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Biomedical subjects

L R Elveback

Publications and source records attributed to L R Elveback.

At least 19 recordsLinked to original sources
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↗
PubMed1979

Remission of seizures and relapse in patients with epilepsy.

In a longitudinal study of patients with epilepsy in Rochester, Minnesota, we found that the probability of being in remission (at least 5 consecutive years seizure-free, and continuing) at 20 years after diagnosis was 70%. The rates for remission we encountered were generally higher than those previously reported. We believe that the better prognosis in our series results from inclusion of all incidence cases in a defined population, beginning at the initial diagnosis of epilepsy. Prognosis for remission of epilepsy is poor in patients with associated neurologic dysfunction identified from birth. Patients with idiopathic seizures and survivors of postnatally acquired epilepsy have better prospects for eventual remission. The probability of remission is highest in patients with generalized-onset seizures diagnosed before 10 years of age. Prognosis is less favorable for those with partial complex seizures and adult-onset epilepsy.

Adolescent↗
PubMed1979

Comparative effectiveness of dextrothyroxine and levothyroxine in correcting hypothyroidism and lowering blood lipid levels in hypothyroid patients.

Data reported here establish that treatment regimens of 4 mg dextrothyroxine and 0.15 mg levothyroxine in hypothyroid subjects produce similar degrees of lowering of serum TSH, cholesterol, triglycerides, and phospholipid levels and equal stimulation of metabolic rate. The Murphy-Pattee total T4 determination applied to blood samples drawn 24 h after the last dose of dextrothyroxine can be used to assess adequacy of treatment. Correction of hypothyroidism requires high serum levels of dextrothyroxine than of levothyroxine. Serum T3 levels increase in patients treated with dextrothyroxine. In the treatment of hypothyroidism, the cholesterol-lowering and metabolic rate-stimulating effects of dextrothyroxine do not appear to be dissociated. Further studies are needed to determine whether such an effect can be demonstrated in euthyroid hypercholesterolemic subjects with doses established herein as equivalent in terms of the stimulating effect on metabolic rate.

Basal Metabolism↗
PubMed1979

The risk of epilepsy following febrile convulsions.

A cohort of 666 children who had convulsions with fever were followed to determine the risks of subsequent epilepsy. High risks were found in children with preexisting cerebral palsy or mental retardation. Other major risk factors were atypical features of the febrile convulsions (such as focal seizures) and duration of febrile seizures for 10 minuts or more. The risk of developing epilepsy by age 20 was about 6 percent for all children who had experienced febrile convulsions. However, this risk figure consisted of a combination of 2.5 percent of children without prior neurologic disorder or atypical or prolonged seizures, and 17 percent of those with such complications.

Age Factors↗
PubMed1979

Cancer of the pancreas in Olmsted County, Minnesota, 1935-1974.

All confirmed cases of pancreatic carcinoma in bona fida residents of Olmsted County, Minnesota, from 1935 through 1974 were identified and reviewed. The average annual age-adjusted incidence rates were 7.4 for males and 3.5 for females per 100,000 population. Rates increased with age for both sexes and increased slightly over the 40-year period of study, with lower incidence rates observed for rural inhabitants in the first 2 decades. At the time of diagnosis, almost 75% of patients were 60 years of age or older and adenocarcinoma was histologically identified in 92% of the cases. One-year survival was 11%, and all patients died within 3 years of the initial diagnosis. An association between pancreatic carcinoma and diabetes was noted. There does not appear to be a clear association with cholelithiasis or chronic pancreatitis. There was a high percentage (20%) of multiple primary carcinomas and an overrepresentation of metal workers observed among patients with pancreatic carcinoma.

Adenocarcinoma↗
PubMed1979

Copper stains and the syndrome of primary biliary cirrhosis. Evaluation of staining methods and their usefulness for diagnosis and trials of penicillamine treatment.

Use of Shikata's stain was found to be a sensitive method for the demonstration of copper-protein complexes, but use of the rhodamine stain may be more reliable. Interobserver agreement was slightly better with Shikata's stain. Hepatic copper increased with the histologic progression of chronic nonsuppurative destructive cholangitis (CNDC). All specimens that contained Mallory bodies and most specimens (91%) that contained bile yielded positive copper stains. No correlation was found between positive copper stains and other histologic features. A strongly positive copper stain aided in the diagnosis of CNDC. All specimens with negative copper stains contained less than 250 microgram of copper per gram of dry weight. From a strongly positive copper stain, the chemical copper content could not be predicted with certainty. Shikata's method seemed adequate to evaluate penicillamine treatment trials.

