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Biomedical subjects

L R Elveback

Publications and source records attributed to L R Elveback.

At least 73 records · Page 4Linked to original sources
PubMed1977

Survival predictors in coronary artery disease. Medical and surgical comparisons.

Linear discriminant function analysis was used to test the independent prognostic value of nine variables in patients with coronary artery diseaase. For 68 medically treated patients who met the criteria for inclusion in the discriminant function analysis, the most reliable predictor of 2-year survival status was the left ventricular ejection fraction. The prognostic value of the ejection fraction was not improved by the addition of the number of vessels diseased. Comparisons of the survival of 130 medical and 284 surgical patients were made using subsets based on the ejection fraction. When the ejection fraction was greater than or equal to 50%, the probability of 4-year survival was high for both medical (91%) and surgical (96%) groups. When the ejection fraction was less than 25%, the probability of 2-year survival was low in both groups. However, for patients with ejection fraction 25 through 49%, the surgical patients had a better chance (P less than 0.05) for a 3-year survival (89%) than did medical patients (68%). This study emphasizes the prognostic significance of the left ventricular ejection fraction, which should be considered in any comparison of survival in medically and surgically treated patients.

Age Factors↗
PubMed1977

Pleural fluid complement, complement conversion, and immune complexes in immunologic and nonimmunologic diseases.

Forty-four pleural fluids and 41 blood specimens from patients with various diseases were examined for concentration of whole complement, C4, C3, conversion products of C3 and C3PA, and immune complexes. C3 conversion was found in all eight pleural fluids from patients with rheumatoid arthritis, five of seven with lupus erythematosus, two of six with congestive heart failure, and nine of 23 with malignant diseases. Conversion of C3PA correlated closely with C3 conversion and both were significantly inversely related to whole complement, C4, and C3. Concentration of immune complexes was highest in patients with rheumatoid arthritis. Pleural fluid immune complex concentrations correlated positively with conversion of C3 and C3PA. These findings suggest that the reduced levels of pleural fluid complement in rheumatoid arthritis and lupus erythematosus may be secondary to complement conversion by immune complexes.

Antigen-Antibody Complex↗
PubMed1977

The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974.

A population-based study of mumps orchitis over a 40-year period in Rochester, Minnesota, is reported. All medical records for patients with orchitis, atrophic testis, parotitis, and diagnosed or suspected mumps for the population of Rochester were reviewed, and detailed abstracts were prepared for all those with mumps orchitis. Information abstracted included the relationship of testicular to parotid involvement, the presence of unilateral or bilateral testicular involvement and subsequent atrophy, the presence of other complications of mumps, the treatment of mumps orchitis, and the presence of other major diagnoses. Also investigated was the number of subsequent congenital malformations in male offspring of these patients. The age distribution of the patients with orchitis (median age, 29 years) differed appreciably from those with mumps (median age, 8 years). There was no apparent increase in genitourinary malformations in the male offspring conceived after the occurrence of mumps orchitis in the fathers. Of the 132 men who had orchitis, 2 subsequently had testicular neoplasms. Both of these patients were in the group of 47 who were noted to have an atrophic testis after the occurrence of orchitis.

Adolescent↗
PubMed1977

Incidence of malignant testicular tumors in the population of Rochester, Minnesota, 1935 through 1974.

Twenty-four cases of testicular neoplasms detected in male Rochester residents over a 40-year period were identified using the Rochester-Olmsted County epidemiologic data base. This resource contains nearly complete medical information on residents of Rochester, Minnesota, and the surrounding community. An incidence rate of 3.7/100,000 males per year was calculated. This agrees well with other rates reported in the literature which range from 2.5 to 3.7/100,000 per year; there was no detectable trend over time.

Adolescent↗
PubMed1977

Carotid and vertebral-basilar transient cerebral ischemic attacks. A community study, Rochester, Minnesota.

