Melricflash/CW_MedAbstractsAlt huggingface dataset:
The diagnosis and definition of hepatic malignancies by use of arterial enhanced computerized tomographic scanning. Axial computerized tomography is a useful tool in the evaluation of either primary or metastatic hepatic neoplasms. An adjunct to this technique is visceral arterial enhanced computerized tomography (AECT). To determine the effectiveness of this modality, bolus intravenous enhanced computerized tomography scans and AECT were compared and correlated to operative findings. Fifty-four consecutive patients were evaluated by AECT and bolus intravenous enhanced computerized tomography over a 30-month period (May 1986 to August 1989) for suspected primary or metastatic hepatic malignancies. Forty-four patients (81%) had hepatic lesions. Fifty-two percent (23 of 44 patients) of the metastatic tumors were from colonic or rectal primary lesions, and 20% were hepatocellular primary lesions. The remainder of the lesions were metastases from a variety of primary lesions. When studies were compared, 34% of the patients (15 of 44 patients) differed in either the location or total number of lesions noted. The lesions of three of the 15 patients (20%) were determined unresectable on the basis of AECT. Of the remaining patients, planned resections were revised in seven patients to either lesser or greater procedures. The number of lesions found at laparotomy equaled the number found by AECT in all but two cases. AECT caused no complications. AECT improved our ability to identify and localize primary and metastatic lesions of the liver. This technique offers the advantage of preoperative definition of the hepatic arterial and portal venous anatomy. 

Category: neoplasms
Salvage of branch vessels during bifurcation lesion angioplasty: acute and long-term follow-up. To evaluate angiographic success, frequency of branch vessel loss and salvage, and long-term outcome, we studied the early and late outcomes of 56 consecutive patients who underwent PTCA of bifurcation lesions, which involved the left anterior descending or left circumflex coronary artery, with stenoses greater than 70% in both the parent and an involved branch vessel. In 35 patients (63%), the PTCA strategy was attempted dilation of both the main vessel and the involved branch vessels using predominantly a double-wire, sequential balloon technique; in 21 (27%) the PTCA attempt was confined to the main vessel alone. Transient angiographic occlusion of the branch vessel occurred in 32% of patients in whom dilation of both vessels was attempted, and in 38% in whom the main vessel alone was dilated (p = NS); 91% of the occluded branch vessels were the salvaged when sequential angioplasty of both vessels had been initially planned, compared to only 38% when the initial strategy had been dilation of the main vessel alone (p less than .05). Predischarge exercise testing showed residual ischemia in 6% of patients who had both vessels successfully dilated, versus 37% in those in whom dilatation was confined to the main vessels (p less than .01). Clinical restenosis, defined as late (greater than 6 weeks) recurrence of angina or a positive exercise test, occurred in 42% of patients who had both vessels successfully dilated. Thus although bifurcation lesion angioplasty frequently results in transient branch vessel loss, these branches can usually be salvaged using a double-wire technique but tend to have a higher late restenosis than conventional single vessel PTCA. 

Category: cardiovascular diseases
Massive histamine release in a patient with systemic mastocytosis. We have measured plasma histamine concentrations, systemic vascular resistance, cardiac output and arterial pressure during laparotomy in a patient with systemic mastocytosis. The patient developed vasodilation and hypotension during surgery, associated with a massive increase in plasma histamine concentration. 

