Melricflash/CW_MedAbstractsAlt huggingface dataset:
Flexion osteotomy of the femur for genu recurvatum after poliomyelitis. We report the results of 21 femoral osteotomies performed in 18 patients for genu recurvatum and flattening of the femoral condyles after poliomyelitis. Before operation the average angle of recurvatum was 31 degrees and all the limbs required bracing. After a mean follow-up of four years there has been partial recurrence in only one case. Nine patients (10 limbs) needed no orthosis and the others had less discomfort and an improved gait. Complete remodelling of the femoral and tibial epiphyses was noted in two of the younger patients. 

Category: general pathological conditions
Milk protein enteropathy after acute infectious gastroenteritis: experimental and clinical observations. Animal models of allergic gastroenteropathy have defined both morphologic and physiologic changes that accompany the immune-mediated reaction to a dietary protein. In such models a broadening of the allergic response to other dietary proteins present in the gastrointestinal tract may occur during the localized anaphylactic reaction. The characteristic histologic intestinal findings of food protein-induced enteropathy may develop in selected infants with protracted diarrhea after infectious enteritis. Mechanisms underlying the induction of this response remain to be explained, but they may in part be similar to the broadening of the hypersensitivity response seen in experimental models of allergic enteropathy. 

Category: general pathological conditions
Selective myectomy for postparetic facial synkinesis. Synkinetic movements are secondary to facial palsy because they appear like a late sequela to spontaneously healing facial nerve injury. They are produced by an involuntary contraction of a muscle group simultaneous with contraction of other homologous muscle groups. The disorderly regeneration of severed axons is responsible for these movements. According to the Lippschitz theory, the regenerating nerve fibers sprout into the wrong peripheral branches. Between 1975 and 1986, 71 patients with facial paralysis were evaluated. Spontaneous recovery from the facial paralysis occurred in 28 of these patients; 14 (50 percent) developed synkinetic movements, and surgical treatment was sought by only 6 patients. In all patients, the lesion of the facial nerve was in the trunk, proximal to the principal ramification. The most frequent clinical finding was simultaneous activation between the orbicularis oculi and the elevators of the corner of the mouth (12 patients) or the elevators of the upper lip (2 patients). In 8 patients, in whom the slight synkinesis was not noticed by the patients, surgical correction was not necessary, but in the other 6 patients with severe aesthetic disturbances, surgical treatment for "disconnection" of the wrong impulses was realized. I obtained this "disconnection" through resection of the involved perioral muscle groups instead of paralysis of the orbicularis oculi. Follow-up of the 6 patients operated with the surgical treatment proposed herein for between 4 and 8 years has shown good aesthetic results without functional or aesthetic sequelae. 

Category: general pathological conditions
Extracranial repair of cerebrospinal fluid fistulas: technique and results in 37 patients. Although neurosurgeons have traditionally preferred intracranial repair for the management of cerebrospinal fluid (CSF) fistulas, this approach is associated with the complications of a craniotomy, anosmia, and a high incidence of recurrent fistulas. Extracranial repair, on the other hand, produces no central nervous system morbidity, preserves olfaction, and is associated with a low incidence of recurrence. Although there have been several reports of extracranial repair of CSF fistulas by otorhinolaryngologists, this approach has received scant mention in the neurosurgical literature. We report here our experience with 37 patients with CSF rhinorrhea or otorrhea who underwent extracranial repair. The etiology of the fistula was postoperative in 22, traumatic in 6, and spontaneous in 9. The fistulas were repaired using one of four techniques: external ethmoid-sphenoid in 18 patients, transmastoid in 9, transseptosphenoid in 7, and osteoplastic frontal sinusotomy in 3. In 32 of the 37 patients (86%) the fistulas were successfully repaired with the initial procedure. Of the 5 patients requiring a second operation, the fistula was successfully closed in 4 for an overall success rate of 97%. Complications were few and consisted of a transient facial paresis in a patient undergoing transmastoid repair and one death from meningitis. The authors conclude that because of low morbidity and mortality and a high success rate in closing fistulas, extracranial repair is the preferred technique for the operative management of CSF rhinorrhea and otorrhea. 

