Lumbar spondylolisthesis: a rational approach to conservative treatment.

Forth-seven patients with symptomatic back pain secondary to spondylolisthesis who were not surgical candidates were instructed in a treatment program that included flexion or extension or combined flexion-extension exercises. At follow-up, symptomatic changes were correlated with the type of exercise program. Patients treated with flexion-type exercises were less likely to require use of back supports, require job modification, or limit their activities because of pain.

Carotid sinus reflex in patients undergoing coronary angiography: relationship of degree and location of coronary artery disease to response to carotid sinus massage.

Heart rate and blood pressure responses during and after carotid sinus massage were examined in 66 patients just before coronary angiography. A significant relationship was found between heart rate and blood pressure responses and (1) angina pectoris class, (2) total coronary artery disease score and (3) presence of high-grade (> 90%) stenosis of any of the three major coronary arteries. Only patients with contraction abnormalities of the anterolateral left ventricular region had greater cardionhibitory responses than patients with normal left ventricular angiograms.

Are elevated pancreatic polypeptide levels in patients with insulinoma secondary to hypoglycaemia?

In 13 patients with insulinoma, human pancreatic polypeptide (hPP) was measured under basal conditions, after a mixed meal, and during a fast of up to 72 h. Significant negative correlatons between hPP and plasma-glucose levels were found both under basal conditions and during fasting. Patients with insulinoma and basal plasma-glucose values above 60 mg/dl had hPP values similar to those in control subjects, whereas insulinoma patients with plasma-glucose values under 60 mg/dl had significantly higher hPP values (323 versus 115 pg/ml).

Azathioprine with prednisone for polymyositis. A controlled, clinical trial.

A controlled, prospective, double-blind, therapeutic trial of azathioprine was conducted in the initial therapy of polymyositis. Sixteen patients received 60 mg prednisone per day plus either azathioprine (2 mg/kg of body weight per day) or placebo for a period of 3 months. Creatine phosphokinase (CPK) levels fell to normal slightly sooner in the placebo group, but not significantly so.

Clinical features, prognosis, and response to treatment in polyarteritis.

Fifty-three patients with polyarteritis who were followed up for at least 2 years were defined clinically and studied retrospectively to determine the influence of clinical factors and treatment on the prognosis. There was a spectrum of severity of disease, and the 5-year survival in the group was 55%. A small number of patients had evidence of ongoing immune-complex disease, as indicated by the presence of cryoglobulins or hepatitis Bs antigen or by diminished serum complement.

Use of medical services and satisfaction with ambulatory care among a rural Minnesota population.

Patient satisfaction with health care services and the use of ambulatory care in rural southeastern Minnesota were surveyed before and after physician manpower was increased. This report is confined to the findings in 1974, before the three local practicing physicians were joined by two additional physicians. The physician to population ratio at the time of the initial survey was 1 to 6,200 in 1974 and 1 to 2,500 with the additional physicians in 1975.

Experience with the extracardiac conduit.

A review is made of all Mayo Clinic cases wherein 468 patients have received 516 extracardiac conduits in the repair of congenital heart defects. All patients had complex defects, which are classified in 10 basic diagnostic categories. The early mortality rate (which ranged from 4% to 49%, according to diagnostic group) averaged 25%, improving with experience.

Evaluation of vented blood culture media with sorbitol.

Two consecutive studies comparing the recovery of microorganisms from transiently vented blood cultures in tryptic soy or brain heart infusion broth with added sorbitol and that from tryptic soy broth without sorbitol failed to demonstrate any significant advantage of hypertonic media. A significantly greater number of organisms was isolated in both studies from the medium without sorbitol.

Evaluation of a biphasic medium for blood cultures.

A study comparing the recovery of microorganisms from a transiently vented biphasic brain heart infusion medium bottle and a vacuum bottle containing tryptic soy broth demonstrated that growth was initially detected on the slant of the biphasic bottle or on a routine subculture of either broth in nearly 50% of instances. All organisms were isolated equally well in both bottles, with the exception of Staphylococcus aureus, which was isolated significantly more frequently from the biphasic bottle, and anaerobic bacteria, which were isolated significantly more frequently from the tryptic soy broth bottle.

Mechanical cornpicker hand injuries.

The mechanical cornpicker causes tearing anse injuries from 1962 to 1975 were studied with regard to mechanism and extent ohe time of injury in 36% of hands, and in 73% of the remainder following treatmophylaxis, and antibiotics, and 73% hands required some form of delayed surgical treatment. Antibiotics did not appear to be helpful. Eighty-nine ps the most common cause given for farmers for their injuries.

Comparison of three immunoassays for immune complexes in rheumatoid arthritis.

Three widely used radioassays that depend on different principles for the measurement of circulating immune complexes (CIC) in biologic fluids are the monoclonal rheumatoid factor (mRF), Raji cell, and C1q binding tests. A comparison of the ability of these methods to measure immune complex-like material in 71 sera and 30 synovial fluids of 91 patients with rheumatoid arthritis (RA) was carried out by a group working in adjacent laboratories in a single institution. The highest number of abnormal levels in the seropositive group was detected by the C1q binding assay (91%).

