnosis of hypervascular renal tumors and the early detection of venous extension of hypernephromas.
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TL;DR: The cobalt excretion test may have some usefulness as a simple, apparently safe, noninvasive test for identification of persons with iron depletion resulting from uncomplicated blood loss, but in more complex circumstances it fails to differentiate iron deficiency anemia from anemia due to other causes.
TL;DR: Two cases of anomalous systemic venous return were correctly diagnosed preoperatively and repaired by intracardiac baffle.
TL;DR: It is concluded that oxygen or possibly nylidrin are suitable agents should an intermittently bleeding mesenteric artery be dilated for diagnostic purposes prior to angiography.
Abstract: Radiodiagnostic potential of intra-arterially injected vasodialting agents was investigated by their effect on total and segmenal resistances (VR) of mesenteric vasculature, blood flow in superior mesenteric artery and its bleeding branch; heart rate and ventricular and systemic blood pressure. Dipyridamole, isoxsuprine, protricular and systemic blood pressure. Dipyridamole, isoxsuprine, prochlorperazine, lidocaine, meglumine diatrizoate and carbon dioxide were poor dilators. Phentolamine produced hypotension; glucagon and serpasil an extremely long dilation. A large and short vasodilation was produced with tolazoline and nylidrin, but both agents increased VR of the postcapillary segment and caused transient hypotension and arrhythmias, nylidrin's side effects were smaller. Oxygen produced large and long vasodilation and minimal systemic effects. It is concluded that oxygen or possibly nylidrin are suitable agents should an intermittently bleeding mesenteric artery be dilated for diagnostic purposes prior to angiography.
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TL;DR: The cloth-covered prostheses have substantially lowered the incidence of emboli after mitral replacement, and have thus far eliminated emboliAfter aortic replacement in patients receiving warfarin, and a clinical trial is currently in progress to assess the adequacy of antiplatelet drugs.
Abstract: Experience with isolated mitral and aortic valve replacement at the University of Oregon Medical School since 1965 is presented. Results with non-cloth-covered and cloth-covered valves were analyzed with actuarial techniques and were compared in terms of late survival, thromboembolic complication rate, reoperation rate and the influence of anticoagulation therapy. The cloth-covered prostheses have substantially lowered the incidence of emboli after mitral replacement, and have thus far eliminated emboli after aortic replacement in patients receiving warfarin. Although anticoagulation therapy is still necessary, a clinical trial is currently in progress to assess the adequacy of antiplatelet drugs. The choice of a cloth-covered or non-cloth-covered valve should be individualized for each patient, based on the different risks and benefits of each prosthesis.
TL;DR: A new small intestinal biopsy technique was developed and evaluated: it involves the rapid replacement of a simple duodenal tube using a controllable spring guide and fluoroscopy, which proved safe and effective.
Abstract: A new small intestinal biopsy technique was developed and evaluated: it involves the rapid preplacement of a simple duodenal tube using a controllable spring guide and fluoroscopy. A suction biopsy catheter was then passed coaxially through the tube as often as needed for sampling, after which other diagnostic studies were done with the same intubation. In clinical trials totaling 31 biopsies in 15 adult patients, the method proved safe and effective. Currently, the time required to intubate the ligament of Treitz and obtain two biopsies is usually less than 15 minutes.
TL;DR: The detection of pancreatic cancer in patients not approachable by arteriography and the intensified search for small islet cell tumors are possible indications for pancreatic venography when the safety of this method is further demonstrated.
Abstract: To explore the feasibility of retrograde pancreatic venography, transhepatic portal catheterization via jugular and hepatic veins was performed in 10 dogs. Coaxially introduced catheters were then used to enter individual pancreatic veins for retrograde venography. Appropriate injection technique led to detailed visualization of the pancreatic venous system without anatomically evident injury to the pancreas. The (readily avoidable) injection of contrast agent through catheters wedged into pancreatic veins caused parenchymal extravasation and hemorrhagic pancreatitis. The detection of pancreatic cancer in patients not approachable by arteriography and the intensified search for small islet cell tumors are possible indications for pancreatic venography when the safety of this method is further demonstrated.