RBRVS: unfinished business.
Explore the source record for details and available documents.
Delivery of Health Care↗
Biomedical subjects
A L Weaver
Publications and source records attributed to A L Weaver.
Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy.
BACKGROUND: The subdivision of undiagnosed patients with dyspepsia into symptomatic subgroups (ulcerlike, dysmotilitylike, refluxlike, and nonspecific) may give a clue to the underlying cause; however, the value of this approach in practice is unclear. This study aimed to determine the discriminant value of dyspeptic symptoms and combinations of these symptoms. METHODS: A consecutive sample of 820 outpatients (median age, 62 years; 47% male) completed, before endoscopy, a validated questionnaire that measured 46 gastrointestinal symptoms. RESULTS: Of patients with functional dyspepsia (n = 162), 17% had ulcerlike, 9% dysmotilitylike, and 16% refluxlike dyspepsia alone; 31% fell into two or more symptom subgroups; and 27% had nonspecific symptoms. A similar distribution of the dyspepsia subgroups was observed in patients without functional dyspepsia. Younger age, female gender, frequent upper abdominal pain, no (or sometimes) pain relief with antacid use, and infrequent vomiting were predictive of functional dyspepsia vs. all other diagnoses (at a specificity of 80%, the sensitivity was 60%). The dyspepsia subgroups were poor discriminators in a separate model for functional dyspepsia vs. all other diagnoses (at a specificity of 80%, the sensitivity was only 43%). CONCLUSIONS: The dyspepsia subgroups, as currently defined, appear to have little clinical utility and may be an inappropriate way of classifying dyspepsia.
Adolescent↗
Functional constipation and outlet delay: a population-based study.
BACKGROUND: Chronic constipation may result from many mechanisms including colonic inertia or rectosigmoid outlet delay, but risk factors for constipation in the community are poorly defined. The prevalence of and predictors for symptoms consistent with functional constipation and outlet delay were estimated. METHODS: An age- and gender-stratified random sample of 1,021 residents of Olmsted County, MN, aged 30-64 years, was mailed a valid self-report questionnaire; 835 responded (82%). These respondents were mailed a second questionnaire 12-20 months later that gathered data on symptoms compatible with functional constipation and outlet delay; 690 responded (83%). RESULTS: Self-reported constipation did not reliably identify functional constipation or outlet delay. The overall age- and gender-adjusted prevalences (per 100) of functional constipation and outlet delay were 19.2 (95% confidence interval [CI], 16.1-22.3) and 11.0 (95% CI, 8.7-13.3), respectively. Outlet delay but not functional constipation was more frequent in women. After adjusting for age, gender, and other symptoms, an increased usage of aspirin was associated with functional constipation but not outlet delay. CONCLUSIONS: In apparently healthy middle-aged persons, approximately 1 in 5 have symptoms compatible with functional constipation, and 1 in 10 may experience outlet delay, but these groups correspond poorly with self-reported constipation.
Adult↗
Discriminate value of esophageal symptoms: a study of the initial clinical findings in 499 patients with dysphagia of various causes.
The aim of this study was to determine whether the characteristics of esophageal symptoms may be of diagnostic utility in distinguishing dysphagia of various causes. Included in the study were a total of 499 patients with three types of dysphagia: 234 with dysphagia related to an obstructive lesion in the esophagus, 162 with dysphagia related to disturbed esophageal motility, and 103 with dysphagia who had no demonstrable structural or motor abnormalities in the esophagus. In the first part of the study, the initial esophageal symptoms of 402 patients with dysphagia were retrospectively reviewed and analyzed with use of a stepwise logistic regression. This analysis led to development of models that could distinguish among the various diagnostic groups of dysphagia. In the second segment of the study, these models were validated in a prospective assessment that involved 97 patients with dysphagia. In the third part of the study, the models were further refined by using data from all 499 patients from the first two parts. The results presented herein suggest that a subset of selected esophageal symptoms can distinguish among diagnostically identified groups of dysphagia. The discriminate models presented rely on a few easily determined clinical variables and hence are practical and potentially useful in the evaluation of undifferentiated dysphagia.
Adult↗
Autologous platelet-rich plasma does not reduce transfusion of homologous blood products in patients undergoing repeat valvular surgery.
BACKGROUND: Patients undergoing cardiac surgery employing cardiopulmonary bypass frequently require transfusion of homologous blood products and, therefore, are exposed to the risk of transfusions. Autologous platelet-rich plasma administration may reduce homologous transfusion and attendant risks. METHODS: In a blinded, randomized fashion, patients undergoing repeat sternotomy and valvular surgery received either a sham product (n = 28) or autologous platelet-rich plasma (n = 28) at the conclusion of cardiopulmonary bypass. Perioperative blood loss, coagulation profiles, and transfusion requirements were compared between the two groups. RESULTS: In the first 24 h postoperatively, both the platelet-rich plasma and sham groups received a median of 10.5 units of homologous blood products. Total median perioperative homologous transfusion requirements were 13 and 11.5 units for the platelet-rich plasma and sham groups, respectively. There was no significant difference in intraoperative or postoperative bleeding between the groups. CONCLUSIONS: Autologous platelet-rich plasma did not reduce perioperative bleeding or transfusion requirements in repeat valvular surgery.
