123rc/medical_text huggingface dataset:
Facial bone fracture associated with carotid-cavernous sinus fistula. Out of 989 cases of facial bone fracture, ten patients had carotid-cavernous sinus fistulas (1.01%). Their ages ranged from 25 to 48 years. Seven were male and three female. Two of the ten patients had lower third, three patients had middle third, three patients had upper third, and two patients had combined middle and lower third facial bone fractures. The signs and symptoms of a fistula appeared from the first postinjury day up to 50 days after the injury (mean, 21 days). Four patients had symptoms after operation for facial bone fracture. Most fistulae were identified by arteriography before treatment. Followup ranged from 1 year, 8 months, to 5 years, 9 months (mean, 2 years, 9 months). One patient had a malocclusion. Nine patients had complete resolution of their bruits. Complications included unilateral complete visual loss (two), CSF rhinorrhea (two), and stroke in one of the two CSF rhinorrhea patients. One patient expired due to a severe head injury, and there was one death from an unrelated cause.
Nephropathy in model combining genetic hypertension with experimental diabetes. Enalapril versus hydralazine and metoprolol therapy. We compared the effects of the angiotensin-converting enzyme inhibitor enalapril and a conventional antihypertensive regimen (hydralazine and metoprolol) on kidney function, albuminuria, and glomerular ultrastructure in hypertensive diabetic and nondiabetic rats. Diabetes was induced with streptozocin at 8 wk of age in spontaneously hypertensive (SHR) rats. Antihypertensive drugs were administered in drinking water from the time of induction of diabetes in all groups. Blood pressure reduction was equal in the diabetic and nondiabetic SHR rats receiving either enalapril or hydralazine plus metoprolol. In diabetic SHR rats, there was a rise in serum creatinine after 32 wk, which did not occur in diabetic rats treated with either antihypertensive regimen or in nondiabetic rats. Both drug regimens reduced albuminuria in diabetic and nondiabetic SHR rats to a similar degree. Enalapril and the combination of hydralazine and metoprolol were associated with decreased glomerular basement membrane thickness and glomerular volume in diabetic and nondiabetic SHR rats without significant effect on fractional mesangial volume. Thus, antihypertensive therapy retards the development of albuminuria, glomerular basement membrane thickening, and glomerular hypertrophy in the rat in the presence or absence of diabetes. No specific benefit of angiotensin-converting enzyme inhibition was observed in these hypertensive models of nephropathy. Human studies comparing the effects of different classes of antihypertensive drugs on kidney function, proteinuria, and glomerular morphology are warranted.
Endoscopic appearance and significance of functional lymphangiectasia of the duodenal mucosa. Intestinal lymphangiectasia is found in a wide variety of pathologic conditions. Functional lymphangiectasia has not been well characterized. We report 20 patients followed for 9 to 55 months (mean 30 months) after incidental detection at endoscopy of lymphangiectasia. Our study indicates that functional lymphangiectasia is not pathologic and does not warrant repeat endoscopy in the absence of other clinical indications.
Postictal psychosis after partial complex seizures: a multiple case study. Bouts of unusually frequent partial complex seizures originating in the temporal lobe, that sometimes became secondarily generalized, induced psychotic episodes in 9 patients. In 7, the increase in seizures occurred at a time when antiepileptic drugs (AEDs) were being reduced during intensive EEG monitoring with a view to surgical treatment of intractable epilepsy. According to DSM-III-R criteria, the postictal psychosis resembled an organic delusional syndrome which was paranoid in 7 and schizophreniform in 1 and an organic mood syndrome in 1. A high incidence of ictal fear, of bilateral independent epileptogenic discharge, and of small foreign tissue lesion were unexpected findings and appeared to represent risk factors, especially in patients otherwise handicapped by an epileptic personality disorder. Recognition of postictal psychosis in this setting and in others is important both prognostically and therapeutically. Postictal psychosis does not constitute a contraindication to surgical treatment of epilepsy.