Category: cardiovascular diseases
Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. The diagnostic yield of transesophageal and transthoracic echocardiography for identifying a cardiac source of embolism was compared in 79 patients presenting with unexplained stroke or transient ischemic attack. There were 35 men and 44 women with a mean age of 59 years (range 17 to 84); 52% had clinical cardiac disease. Both transthoracic and transesophageal echocardiograms were performed using Doppler color flow and contrast imaging. Transesophageal echocardiography identified a potential cardiac source of embolism in 57% of the overall study group compared with only 15% by transthoracic echocardiography (p less than 0.0005). Compared with transthoracic echocardiography, transesophageal echocardiography more frequently identified atrial septal aneurysm associated with a patent foramen ovale (9 versus 1 of 79 patients, p less than 0.005), left atrial thrombus or tumor (6 versus 0 of 79 patients, p less than 0.05) and left atrial spontaneous contrast (13 versus 0 of 79 patients, p less than 0.0005). All cases of left atrial thrombus or spontaneous contrast were identified in patients with clinically identified cardiac disease. In the 38 patients with no cardiac disease, transesophageal echocardiography identified isolated atrial septal aneurysm and atrial septal aneurysm with a patent foramen ovale more frequently than transthoracic echocardiography (8 versus 2 of 38 patients, p less than 0.05). The two techniques had a similar rate of identifying apical thrombus and mitral valve prolapse. Overall, transesophageal echocardiography identified abnormalities in 39% of patients with no cardiac disease versus 19% for transthoracic echocardiography (p less than 0.005). Thus, transesophageal echocardiography identifies potential cardiac sources of embolism in the majority of patients presenting with unexplained stroke. 

Category: cardiovascular diseases
Intra-abdominal palpation of a nasogastric tube in the stomach does not assure appropriate placement. Improperly placed nasogastric (NG) tubes have been associated with considerable morbidity. The only reliable indicator of correct NG tube placement appears to be the aspiration of gastric contents. We have reported a case of major morbidity from an improperly placed NG tube that perforated the cervical esophagus, dissected the mediastinum, and terminated in the omental bursa. No gastric aspirate was obtained by suctioning of the tube, but correct placement was presumed based upon the surgeon's direct intraoperative palpation of the tip of the tube. Failure to aspirate gastric contents should alert the practitioner to the possibility of improper NG tube placement. 

Category: digestive system diseases
Intradural chordoma of the tentorium cerebelli. Case report. A rare case of intradural chordoma is described. The literature contains seven examples of intradural extraosseous chordoma, all reported in a ventral location. This is the first reported case of a primary intradural chordoma distant from the clivus and involving both the supra- and infratentorial compartments. 

Category: nervous system diseases
Indications for distal arterial reconstruction in the presence of palpable pedal pulses. Eight patients with severe pedal ischemia in the presence of palpable foot pulses are described. All had atherosclerosis, and seven patients also had diabetes. There were two anatomic patterns of disease, including supramalleolar obstruction with reconstitution of pulsatile flow in three patients and segmental occlusion of the pedal vessels in five. All patients underwent arterial reconstructive surgery. Patency was sustained in six patients, with limb salvage in five and below-knee amputation in one patient for persistent necrosis and infection of an open amputation. Of the two eventual bypass failures, a transmetatarsal amputation continued to heal in one patient, and the other required amputation below the knee. Palpable pedal pulses and satisfactory ankle/brachial indexes did not rule out the presence of surgically correctable distal arterial occlusive disease. Therefore arteriography is indicated in any patient with persistent forefoot ischemia that fails to respond to conservative measures. The safety and patency of the distal reconstructive procedures performed in this series suggest that salvage of weight-bearing tissue and rapid healing, as well as limb salvage, are legitimate indications for revascularization. 

Category: cardiovascular diseases
A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer [published erratum appears in JAMA 1991 Sep 11;266(10):1362] To quantify the effect of estrogen replacement therapy on breast cancer risk, we combined dose-response slopes of the relative risk of breast cancer against the duration of estrogen use across 16 studies. Using this summary dose-response slope, we calculated the proportional increase in risk of breast cancer for each year of estrogen use. For women who experienced any type of menopause, risk did not appear to increase until after at least 5 years of estrogen use. After 15 years of estrogen use, we found a 30% increase in the risk of breast cancer (relative risk, 1.3; 95% confidence interval [CI], 1.2 to 1.6). The increase in risk was largely due to results of studies that included premenopausal women or women using estradiol (with or without progestin), studies for which the estimated relative risk was 2.2 (CI, 1.4 to 3.4) after 15 years. Among women with a family history of breast cancer, those who had ever used estrogen replacement had a significantly higher risk (3.4; CI, 2.0 to 6.0) than those who had not (1.5; CI, 1.2 to 1.7). 

