Melricflash/CW_MedAbstractsAlt huggingface dataset:
The severity of coronary atherosclerosis at sites of plaque rupture with occlusive thrombosis. Atherosclerotic plaque rupture with superimposed thrombosis is recognized as the lesion causing greater than 90% of acute myocardial infarctions. To determine the severity of atherosclerosis at the site of plaque rupture, 184 coronary arteries from autopsies of 162 patients who died of acute myocardial infarction were studied. There were 102 men, 72 +/- 10 years old (mean +/- SD), and 60 women, 75 +/- 8 years old. All arteries were dissected from the heart, fixed, decalcified, cut at 2 to 3 mm intervals and processed routinely for histologic examination. A planimeter was used to measure artery, plaque, thrombus and luminal cross-sectional area at the site of plaque rupture with thrombosis in sections projected at x13.8 magnification. At the site of atherosclerotic plaque rupture with superimposed thrombosis, the degree of stenosis due to plaque was: 90 +/- 7% for the right (n = 67), 91 +/- 6% for the left anterior descending (n = 79) and 91 +/- 6% for the left circumflex (n = 38) coronary arteries. Plaque rupture in fatal acute myocardial infarction occurs at sites of severe narrowing (mean 91%, range 67% to 99%). Thus, plaque rupture with thrombosis is unlikely to cause the fatal acute myocardial infarction in patients with mild to moderate coronary stenosis. 

Category: cardiovascular diseases
Delta sleep ratio. A biological correlate of early recurrence in unipolar affective disorder. Slow wave sleep abnormalities have long been described in depression but were considered to be nonspecific indicators of psychopathology. Computerized techniques, including amplitude frequency measures and spectral analyses, are permitting new approaches to the examination of delta sleep. Early studies suggested that many depressed patients demonstrate lower delta wave intensity during the first non-rapid eye movement period than the second one. This finding, prominent in middle-aged depressed patients, has led to an examination of the ratio between the first and second non-rapid eye movement periods. This delta sleep measure seems to be a more robust predictor of recurrence than rapid eye movement latency. Analysis of data on 74 patients in a long-term maintenance treatment study for a minimum of 24 months demonstrates that the delta sleep ratio can predict survival time following discontinuation of drug treatment. Individuals with a high delta sleep ratio remain clinically remitted five times longer than those with a low delta sleep ratio. 

Category: general pathological conditions
Spontaneous rupture of the spleen in initial presentation of Hodgkin's disease. A 46-year-old man presented with a four-week history of fevers, occasional chills, and a two-week history of sweats and poor appetite. He also complained of progressive weakness and lethargy. After initial evaluation, while awaiting further consultation, the patient developed rapidly progressing abdominal pain and light-headedness. He was moved immediately into the emergency treatment area. He was noted to have an acute abdomen and was taken to surgery. An enlarged Hodgkin's-infiltrated spleen with an actively bleeding hematoma was removed. The patient denied any history of trauma. 

Category: general pathological conditions
L-methionine uptake by human cerebral cortex: maturation from infancy to old age Age-associated changes in amino acid transport from blood to normal frontal cortex were studied using positron emission tomography (PET). Seventeen patients, 1.8-71 yr, were injected intravenously with tracer doses of [11C] L-methionine and a baseline PET scan was obtained. To assess competitive inhibition of [11C]L-methionine uptake, patients received either oral L-phenylalanine or an i.v. infusion of amino acids 1 hr before a second PET study. Uptake of [11C]L-methionine by frontal cortex decreased seven-fold between 1.8 and 71 yr (r = -0.71; p less than 0.05). Blood-to-brain transfer of [11C]L-methionine, at 4.5 yr, exceeded mean adult values by more than five-fold. Competitive inhibition reduced L-methionine uptake in all patients older than 4.6 yr. These developmental changes parallel findings in animals. The neutral amino acid transport system may modulate human brain amino acid levels to meet changing developmental metabolic needs. 