Popliteal artery aneurysms. Long-term follow-up of aneurysmal disease and results of surgical treatment. The natural history of aneurysmal disease was analyzed in 50 patients who were treated for 71 popliteal aneurysms. No patients were lost to follow-up (mean, 5.0 years). Initially, 25 popliteal aneurysms (25/71; 35%) were treated nonsurgically, and 46 (46/71; 65%) were treated surgically. Complications developed in 12 of the 21 asymptomatic popliteal aneurysms (57%) and in 2 of the 4 symptomatic popliteal aneurysms (50%), which were treated nonsurgically. The probability of developing complications increased with time to 74% within 5 years. When reconstruction of a popliteal aneurysm was performed, graft patency and foot salvage were 64% and 95% at 10 years, respectively. Particularly acute arterial thromboembolism was a severe presenting complication. Another important finding was the development of 23 arteriosclerotic aneurysms at other locations during follow-up in 16 patients (32%). The probability of developing these new aneurysms increased to 49% 10 years after repair of the initial popliteal aneurysm. The presence of multiple isolated aneurysms at the initial examination was the most significant risk factor limiting the survival of these patients. Consequently patients at risk could be identified early. This study confirms the limb-threatening potential of popliteal aneurysms when left untreated. Therefore prophylactic reconstructive surgery should be undertaken. Moreover, this study demonstrates that patients with a popliteal artery aneurysm have an increased risk of new aneurysm formation, both in the popliteal artery and at other locations. Therefore these patients should be followed and, in the event that new aneurysms develop, should be considered for elective reconstructive surgery to prevent limb-threatening or life-endangering complications.
Ogilvie's syndrome. Would you recognize it? Numerous conditions predispose to Ogilvie's syndrome, a process that mimics bowel obstruction. Characteristic radiographic findings of acute pseudo-obstruction include dilatation of the cecum and the remainder of the colon but not the small intestine. Treatment is individualized. Massive cecal dilatation carries the risk of cecal perforation and its attendant high mortality rate. Conservative therapies, such as nasogastric suction, gentle enemas, and use of a rectal tube, may be beneficial. Decompression by colonoscopy or other means may be necessary.
Second primary cancer following Hodgkin's disease: updated results of an Italian multicentric study. The risk of second primary cancer (SPC) was evaluated in 947 patients treated for Hodgkin's disease (HD) during the period January 1969 to December 1979. The median follow-up of this series was 10.5 years (range, 9 to 19). Treatment categories included radiotherapy (RT) alone (115 patients, 12%), chemotherapy (CHT) alone (161 patients, 17%), combined RT plus CHT (381 patients, 40%), and salvage treatment for resistant or relapsing HD (290 patients, 30.6%). Fifty-six SPCs were observed, occurring between 1 and 17 years from initial treatment. Among these, secondary acute nonlymphoid leukemia (s-ANLL) was the most frequent SPC (23 cases). Secondary non-Hodgkin's lymphoma (s-NHL) occurred in 5 patients, whereas a secondary solid tumor (s-ST) was observed in 28 patients. The calculated actuarial risk (+/- SE) of developing SPC was 5.0% (+/- 0.9%) and 23.1% (+/- 5.8%) at 10 and 19 years, respectively. Concerning treatment modalities and s-ANLL risk, no cases were observed in the radiotherapy group, whereas CHT plus RT and salvage groups showed the highest actuarial risk. This was, in fact, at 10 and 19 years, 3.1% (+/- 0.9%) and 8.1% (+/- 4.0%) in the former group, and 1.8% (+/- 1.0%) and 16% (+/- 9.0%) in the latter. A statistically significant difference was observed when the CHT plus RT group was compared with CHT and RT groups (P = .04). Concerning the relationships with chemotherapeutic regimens, 12 s-ANLL cases occurred in the mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) plus RT group, and only one case in the group receiving doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) plus RT. A statistically significant difference of s-ANLL actuarial risk was found comparing patients receiving MOPP plus RT to all other treatment groups (P = .04). With respect to s-ST, the actuarial risk at 10 and 19 years was 2.0% (+/- 0.6%) and 13.0% (+/- 3.8%), respectively. No significant differences were found among groups treated with different modalities. These data were confirmed by a multivariate analysis, which indicated treatment modality and age as independent variables for s-ANLL and s-ST development, respectively. Based on the prolonged follow-up analysis, the actuarial SPC risk at 10 years hereby reported should reflect the real SPC incidence in our series.