Category: neoplasms
Naloxone and spinal fluid drainage as adjuncts in the surgical treatment of thoracoabdominal and thoracic aneurysms. Forty-seven patients who were treated for thoracoabdominal or thoracic aneurysms over a 5 1/2-year period were analyzed for neurologic deficit risk. Patients were divided into two groups for analysis. Twenty-four patients, who were treated from January 1984 to December 1986, did not undergo spinal fluid drainage or naloxone administration (group A). Twenty-three patients, who were treated from January 1987 to August 1989, had spinal fluid drainage (group B); 12 patients in this group also received naloxone as an intravenous drip at 1 microgram/kg/hr for 48 hours after surgery. Permanent neurologic deficits occurred in seven (29%) group A patients but in only one (4%) group B patient, who did not receive naloxone (p less than 0.03). The first two group B patients to receive naloxone showed complete reversal of neurologic deficits on waking from anesthesia. This significant reduction in neurologic deficit was associated with an increased 1-year survival rate (72% in group A, 91% in group B). We conclude that the use of naloxone and spinal fluid drainage reduces the incidence of neurologic deficit that is associated with repair of thoracoabdominal and thoracic aortic aneurysms. This reduction in neurologic deficit is associated with improved survival in the long term. The observed reversal of postoperative neurologic deficits with naloxone implicates opiates as a major factor in the pathophysiology of spinal cord ischemia. 

Category: nervous system diseases
Genetic analysis of breast cancer in the cancer and steroid hormone study. The familial risk of breast cancer is investigated in a large population-based, case-control study conducted by the Centers for Disease Control. The data set is based on 4,730 histologically confirmed breast cancer cases aged 20 to 54 years and on 4,688 controls who were frequency matched to cases on the basis of both geographic region and 5-year categories of age, and it includes family histories, obtained through interviews of cases and controls, of breast cancer in mothers and sisters. Segregation analysis and goodness-of-fit tests of genetic models provide evidence for the existence of a rare autosomal dominant allele (q = .0033) leading to increased susceptibility to breast cancer. The effect of genotype on the risk of breast cancer is shown to be a function of a woman's age. Although, compared with noncarriers, carriers of the allele appear to be at greater risk at all ages, the ratio of age-specific risks is greatest at young ages and declines steadily thereafter. The proportion of cases predicted to carry the allele is highest (36%) among cases aged 20-29 years. This proportion gradually decreases to 1% among cases aged 80 years or older. The cumulative lifetime risk of breast cancer for women who carry the susceptibility allele is predicted to be high, approximately 92%, while the cumulative lifetime risk for noncarriers is estimated to be approximately 10%. 

Category: neoplasms
Emergent aneurysm surgery without cerebral angiography for the comatose patient Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhage (SAH). These grading scales are less applicable to patients with life-threatening intraparenchymal hematomas after aneurysmal rupture. During the last 3 years, four patients in a comatose state with brain stem compression syndromes documented by computed tomographic scans have undergone emergent operation in our neurosurgical service. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the onset of coma to skin incision was 3.02 hours (range, 1.67-6.5 hours), and the average delay from arrival in our unit until skin incision was 1.8 hours (range, 0.75-2.5 hours). The condition of two arousable patients deteriorated while they were in the emergency room, presumably from new bleeding. Each patient underwent craniotomy for hematoma evacuation, definitive aneurysm clipping, and lobectomy for decompression. Temporary clipping was employed in one patient, and intraoperative rupture occurred in two others. Three patients survived but retain significant disability. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression. 