Category: neoplasms
The costs of prevention. A prevention program is cost-effective if it yields more health benefits than do alternative uses of health care resources. Some prevention programs meet this standard: either they actually save more health care resources than they utilize, or their net costs per healthy year of life gained are lower than those of alternatives such as curative or palliative medicine. Other prevention programs, however, are less cost-effective than are medical treatments for the same disease. One lesson for public policy is that generalizations about the cost-effectiveness of "prevention" are unwise. Another lesson is that prevention programs should not be subjected to a higher standard than other health programs: they should not be expected to save money, but they should be expected to yield improved health at a reasonable price. 

Category: cardiovascular diseases
Genetic mapping of "Lubag" (X-linked dystonia-parkinsonism) in a Filipino kindred to the pericentromeric region of the X chromosome. "Lubag" is an X-linked disorder causing dystonia and parkinsonism that has only been described in families from the Philippines, principally from the island of Panay. We have established linkage between the disease phenotype "lubag" and DNA markers which span the Xp11.22-Xq21.3 region by using a large Filipino family with 8 affected men in three generations. These DNA markers define an interval of about 20 centimorgans in the pericentromeric region of the X chromosome as the most likely site of the disease locus XDPD (X-linked dystonia-parkinsonism). XDPD has a maximum multipoint log likelihood ratio score (Zmax) of about 4.6 over the interval from Xq12 to Xq21.31 (DXS159-DXYS1X). The co-occurrence of dystonia and parkinsonism in lubag and in other known disorders suggests there may be a common pathogenetic mechanism. Identification of the genetic defect in this family may provide an important clue toward understanding the pathogenesis and pathophysiology of both dystonia and parkinsonism. 

Category: general pathological conditions
Abdominal trauma in pregnancy. When is fetal monitoring necessary? The type and duration of observation and monitoring of mother and fetus after abdominal trauma are dependent on gestational age and severity of trauma. Fetal monitoring is usually not required when the fetus is not viable; the primary consideration is the safety of the mother. When the fetus is viable, 24-hour inpatient fetal monitoring is indicated in cases of major trauma, even when no symptoms of injury are obvious. 

Category: general pathological conditions
The Dolenc technique for cavernous sinus exploration (cadaveric prosection). Technical note. This report describes a surgical approach to the cavernous sinus. Based on the work of Parkinson, Dolenc, and other pioneering investigators, a comprehensive surgical approach for the treatment of lesions of the cavernous sinus is distilled and presented in 12 simple steps. The approach to surgical exploration of this region is divided into an extradural and intradural phase, each with six steps. The bony, neural, and/or vascular structures of each step are discussed. These steps may be used in their entirety for total exploration of the cavernous sinus, but also in part for lesions that involve only limited regions of the cavernous sinus. Either by design or circumstance, every intracranial neurosurgeon will eventually be led to the cavernous sinus region, and a clear understanding of cavernous sinus anatomy should be part of their armamentarium. 

Category: general pathological conditions
Body mass index and prognosis in elderly hypertensive patients: a report from the European Working Party on High Blood Pressure in the Elderly. Obesity and hypertension are often found in the same patients, particularly in elderly women. However, few data on the joint impact of these two conditions in women and the elderly are available. In the current study of 800 elderly hypertensive patients randomly assigned to active treatment or placebo, the initial mean body mass index (BMI) was 26.7 kg/m2 in 560 women and 25.7 kg/m2 in 240 men. During the trial, total mortality and cardiovascular and noncardiovascular terminating events were highest in the patients at the leanest BMI quintile. The association between BMI and cardiovascular end points was U-shaped, whereas noncardiovascular mortality decreased with increasing BMI. The results in the women were similar to those in the total group. The U-shaped relation was confirmed with Cox's proportional hazards model, controlling for age, gender, systolic blood pressure, hemoglobin, serum cholesterol, blood glucose, and cardiovascular complications at entry. The BMI level with the lowest risk was 28 to 29 kg/m2 for total mortality and cardiovascular terminating events, 26 to 27 kg/m2 for cardiovascular mortality, and 31 to 32 kg/m2 for noncardiovascular mortality. BMI did not modify the favorable effects of drug treatment. There was no evidence that obesity would protect elderly hypertensive men or women from cardiovascular complications. 

