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Biomedical subjects

L R Elveback

Publications and source records attributed to L R Elveback.

At least 37 records · Page 2Linked to original sources
PubMed1983

Transient ischemic attack and stroke in a community-based diabetic cohort.

The role of hypertension was evaluated as a factor in the increased frequency of cerebrovascular disease in a community-based diabetic cohort. Hypertension was found to account only in part for the increased frequency of transient ischemic attacks in the diabetic patient but appeared to account entirely for the increased frequency of stroke in these patients. Most transient ischemic attacks were found to arise from the carotid circulation. The ratio of ischemic cerebral infarction to hemorrhage was greater among diabetic patients than in the general population.

Aged↗
PubMed1983

Coronary heart disease in residents of Rochester, Minnesota, 1950-1975. III. Effect of hypertension and its treatment on survival of patients with coronary artery disease.

The data in this blood pressure study were obtained from 1,069 patients who had their first manifestation of coronary artery disease during the 16-year period 1960 through 1975. Case fatality rates (death within 30 days) were least in the normotensive and treated hypertensive patients with myocardial infarction and greatest in the untreated hypertensive patients. Women were less likely than men to acquire coronary artery disease, but a higher proportion of women with coronary artery disease had hypertension. Patients with definite hypertension were older than those with borderline hypertension, and patients with borderline hypertension were older than normotensive patients with coronary artery disease. The data demonstrate that hypertension is a prognostic factor of serious significance in patients who have symptomatic coronary artery disease, and the prognostic significance of borderline hypertension is almost as serious as that of definite hypertension in these patients. Treatment improved survival in patients with definite hypertension, and adequate treatment improved survival to a greater degree than did inadequate treatment.

Age Factors↗
PubMed1982

A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency.

To prevent occlusion of aortocoronary-artery-bypass grafts, we conducted a prospective, randomized-double-blind trial comparing dipyridamole (instituted two days before operation) plus aspirin (added seven hours after operation) with placebo in 407 patients. Vein-graft angiography was performed in 360 patients (88 per cent) within six months of operation (median, eight days). Within one month of operation, 3 per cent of vein-graft distal anastomoses (10 of 351) were occluded in the treated patients, and 10 per cent (38 of 362) in the placebo group; the proportion of patients with one or more distal anastomoses occluded was 8 per cent (10 of 130) in the treated group and 21 per cent (27 of 130) in th placebo group. This benefit in graft patency persisted in each of over 50 subgroups. Early postoperative bleeding was similar in the two groups. In this trial dipyridamole and aspirin were effective in preventing graft occlusion early after operation.

Adult↗
PubMed1982

Strong family history and cigarette smoking as risk factors of coronary artery disease in young adults.

This study is based on 435 consecutive patients age 50 or less who had coronary arteriography. There were 335 patients with coronary artery disease and 100 with normal coronary arteries. Risk factors reviewed were "packet-years" of cigarette smoking, family history of coronary disease in first-degree relatives 50 years of age or less, age- and sex-corrected serum cholesterol and triglycerides, hypertension, and diabetes. By univariate analysis, each risk factor except hypertension and diabetes was significantly more frequent in patients with coronary disease than in those without. By multivariate analysis of all risk factors in patients with and without coronary disease, the male or female patient with coronary disease could best be identified by the strong family history, cigarette smoking history, and age- and sex-corrected serum cholesterol. The percentage of patients with coronary disease when the three risk factors were present was 95%, two factors present 88%, one factor present 67%, none of the three 25%, strong family history alone 90%, smoking alone 66%, and serum cholesterol greater than 80th centile alone 52%.

Adult↗
PubMed1982

Daily and seasonal variation in sudden cardiac death, Rochester, Minnesota, 1950-1975.

Incidence cases of coronary heart disease that occurred in Rochester, Minnesota, during the years 1950 through 1975 were used for a study of the distribution of sudden cardiac death (1,054 cases) by day of the week and season of the year. Overall, sudden cardiac death--that is, death within 24 hours of onset of symptoms--occurred with greater frequency on Saturdays than on other days of the week. The frequency of occurrence of sudden cardiac death by season varied somewhat--the highest frequency was in winter and the lowest in summer-- but no more than expected by chance. Among males, there was a decreasing trend by day of the week from Saturday to Friday, and this was so for those with and those without a history of coronary heart disease (P less than 0.01).

Coronary Disease↗
PubMed1981

Association of risk factor variables and coronary artery disease documented with angiography.