Category: neoplasms
High cardiac output as a paraneoplastic syndrome. A high cardiac output (17 1 min-1) was recorded in a young man suffering from lymphoplasmatocytotic lymphoma. The evolution of the blood disease was characterized by two relapses, during which clinical signs of heart failure were prominent but resolved with efficient blood chemotherapy. The known aetiologies of high cardiac output were excluded. The complete normalization of the cardiac parameters with blood remission suggests that the high cardiac output represented an unusual paraneoplastic syndrome, the pathogenesis of which still remains unknown, although several hypotheses were tested. 

Category: cardiovascular diseases
Advances in molecular biology. Potential impact on diagnosis and treatment of disorders of the thyroid. Advances in molecular biology research continue to have a major impact on clinical medicine. These advances have provided a means to produce proteins previously available in limited supply and allow for the production of novel proteins that are improved agonists or else antagonists with greater specificity for therapeutic targets. Newer drug delivery systems should facilitate delivery of these proteins. By combining the capabilities to produce drug targets in acceptable quantities with improved methods for determining the three-dimensional structures of these targets, novel organic therapeutic molecules that act on these targets will be designed. Gene transfer therapy using genes that express important proteins or that encode "antisense" RNAs that inhibit the translation of specific mRNAs will soon become a reality. The use of RFLPs and PCR methodologies promises increased means to diagnose specific genetic diseases and infections. Most importantly, molecular biology is helping to understand the mechanisms of disease such that novel diagnostic and therapeutic approaches can be described. These advances are providing an understanding of the mechanisms involved in cancers of the thyroid gland. They have already led to an enhanced understanding of (1) the growth factors that control proliferation of the thyroid gland, (2) the potential steps in thyroid nodule and neoplasia development, (3) particular mutations that may occur as thyroid cancers develop, (4) oncogenes that are expressed in thyroid cancers, and (5) the genetic defects that are responsible for thyroid gland malignancies in the multiple endocrine neoplasia (MEN) syndromes. With the latter, the RFLP technology has already provided an enhanced means to diagnose the disorder. With further progress, enhanced means for diagnosis and treatment should emerge. Molecular biology techniques are contributing to an increased understanding of the mechanisms of development of autoimmune thyroid disease as with Graves' disease and Hashimoto's thyroiditis. The potential role of infections, histocompatibility antigens, thyroid gland and extraglandular antigens, immune modulators, subpopulations of T-cells such as suppressor and helper cells, other cells involved in immune responses, and a combination of influences of several different functions on the thyroid gland are being defined. This knowledge should soon suggest improved means for diagnosis and treatment. Understanding of the function of the thyroid hormone receptors should have clinical importance. This knowledge suggests a means to develop thyroid hormone antagonists that may be used to more rapidly ameliorate the effects of hyperthyroidism and could be useful in nonthyroidal disorders such as cardiac arrhythmias.(ABSTRACT TRUNCATED AT 400 WORDS). 

Category: neoplasms
Pelvic lipomatosis associated with cystitis glandularis and adenocarcinoma of the bladder. Pelvic lipomatosis is a rare condition characterized by an overgrowth of normal fat in the perivesical and perirectal spaces. Cystitis glandularis, cystica or follicularis has been observed in 75% of the patients with pelvic lipomatosis. Although cystitis glandularis is widely regarded as premalignant few reports have documented its transition to adenocarcinoma. We describe a 41-year-old man with pelvic lipomatosis in whom primary adenocarcinoma of the bladder developed 6 years after a histological diagnosis of cystitis cystica and glandularis was established. To our knowledge this is the second case reported of pelvic lipomatosis associated with proliferative cystitis and adenocarcinoma of the bladder, indicating that intestinal metaplasia of the urothelium may be a precursor of malignancy in these patients. 