Category: cardiovascular diseases
High blood cholesterol in elderly men and the excess risk for coronary heart disease. OBJECTIVE: To determine whether high blood cholesterol is an important risk factor for mortality from coronary heart disease in elderly men. DESIGN: Cohort study with a mean follow-up of 10.1 years. SETTING: A health maintenance organization. PATIENTS: The cohort included 2746 white men 60 to 79 years of age who had no self-reported history of coronary heart disease. MEASUREMENT AND MAIN RESULTS: A total of 260 deaths occurred during 27,842 person-years of follow-up. The relative risk for mortality from coronary heart disease in men 60 to 79 years of age in the highest serum cholesterol quartile was 1.5 (95% CI, 1.2 to 2.0) compared with those in the three lower quartiles combined. The relative risk did not change greatly with age, ranging from 1.4 in men 60 to 64 years of age to 1.7 in men 75 to 79 years of age. However, because mortality from coronary heart disease increased with age, the excess risk for such mortality attributable to elevated serum cholesterol levels increased fivefold over these 20 years, from 2.2 deaths per 1000 person-years to 11.3 deaths per 1000 person-years. CONCLUSIONS: Our results support those of other observational studies in elderly men. If treatment of high blood cholesterol is as effective in reducing cholesterol-related risk for coronary heart disease after 65 years of age as it is in middle-aged men, it might actually produce greater reductions in mortality due to coronary heart disease. A clinical trial is needed to confirm this extrapolation. 

Category: cardiovascular diseases
Round fingerpad sign: an early sign of scleroderma. We describe a clinical skin sign in scleroderma termed round fingerpad sign. This term refers to disappearance of the peaked contour on fingerpads and replacement with a hemisphere-like fingertip contour; this change is especially apparent on the ring fingers. A positive round fingerpad sign was found in 72 of 72 ring fingers in 36 patients with progressive systemic sclerosis in 69 of 72 ring fingers in patients with mixed connective tissue disease, and in 24 of 24 ring fingers of patients with Raynaud's phenomenon and sclerodactyly. In contrast, a negative round fingerpad sign was seen in 240 of 240 fingers in normal women (controls). The high sensitivity of this sign is noteworthy. A positive round fingerpad was seen in sign not only typical scleroderma patients but also in groups with less severe skin sclerosis (i.e., in those patients with mixed connective tissue disease or those with Raynaud's phenomenon and sclerodactyly). The sign is a new and useful clinical marker for the early diagnosis of scleroderma. 

Category: cardiovascular diseases
Association between urinary symptoms at 7 years old and previous urinary tract infection. The association between current micturition habits and previous urinary tract infection was analysed among 3553 school entrants aged 7 years by means of a questionnaire. A high incidence of urinary infection, confirmed by urine culture, was found (145 (8.4%) in the 1719 girls and 32 (1.7%) in the 1834 boys). There was a significant association between current symptoms that were suggestive of disturbed bladder function and previous urinary tract infection, but only among girls who were over 3 years of age at the time the first episode was diagnosed. 

Category: general pathological conditions
Is banding of the pulmonary trunk obsolete for infants with tricuspid atresia and double inlet ventricle with a discordant ventriculoarterial connection? Role of aortic arch obstruction and subaortic stenosis Banding the pulmonary trunk may exacerbate or promote the development of subaortic stenosis in patients with double inlet ventricle or tricuspid atresia with a dominant left ventricle and discordant ventriculoarterial connection and, therefore, may be an inappropriate palliative procedure for such patients. To examine this possibility, 102 consecutive infants were studied who presented with this anatomy between 1972 and 1987. Obstruction of the aortic arch was present in 52 patients. In 28 patients (17 with aortic arch obstruction), subaortic stenosis was already apparent at presentation. Of the remaining 74 patients, 19 received no palliative surgery and 55 underwent banding of the pulmonary trunk either with (n = 22) or without (n = 33) aortic arch repair. Outcome was significantly worse in patients with associated aortic arch obstruction. All such patients either died or developed subaortic stenosis by 3 years of age (survival free of subaortic stenosis 0 of 22 versus 22 of 33 for patients with isolated banding of the pulmonary trunk, p less than 0.001). After isolated banding, there was a lower ratio of the ventricular septal defect to ascending aorta diameters at presentation in the patients who developed subaortic stenosis than in the patients who did not (0.60 +/- 0.08 versus 1.03 +/- 0.15, p less than 0.001). Of the latter, 18 (95%) of 19 patients fulfilled criteria for a Fontan procedure at recatheterization. Thus, the presence of aortic arch obstruction is associated with rapid development of subaortic stenosis after banding of the pulmonary trunk. Alternative initial surgery, even though high risk, may be indicated. In the absence of such obstruction, banding the pulmonary trunk can be performed at reasonable risk and, provided that the ventricular septal defect is of adequate size, satisfactorily prepares most patients for a later Fontan procedure. 

