Physiological activation of the human fibrinolytic system. Isolation and characterization of human plasminogen variants, Chicago I and Chicago II.
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The association of total serum cholesterol with mortality from coronary heart disease was examined in 1210 white men aged 42 to 60 in 1959 to 1963 and 1008 white men aged 45 to 64 in 1959 to 1969, followed up to 25 years from the Chicago Peoples Gas Company Study; in 1903 white men aged 41 to 57 in 1959, followed up to 24 years from the Chicago Western Electric Company Study; and in 17,880 white men aged 25 to 74 and 8327 white women aged 40 to 74 in 1967 to 1973, followed up to 18 years from the Chicago Heart Association Detection Project in Industry. In these studies total cholesterol level was related positively to coronary mortality in young men and in middle-aged and older men and women. Relative risks of mortality were generally higher in young and middle-aged persons compared to older persons, whereas absolute excess risks were generally greater in older than in younger persons.
An 18% reduction in the carboxyhemoglobin (HbCO) saturation in nonsmoking Chicago blood donors occurred between 1970 and 1974, indicating that current donors are being exposed to a lower average carbon monoxide (CO) concentration than had been experienced by 1970 donors. In contrast to the situation in 1970, when it was discovered that 74% of the nonsmokers in Chicago were being exposed to CO in excess of the amount permitted by the federal air quality standards, in 1974 only 41% of the nonsmokers were being overexposed. The observed reduction in HbCO correlates well with both the ambient CO levels recorded at the air monitoring stations and the reduction in CO emission from automobiles. If the current trend continues, Chicago should reach compliance with air quality standards for CO by 1985. The measurement of HbCO in a representative urban population is an accurate index of actual CO exposure and supplements the air pollution data provided by air monitoring stations.
The second clinical isolant in the United States and the Chicago area of the dermatophyte Microsporum racemosum has been made. The circinate macropapular lesion was on the dorsum of the right hand. It was vesicular with an erythematous border, was pruritic and developed rapidly to 5 cm in diameter. Within 48 hrs of the institution of systemic griseofulvin therapy and topical Burow's solution (1:20) symptoms subsided. Both this patient and the one reported by Daum and McCloud (4) live on the mid-northwest side of Chicago. So far the fungus has not been isolated from soil in the area.
In 1970, 250,000 Spanish-speaking persons resided in Chicago, 80,000 of whom were Puerto Rican. Because migration to Chicago is constantly occurring from areas where intestinal parasites are endemic, a survey was conducted in a predominantly Puerto Rican neighborhood to determine the prevalence of these parasites and to provide impetus for further case finding and treatment programs. The survey was part of an epidemiologic and cutreach workers going door-to-door obtained histories, hematocrits, and single stool specimens from 358 individuals. An overall intestinal parasite prevalence rate of 18.6% (67 persons) was found. Specific rates were Trichuris trichiura 13.9% (50 cases), hookworm 6.6% (24 cases), Giardia lamblia (3.9% (14 cases), and Strongyloides stercoralis 1.7% (6 cases). There were no cases of Ascaris lumbricoides or ENTAMOEBA HISTOLYTICA, Although several nonpathogenic protozoa were found. The most affected age groups were 15--24 years followed by 5--14. Two of the Giardia cases were individuals never out of the continental United States. An incidental finding was a high rate of low hematocrit readings not correlated with the parasite findings.
In several large Chicago companies and institutions, workplace screening of 7,151 persons yielded 833 suspect hypertensives. Of these, 91% attended a follow-up verification visit, where for 513 persons high diastolic pressure was confirmed. One-half of these persons were referred to their physicians for treatment and one-half were randomly assigned to be treated directly by HDFP, in a step-wise pharmacologic regimen to normalize diastolic pressure. Of the 257 persons assigned to program treatment, 94% accepted such treatment, and over 90% of these still living in the community were active participants at one year. Average diastolic pressure of these active participants was 83.1 mm Hg at one year, compared to 102.6 at first screen and 98.8 at the second confirmatory screening. A strenuous effort has been made to reduce or eliminate obstacles to treatment, including lack of understanding of the need for long-term therapy, cost barriers and barriers of inconvenience of treatment. The medical team conducting the program combined physicians with nonphysician therapist-health counselors, plus "outreach" staff, to maximize program adherence. Preliminary experiences in the Chicago Center of the Hypertension Detection and Follow-Up Program (HDFP) give encouraging evidence that the workplace is a useful base for successful hypertension control efforts.
