Melricflash/CW_MedAbstractsAlt huggingface dataset:
Importance of hemodynamic response to therapy in predicting survival with ejection fraction less than or equal to 20% secondary to ischemic or nonischemic dilated cardiomyopathy. To identify patients with left ventricular ejection fractions less than 20% who are likely to survive on tailored medical therapy after referral to transplantation, this study of 152 patients addressed the hypotheses that (1) severely elevated filling pressures initially measured at referral would not necessarily predict poor outcome, (2) survival would be best when low pulmonary wedge pressures could be achieved with therapy tailored for hemodynamic goals, and (3) coronary artery disease would be an independent risk factor for early mortality. Despite an average initial ejection fraction of 0.15, cardiac index of 2.0 liters/min/m2 and pulmonary artery wedge pressure of 28 mm Hg, the actuarial survival with tailored therapy was 63% at 1 year, with 34 of 41 (83%) deaths occurring suddenly. Survival was not related to initial filling pressure elevation, but was best predicted by the pulmonary artery wedge pressures during therapy; patients achieving pressure of less than or equal to 16 mm Hg had 1-year survival of 83 vs 38% (p = 0.0001). The other independent predictors were serum sodium and coronary artery disease. Patients with high filling pressures during therapy and coronary artery disease had 21% survival at 1 year. Survival after referral to transplantation with an ejection fraction less than or equal to 20% is better than previously described. Patients in whom left ventricular filling pressures cannot be adequately reduced by tailored therapy, particularly if coronary artery disease is present, should be considered for early transplantation. 

Category: general pathological conditions
Spontaneous rupture of an aortic aneurysm into the left renal vein. A diagnostic challenge. Rupture of an aortic aneurysm into a renal vein presents a rare and difficult diagnostic problem. Often, therapy is delayed because the patient is thought to have a urologic problem. In this instance, CT scan provided useful clues leading to the diagnosis of this entity, and its rapid treatment. To our knowledge, this is the first CT scan done in a patient with aorto-renal vein fistula. 

Category: cardiovascular diseases
Aggravation of myasthenia gravis by erythromycin. Erythromycin is not currently recognized as causing clinical aggravation of myasthenia gravis. We report the case of a patient who experienced exacerbations of myasthenia gravis subsequent to each of several doses of intravenous erythromycin. We suggest that erythromycin can cause clinical worsening in patients with disease of the neuromuscular junction. 

Category: general pathological conditions
Percutaneous support devices for high risk or complicated coronary angioplasty. Indications for coronary angioplasty have expanded to include patients with unstable acute ischemic syndromes, severe multivessel coronary artery disease and impaired left ventricular function. Several mechanical approaches have been developed as adjuncts to high risk coronary angioplasty to improve patient tolerance of coronary balloon occlusion and maintain hemodynamic stability in the event of complications. These percutaneous techniques include intraaortic balloon counterpulsation, anterograde transcatheter coronary perfusion, coronary sinus retroperfusion, cardiopulmonary bypass, Hemopump left ventricular assistance and partial left heart bypass. The intraaortic balloon pump provides hemodynamic support and ameliorates ischemia by decreasing myocardial work; it may be inserted for periprocedural complications or before angioplasty in patients with ischemia or hypotension. Anterograde distal coronary artery perfusion may be accomplished passively through an autoperfusion catheter or by active pumping of oxygenated blood or fluorocarbons through the central lumen of an angioplasty catheter. Synchronized coronary sinus retroperfusion produces pulsatile blood flow via the cardiac veins to the coronary bed distal to a stenosis. Both perfusion techniques limit development of ischemic chest pain and myocardial dysfunction in patients undergoing prolonged balloon inflations. Percutaneous cardiopulmonary bypass provides complete systemic hemodynamic support which is independent of intrinsic cardiac function or rhythm and has been employed prophylactically in very high risk patients before coronary angioplasty or emergently for abrupt closure. These and newer support devices, while associated with significant complications, may ultimately improve the safety of coronary angioplasty and allow its application to those who would otherwise not be candidates for revascularization. 