Category: cardiovascular diseases
Retroperitoneal lymph node dissection in malignant mesothelioma of tunica vaginalis testis. A case of metastatic mesothelioma of the tunica vaginalis testis in a 57-year-old man is reported. Clinicopathological findings and treatment options are reviewed. 

Category: neoplasms
Repeated intestinal ulcerations in a patient with systemic lupus erythematosus and high serum antiphospholipid antibody levels. We report the case of a patient with SLE who had repeated ulceration of the small intestine requiring emergency surgery. Pathologic examination revealed microthrombosis and vasculitis at the site of the intestinal ulcers. High levels of antiphospholipid antibodies, thrombocytopenia, and prolonged prothrombin time coincided with the episodes of intestinal ulceration. Antiphospholipid antibodies may be involved in the development of thrombosis resulting in the repeated episodes of intestinal ulceration in this patient. This possibility should be considered in patients with SLE who have intestinal ulceration and appropriate antithrombotic medication should be administered. 

Category: general pathological conditions
Evolution of energy expenditure and nitrogen excretion in severe head-injured patients. OBJECTIVE: The aim of the study was to estimate the influence of therapeutic changes on the level of energy expenditure (EE) and N excretion in a homogeneous group of patients usually considered hypermetabolic. DESIGN: EE and N excretion of head-injured patients were measured simultaneously at phases 1 and 2 (patients treated 4 +/- 3 and 18 +/- 8 days after injury, respectively). SETTING: Acute care hospital. PATIENTS: Eight severe head-injured patients, mean weight 63.1 +/- 6.1 (SD) kg, mean age 21 +/- 3.8 (SD) yr. INTERVENTIONS: At phase 1, all patients were sedated with fentanyl (6.7 +/- 1.9 micrograms/kg.hr) plus flunitrazepam (9.1 +/- 4.8 micrograms/kg.hr) and were mechanically ventilated. All patients received continuous total parenteral nutrition. The nonprotein caloric intake averaged 1092 +/- 200 kcal/day, including 77% glucose and 23% fat (Intralipid 20%). The total N intake averaged 7 +/- 5 g/day, consisting of crystalline amino acids. At phase 2, no patient received any sedative and all were breathing spontaneously via tracheostomy. All patients received parenteral and/or enteral nutrition. The nonprotein caloric intake averaged 1929 +/- 200 kcal/day consisting of 65% carbohydrates and 35% fat. The total N intake averaged 13 +/- 2 g/day. MEASUREMENTS AND MAIN RESULTS: The EE was significantly higher at phase 2 than at phase 1 (2121 vs. 1737 kcal), but the interindividual variability was low at both phases. N excretion was high at the two periods of the study and not correlated to the level of EE. The RQ was 0.75 at both periods, indicating predominant fat oxidation. CONCLUSIONS: We could not demonstrate any parallelism in the evolution of EE and protein catabolism in head-injured patients. The therapeutics (mechanical ventilation, sedation, and nutrition) have a major effect on EE but little on N excretion. 