Category: neoplasms
An estimate of the incidence of dementia in idiopathic Parkinson's disease. The proportion of patients with idiopathic Parkinson's disease (PD) who are considered demented ranges from 10% to 15%. Because dementia may affect survival in PD, the incidence rate of dementia, rather than proportion, would be a more accurate measure of disease frequency. We previously estimated the proportion of patients with PD and dementia to be 10.9% from the records of a cohort with the idiopathic form of PD in a major medical center. We reviewed the clinical records of this cohort after 4 years and 9 months to estimate the incidence rate of dementia. We identified 65 new cases of dementia from the 249 patient-records available. Using the number of person-years of follow-up for each case as the denominator, we estimated the overall incidence rate to be 69 per 1,000 person-years of observation. The mean age of this cohort was 71.4 years. The cumulative incidence of dementia increased with age. By 85 years of age, over 65% of the surviving members of the cohort were demented. The age-specific incidence rates for dementia in this cohort of PD were significantly greater than for a similarly aged cohort of healthy elderly people. The age-specific standard morbidity ratios indicated that, compared with people of similar ages, patients with PD have the highest increase in risk for dementia between ages 65 and 75. 

Category: nervous system diseases
The TURP syndrome. This article discusses the presentation, aetiology, treatment and prevention of central nervous system disturbances after transurethral resection of the prostate. Nausea and vomiting, visual symptoms, and altered states of consciousness have been reported as complications due to intravascular absorption of irrigating fluid. Hypotonicity after absorption of the irrigating fluid causes cerebral oedema. Hyperglycinaemia may cause visual disturbances and hyperammonaemia may cause delayed coma. 

Category: general pathological conditions
Sensorineural hearing loss: a reversible effect of valproic acid. We report 2 patients over the age of 70 who, while on valproate (VPA) for complex partial seizures, developed sensorineural hearing loss. Following discontinuation of VPA for nonaudiologic reasons, the patients reported improved hearing which was confirmed by audiometry. These findings represent VPA-induced sensorineural hearing loss, possibly in preexisting presbycusis. 

Category: nervous system diseases
Vitamin C and cardiovascular risk factors. The concept that ascorbic acid (vitamin C) supplementation protects against coronary heart disease developed in the late 1970s when vitamin C intakes in industrialized nations were lower than at present. Supplementation was then shown to lower plasma total cholesterol and, among some elderly men, to raise high-density lipoprotein cholesterol. However, among people in initially good vitamin C nutriture, these effects are usually not seen. In five populations of essentially healthy people, blood pressure has been found to correlate negatively with vitamin C status. Recently, in a placebo-controlled, double-blinded study, extra ascorbic acid for 6 wk was observed to lower systolic and pulse pressure in a small group of borderline hypertensive subjects. 

Category: cardiovascular diseases
Down-regulation of LFA-1 adhesion receptors by C-myc oncogene in human B lymphoblastoid cells. The function of the c-myc gene and its role in tumorigenesis are poorly understood. In order to elucidate the role of c-myc oncogene activation in B cell malignancy, the phenotypic changes caused by the expression of c-myc oncogenes in human B lymphoblastoid cells immortalized by Epstein-Barr virus were analyzed. C-myc oncogenes caused the down-regulation of lymphocyte function-associated antigen-1 (LFA-1) adhesion molecules (alpha L/beta 2 integrin) and loss of homotypic B cell adhesion in vitro. Down-regulation of LFA-1 occurred by (i) posttranscriptional modulation of LFA-1 alpha L-chain RNA soon after acute c-myc induction, and (ii) transcriptional modulation in cells that chronically express c-myc oncogenes. Analogous reductions in LFA-1 expression were detectable in Burkitt lymphoma cells carrying activated c-myc oncogenes. Since LFA-1 is involved in B cell adhesion to cytotoxic T cells, natural killer cells, and vascular endothelium, these results imply functions for c-myc in normal B cell development and lymphomagenesis. 