Multivariate analysis of the association at baseline between problem drinking and cardiovascular risk factors among 1,233 white male employees of the Chicago Peoples Gas Company age 40-59 showed the 38 problem drinkers with significantly higher blood pressures and cigarette consumption and significantly lower relative weights than the others. Similar analysis among 1,899 white male employees of the Hawthorne Works of the Western Electric Company in Chicago age 40-55 showed the 117 men consuming 5 or more drinks per day with significantly higher blood pressures and cigarette use than the others. No significant differences were recorded between heavy drinkers and the others in serum cholesterol level. The gas company problem drinkers had significantly higher 15-year mortality rates from all causes, cardiovascular diseases, coronary heart disease, and sudden death. These differences could not be entirely explained by their blood pressure, smoking, and relative weight status. The Western Electric heavy drinkers had increased 10-year mortality rates both for all causes and noncardiovascular causes.
The largest laboratory-documented outbreak of St. Louis encephalitis (SLE) in the United States occurred in the Chicago metropolitan area in the summer and early fall of 1975. Of 1,456 illnesses investigated, 326 cases of confirmed or probable SLE and 420 cases of suspected SLE were found in the six-county area. The outbreak peaked in early September, but cases continued to occur through October. Cases clustered geographically in the southwestern suburbs. There was a direct correlation between age and attack rate, severity of illness, and mortality rate--all of which increased with successive age groups. Thirty-six persons died. Males and females were equally affected. This epidemic marked the first time that St. Louis encephalitis has been documented in the Chicago area.
A new variant of clinical galactosemia with two hitherto unidentified alleles on the transferase locus in one family is described. This new clinical variant of transferase has 25% of normal control activity in blood and in skin fibroblasts, and the patient accumulates galactose-1-phosphate in blood on an unrestricted galactose diet. Using starch gel electrophoresis on the hemolysate of the family members, a fast-moving transferase with mobility in between those of the normal control and of the Duarte variant is identified. This new allele is designated as GALTC1 (fast-moving Chicago variant). In addition, a second new allele was documented in this family by studying the instability of the transferase enzyme in hemolysates of family members at 50 degrees C for various time intervals. This new allele is designated as GALTC2 (heat-labile Chicago variant). On the basis of these studies, the transferase genotype of this patient is thought to be a double heterozygote compound, GALTC1/GALTG.
Between Jan 15 and March 15, 1971, forty-eight grade-school patients living in western Chicago were hospitalized with an encephalopathic illness. Fourteen of these children had illnesses compatible with Reye syndrome (encephalpathy with liver impairment). Most of the children showed evidence of central nervous system (CNS) dysfunction within ten days after onset of a febrile upper respiratory tract illness. Seizures developed in 11 of the 48 patients (including 4 of the 14 with Reye syndrome). Eight of the encephalopathic patients, including 6 of the 14 with Reye syndrome, died. Two children without Reye syndrome had abnormalities of liver enzymes coincident with cerebrospinal fluid pleocytosis. Sixteen of the 24 patients tested had titer rises in serum against influenza type B only; influenza type B was isolated from throat cultures of 2 patients. This, the seventh report of CNS complications (Reye syndrome) associated with influenza type B, suggests that surveillance for neurologic sequelae should become part of the epidemiologic evaluation of influenza epidemics.
Data are presented on 39,270 cultures taken over a 44 year span (1944-1988) at the University of Chicago's Dermatology Clinic. In the mid 1940's Microsporum audouinii accounted for 60-80% of isolates. It gradually decreased over the next two decades and disappeared altogether in the 1970's. Trichophyton rubrum, rare in the 1940's accounted for over 60% of isolates in the mid-1960's only to be overtaken by T. tonsurans. This species, not isolated till the mid 1950's, became and remains the dominant dermatophyte at the present time. Both T. mentagrophytes and Epidermophyton floccosum increased in the 1970's and decreased later. Unusual circumstances resulted in clusters of T. verrucosum, T. terrestre, and T. schoenleinii isolates. Infections were associated with rural dairy workers, zoo handlers and immigrant families respectively. M. canis and M. gypseum were steady at a low rate throughout the entire period. Rare isolates included M. cookei, M. persicolor, M. racemosum, T. simii, T. soudanense, T. violaceum, and the soil keratinophile, Aphanoascus fulvescens.