Transtelephonic defibrillation. STUDY OBJECTIVES: This study was undertaken to assess the safety and reliability of a device for transtelephonic defibrillation. DESIGN: The transtelephonic system consists of a patient unit and a base station. The patient unit contains a monitor-defibrillator, electrode pads, microphone, microprocessor, and DC defibrillator. The base station comprises a control panel, computer, and ECG display. SETTING: Fifteen patients who were treated in our emergency department for cardiac arrest were placed on patient units that activated our base station in a remote location within the ED. TYPE OF PARTICIPANTS: Thirteen patients were treated for ventricular fibrillation, and two patients were treated for ventricular tachycardia. INTERVENTIONS: Thirty-one shocks were delivered transtelephonically. MEASUREMENTS AND MAIN RESULTS: In all cases, voice and ECG transmission were established without difficulty. CONCLUSIONS: We conclude that this system represents a safe and reliable method for the treatment of ventricular fibrillation, and we advocate additional use to study the prehospital applications of transtelephonic defibrillation.
How selective is selective posterior rhizotomy? Although selective posterior rhizotomy has become an increasingly utilized surgical treatment for spasticity, the procedure is unstandardized and is performed differently at various medical centers. Most surgeons use some form of direct dorsal rootlet stimulation with intraoperative multichannel electromyographic response monitoring. Electrophysiological monitoring offers the theoretical advantage of identifying pathologic reflex circuits for interruption while preserving those pathways that are "normal." However, the monitoring technique most commonly used has not been critically evaluated and, therefore, its value remains uncertain. In 22 selective posterior rhizotomy procedures performed for spastic cerebral palsy, the authors were unable to identify a single electromyographic response that could be called normal by presently accepted criteria. Dorsal rootlets were chosen for division on the basis of relative degrees of abnormality. Intraoperative electromyographic monitoring of a nonspastic patient produced tracings suggestive of spasticity by presently accepted criteria. These discrepancies suggest that current electrophysiological monitoring in selective posterior rhizotomy should be reevaluated.
Hepatomuscular failure in septic catabolism: altered muscular response to plasma proteolytic factor in decreased hepatic mitochondrial redox potential. To estimate the contribution of muscle protein in whole-body protein catabolism, the muscular contribution index (MCI; urine 3-methylhistidine/urine total nitrogen) was determined in 49 cases of elective laparotomy, together with the arterial blood ketone body ratio (KBR; acetoacetate/beta-hydroxybutyrate), which reflects hepatic mitochondrial redox potential. MCI increased after operation and the occurrence of severe infection, provided KBR was maintained above 0.7. In patients with sepsis, however, MCI decreased dependently with KBR (n = 33; p less than 0.01). In these patients, plasma proteolysis-inducing activity determined by in vitro bioassay increased in inverse proportion to KBR (n = 20, p less than 0.01). Moreover, plasma concentrations of not only aromatic but also branched-chain amino acids markedly increased when KBR decreased to below 0.4 (n = 23; p less than 0.05). Thus the role of muscle protein in septic catabolism is diminished under reduced hepatic mitochondrial redox potential, despite the rapid increase of proteolysis-inducing activity. This finally leads to the failure of amino acid uptake by muscles, as well as liver. These results suggest that the deteriorated substrate exchange may form the metabolic background for multiple systems organ failure, which is often preceded by reduced KBR.
Therapeutic embolization: enhanced radiolabeled monitoring. Radiolabeling of Ivalon (polyvinyl alcohol sponge) particles permits localization of injected particles during embolization through the use of a portable gamma camera and provides a means to prevent potentially fatal complications such as pulmonary embolization. A more efficient technique of labeling Ivalon particles with technetium-99m sulfur colloid was developed. An increase in labeling efficiency allowed more accurate determination of the distribution of injected Ivalon particles. Scanning electron microscopy demonstrated the stability of the Ivalon particles during this new labeling process. Two patients with arteriovenous malformations underwent therapeutic embolization with radiolabeled Ivalon particles; gamma camera imaging of the lesion and chest was performed throughout the procedure.