Aged↗
Carotid artery: prospective blinded comparison of two-dimensional time-of-flight MR angiography with conventional angiography and duplex US.
A prospective blinded comparison of two-dimensional (2D) time-of-flight (TF) magnetic resonance (MR) angiography and color duplex flow ultrasound (US) with conventional angiography as a standard of reference was performed in 50 patients with hemispheric ischemic symptoms. The guidelines of the North American Symptomatic Carotid Endarterectomy Trial for measuring stenosis of the internal carotid artery were utilized for maximum-intensity-projection (MIP) images and conventional angiograms. While the 2D TF MIP technique overrepresented the degree of stenosis in the internal carotid arteries, it matched the performance of color duplex flow US as measured by means of receiver operating characteristic curves. A signal void on the MIP images corresponded to a 70% or greater internal carotid artery stenosis in 17 of 20 arteries. At its current state of development, the accuracy of 2D TF MR angiography equals that of US in characterizing the degree of carotid stenosis but cannot be considered a replacement for conventional angiography.
Adult↗
Evaluation of portal venous hypertension with cine phase-contrast MR flow measurements: high association of hyperdynamic portal flow with variceal hemorrhage.
Thirty-two patients with portal venous hypertension and endoscopically proved esophageal varices who were being evaluated for possible liver transplantation were studied with cine phase-contrast magnetic resonance (MR) imaging. Flow measurements in the main portal vein were obtained and associated with the presence of variceal hemorrhage within 2 years before the MR examination. Low (hypodynamic) flow was present in 22 patients, while high (hyperdynamic) flow was present in 10 patients. The presence of variceal hemorrhage was significantly associated with a high portal venous flow rate (P = .001), high variceal grade (P = .030), and Child class A or B (P = .003); however, only portal venous flow (P = .006) and variceal grade (P = .044) were found to be associated with variceal hemorrhage in a multiple logistic regression analysis. The portal venous flow rate was significantly higher among patients with Child class A or B disease compared with those with class C disease (median, 24.6 vs 8.0 mL/min.kg; P = .004).
Adult↗
Acute fractures and dislocations of the cervical spine in children and adolescents.
We reviewed the records of 143 patients, two months to fifteen years old, who were seen at the Mayo Clinic between 1950 and 1991 because of an injury to the cervical spine. There was a clear demarcation between the characteristics of the injury of two age-groups. Children who were less than eleven years old had fewer injuries as a group, were most often injured in falls, tended to have a predominance of ligamentous injuries of the cephalic portion of the cervical spine, and had a high rate of mortality as a consequence of injury to the spinal cord. Children who were eleven through fifteen years old had more injuries as a group, were most often injured during sports and recreational activities, had a higher male-to-female ratio, were more frequently injured in the caudal portion of the cervical spine, and had a pattern of injury similar to that of adults. The age and sex-adjusted incidence was 7.41 per 100,000 population per year.
Adolescent↗
Rapid fluorescence quantitation of plasmid miniprep DNA.
Explore the source record for details and available documents.
Bisbenzimidazole↗
Prospective 5-year followup of recombinant interferon-gamma in rheumatoid arthritis.
OBJECTIVE: To define clinical and laboratory outcomes of longterm recombinant interferon-gamma (rIFN-gamma) treatment of patients with rheumatoid arthritis (RA). METHODS: Patients with RA (70) completing a 12-week multicenter double blind trial comparing rIFN-gamma with placebo were enrolled in a longterm prospective protocol evaluating rIFN-gamma in RA. RESULTS: The majority of patients sustained clinical improvement for one year. Eight (11%) patients with RA continued to receive rIFN-gamma after 5 years. One patient fulfilled remission criteria. rIFN-gamma was well tolerated with remarkably few suspected adverse drug reactions. Forty-seven (67%) patients discontinued rIFN-gamma because of lack of efficacy, 7 (10%) because of concurrent illnesses, 5 (7%) were not compliant to study protocol, 3 (4%) developed suspected adverse drug reactions for a total of 62 (89%) withdrawals over the 5 years of followup. Patients continuing rIFN-gamma treatment for 5 years had lower initial total leukocyte and neutrophil counts and higher hemoglobin and hematocrit levels than patients who discontinued rIFN-gamma during the 5-year followup. CONCLUSIONS: Longterm treatment of RA with rIFN-gamma was generally well tolerated. Although many patients maintained sustained clinical improvement for at least one year, the main reason for discontinuing the drug over 5 years was the lack of continued benefit.