Idiopathic membranoproliferative (mesangiocapillary) glomerulonephritis: a clinicopathologic study.

In 51 patients with type 1 and 9 patients with type 2 membranoproliferative glomerulonephritis, we found a male predominance in both types, a wide age range but with younger patients having predominantly type 2 disease, and clinical presentations that varied and included the nephrotic syndrome, an abnormal urinalysis only, acute nephritis, and recurrent hematuria. Hypertension and impaired renal function at the time of first evaluation, which were present in more than one-third of the patients, presaged a poor prognosis; in most of these patients end-stage renal failure or worsening of renal function occurred. Acute nephritis at onset was also related to a deteriorating course and was especially frequent in patients with type 2 membranoproliferative glomerulonephritis.

Immune responsiveness in patients with choroidal malignant melanoma.

We studied selective in vivo and in vitro immunologic factors of 25 patients with choroidal malignant melanoma. Immune profile factors did not show consistent differences between patients with melanoma and an age-matched control population. The studies were also non-contributory in delineating variations in immunocompetence with respect to melanoma cell types.

Acute lymphoblastic leukemia in children: immunologic, cytochemical, morphologic, and cytogenetic studies in relation to pretreatment risk factors.

Thirty children with previously untreated acute lymphoblastic leukemia were studied prior to therapy to determine whether sheep erythrocyte (E)-receptor status correlated with clinical factors, cytochemical staining characteristics, FAB morphologic classification, and karyotype. Five patients (17%) with more than 50% E+ blasts had intense focal acid phosphatase staining and distinct clinical characteristics, including high leukocyte counts, mediastinal masses, and involvement of the central nervous system at diagnosis. Focal acid phosphatase activity was present in blasts of patients with greater than 20% E+ blasts, but this group had fewer poor risk factors.

Treatment of diffuse proliferative lupus nephritis with prednisone and combined prednisone and cyclophosphamide.

To evaluate the effectiveness of cyclophosphamide in the treatment of lupus nephritis, we designed a prospective study of patients with diffuse proliferative lupus nephritis. Twenty-six patients received prednisone (average dose, 40 mg per day) and 24 combined prednisone (average dose, 29 mg per day) and cyclophosphamide (average dose, 107 mg per day) for six months. Thereafter, all patients received maintenance doses of prednisone.

Comparison of three blood culture media with tryptic soy broth.

Four consecutive studies comparing commercially prepared bottles that contained brain heart infusion, brucella (vented and unvented), and Trypticase soy broths with Tryptic soy broth failed to demonstrate significant differences in rates of isolation of organisms from blood. Statistically significant differences between bottles were limited to the average times required to detect growth of viridans streptococci in one study and of all organisms in another.

Class of immunoglobulin deposition and prognosis in lupus nephritis.

In the three major morphologic groups of lupus nephritis--diffuse, focal proliferative, and membranous--glomerular deposition of immunoglobulins is usually a combination of IgG, IgM, and IgA and is not a good indicator of initial renal severity or outcome. In this study of 60 patients with systemic lupus erythematosus and nephritis, patients with exclusive or predominant glomerular deposition of IgG did not have more severe renal disease or a worse prognosis than those with combined IgG-IgM deposition.

Total hip arthroplasty.

A review of 333 consecutive Charnley total hip arthroplasties four to seven years after operation showed that twenty-eight patients had died, and three deaths were directly related to the surgery. The survivors had an average improvement of 46.6 points in their evaluation scores to a level of 91.

Effect of cation content of agar on the activity of gentamicin, tobramycin, and amikacin against Pseudomonas aeruginosa.

Fifty-five strains of Pseudomonas aeruginosa were tested against arithmetic increments in concentrations of gentamicin, tobramycin, and amikacin in 14 different lots of Mueller-Hinton agar. The divalent cation content of each lot was determined by atomic absorption spectrometry. The relation between mean minimal inhibitory concentration (MIC) for strains within each lot and cation content was studied by stepwise regression.

Circulating immune complexes in systemic lupus erythematosus. Association with other immunologic abnormalities but not with changes in renal function.

In a study of the usefulness of two widely performed tests for immune complexes (IC) in the assessment of disease activity of lupus nephritis the Raji cell assay detected IC in sera of 14 of 32 patients and the monoclonal rheumatoid factor (MRF) test in only five. There was a close correlation of levels of IC with number of organ systems showing disease activity and with serum complement levels and a somewhat less significant correlation with serum levels of anti-DNA. Although in a few patients levels of IC closely paralleled improvement in renal function with treatment, there was no overall correlation of changes of levels of IC with changes in creatinine clearance.

Deep wound sepsis following total hip arthroplasty.

After follow-ups ranging from two to five years on all but four (five hips) of 2,694 patients who had 3,215 total hip arthroplasties, deep wound infection had been demonstrated in forty-two hips (1.3 per cent). The infections among the 3,210 hips appeared during the immediate postoperative period or as long as five years after surgery.