The current concepts of the etiologic factors and spread of carcinoma of the gallbladder are discussed. The experience at the university of Chicago with this condition over a period of thirty years is reviewed. Of eighty-two cases diagnosed during this time, 88 per cent of the patients died within one year of diagnosis and the five year survival rate was 5 per cent. The difficulties in diagnosis of cholecystic neoplasms are considered, and the possibility of increasing diagnostic accuracy by the use of celiac axis angiography, immunologic tests for tumor-associated antigens, peptide hormone assays, and cytologic study of duodenal juice is discussed. The place of palliative surgery in the management of cancer of the gallbladder is outlined. Means of improving the current high mortality of this condition are evaluated, and a plea is made for a controlled trial of the various forms of treatment that have been suggested.
In a northern Chicago neighborhood, observational and interview data were collected at parks, school lots, and beaches where adolescents congregate to buy, sell, and use nonopiate drugs. These sites were geographically distinct from areas where heroin is regularly distributed. Users at each area generally resided in the immediate neighborhood, were well known to one another, were predominantly male, displayed similar socioeconomic, religious and ethnic backgrounds, and had attended the same grade schools and high schools. These sites were relatively stable during the summer months, although visitors occasionally changed locations in response to police harassment. Attendance fluctuated with weather and time of day. Drug use was generally confined to the daily use of marihuana and weekend use of alcohol and sedative-hypnotics, but availability seemed to determine the type and frequency of drug use to a greater extent than drug perference. This study suggests the potential of a fieldwork model for prevention and intervention activities prior to the onset of more intense and diversified drug use.
The identification of a common mutation, delta F508, in the CFTR gene allowed, for the first time, the detection of cystic fibrosis (CF) carriers in the general population. Further genetic studies revealed > 100 additional disease-causing mutations in this gene, few of which occur on > 1% of CF chromosomes in any ethnic group. Prior to establishing counseling guidelines and carrier risk assessments, we sought to establish the frequencies of the CFTR mutations that are present in CF families living in the Chicago area, a region notable for its ethnic heterogeneity. Our sample included 283 unrelated CF carriers, with the following ethnic composition: 78% non-Ashkenazi Caucasians, 5% Ashkenazi, 9% African-American, 3% Mexican, 0.3% Native American, and 5% mixed ancestry. When a panel of 10 mutations (delta F508, delta I507, G542X, G551D, R553X, S549N, R1162X, W1282X, N1303K, and 1717-1G-->A) was used, detection rates ranged from 75% in non-Ashkenazi Caucasians to 40% in African-Americans. These data suggest that the goal of screening for 90%-95% of CF mutations may be unrealistic in this and other, similar U.S. populations.
This report is based on 13,231 tenth-grade students who participated in the Chicago Heart Association Pediatric Heart Screening Project. The blood pressures of these fifteen and sixteen-year-olds were analyzed with respect to sex, race, adiposity, pulse rate, and father's educational attainment. The mean systolic blood pressure was higher in boys than girls by nearly 5 mm Hg, but mean diastolic blood pressure was lower by less than 1 mm Hg. Black tenth-graders had higher mean diastolic blood pressure than whites; the difference in systolic blood pressure was not statistically significant. Adiposity and resting pulse rate were positively correlated with systolic blood pressure and, to a lesser degree, with diastolic blood pressure. After taking adiposity and pulse rate into account, father's educational attainment had a small but statistically significant negative association with diastolic blood pressure in white but not in black students. Nearly 5 percent of students were recalled for a second test because the initial screening blood pressures equaled or exceeded 150 mm Hg systolic or 90 mm Hg diastolic, and almost half of students at the recall examination continued to have pressures of 145/85 or greater.
In 150 middle-aged men prone to coronary disease, long-term data based on the Chicago Coronary Prevention Evaluation Program's diet showed that there was a favorable effect on fasting glycemia level and glucose tolerance. This diet for reducing obesity and hypercholesterolemia was low in cholesterol and saturated fat and moderate in polyunsaturated and total fat, with replacement of some fat by carbohydrate. At 2 years, decreased weight and serum cholesterol values of normoglycemic men were accompanied by a modest but significant fall in fasting and postload glycemia; at 4 years. fasting glycemia levels remained slightly below baseline. For men with suspect fasting hyperglycemia at baseline, sustained fall in weight and serum cholesterol value was associated with sizeable long-term reductions in fasting glycemia and improvement of glucose tolerance. Decrease in plasma glucose was significantly related to decrease in weight. No evidence of impairment of glucose tolerance with years-long consumption of this diet was recorded.
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