Category: general pathological conditions
Prognostic implications of tumor diameter in carcinoma of the head of the pancreas. Two hundred twenty patients with a carcinoma in the head of the pancreas were divided into three tumor diameter groups: group 1, 0.5 to 4.4 cm (n = 72); group 2, 4.5 to 6.0 cm (n = 77); and group 3, 6.1 to 15.0 cm (n = 71). For these tumor diameter groups a six-fold eliminatory curability analysis was performed. Of the patients with liver metastases in group 1 the last patient had died at 10 months and in groups 2 and 3 no patients were alive at 18 months after the start of complaints. Patients with extrahepatic metastases did not survive 12 months in group 1, 16 months in group 2, and 25 months in group 3. The 6% actuarial survival rate for inoperable patients was reached in group 1 after 17 months, in group 2 after 36 months, and in group 3 after 27 months after the start of complaints. For groups 1 through 3 in curable, but not curatively operated patients, the respective 0% actuarial survival rate was reached at 24 months, 23 months, and 14 months. The 0% actuarial survival rate in patients with irresectable vessel invasion was reached in group 1 at 33 months, in group 2 at 23 months, and in group 3 at 25 months. The 0% actuarial survival rate in patients with an irresectable tumor was reached at 33 months, 31 months, and 27 months after the start of complaints in groups 1, 2, and 3, respectively. The 0% actuarial survival rate in curatively operated patients was reached in group 3 after 26 months and in group 2 after 29 months. In group 1 25% of the patients were alive at 36 months after the start of complaints. Small tumors were associated with the greatest chance of curative operation and on average had the longest survival. However, small tumors with liver or other metastases carried a worse prognosis than large tumors with liver or other metastases. If tumors were found not to be resectable at the time of operation, the size of the tumor did not appear to affect survival. 

Category: neoplasms
Snow skiing for the physically disabled. The sport of snow skiing by the physically disabled, which originated in Europe in 1935 and first received attention in the United States in the 1940s, is reviewed in terms of opportunities available, instructions, adaptive equipment necessary, and benefits provided. Persons with a wide variety of disabilities (such as cerebral palsy, multiple sclerosis, spinal cord injury, hemiplegia, amputation, blindness, spina bifida, and muscular dystrophy) can participate. Accordingly, a wide range of adaptive equipment is available--including outrigger skis, flip-skis, canting wedges, ski bras, "toe spreaders," sit-skis, and mono-skis--to allow safe enjoyment of the sport. Programs for instruction of the disabled skier are increasing in number and popularity, and numerous opportunities are available to enter competitive events sponsored by National Handicapped Sports. Both the participants and the instructors relate the numerous physical and psychologic benefits that can be derived from skiing; the sport provides an almost universal enjoyment of the sense of freedom and independence. Snow skiing is an enjoyable, beneficial, outdoor cold-weather activity that the disabled population can safely learn with proper instruction. 

Category: nervous system diseases
Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. BACKGROUND AND METHODS: An experimental canine model of hemorrhagic, hypovolemic shock is described that uses oxygen debt and its metabolic consequences of lactic acidemia and metabolic base deficit as independent variables for the prediction of probability of death. RESULTS: Lactic acidemia and metabolic base deficit are compared with the conventional hemodynamic variables of BP and cardiac output (Qt) as predictors of outcome and are shown to be superior using a modified Kaplan-Meier probability statistic. The LD50 for oxygen debt is shown to be 113.5 mL/kg, 12.9 mmol/L for lactate, and -18.8 mmol/L for base excess (BE). Comparison is made between the ability of Qt, BP, shed blood, BE, and lactate to predict oxygen debt. CONCLUSIONS: Of the single-variable predictors, BE shows the highest explained variability. However, a combined prediction from both lactate and BE appears superior to the use of either alone. Using this regression to compute the oxygen debt, it is possible to estimate accurately the actual level of oxygen debt from the BE and lactate values obtained during hemorrhagic hypovolemia. From serial determinations over time of the increase in these biochemical variables above the oxygen debt baseline, it is possible to estimate the rate of oxygen debt accumulation and the time remaining until the LD50 will be reached as indicators of the severity of the total body ischemia resulting from hemorrhagic shock. 

Category: general pathological conditions
Cancer in populations living near nuclear facilities. A survey of mortality nationwide and incidence in two states. Reports from the United Kingdom have described increases in leukemia and lymphoma among young persons living near certain nuclear installations. Because of concerns raised by these reports, a mortality survey was conducted in populations living near nuclear facilities in the United States. All facilities began service before 1982. Over 900,000 cancer deaths occurred from 1950 through 1984 in 107 counties with or near nuclear installations. Each study county was matched for comparison to three "control counties" in the same region. There were 1.8 million cancer deaths in the 292 control counties during the 35 years studied. Deaths due to leukemia or other cancers were not more frequent in the study counties than in the control counties. For childhood leukemia mortality, the relative risk comparing the study counties with their controls before plant start-up was 1.08, while after start-up it was 1.03. For leukemia mortality at all ages, the relative risks were 1.02 before start-up and 0.98 after. For counties in two states, cancer incidence data were also available. For one facility, the standardized registration ratio for childhood leukemia was increased significantly after start-up. However, the increase also antedated the operation of this facility. The study is limited by the correlational approach and the large size of the geographic areas (counties) used. It does not prove the absence of any effect. If, however, any excess cancer risk was present in US counties with nuclear facilities, it was too small to be detected with the methods employed. 