Category: general pathological conditions
Separation and characterization of saponins with adjuvant activity from Quillaja saponaria Molina cortex. Saponins were purified from Quillaja saponaria Molina bark by silica and reverse phase chromatography. The resulting purified saponins were tested for adjuvant activity in mice. Several distinct saponins, designated QS-7, QS-17, QS-18, and QS-21, were demonstrated to boost antibody levels by 100-fold or more when used in mouse immunizations with the Ag BSA and beef liver cytochrome b5. These purified saponins increased titers in all major IgG subclasses. To determine optimal dose in mice for adjuvant response, QS-7 and QS-21 were tested in a dose-response study in intradermal immunization with BSA in mice; for both of these purified saponins, adjuvant response (determined by stimulation of ELISA titers to BSA) neared maximum at doses of 5 micrograms and was shown to plateau up to the highest dose tested, 80 micrograms. These purified saponins vary considerably in their toxicity, as assessed by lethality in mice; the main component, QS-18, being the most toxic. Saponins QS-7 and QS-21 showed no or very low toxicity in mice, respectively. None of these saponins stimulated production of reaginic antibodies. The monosaccharide composition of these saponins showed similar but distinct compositions with all four containing fucose, xylose, galactose and glucuronic acid. Predominant differences were observed in the quantities of rhamnose, arabinose, and glucose. Monomer m.w. (determined by size exclusion HPLC) were determined to range from 1800 to 2200. 

Category: general pathological conditions
Response by women aged 65-79 to invitation for screening for breast cancer by mammography: a pilot study [published erratum appears in BMJ 1991 Jul 27;303(6796):234] OBJECTIVE--To determine whether there is sufficient benefit to be gained by offering screening for breast cancer with mammography to women aged 65-79, who are not normally invited for screening. DESIGN--Pilot study of women eligible for screening but not for personal invitation. The results of this study were compared with the results of routinely screened younger women (aged 50-64) from the same general practice. SETTING--One group general practice in south Manchester. PATIENTS--The 631 women aged 65-79 on the practice list. A total of 42 (7%) were excluded by the general practitioner, and 22 (4%) invitation letters were returned by the post office. MAIN OUTCOME MEASURES--Response rates to invitation for screening assessed by three indices: crude population coverage ratio, crude invited population coverage ratio, and corrected invited population coverage ratio. RESULTS--344 Patients aged 65-79 (61% of those invited, excluding those who could not be traced) were screened compared with 77% of women aged 50-64. The three response indices were higher for younger women than older: crude population coverage ratio = 66.5%, crude invited population coverage ratio = 69.3%, corrected invited population coverage ratio = 76.8% for women aged 50-64, compared with 54.5%, 58.4%, and 60.7% respectively for women aged 65-79. All four biopsies done in the older women gave positive results, giving a cancer detection rate of 11.6/1000 compared with 4.1/1000 among younger women. CONCLUSIONS--These results show that there is a potential for high attendance at routine screening by older women if they are invited in the same way as younger women. If these results are found elsewhere the costs and benefits of screening older women should be reassessed. 

Category: neoplasms
Treatment of condyloma acuminatum with three different interferon-alpha preparations administered parenterally: a double-blind, placebo-controlled trial. One hundred seventy-eight patients were enrolled in a placebo-controlled trial to evaluate three interferon-alpha preparations administered parenterally for the treatment of condyloma acuminatum. When all interferon groups were combined and compared with placebo, interferon recipients had greater rates of complete, 75%, 50%, and 25% lesion resolution than did placebo recipients (P = .21, P = .14, P = .02, and P = .02, respectively). Rates of lesion resolution were higher among women than among men, and women were more likely than men to respond to interferon. Virologic measurements in paired lesion biopsies did not correlate with interferon treatment or disease outcome. Although interferon toxicity was observed frequently, no participant withdrew from the study because of side effects, and dosage alterations were not required. Parenterally administered interferon-alpha is more effective than placebo in treating condyloma acuminatum, although rates of complete response are low. Different regimens, including combination therapy, should be evaluated for treatment of this common sexually transmitted disease. 

Category: general pathological conditions