Category: nervous system diseases
Endometrioma of the liver. Hepatic endometriosis is extremely rare. We describe a patient sent to us with epigastric pain as the only symptom and who was found to have associated endometrioma of the liver and left ovary. We suggest a gynecologic evaluation before surgery for hepatic cyst of unknown cause. 

Category: neoplasms
Requirement of endogenous tumor necrosis factor/cachectin for recovery from experimental peritonitis. By intrasplenic immunization we raised a rat mAb (mAb V1q; IgG2a, kappa) with a potent neutralizing activity against natural mouse TNF (1 microgram/ml mAb V1q/100 U/ml TNF). mAb V1q was used to study the role of endogenous TNF in experimental peritonitis induced by sublethal cecal ligation and puncture. mAb V1q persisted for over 5 days in the serum of mice injected with 100 micrograms of the antibody and, therefore, proved useful for in vivo experiments. As little as 20 micrograms mAb V1q/mouse prevented lethal shock of the animals by 400 micrograms LPS/mouse. In sublethal cecal ligation and puncture i.p. injection of mAb V1q directly and up to 8 h after induction of experimental peritonitis lead to death of the animals within 1 to 3 days. The lethal effect of mAb V1q was compensated by injection of recombinant mouse TNF. Similar mAb V1q effects as in immunocompetent mice were shown in severe combined immune deficiency mice deficient of mature functional B and T cells. Taken together, these data suggest that during the early phase of peritonitis endogenous TNF may stimulate nonlymphoid cells such as granulocytes, macrophages, platelets, and fibroblasts to ingest bacteria and to localize inflammation, respectively. These beneficial effects of TNF may determine survival. Thus, our data may have implications for the therapeutic management of a beginning peritonitis. 

Category: digestive system diseases
Giant hemangioma of the liver with pain, fever, and abnormal liver tests. Report of two cases. In conclusion, we report the cases of two patients with large hemangiomas of the liver, abdominal pain, increased ESR and fibrinogen, increased serum alkaline phosphatase and gamma-glutamyltransferase activity, and normal white blood cell counts. Clinical and biochemical abnormalities disappeared after surgical resection. Increased ESR and fibrinogen are probably related to thrombosis within the tumor. This mode of presentation may suggest a diagnosis of hepatocellular carcinoma. 

Category: general pathological conditions
Importance of the omentum in the development of intra-abdominal metastases. Areas of trauma are preferred sites for metastatic tumour growth. In extensive intra-abdominal tumour recurrence the omentum is invariably involved. The importance of the omentum in the development of tumours at sites of intra-abdominal trauma has been investigated. Colonic anastomoses were performed in Hooded-Lister rats with and without omentectomy. Animals received intraluminal or intraperitoneal injections of a syngeneic tumour. With intraluminal injection, tumour occurred at the anastomosis and in the omentum in 38 and 43 per cent of animals respectively but following omentectomy the values were 14 and 9 per cent (omental remnant). With intraperitoneal administration tumour occurred in 53 per cent at the anastomosis and in 79 per cent in the omentum compared with 16 and 29 per cent (in omental remnant) following omentectomy. In this model a reduced ability of an anastomosis to support 'seeded' tumour following removal of the omentum is demonstrated and the development of local recurrence from spilled tumour cells during operation may be enhanced by, or be dependent on, the proximity of the omentum. 

Category: neoplasms
Generalized pustular psoriasis in childhood. Report of thirteen cases. Generalized pustular psoriasis is rare in children. Less than 100 cases have been reported. We describe 13 children with this type of psoriasis. Seven had acute onset of widespread sterile pustules coalescing into lakes of pus with subsequent exfoliation (the Zumbusch pattern). This usually occurred in infancy and was difficult to control; recurrences developed several times per year. Three had the subacute benign annular pattern. They tended to be older and often had resolution within several years. Three had a mixed pattern with Zumbusch flares preceded by an annular or acral pattern. Most patients had an eruption preceding the generalized pustular psoriasis and often had precipitating factors. Generally, generalized pustular psoriasis has little serious chronic morbidity. The condition in most patients was well controlled with topical therapy. Systemic steroids were not helpful. 

Category: general pathological conditions