Category: neoplasms
Management of aortic insufficiency in chronic aortic dissection. From January 1980 to December 1988, 44 patients with chronic aortic dissection and aortic insufficiency underwent operation. This group of patients was analyzed to evaluate the outcome of those in whom the aortic valve was preserved compared with those having valve replacement. The overall preoperative characteristics of the two groups were similar except for the incidence of Marfan's syndrome. Valve replacement was the elected procedure in patients with valve degeneration or annuloaortic ectasia. In patients with leaflet prolapse with or without an enlarged annulus, a plastic procedure was used. In 48% of the patients, it was possible to preserve the valve. There were five hospital deaths (11%): three were due to low-output syndrome, one was due to bleeding, and one was due to neurological complications. There were two late deaths (5%). Follow-up of the 37 surviving patients ranged from 2 to 108 months (mean follow-up, 18 months). Seventy-eight percent of the survivors were in functional class I and the others were in class II. Two patients in whom the aortic valve was preserved had mild aortic insufficiency. Three patients with bioprostheses underwent reoperation because of prosthetic valve dysfunction. One patient who had aortoplasty and an aortic valve plastic procedure was seen with redissection and aortic insufficiency after 60 months and was reoperated on using the Bentall technique. The actuarial survival curves showed that patients who underwent valvoplasty had higher, but not significantly higher, survival rates than the valve replacement patients. 

Category: cardiovascular diseases
What affects continence after anterior resection of the rectum? Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had occasional episodes of soiling from liquid feces, 5 patients (25 percent had frequent soiling or occasional incontinence for solid feces, and 1 patient (5 percent had frequent solid stool loss requiring surgical treatment. Anal canal resting pressure at 3 and 4 cm from the anal verge was significantly lower in the LAR group (P less than 0.02 and P less than 0.05, respectively) than in the HAR group. However, the maximum voluntary contraction did not differ between the two groups. Rectoanal inhibitory reflex was found to be present in 17 of the 20 patients with LAR and in all patients with HAR. The volume at which the anal sphincter is continuously inhibited was significantly reduced in the LAR group (P less than 0.001). Also, the conscious rectal sensibility volumes were found to be significantly reduced for threshold, constant, and maximum tolerated volume. Threshold volume for internal sphincter relaxation was lower than the threshold volume for rectal sensation in some patients with LAR. This could allow postoperative fecal soiling. Rectal compliance was decreased (P less than 0.001) in the LAR group. Evacuation proctography, performed in six LAR patients affected by major soiling or solid stool loss, revealed an abnormal obtuse anorectal angle and pathologic lowering of the perineum at rest and during defecation. The concomitance of internal and sphincter impairment, reduction in rectal compliance, and previous pelvis floor muscle damage are postulated as cause affecting continence in patients who underwent LAR. 

Category: neoplasms
The pharmacology of intravenous and oral etoposide. The epipodophyllotoxin derivative etoposide (VP-16) has been in widespread use both alone and in combination chemotherapy for the past decade. It has phase-specific cytotoxicity that acts in the last S and G2 phases of the cell cycle. Although its mode of action is not certain, it appears to act by causing breaks in DNA by interaction with DNA-topoisomerase II or by the formation of free radicals. Most studies show biexponential decay after the intravenous (IV) administration of etoposide. Approximately 30% to 70% of administered etoposide is excreted, with approximately 45% present in the urine. Etoposide is available in oral and IV preparations. It is highly schedule-dependent, with once-daily doses (e.g., for 5 to 8 days every 21 days) giving results superior to intermittent administration. The bioavailability of oral etoposide is approximately 50%, but its absorption is not linear with increasing dose (e.g., greater than 200 mg/d, bioavailability decreases). Factors influencing the bioavailability of oral etoposide include patient status, concurrent medications, hepatic and renal function, and nausea and vomiting. In numerous clinical trials, etoposide has demonstrated excellent activity against a range of tumors, including small cell lung cancer (SCLC), malignant lymphomas, gestational trophoblastic tumors, Ewing's and soft tissue sarcomas, and germ cell tumors, with more modest activity in other tumors (e.g., non-SCLC). Although few comparative studies have been carried out, available data suggest that oral etoposide administered daily during 5 to 8 days is similar to the IV preparation in range of activity. In a study of 53 elderly patients with SCLC treated with etoposide (200 mg/d for five times), there was a response rate of 79% and a median survival of 9.5 months. These results were similar to those achieved with more intensive IV regimens. Several studies of chronic oral etoposide (50 mg/m2/d for 21 times) have been reported recently. Responses were observed in SCLC and germ cell tumors among patients who had relapsed after standard etoposide-containing regimens. These data suggest that etoposide may be a "new" drug when given in this schedule. The high response rates with oral etoposide suggest that oral administration may be substituted for IV administration. This substitution may allow for greater flexibility in chemotherapeutic administration, less hospitalization, and more acceptable toxicity. 