THE purpose of this study was to determine the difference in prognosis among patients with transient ischemic attacks (TIA) in the carotid arterial system and those with TIA in the vertebral-basilar arterial system. Nearly twice as many patients had TIA in the carotid system as had TIA in the vertebral-basilar system. The survival rates for patients with carotid TIA and those with vertebral-basilar TIA were similar. In both groups, the survival rate was lower than the expected survival rate, but only for the patients with carotid TIA was the difference significant. There was no significant difference in the probability of the occurrence of stroke between patients with carotid TIA and those with vertebral-basilar TIA. These data also indicate that the risk of stroke is much greater soon after the onset of TIA in either arterial system. Among all patients with TIA, the primary cause of death was cardiac disease. The causes of death had a similar distribution for patients with carotid TIA, for those with vertebral-basilar TIA, and for those with "mixed" or "unknown" types of TIA.

Carotid Artery Diseases↗
PubMed1977

Alkaline phosphatase activity in the plasma of children and adolescents.

We determined plasma (serum alkaline phosphatase activity in 854 healthy students of the Rochester, Minnesota, public schools. Prepubertal girls had somewhat greater upper limits than did boys, and there was a low trend of increasing activity in both sexes. At the beginning of adolescence increasing activities were observed, which peaked at ages 11 to 12 years in girls and at ages 13 to 14 in boys. Adult values were not reached until six to eight years later. In 180 pairs of siblings, a significant intraclass correlation was noted. A possible role of alkaline phosphatase in the regulation of protein synthesis is suggested.

Adolescent↗
PubMed1977

HLA antigens in patients with giant cell arteritis and polymyalgia rheumatica.

The frequency of 24 HLA antigens was determined in 43 patients with giant cell arteritis (25 of whom had polymyalgia rheumatica) and 12 others with polymyalgia rheumatica without evident arteritis. No haplotype was present in significantly increased frequency above controls in the total group nor when the patients were separated according to the presence or absence of polymyalgia rheumatica.

Giant Cell Arteritis↗
PubMed1976

Carcinoma of the supraglottic larynx. A review of 221 cases.

Between 1962 and 1971, 221 patients (197 men and 24 women) with carcinoma of the supraglottic larynx were treated at our institution. Most of the patients were in the sixth and seventh decades of life. In 89% of the patients, the epiglottis was involved. One hundred ninety patients underwent surgery, 161 for cure initially and 29 for salvage after radiation failure. Definitive surgery included laryngectomy in 117 patients and conservation procedures in 40. Fifty-five patients were treated by radiation for cure. Survival rates after laryngectomy or supraglottic laryngectomy were similar, but radiation therapy carried a poorer prognosis than did definitive surgery. Routine neck dissection was not necessary in all patients with supraglottic carcinoma.

Aged↗
PubMed1976

Comparison of serum cholesterol in children fed high, moderate, or low cholesterol milk diets during neonatal period.

The long-term effects of milk diets in infancy on the blood serum cholesterol concentrations were studied in 97 school children 7-12 yr of age. Detailed histories were available for these children with respect to their diets during infancy. The major criterion for inclusion in the study was milk (human milk, cow's milk, or commercial formula) as the exclusive source of diet cholesterol during the first 3 mo of life. Fasting blood cholesterol and triglycerides were measured in these 97 school children, and the current diets of 29 of the 97 were evaluated for daily cholesterol intake. A 7-day diet diary was recorded, the food intake was measured and analyzed for nutrients, and validity of the diets was verified by determination of urinary nitrogen excretion. Results of the study showed that the school children fed a low cholesterol formula during infancy had a mean serum cholesterol value 7-12 yr later that was lower than the mean values of the groups fed greater amounts of cholesterol in infancy. Analysis of current diets of 29 of the 97 school children showed that their current dietary intake of cholesterol was low. Dietary intake of cholesterol did not have a noticeable effect on the serum cholesterol levels of the 29 children.

Animals↗
PubMed1976

An influenza simulation model for immunization studies.