Accuracy of prospective two-dimensional/Doppler echocardiography in the assessment of reparative surgery. Between January 1987 and January 1989, all 129 patients (aged 11 days to 25 years, median 39 months) undergoing both an echocardiographic examination and cardiac catheterization after reparative surgery were prospectively included in a study to assess the accuracy of combined two-dimensional and Doppler color flow imaging. The patient diagnoses were transposition of the great arteries (n = 20), tetralogy of Fallot (n = 38), coarctation of the aorta (n = 24), complete atrioventricular (AV) canal (n = 15), atrial septal defect (n = 8), ventricular septal defects (n = 3), pulmonary stenosis (n = 4), aortic stenosis (n = 8) and subaortic stenosis (n = 9). In arterial tract stenosis, there was high correlation between Doppler estimates and catheterization-derived measurements of residual right ventricular outflow tract obstruction in patients after the arterial switch operation for transposition of the great arteries (r = 0.95) as well as in patients after corrective repair of tetralogy of Fallot (r = 0.84). In semilunar/AV valve regurgitation, graded as none, mild, moderate or severe, echocardiographic estimates correlated exactly with angiographic grading in 84% and differed by one angiographic grade in the other 16%. In residual left to right shunting, no hemodynamically significant shunt was missed by echocardiography. For residual shunts at the ventricular level (n = 32), addition of Doppler color flow imaging improved the sensitivity (from 63% to 94%) and the negative predictive value (from 88% to 98%). In elevated right ventricular pressure, Doppler-derived right ventricular-right atrial pressure estimates in 24 patients correlated well with catheterization measurements (r = 0.93). Combined two-dimensional and Doppler color flow echocardiography was highly accurate in the prospective evaluation of these four types of postoperative residual.
Surgical management of carcinoid heart disease Metastatic carcinoid tumor is often seen with flushing, diarrhea, and cardiac symptoms--the carcinoid syndrome. Cardiac failure is often associated with major morbidity and mortality in carcinoid disease. In this report, a case of successful cardiac valvar surgical intervention has resulted in prolonged alleviation of cardiac symptoms and survival.
Radiation-induced cranial nerve palsy: hypoglossal nerve and vocal cord palsies. Cranial nerve palsies are an unexpected complication of radiotherapy for head and neck tumours. We present a case of this radiation-induced cranial palsy. An 18-year-old female with nasopharyngeal carcinoma developed a right hypoglossal nerve palsy 42 months after cancericidal doses of radiotherapy. In addition, she developed a bilateral vocal cord palsy 62 months after therapy. Follow-up over four years has demonstrated no evidence of tumour recurrence and no sign of neurological improvement.
Serum enzyme alterations in chronic muscle disease. A biopsy-based diagnostic assessment. The results of interpretation of muscle biopsies were compared retrospectively to activities of serum enzymes and isoenzymes. A total of 137 patients seen at the Cleveland Clinic Foundation in 1986 and 1987 were included in this study. Serum enzymes evaluated were CK, AST, LD, and aldolase (ALS), as well as the percentage CK-MB isoenzyme. The units of CK-MB and the ratios of CK to AST, LD, and ALS were calculated. Descriptive statistics, Kruskal-Wallis one-way analysis of variance, and stepwise logistic regression were performed. A diagnostic algorithm was constructed using a computer-assisted rule generation program. Myopathic diseases yielded a greater mean increase in serum enzyme activity than atrophic diseases. By multivariate stepwise logistic regression, increases in serum AST and CK activity were independently associated with the presence of inflammation in a muscle biopsy specimen. The diagnostic algorithm allowed for the separation of myopathies from atrophies and could identify cases of Duchenne's muscular dystrophy and polymyositis.