Arthritis, Rheumatoid↗
Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders.
Functional gastrointestinal disorders, including the irritable bowel syndrome, account for up to 40% of referrals to gastroenterologists, but accurate data on the natural history of these disorders in the general population are lacking. Using a reliable and valid questionnaire, the authors estimated the onset and disappearance of symptoms consistent with functional gastrointestinal disorders. An age- and sex-stratified random sample of 1,021 eligible residents of Olmsted County, Minnesota, aged 30-64 years were initially mailed the questionnaire; 82% responded (n = 835). In a remailing to responders 12-20 months later, 83% responded again (n = 690). The age- and sex-adjusted prevalence rates per 100 for irritable bowel syndrome, chronic constipation, chronic diarrhea, and frequent dyspepsia were 18.1 (95% confidence interval (CI) 15.1-21.1), 14.7 (95% CI 11.9-17.4), 7.3 (95% CI 5.3-9.3), and 14.1 (95% CI 11.5-16.8), respectively, on the second mailing. Symptoms were not significantly associated with nonresponse to the second mailing; moreover, the estimated prevalence rates were not significantly different from the first mailing. Among the 582 subjects free of the irritable bowel syndrome on the first survey, 9% developed symptoms during 795 person-years of follow-up, while 38% of the 108 who initially had the irritable bowel syndrome did not meet the criteria after 146 person-years of follow-up. Similar onset and disappearance rates were observed for the other main symptom categories. While functional gastrointestinal symptoms are common in middle-aged persons and overall prevalence appears relatively stable over 12-20 months, substantial turnover is implied by the observed onset and disappearance rates; several potential sources of bias do not seem to account for this variation.
Adult↗
Prevalence of antibody to caprine arthritis-encephalitis virus in goats in the United States.
Goats from 28 states were tested for antibodies to caprine arthritis-encephalitis virus. Of 3,790 goats, 1,175 (31%) tested positive, and of 196 herds tested, 143 (73%) had 1 or more seropositive members. This prevalence, based on serum samples from all goats in the participating herds, was lower than most rates reported in other studies. Such studies were based on fewer samples, incomplete sampling of herds, or smaller geographic base. Prevalence was highest in western Pacific and northern plains regions, increased with age to 3 years, was highest among goats on family-owned farms, and was lowest in the Angora breed. Differences in prevalence was not related to gender or size of herd.
Animals↗
Laparoscopic cholecystectomy: early Mayo Clinic experience.
Prospective data and follow-up information were collected on the initial 200 patients who underwent laparoscopic cholecystectomy at the Mayo Clinic. The operation was completed laparoscopically in all but five patients, who required conversion to laparotomy because of dense scarring or stones in the common bile duct. The median surgical time was 85 minutes. The major postoperative complications were retained stones in the common bile duct (in seven patients), intraperitoneal hemorrhage that necessitated transfusion (in two patients), and intra-abdominal abscess and pulmonary infection (in one patient each). The median hospital stay was 1 day (range, 0 to 8 days), and the median times to full activity and normal employment were 8 days and 12 days, respectively. Laparoscopic cholecystectomy is associated with a low frequency of complications in most patients with symptomatic gallstones and allows a rapid return to normal activity. Currently, laparoscopic cholecystectomy is the treatment of choice for most patients with symptomatic cholelithiasis.
Academic Medical Centers↗
The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects.
Serous cystadenoma of the pancreas is a rare lesion thought to be almost invariably benign. Since 1978, 211 cases have been reported in the literature. Some have been recognized by computed tomography (CT) when small and asymptomatic. The authors have reviewed their experience with 40 patients (median follow-up of 1.9 years, maximum of 22.2 years) from 1936 to 1991. One third (13) were asymptomatic, of whom eight (20%) were discovered intraoperatively. Of those 20 who had CT, an unequivocal preoperative diagnosis was reached in none. Needle biopsy proved accurate in two patients. Endoscopic retrograde cholangiopancreatography (ERCP) and biopsy were performed with diagnostic success on one occasion. Three patients presented acutely. The tumor was resected in 90%, with an operative mortality rate of 10%. Enucleation of the tumor without formal anatomic pancreatectomy necessitated reoperation for complications in four of eight patients. Survival after successful resection paralleled expected survival. Serous cystadenoma may be associated with von Hippel-Lindau syndrome. The current role for conservative management remains questionable because of our current inability to reliably differentiate many of these benign neoplasms from malignant cystic neoplasms of the pancreas.