A stochastic simulation epidemic model based on discrete time intervals and appropriate for any infectious agent spread by person-to-person contacts is presented. The population is highly structured, allowing for five age groups and for subgrouping mixing in families, neighborhoods, schools, and preschool playgroups as well as total community mixing. With proper choice of relative susceptibility by age, length of latency and infectivity periods, pathogenicity and withdrawal patterns, and the relative infectiousness of silent infections, the model becomes highly agent-specific. The model includes flexible immunization routines and variable vaccine response patterns. The model is applied to the 1957 Asian and 1968 Hong Kong pandemic strains of influenza A. The results of several schedules of immunization of school children are presented and compared for the two strains.

Adolescent↗
PubMed1976

Seizure disorders in offspring of parents with a history of seizures - a maternal-paternal difference?

If the patterns of seizure disorders in parents and offspring could be assessed accurately, some insight might be gained into the relative role of genetic and environmental factors in the development of convulsive disorders. In this study 908 children born in a Rochester, Minnesota hospital from 1922 through 1972 whose mother or father had a verified and classified diagnosis of seizure have been followed from birth for evidence of any convulsive episode or seizure disorder. The observed numbers of various types of convulsions in the offspring are compared to the expected the number based on local age-specific incidence rates. The outstanding finding was that a higher than expected number of children whose mothers had epilepsy also suffered from seizures (epilepsy or febrile convulsions), whereas no such increase was detected among the children of affected fathers.

Age Factors↗
PubMed1976

Ischemic heart disease in patients with epilepsy.

It has been suggested that patients with epilepsy and particularly those on long-term anticonvulsant medication may have a lower than expected risk of ischemic heart disease. The records of a cohort of patients with epilepsy in Rochester, Minnesota were reviewed to ascertain their rates of occurrence of ischemic heart disease. The results did not show any relative decrease in the incidence or mortality rates due to ischemic heart disease among men or women with epilepsy. The numbers of ischemic heart disease incidence and mortality cases were 25 and 15, respectively, relative to corresponding expected values of 15.0 and 15.7 new and fatal events. The use of anticonvulsant medications did not appear to influence the rates of ischemic heart disease among the patients with epilepsy. Subgroups of the epilepsy patients, by etiology and types of epilepsy, were not found to account for a disproportionate share of the ischemic heart disease. The survivorship of epilepsy patients after the initial manifestations of ischemic heart disease was comparable to that expected among all ischemic heart disease patients.

Adult↗
PubMed1976

Contrasting features and responses to treatment of severe chronic active liver disease with and without hepatitis BS antigen.

To determine the clinical implications of HBSAg in severe chronic active liver disease (CALD), patients with HBSAg positive CALD were compared with those chosen by identical clinical, functional, and morphological criteria in whom this test and anti-HBS were negative. HBSAg positive patients were predominantly males over 40 years of age and more frequently failed to respond to conventional treatment programmes with prednisone. HBSAg negative patients were more often female and younger, had a higher incidence of associated immunopathic disease and immunoserological markers in high titre, and more often responded to treatment with full remission of their disease. HBSAg positive patients failing treatment with conventional doses of prednisone often improved with higher doses, but did not reach full remission of their disease. The benefit-risk ratio of both conventional and high doses of prednisone in HBSAg positive severe CALD needs further clarification.

Adult↗
PubMed1976

Diabetes mellitus: incidence, prevalence, survivorship, and causes of death in Rochester, Minnesota, 1945-1970.