Category: cardiovascular diseases
Establishment and characterization of unique cell lines (KCC-1a and KCC-1b) from endometrial adenocarcinoma with clear cell carcinoma presenting unusual karyotypes and estrogen secretion. Human endometrial adenocarcinoma cell lines (KCC-1a and KCC-1b) were established from a resected endometrial carcinoma of a 67-year-old woman. The original tumor showed the bimorphic patterns of tubular adenocarcinoma and clear cell carcinoma. The cell lines have been maintained for 50 months through 100 passages. The doubling time of KCC-1a was 87 hours, whereas that of KCC-1b was 144 hours. The number of chromosomes of KCC-1a distributed in a range from 33 to 79, whereas that of KCC-1b distributed in a range from 64 to 82 (mode, 76). Functionally, both KCC-1a and KCC-1b cells showed the productions of estrone (E1) and estradiol (E2) but not estriol (E3) or progesterone (P). These cells grown in a serum-free medium secreted E1 (KCC-1a, 13.6 pg/ml; KCC-1b, 9.5 pg/ml) and E2 (10.5 pg/ml, 9.5 pg/ml) at passage 40. Neither KCC-1a nor KCC-1b cells contained estrogen or progesterone receptors. Tumor markers--alpha-fetoprotein, carcinoembryonic antigen, CA 125, and CA 19-9--were not detected. Both KCC-1a and KCC-1b cells produced tumors in nude mice xenografts. Histologically, the tumors of KCC-1a cells were clear cell carcinoma, whereas those of KCC-1b cells were tubular adenocarcinoma. These findings suggest that KCC-1a and KCC-1b cells will provide useful information to clarify the histogenesis of endometrial carcinoma combined with clear cell carcinoma. 

Category: neoplasms
Surgical treatment of laryngeal web with mucosa graft. Surgical treatment of laryngeal webbing varies with the extent and site of the web. An extensive one seems to be best treated by laryngofissure and skin or mucosa transplantation. Recent experiences with four cases of thick glottal webbing indicated that a mucosa graft was better for the voice result than a skin graft. For success in the airway and voice results, the salient points in surgery include 1) precise midline thyrotomy, 2) shaping of the vocal cord under fiberoptic control, and 3) mucosa grafting with the combined use of a pliable stent or fibrin glue for fixation. 

Category: general pathological conditions
Durability of vein graft revision: the outcome of secondary procedures. Occlusive lesions that reduced graft blood flow and ankle systolic pressure were identified in 83 femorodistal saphenous vein bypasses by use of duplex scanning or arteriography. Sites of stenosis included vein conduit (n = 41), anastomoses (n = 20), outflow arteries (n = 15), or inflow (n = 9) arteries. One hundred three secondary procedures consisting of vein-patch angioplasty (n = 31), sequential (n = 21) or interposition (n = 17) graft placement, percutaneous transluminal balloon angioplasty (n = 17), or excision of the lesion and primary anastomosis (n = 16) were performed to correct primary (n = 85) or recurrent (n = 18) graft stenoses. Cumulative graft patency after reintervention was 96% at 1 year, and 85% at 5 years. Stenosis or occlusion of revision sites was less after excision (0 of 16) or replacement (1 of 17) of abnormal segments compared to vein-patch angioplasty (8 of 31) or balloon angioplasty (9 of 18). Sequential or jump grafts constructed to improve graft outflow impaired by either myointimal or atherosclerotic occlusive lesions were the least durable secondary procedures. Five of eight graft failures in this series resulted from sequential/jump graft occlusion. All categories of secondary procedures normalized graft and limb hemodynamics, although only one third of patients reported symptoms of limb ischemia before revision. Surveillance of infrainguinal vein bypasses for occlusive lesions is a valid concept to salvage patent but hemodynamically-failing grafts. Secondary procedures that excised the lesion, used autologous tissue reconstruction, and normalized hemodynamics at the revision site and in the vein bypass were associated with a low incidence of restenosis and prolonged graft patency. 

Category: general pathological conditions
Mucosal characteristics of pelvic ileal pouches. This study aimed to investigate the degree of colonic metaplasia in ileo - anal pouches. Biopsy specimens from 25 patients with functioning pouches, eight of whom had pouchitis, were studied using routine histology, mucosal morphometry, mucin histochemistry, and immunoperoxidase staining with monoclonal antibodies directed towards a 40kD colonic protein and a small bowel specific disaccharidase-sucrase isomaltase. Thirteen patients (including all eight with pouchitis) had subtotal or total villous atrophy and crypt hyperplasia. In this group, nine had colorectal type sulphomucin and the 40kD colonic protein was detected in two. These changes were not observed in patients with less severe villous abnormalities. Sucrase-isomaltase activity was, however, present in all 25 pouch specimens. We conclude that although some ileal pouches acquire certain colonic characteristics, complete colonic metaplasia does not occur. 