Postcardiotomy mechanical circulatory support in the elderly. The role of mechanical circulatory support after cardiac operations in elderly patients is not clearly established. Between November 1985 and July 1989, 18 patients 65 years of age or older (mean age, 71 years; range, 65 to 82 years) were treated after cardiotomy with a centrifugal vortex or pneumatic mechanical ventricular assist device. This group comprised 1.9% of the 926 patients 65 years of age or older undergoing cardiac surgical procedures and 69% of the 26 patients requiring postcardiotomy support during this interval. Before institution of mechanical support, all patients were receiving maximal inotropic support and 16 patients had intraaortic balloon pumps inserted. Univentricular support was used in 9 patients (6 left, 3 right) and biventricular support in 9 patients. The mean duration of support was 45 hours (range, 8 to 118 hours). Twelve patients (67%) were successfully weaned, 8 (44%) were discharged from the hospital, and 6 (33%) remain alive 11 to 31 months postoperatively. Four of the 6 survivors are in New York Heart Association class I, 1 is in class II, and 1 is in class IV. The Combined Registry for ventricular assist device support has recently reported an overall survival rate of 12% in patients 65 to 70 years of age and 6% in those older than 70 years. Our results are comparable with those reported for younger patients and justify the use of postcardiotomy ventricular assist device support in the elderly.
Abnormal epidermal changes after argon laser treatment. A 26-year-old woman with a congenital port-wine stain on the forehead was treated three times at 2-month intervals with an argon laser. Six months after the last treatment, moderate blanching and mild scaling confined to the treated area was observed. A biopsy specimen of the treated area revealed a significant decrease in ectatic vessels. However, epidermal changes similar to those of actinic keratosis with disorganized cell layers and marked cytologic abnormalities were seen. Analysis of peripheral blood lymphocytes for a defect in DNA repair was negative. Multiple, argon laser-induced photothermal effects may be responsible for the changes observed in our case and may lead to premalignant epidermal transformation.
Ultrasound-guided aspiration for transient synovitis of the hip. We reviewed 15 children with transient synovitis of the hip who had aspiration of an effusion under local anaesthesia with ultrasound guidance. There were no significant complications; aspiration was useful for diagnosis and gave considerable symptomatic relief. We discuss the role of ultrasound in diagnosis and treatment.
Left ventricular mid-cavitary obstruction after balloon dilation in isolated aortic valve stenosis in children. A hyperdynamic left ventricle can lead to post-dilation mid-cavitary obstruction in the absence of any preballoon mid-cavitary obstruction in children with aortic valve stenosis. The purpose of this study was to define the incidence and course of post-dilation mid-cavitary obstruction. We reviewed the catheterization and echocardiographic data of 35 patients, ages 3 days to 18 years (mean = 7.9 years), with isolated aortic valve stenosis who underwent balloon dilation with a fall in aortic valve gradient to less than 20 mm Hg. Post-dilation mid-cavitary obstruction was suspected from post-dilation left ventricular angiogram and was quantitated by echocardiographic and Doppler examinations performed immediately after dilation and in a 1-3 month follow-up period. Continuous wave Doppler directed by color flow Doppler was used for evaluation and differentiation of post-dilation mid-cavitary obstruction and residual aortic valve stenosis. Three children (3/35 [9%]) all under 2 years of age developed post-dilation mid-cavitary obstruction immediately after dilation. The obstruction within the cavity resolved spontaneously in all three patients. Conclusions: 1) Post-dilation left ventricular mid-cavitary obstruction can occur in children under 2 years of age after balloon dilation of severe aortic valve stenosis, and 2) total regression of post-dilation mid-cavitary obstruction occurs spontaneously in all patients.
Generation of "soft x-rays" by using the free electron laser as a proposed means of diagnosing and treating breast cancer. The diagnosis and treatment of breast lesions may be markedly enhanced by the use of a unique new source of near-monochromatic x-rays. Concentric beams of near-monochromatic x-ray photons may be generated by collision of the free electron laser (FEL) electron beam with the optical beam in an interaction zone that delivers the x-rays to a shirtsleeve environment. The absence of Compton scatter and the photoelectric interaction within tissues improves conspicuity of lesions by two to six times. Increased attenuation of x-rays in malignant vs. normal tissues makes tumors more obvious. K-edge subtraction allows chemical analysis of tumors in vivo--all at radiation doses that are one-tenth to one-fiftieth that delivered by the lowest-dose mammographic x-ray technique available. This allows for an increased sensitivity and specificity and permits prediction of histology, negating necessity for biopsies. Selective bond-breaking at depth in tissues as well as x-ray-activated photodynamic therapy are also being explored.