Adult↗
Seroprevalence of ovine progressive pneumonia virus in sheep in the United States as assessed by analyses of voluntarily submitted samples.
Ovine progressive pneumonia (OPP) is a lentivirus-induced disease of sheep in the United States that is similar, if not identical, to maedi/visna in many other countries. Prevalence estimates of seropositivity to this virus in sheep in the United States have been confined to limited groups or flocks of sheep and have varied from 1 to 90%. In this study of detection of antibodies against OPP virus, we found a lower general prevalence of antibodies to OPP virus in sheep than was previously reported. Of 16,827 sheep from 29 states in the United States, 26% were seropositive and 48% of 164 flocks that were tested had 1 or more seropositive sheep. Seropositivity to OPP virus for sheep within special categories was determined, although nonrandom samples that were available may have biased the results. Within regions of the United States, prevalence was highest in the Rocky Mountain region at 49% and lowest in the northern Atlantic region at 9%. Seropositive sheep were not evenly distributed among flocks, but were clustered in a few flocks of sheep. A high number of flocks had no or few seropositive sheep. Prevalence increased with age from 4% at less than 1 year to a plateau of 34% at 4 years. Seropositivity was variable among breeds and was not associated with sex, wool class, or place of origin of ancestors.
Age Factors↗
Ruptured abdominal aortic aneurysms: repair should not be denied.
The records of 231 patients (189 men, 42 women) treated during the last decade for ruptured infrarenal abdominal aortic aneurysm were reviewed to evaluate complications and mortality rates and to determine if preoperative factors would preclude attempt at surgical repair. Mean age was 73.7 years (range, 50 to 95 years). Fifty-seven patients (24.7%) were greater than or equal to 80 years of age. Sixty-eight patients (29.4%) had known abdominal aortic aneurysm before rupture. Preoperative systolic blood pressure was less than or equal to 90 mm Hg in 155 patients (67.1%). Fifty-six patients (24.2%) had cardiac arrest before operation. The overall mortality rate from admission until the end of the hospital stay was 49.4% (114 of 231). Seventeen patients (7.4%) died in the emergency department, 40 (17.3%) in the operating room, 27 (11.7%) during the first 48 postoperative hours, and 30 (13.0%) died later but during the same hospitalization. The 30-day operative mortality rate was 41.6%. Mean age of those who died was higher (75.3 years) than of those who survived (72.2 years) (p less than 0.02). Of patients greater than or equal to 80 years, 43.9% survived. Survival was lower among women (35.7%) than men (54.0%; p less than 0.04). A high APACHE II score, a low initial hematocrit, preoperative hypotension, and chronic obstructive pulmonary disease were associated multivariately with increased mortality rates (p less than 0.02). However, 59 of the 155 patients (38.1%) with preoperative hypotension survived. Deaths were high (80.4%) among patients with cardiac arrest (45 of 56); still, 28.2% of patients (11 of 39) survived repair after cardiac arrest.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Molecular evolution of inversions in Drosophila pseudoobscura: the amylase gene region.
The amylase region of the third chromosome of Drosophila pseudoobscura has been cloned and localized to cytological band 73A. It is contained within a series of highly polymorphic inversions and serves as a convenient tool for a molecular evolutionary analysis of the inverted gene arrangements. Amylase in D. pseudoobscura is a family of three genes, and some chromosomes have deletions for one or two of them. Two overlapping clones covering 26 kilobases were isolated and used as probes to survey DNA restriction map polymorphism among 28 lines, representing five of the major inversion types found in natural populations, as well as single chromosomes from the closely related species Drosophila persimilis and Drosophila miranda. Restriction-site differences are considerably greater among the various gene arrangements than among chromosomes with the same gene arrangement. Clustering the restriction map haplotypes yielded a dendrogram concordant with the phylogeny generated independently from cytogenetic considerations. The inversion polymorphism is estimated to be about 2 million years old.
Amylases↗
Metastatic melanoma of the gastrointestinal tract. Results of surgical management.
Between 1954 and 1989, 41 patients with melanoma metastatic to the gastrointestinal tract underwent surgical treatment at the Mayo Clinic, Rochester, Minn. The small bowel was most commonly involved (71%), followed by the stomach (27%), large bowel (22%), and esophagus (5%). Gross total excision of all intra-abdominal metastases was performed in 52% of patients. The postoperative mortality was 5% and the median patient survival was 0.8 years, with 1- and 5-year survival rates of 44% and 9%, respectively. Of the patient, tumor, and treatment variables evaluated, patients with small-intestinal metastases had a significantly worse prognosis. Although patients with melanoma metastatic to the bowel have a limited life expectancy, surgical resection of their metastases provides effective palliation. Operative treatment of selected patients with symptomatic melanoma metastatic to the gastrointestinal tract is a worthwhile undertaking.
Adult↗