Category: general pathological conditions
Ectopic thyroid tissue in the submandibular region. This report describes an unusual location of ectopic thyroid gland tissue. A growth in the left submandibular area was surgically excised, and the microscopic examination of the specimen revealed thyroid tissue with colloid goiter. Because this entity cannot be clinically distinguished from a salivary gland tumor, ectopic thyroid tissue should be considered in the differential diagnosis of swellings involving the submandibular area. 

Category: neoplasms
Maternal and fetal effects of labetalol in pregnant ewes. Labetalol has been advocated to rapidly decrease blood pressure in preeclamptic women and to blunt the hemodynamic response to tracheal intubation. To assess labetalol's actions in a setting of uterine vasoconstriction, saline or labetalol (1 mg/kg) was infused into maternal venous catheters in 12 pregnant ewes receiving continuous maternal intravenous infusions of norepinephrine. Norepinephrine increased maternal mean arterial pressure (MAP) to 120 +/- 4% of control and decreased uterine blood flow to 45 +/- 6% of control. Labetalol, but not saline, altered these parameters: it decreased MAP to 101 +/- 3% and increased uterine blood flow to 70 +/- 7% of prenorepinephrine values. In the second protocol, to assess the degree of labetalol-induced fetal adrenergic blockade, 7 pregnant ewes received, on separate days, saline or labetalol (0.3, 1.0, 3.0 mg/kg) via a maternal venous catheter. Maternally administered labetalol produced minor (less than 12%) decreases in maternal and fetal MAP, without significantly altering heart rate (HR). At each labetalol dose, the degree of alpha- and beta-adrenergic blockade, determined by phenylephrine and isoproterenol challenge, was greater in the ewe than in the fetus. In the near-term pregnant ewe, intravenous (iv) bolus administration of labetalol ameliorated the effects of increased circulating norepinephrine on maternal MAP, uterine blood flow, and fetal pH and arterial O2 tension (PaO2), and produced less adrenergic blockade in the fetus than in the mother. 

Category: cardiovascular diseases
The technicon H6000 analyzer discriminates chronic lymphocytic leukemia from other B-cell leukemias through automatic assessment of large unstained cells. The separation of chronic lymphocytic leukemia of B-cell origin from other chronic B-cell leukemias is subjective, being largely based on the morphologic features of the lymphoid cells in the peripheral blood. The percentage of large unstained cells determined with a Technicon H6000 analyzer (an automated blood cell differential analyzer, Technicon Instruments Corp, Tarrytown, NY) was used as a cell volume variable in an investigation of 70 cases of chronic lymphocytic leukemia of B-cell origin and of other chronic B-cell leukemias. The significant degree of correlation between the percentage of large unstained cells and morphoimmunophenotypic diagnosis, although obtained for a relatively small number of cases, suggests that this method of cell volume analysis can be used to improve diagnostic reproducibility in chronic B-cell leukemia. 

Category: neoplasms
Overnight admission of outpatient strabismus patients. The trend to outpatient strabismus surgery prompted us to determine the frequency of, and the reasons for, postoperative overnight hospital admission following such surgery. In one year, 303 outpatient strabotomies were performed at the Jules Stein Eye Institute on patients over 15 months old. Twenty-four (7.9%) were admitted overnight postoperatively. Compared with controls, those admitted were older (37 vs 20.5 years), and had a longer duration of anesthesia (145 vs 116 minutes) and surgery (104 vs 75 minutes) (P less than .01 for each). The time that surgery commenced and the use of perioperative medications were not significant factors. The most frequent reasons for overnight admission were nausea (38%) despite prophylaxis and the use of bilateral patches (16%). To minimize postoperative admissions, better strategies should be developed to decrease the frequency of significant postoperative nausea, the duration of surgery and anesthesia, and, if possible, the use of bilateral patches. 

Category: general pathological conditions
Accessory arm--dysraphism or disparity? Case report. The case of a 3-month-old infant with an accessory third arm is reported. The extra appendage was attached at the midcervical region and was associated with posterior cervical dysraphism and a cervical cord lipoma. Possible theories of origin are examined. 