Adult↗
PubMed1978

Carotid and vertebral-basilar transient ischemic attacks: effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence--a population study.

A population of 199 patients from Rochester, MN, was followed from the time of their first carotid or vertebral-basilar transient ischemic attack (TIA). Patients treated with anticoagulants had no significant difference in survival from untreated patients. Among patients with carotid TIA who received anticoagulants, the net probability of stroke was slightly but not significantly lower than in untreated patients. The difference favoring treated patients with vertebral-basilar TIA was significant starting at three months. The rate of intracranial hemorrhage was higher higher among all patients receiving anticoagulant treatment than among untreated patients and was significantly higher among those 55 to 74 years old. Almost all the hemorrhages occurred after a year or more of anticoagulant treatment and in patients more than 65 years old. Patients with high diastolic blood pressure had a significantly higher net probability of stroke than did patients with lower blood pressure and those receiving antihypertensive drugs. By implication, treatment of hypertension was effective in preventing stroke in patients with TIA. Linear discriminant analysis and actuarial analysis indicated that diastolic blood pressure and anticoagulant therapy were the only factors that influenced stroke occurrence. There was no suggestion that previous myocardial infarction, angina pectoris, valvular heart disease, cardiac arrhythmia, or congestive heart failure--individually or in combination--influenced the occurrence of stroke or survival.

Adult↗
PubMed1978

Investigation of statistical decision rules for sequential hematologic laboratory tests.

A statistical data processing program for identifying patients who are likely to have abnormalities on various hematologic laboratory tests is described. The prediction of abnormal levels of serum vitamin B12, serum folate, transferrin saturation, and reticulocyte counts is based on a statistical analysis of the patient's age, sex, and routine blood cell measurements. The program was developed using data from normal-value studies and data from patients who had these laboratory abnormalities. The sensitivity and specificity of the program were evaluated in a controlled prospective study of about 5,000 ambulatory adult patients. The program's predictions also were compared with the laboratory tests requested by the patients' attending physicians. The program was most sensitive for predicting low serum vitamin B12 (74%) and low transferrin saturation (78%). In the prospective evaluation, the predictive values varied from 11% for predicting low serum folate to 65% for predicting low transferrin saturation.

Adult↗
PubMed1978

Temporal arteritis: a 25-year epidemiologic, clinical, and pathologic study.

Among the population of Olmsted County, Minnesota, 42 patients with temporal arteritis were identified during a 25-year period. The average annual incidence per 100 000 population aged 50 and older rose from 5.1 in 1950-1959 to 17.4 in 1970-1974. The prevalence of patients with a history of the diagnosis of temporal arteritis on 1 January 1975 was 133 per 100 000 population aged 50 and older. All patients received corticosteroid therapy for a range of 1 to 77 months (median, 7 months). Relapses in 10 of 11 patients were associated with corticosteroid reduction. The majority of patients recovered fully and were followed off corticosteroids for 10 months to 19 years (median, 5 years). Temporal arteritis had no significant effect on survival. Vertebral compression fractures and myopathy were the most serious complications of therapy. The presence of giant cells in biopsies was in part related to the number of sections examined, and their presence had no apparent influence on the clinical course.

Adrenal Cortex Hormones↗
PubMed1978

Cholesterol and triglycerides in serum lipoproteins of young persons in Rochester, Minnesota.

Cholesterol and triglyceride levels in whole sera and in the major lipoprotein fractions are presented for 2,421 children and youths in Rochester, Minnesota, ranging in age from 6 to 18 years. This cross-sectional study revealed subtle changes associated with puberty and the occurrence of certain additional sex-specific changes related to age. Hyperlipoproteinemia was detected in 101 youngsters; those cases exemplified types IIa (61 cases), IIb (5 cases), III (5 cases), and IV (30 cases). One case of type V hyperlipoproteinemia was observed in a second and comparable population sample of 1,245 young persons.

Adolescent↗
PubMed1978

Neurologic complications of diabetes mellitus: transient ischemic attack, stroke, and peripheral neuropathy.