Category: neoplasms
Developmental dysmnesia in a poor reader. A 22-yr-old subject with moderate developmental dyslexia experienced poor memory from an early age. In spite of normal intelligence he had great difficulty in learning historical and geographical names, mathematical formulae, poems and songs, and verbal series such as the letters of the alphabet and the months of the year. His recognition of familiar faces was also faulty at times. A battery of memory tests confirmed a moderate deficit of verbal as well as visual memory, whereas spatial memory was preserved. Other cognitive functions were intact, except for a mild reading disability. No evidence of brain pathology was provided by his history, neurological examination and CT scanning. 

Category: general pathological conditions
Persistence and remission of depressive symptoms in late life. OBJECTIVE: The relation of poor health to the onset of depression symptoms in late life is well recognized, but little attention has been given to characteristics that might predict persistence or remission of depressive symptoms. In previous analyses the authors found that increasing disability and declining health preceded the emergence of depressive symptoms in older community residents and accounted for 70% of the variance explained by discriminant analyses. The aim of the present analysis was to examine the relevance of changes in health and disability to the persistence of depressive symptoms. METHOD: A representative sample of 1,855 adults aged 65 or older were assessed with the Center for Epidemiologic Studies Depression Scale at baseline. Twenty-four months later, 1,577 individuals were available for a second assessment of depressive symptoms. The characteristics of the 97 community residents whose depressive symptoms persisted over 24 months were compared to those of the 114 whose symptoms remitted. RESULTS: Changes in health, differences in age, sleep disturbance, and added formal support services accounted for more than 30% of the variance between the persistently depressed and remission groups. Advanced age and worsening health were associated with persistent symptoms, improved health with remission. CONCLUSIONS: Previous studies have indicated that untoward changes in health and disability play a major role in the onset of depressive symptoms. These findings show a substantial contribution to chronicity as well. 

Category: nervous system diseases
Prevention of deep-vein thrombosis and pulmonary embolism after total hip replacement. Comparison of low-molecular-weight heparin and unfractionated heparin. In a prospective, randomized, double-blind study, the efficacy and safety of a low-molecular-weight heparin were compared with those of unfractionated sodium heparin (standard heparin) in 136 patients who had elective total hip replacement. The patients received subcutaneous injection of either 5000 international units of low-molecular-weight heparin once daily or 5000 international units of standard heparin three times a day. Treatment with low-molecular-weight heparin began twelve hours before the operation, and treatment with standard heparin began two hours preoperatively; both regimens were continued for ten days. Twelve days postoperatively, bilateral ascending phlebography was performed in 122 patients, sixty-three in the treatment group that received low-molecular-weight heparin and fifty-nine in the treatment group that received standard heparin. Pulmonary scintigraphy was performed in 127 patients. Deep-vein thrombosis was diagnosed in forty-four patients: nineteen (30 per cent) of the sixty-three who received low-molecular-weight heparin and twenty-five (42 per cent) of the fifty-nine who received standard heparin. All but four patients, two from each treatment group, were asymptomatic. The difference in the total rate of thrombosis in the two groups was not significant (p = 0.189). However, thrombosis occurred in the thigh in only six (10 per cent) of the patients who received low-molecular-weight heparin but in eighteen (31 per cent) of those who received standard heparin, a significant difference (p = 0.011). Pulmonary embolism was detected in twenty-seven patients: eight (12.3 per cent) of those who received low-molecular-weight heparin and nineteen (30.6 per cent) of those who received standard heparin. Only three patients had clinical signs of embolism. Pulmonary embolism was significantly more frequent in the group that received standard heparin (p = 0.016). Total loss of blood and the total amount of blood that was transfused were significantly reduced in the patients who received low-molecular-weight heparin compared with those who received standard heparin. Prophylaxis was not discontinued because of hemorrhage in any patient. The efficacy of low-molecular-weight heparin was superior to that of standard heparin in the prevention of femoral thrombosis and pulmonary embolism, although the over-all incidence of deep-vein thrombosis was not statistically different.(ABSTRACT TRUNCATED AT 400 WORDS). 

Category: cardiovascular diseases
Long-term efficacy of primary laser trabeculoplasty. Sixty glaucomatous eyes of 60 patients treated with laser trabeculoplasty as primary therapy were reviewed retrospectively. There were 42 eyes with capsular glaucoma and 18 with simple glaucoma. The mean prelaser intraocular pressure (IOP) was 35.2 (SD = 6.5) mmHg. Success was defined as IOP less than or equal to 22 mmHg without medication. The probability of success was 0.73 at 1 year, 0.66 at 2 years, 0.57 at 3 years, and 0.50 at 4 years. Three eyes experienced progressive visual field loss or disc damage in spite of an intraocular pressure below 22 mmHg without medication. High prelaser pressure and the severity of the visual field defects were significant predictors of treatment failure. 

Category: general pathological conditions