Stepwise linear discrimination was used to analyze risk factors in 431 consecutive patients who underwent coronary angiography to determine which variables were most closely associated with coronary artery disease. Twenty-one risk factors were considered: total plasma cholesterol and triglycerides; the cholesterol and triglyceride content of high-density lipoproteins (HDL), low-density lipoproteins (LDL) and very low density lipoproteins (VLDL); and the percentage of total cholesterol and triglycerides in each fraction. Age, smoking history, family history, hypertension, diabetes mellitus and relative weight were also considered. Coronary artery disease was assessed using three standard grading scores. There were significant differences in risk factors between males and females. In males, LDL cholesterol and age were selected by multivariate analysis. In females, the ratio of HDL cholesterol to total cholesterol, as well as relative weight, family history, age and smoking were selected. The discriminating value of HDL cholesterol as the percentage of total cholesterol was significantly greater than that of HDL cholesterol itself. Despite highly significant associations between risk factors and the presence of coronary artery disease, the discrimination did not provide sufficient separation of the groups to give results that are useful diagnostically in individual patients.

Adult↗
PubMed1981

Platelet survival and the development of coronary artery disease in the young adult: effects of cigarette smoking, strong family history and medical therapy.

Cigarette smoking or a strong family history of coronary disease was present in 46 of 50 symptomatic patients with coronary artery disease who were younger than 50 years of age. We recorded a shortened platelet survival half-life (less than 92 hours) with 51Cr in 60% of these patients, in 56% of apparently normal persons of the same age who smoked or had a strong family history of coronary disease, and in only 14% of normal persons who did not smoke and had no family history (p less than 0.01). Lengthening of the shortened platelet survival toward normal occurred in coronary patients given dipyridamole plus aspirin and in apparently normal smokers who discontinued smoking (p less than 0.01). The study suggests a possible relationship among cigarette smoking, strong family history of coronary disease and platelet activation in the process of coronary atherogenesis in the young adult.

Adult↗
PubMed1981

The unpredictable progression of symptomatic coronary artery disease: a serial clinical-angiographic analysis.

To determine whether risk factors or angiographic features could be correlated with progression of coronary artery disease, we independently analyzed serial coronary angiograms in 65 symptomatic patients for progression without knowledge of their respective risk factors. An important design feature of this study was that observer variability of coronary lesion assessment was objectively evaluated and taken into account in defining progression of coronary artery disease. The reproducibility of lesion assessment varied with the severity of stenosis: moderate stenoses had the greatest intraobserver and interobserver variability. At initial study, 337 partial and 68 complete occlusions were identified. Of the 337 partial occlusions at risk of progression, 73 (22%) progressed; 13 (3.2%) of the initial lesions regressed. In the 65 patients with persistent or increasing angina, progression occurred in 51 (78%) over a mean period of 24 months. Apart from the tendency of high-grade stenosis( greater than or equal to 98%) to progress to complete occlusion, no measured clinical, laboratory, or angiographic variable showed any significant effect on progression to coronary artery disease, in this selected group of symptomatic patients these same risk factors did not predict its progression. We believe that (1) and definition of progression should incorporate the factor of observer variability and (2) therapeutic measures designed to influence progression of coronary artery disease should take into account this apparently unpredictable progression.

Aged↗
PubMed1981

Coronary heart disease in residents of Rochester, Minnesota, 1950-1975. I. Background and study design.

The unique medical data resource for the population of Rochester, Minnesota, is centered on the records of the Mayo Clinic and the Olmsted Medical and Surgical Group, which for several decades have provided nearly all medical care in this community. This resource has been utilized in a study of the incidence rates and secular trend in coronary heart disease for the period 1950-1975 among residents of Rochester. A total of 3,080 patients fulfilled the clinical and other criteria for inclusion in this study. The patients, classified by initial manifestation of coronary heart disease, consisted of 1,321 with myocardial infarction, 1,215 with angina pectoris, and 544 with sudden unexpected death. In this paper the background, clinical definitions, and study design are presented.

Adult↗
PubMed1981

Coronary heart disease in residents of Rochester, Minnesota. II. Mortality, incidence, and survivorship, 1950-1975.

For the city of Rochester, Minnesota, the coronary heart disease mortality rate showed approximately the same percentage decline as that for the United States during the period 1968-1978. The incidence rates of coronary heart disease (angina pectoris, myocardial infarction, and sudden unexpected death) for the period 1950-1975 are based on a total of 3,080 cases. The incidence showed a decrease approximately 10 years earlier than the decline in mortality and little change since that time. The age-adjusted case fatality rate for the incidence cases of myocardial infarction decreased from 18.7% in 1965-69 to 9.0% in 1970-75. The death rate during the 5 years following the diagnosis of angina also decreased by almost 50%, and the myocardial infarction patients dismissed from the hospital showed little change in subsequent survivorship.

Adult↗
PubMed1981

Evaluation of the Del Mar Avionics automatic ambulatory blood pressure-recording device.