The incidence of TIA, stroke, and neuropathy was studied in a community-based maturity-onset diabetic population. The frequencies of TIA and stroke were increased in maturity-onset diabetic patients as compared to the population of Rochester, Minnesota. The median age of occurrence of TIA and stroke in diabetics was 74 years, not significantly different from that in non-diabetics. Diabetic patients with hypertension at the time of diagnosis of diabetes mellitus had an increased frequency of TIA and stroke. Control of hypertension and/or diabetes mellitus was associated with a decreased frequency of TIA or stroke. Obesity, clinical coronary heart disease, and an abnormal electrocardiogram at the time of diagnosis of diabetes mellitus were not associated with a significantly increased frequency of TIA or stroke. The most common type of peripheral neuropathy in diabetes mellitus was distal polyneuropathy. Mononeuropathy and autonomic neuropathy were much less frequent. The frequency of distal polyneuropathy increased with the duration of diabetes mellitus. The frequency of neuropathy was increased in patients with poor control, reemphasizing the importance of diabetic control in the prevention of diabetic complications.

Aged↗
PubMed1978

Leukemia in Olmsted County, Minnesota, 1965--1974.

Extending a study of the period 1935-1964, we determined the incidence rates of leukemia in Olmsted County during the decade 1965-1974. In this decade, the overall crude annual incidence rate was 9.5 per 100,000. The ratio of males to females was 2.4 to 1; and the incidence rate was significantly higher among males than among females, especially in the older age groups. Adjusted for age and sex, the mean annual incidence rate among males (17.3) was significantly higher than rates reported previously from other areas (ranging from 10.7 to 13); and it had increased significantly during the 40 years 1935-1974 in Olmsted County. The increase was most prominent in males aged 50 and over, and was detectable only in the subgroup with acute myelocytic leukemia. The observed number of farmers (8) was significantly higher than expected (2.8).

Adult↗
PubMed1978

Incidence of malignant neoplasms of all types of patients with Graves' disease.

The incidence of malignancy among patients with Graves' disease who were residents of one Minnesota county was examined in 342 patients between 1935 and 1967. During 4,736 person-years of observation, 32 malignancies were diagnosed; 24 cases were expected and the difference is not significant. Four cases of breast carcinoma were found vs five expected. Other tumor sites were cervix (five), uterus (two), rectosigmoid colon (three), stomach (two), larynx (two), and lung (two). There were three cases of leukemia, and in nine other sites one cancer each was recorded. There was a slightly higher than expected incidence of malignancy in patients who had received 131I therapy; this finding requires further study in a larger patient population. Among patients who received thyroid hormone, the observed incidence of breast cancer was not significantly different from the expected incidence in our population.

Adolescent↗
PubMed1978

HLA antigens in patients with juvenile diabetes and their first-degree relatives.

The relationship between HLA antigens and juvenile-onset diabetes mellitus was examined. Tissue typing for HLA antigens was carried out in 77 control subjects and in 133 individuals from 29 families, each of which contained one or more patients with juvenile-onset diabetes. A significant increase in the frequency of B18 antigen was found in the juvenile-onset index cases. In these index cases, the frequency of HLA antigens B8 and B15 was increased and the frequency of B7 and B12 was decreased, but these findings were not significantly different from those in the control subjects. Two examples of recombinations were noted among the 29 families, and in both instances the recombinations were present in the index case. In this selected population of diabetic patients and their first-degree relatives, there were three siblings (6%) who had juvenile-onset diabetes mellitus. This frequency of diabetes in siblings is much more than would be expected in individuals of the same age group. Two nondiabetic siblings had haplotypes identical to those of a diabetic sibling. These nondiabetic siblings may represent prediabetic individuals. The most frequent haplotype noted in diabetic patients and their first-degree relatives was A1, B8, which was present in approximately 25% of the index cases and first-degree relatives.

Adolescent↗
PubMed1977

Quantitation of left ventricular myocardial fiber hypertrophy and interstitial tissue in human hearts with chronically increased volume and pressure overload.

Using new techniques, we quantitated left ventricular myocardial fiber hypertrophy and interstitial tissue in four groups of autopsied hearts free of coronary disease: 1) 22 normal hearts, 2) 20 hearts from patients with mitral incompetence (NYHA Class II-III) who died early after mitral valve replacement from causes other than cardiac failure, 3) 22 hearts from patients with mitral incompetence (NYHA Class III-IV) who died early after mitral valve replacement from cardiac failure with low cardiac output syndrome, and 4) 22 hearts from patients with hypertensive heart disease (NYHA Class II-III). Myocardial fiber hypertrophy was quantitated by measuring cross-sectional myocardial fiber diameter; the proportion of interstitial tissue was quantitated by using a computerized, high-resolution video image-digitizing system. Myocardial fiber average diameter in groups 2, 3 and 4 was significantly higher than group 1. The proportion of interstitial tissue was significantly increased in group 3. In chronic mitral incompetence an increase in left ventricular interstitial tissue may play a role in the development of severe cardiac failure.

Cardiomegaly↗