The incidence and prevalence of diabetes mellitus in residents of Rochester, Minnesota, for 25 years (1945 to 1970) were determined from available medical records. The over-all incidence rate for diabetes is 133 new cases per 100,000 population per year (age-adjusted to 1970 U.S. white population). The rate increased with age for both men and women and was higher among men over 30 years of age. The average annual incidence rates per five-year period for juvenile-onset diabetes mellitus were low and variable and showed little change. Polyuria, polydipsia, glycosuria, lean habitus, loss of weight, and high levels of fasting hyperglycemia at initial diagnosis occurred more frequently in younger than in older patients. The peak incidence in 1960 through 1964 and the decrease in the following five years may be a reflection of the introduction of the AutoAnalyzer method for blood glucose in 1958. The average annual incidence rates for 1955 through 1959 and 1965 through 1969 were essentially the same. The over-all prevalence for diabetes mellitus is 1.6 per cent, with a higher rate among men than among women over 40 years of age; among school children the rate is 0.1 per cent. Survivorship in the diabetic population is lower than that in the general population. The leading cause of death was coronary heart disease, the death rate from it being higher than for the general population.

Adolescent↗
PubMed1976

HL-A antigens in Behcet's disease.

Twenty-six patients with Behcet's disease had complete HL-A typing. No patient had an HL-A antigen in significant excess. No patient had an HL-A antigen in significant excess. Only two patients had the B27 antigen: both patients had uveitis, but eight others who also had uveitis were B27 negative. No patient had ankylosing spondylitis or sacroilitis. Behcet's disease, although bearing some clinical resemblances to diseases related to the B27 antigen, i.e. ankylosing spondylitis and Reiter's syndrome, differs from them through the absence of spondylitis and because the association with B27, if it exists, is far weaker than that in ankylosing spondylitis or Reiter's disease.

Adolescent↗
PubMed1976

Insulinoma: clinical and diagnostic features of 60 consecutive cases.

Insulinoma is a rare tumor, occurring more often in women and in the older age range. Eighty percent of patients have a single benign tumor, usually less than or equal to 2 cm in diameter, located with about equal frequency in body, head, or tail of the pancreas and amenable to surgical cure. About 10% have multiple tumors; in this group there is a high incidence of multiple endocrine neoplasia type I syndrome. The remaining 10% of patients have metastatic malignant insulinoma. Symptoms are intermittent, recur at irregular intervals in the food-deprived state over a median of 1 1/2 years, and arise from varying degrees of neuroglycopenia. Symptoms often lead to misdiagnosis as a neurologic or psychiatric disorder. Transient neurologic deficits and EEG abnormalities can be observed during hypoglycemia. Diagnosis requires repeated demonstration of hypoglycemia (glucose less than or equal to 40 mg/dl) during spontaneous or provoked symptoms, relief with ingestion of carbohydrates, simultaneous hyperinsulinemia (serum insulin greater than 6 muU/ml), and absence of insulin antibodies. A useful diagnostic adjunct is the intravenous tolbutamide test, for which new diagnostic criteria are presented.

Adenoma, Islet Cell↗
PubMed1976

Management and prognosis of multiple myeloma.

Patients with asymptomatic or smoldering multiple myeloma should not be treated but should be observed closely for progression. For symptomatic myeloma, chemotherapy is indicated. Melphalan, the agent of choice, should be given with prednisone for 1 week of every 6 weeks, If melphalan brings no response, or response and then relapse, cyclophosphamide (Cytoxan) should be give intravenously every 4 weeks or orally every day. BCNU, CCNU, and doxorubicin (Adriamycin) have also shown activity in myeloma. Hypercalcemia occurs in one-third of patients and should be countered with hydration, corticosteroids, Neutra-Phos, or mithramycin. Long-term hemodialysis has achieved some success. The combination of sodium flouride and calcium carbonate produces new bone formation; it seems a useful adjunct in treatment for myelomatous bone disease. Radiation should be utilized only for severe, localized pain or for solitary lesions. Survival with multiple myeloma varies, mean durations being 2 to 3 years. Multivariate analysis indicates that serum creatinine and calcium levels are the most significant indicators regarding 2-year survival. We have found monoclonal proteinuria not significantly more frequent with renal insufficiency than with normal renal function, renal insufficiency not significantly more frequent with lambda than with kappa chains, and survival not significantly greater with IgG myeloma than with IgA.

Anemia↗