We have the opportunity to evaluate a portable ambulatory device for the recording of sequential indirect arterial blood pressure and continuous electrocardiogram (Del Mar Avionics automatic ambulatory blood pressure recording device). With careful attention to technique, only 11% of systolic and 5% of diastolic blood pressure readings differed by more than 10 mm Hg as compared with a trained technician's observations simultaneously in the same arm. The device has been useful in the evaluation of borderline (labile) hypertension, hypertensive drug therapy programs, and various episodic cardiovascular phenomena--for example, vasodepressor syncope and pheochromocytoma crises.

Adult↗
PubMed1980

Rectal cancer following colectomy for polyposis.

Reevaluation of 178 patients treated for multiple colonic polyposis by abdominal colectomy and restoration of bowel continuity confirmed that patients with both rectal and colonic polyps are at substantial risk of having rectal cancer develop postoperatively. Rectal cancer has not occurred in any of 35 patients who had no rectal polyps preoperatively. However, 46 (32%) of 143 patients with multiple colorectal polyposis have had cancer develop during a median follow-up of nearly 20 years. Multivariate analysis showed a highly significant association between the number of rectal polyps present preoperatively and decreased survivorship free of rectal cancer (P less than .001), and a strong correlation between the presence of cancer in the resected colon and subsequent development of rectal carcinoma (P less than .01). No correlation could be established between low anastomosis and prevention of rectal carcinoma. The risk of cancer developing in the retained segment of large bowel can be established only by extended postoperative observation.

Actuarial Analysis↗
PubMed1980

Incidence of Crohn's disease in Olmsted County, Minnesota, 1935-1975.

The incidence, trend over a 41-year period, prevalence, familial aggregation, and survivorship of Crohn's disease in the population of Olmsted County, Minnesota, are described. During the period 1935-1975, there were 103 incidence cases; the age-adjusted incidence rate per 100,000 rose from 1.9 (1935-1954) to 4.0 (1955-1964) and to 6.6 in the most recent period (1965-1975). The increase of the rate over the last 11 years is due largely to the increase among persons 20 to 29 years old. No difference in the rates by sex was found. The urban rates were higher than the rural for both sexes and in each interval of the study. The prevalence of Crohn's disease among the residents of Olmsted County on Jan. 1, 1976, was found to be 105.7 per 100,000 population. The relatively high prevalence rate reflects the chronic nature of the disease, the recent increase of incidence, the completeness of case ascertainment, and the high survival rate among these patients.

Adult↗
PubMed1980

Seizures after head trauma: a population study.

A cohort of 2747 patients with head injuries was followed for 28,176 person-years to determine the magnitude and duration of the risk of posttraumatic seizures. Injuries were classified as severe (brain contusion, intracerebral or intracranial hematoma, or 24 hours of eight unconsciousness of amnesia), moderate (skull fracture or 30 minutes to 24 hours of unconsciousness or amnesia), and mild (briefer unconsciousness or amnesia). The risk of posttraumatic seizures after severe injury was 7.1% within 1 year and 11.5% in 5 years, after moderate injury the risk was 0.7 and 1.6%, and after mild injury the risk was 0.1 and 0.6%. The incidence of seizures after mild head injuries was not significantly greater than in the general population.

Adolescent↗
PubMed1980

Day-to-day variability and analytic error in determinations of lipids in children.

In a pilot study, short-term (Monday, Wednesday, and Friday of the same week) variability of cholesterol and triglycerides in serum and in very low-density, low-density, and high-density lipoproteins were studied in 10 children aged 6 to 16. All of the subjects had normal levels of cholesterol and triglycerides. Analytic error was determined by blinded triplicate analyses of a fourth specimen from five of the same subjects. In the triglycerides, except for the smallest fraction (high-density), the differences from day to day in the same child were larger than the differences between children. The results indicate that single determinations of whole serum triglyceride carry limited significance since, within the week, the level may well change by a factor of two.

Adolescent↗
PubMed1979

The decreasing incidence of primary intracerebral hemorrhage: a population study.

This population study describes the experience with primary intracerebral hemorrhage (PIH) in residents of Rochester, MN, for the 32-year period from 1945 through 1976. The average annual age-adjusted incidence rate for PIH was 12.1 per 100,000 population, and the incidence for all cases of spontaneous intracerebral hemorrhage was 15.2 per 100,000. The PIH rates were higher for males than for females, and they increased steadily with age. When patients on long-term anticoagulant therapy were excluded, there was a steady decrease in the average annual age-adjusted incidence rate for PIH in each succeeding 8-year interval since 1945. Prehemorrhage hypertension, present overall in 89% of patients, was much more frequent and severe in the earlier years of the study. The frequency and severity of prehemorrhage hypertension also varied inversely with age in the population with PIH. The median age at the onset of PIH increased from 65 years for the period 1945 through 1952 to 71 years for 1969 through 1976.

Adult↗