Category: neoplasms
Stroke in systemic lupus erythematosus [published erratum appears in Stroke 1991 Mar;22(3):417] We investigated the clinical and pathologic characteristics of stroke in 234 patients with systemic lupus erythematosus. Thirteen patients (5.6%) developed cerebrovascular disease. Cerebral infarction was noted in eight, cerebral hemorrhage in two, and subarachnoid hemorrhage in three. In seven (54%) of these 13 patients, stroke occurred less than or equal to 5 years after systemic lupus erythematosus was diagnosed. Among the predisposing risk factors for stroke, hypertension was the most important. Lupus anticoagulant was detected in three (38%) and anticardiolipin antibody in three (43% of seven investigated) of the patients with infarction. Evaluation of the clinical manifestations and autoantibodies indicated that renal involvement and high titers of anti-deoxyribonucleic acid antibody were more frequent in the stroke group than in the non-stroke group. Autopsy studies on six of the patients with stroke revealed small infarcts and hemorrhages in all, but in no case was true angiitis observed. Libman-Sacks endocarditis was found in two of the three patients with infarction. In conclusion, the important contributory factor to the development of stroke in patients with systemic lupus erythematosus is considered to be hypertension mediated by immunologic abnormalities. Antiphospholipid antibodies and Libman-Sacks endocarditis are closely associated with occlusive cerebrovascular disease. 

Category: cardiovascular diseases
The acute aseptic meningitis syndrome. The acute aseptic meningitis syndrome is an entity that presents a diagnostic challenge to the clinician. Although many infectious and noninfectious etiologies exist for this syndrome, viruses, especially nonpolio enteroviruses, are the classic and most important agents encountered. The incidence of polio and mumps meningitis has declined dramatically in the vaccine era, but recently described pathogens, such as human immunodeficiency virus and Borrelia burgdorferi (Lyme disease agent) are now important considerations in the differential diagnosis. Specifically treatable entities (eg, mycobacterial or fungal meningitis, herpes simplex encephalitis, parameningeal infection) that may mimic aseptic meningitis in their initial presentations must not be overlooked. A careful approach to the patient and a rational use of laboratory studies are the basis for establishing a specific diagnosis and assuring a favorable outcome. 

Category: nervous system diseases
Direct measurement of skeletal muscle fatigue in patients with chronic heart failure. Skeletal muscle function was measured as force production and fatigue in both the quadriceps (a large locomotive muscle) and adductor pollicis (a small intrinsic hand muscle) in five healthy volunteers, five patients with mild chronic heart failure, and five patients with severe chronic heart failure. The quadriceps of patients with chronic heart failure had a reduced muscle cross sectional area, a reduced maximum isometric force production, and an increased tendency to fatigue. Isometric force production and fatigue of the adductor pollicis, however, were not significantly different between the three groups under control conditions. But during circulatory occlusion fatigue in the adductor pollicis increased more in the patients with severe chronic heart failure. These differing findings in quadriceps and adductor pollicis suggest that skeletal muscle atrophy and reduced isometric force production are not a necessary consequence of chronic heart failure per se, because they were only present in the large locomotive muscle. The normal values for muscle fatigue observed in adductor pollicis in patients with chronic heart failure imply that skeletal muscle blood flow must increase normally during muscle activation when only a small muscle mass is used. These results are not compatible with the concept of a generalised impairment of normal vasodilatation within active skeletal muscle. In contrast, activation of a large muscle, such as quadriceps, results in the rapid onset of fatigue in patients with severe chronic heart failure. This fatigue may be related to the inability of the cardiovascular system to provide the required blood flow for the activation of a large muscle mass. 

Category: general pathological conditions
Colonoscopy in critically ill patients. What conditions call for it? Indications for colonoscopy in the intensive care unit include acute lower intestinal bleeding, sigmoid volvulus, pseudo-obstruction of the colon, and suspicion of pseudomembranous colitis. Although the incidence of cardiorespiratory complications may be higher in these critically ill patients, the procedure can be done safely with proper attention to detail. Because of colonic dilatation, endoscopy can often be done without bowel preparation. 

Category: digestive system diseases