Melricflash/CW_MedAbstractsAlt huggingface dataset:
Stage A adenocarcinoma of the prostate: transrectal US and sonographic-pathologic correlation. Results of transrectal ultrasound (TRUS) of the prostate and pathologic examination of specimens obtained at transurethral resection of the prostate (TURP) were compared in 29 patients with clinical stage A adenocarcinoma. Ten specimens contained no residual tumors larger than 5 mm in diameter; in the remaining 19 glands, 20 discrete cancers were found. At TRUS, 30 peripheral hypoechoic lesions were demonstrated, of which 11 corresponded to carcinoma at pathologic examination. Other hypoechoic peripheral zone lesions included a focal area of dilated acinar glands in 10 cases, post-TURP scarring with fingerlike projections of fibrosis in seven, dysplasia in one, and no correlation in one. Of nine tumors that were not detected prospectively at TRUS, eight were predominantly in the anterior zone and one was in the posterior peripheral zone but was isoechoic. Overall, the sensitivity of TRUS in the evaluation of clinical stage A lesions was 55% and the specificity was 37%. Clinical stage A carcinomas may be difficult to detect at US, and findings are often nonspecific. Any suspicious peripheral zone lesion should undergo biopsy with TRUS guidance before being diagnosed as malignant. 

Category: neoplasms
A community study of delay in presenting with signs of melanoma to medical practitioners. In the absence of more effective treatment for advanced tumors, early diagnosis and treatment of localized tumors is the most effective way of reducing the burden of illness associated with melanoma. This study examined the following factors: prevalence of signs of melanoma (a mole changing in size, shape, appearance, or color, itching or tingling, bleeding or weeping, becoming raised) in 1344 individuals in a randomly selected sample of 1075 households; the length of delay in seeking medical advice; the factors associated with either going to a medical practitioner or not going/delaying; and the actions of the medical practitioners when first presented with these signs. The results indicate that a large proportion of the sample (11.9%, n = 156) had observed signs of melanoma in the previous 12 months. Of the sample reporting signs that had first appeared in the previous 5 years, only 32% sought medical advice about the signs within the recommended period. Of the sample either not seeking advice at all or delaying, 49% reported that they thought the sign "wasn't serious/would clear up." Furthermore, 30% of the sample either did not known or underrated the importance of early detection and treatment of lesions. These results indicate that there is a deficit in the knowledge of the general public about the signs of melanoma, the severity of the disease, and the possible risks associated with delay. 

Category: neoplasms
Essential thrombocythemia in young adults. Essential thrombocythemia is typically a disorder of adults in the sixth or seventh decade of life and is characterized by frequent thrombohemorrhagic complications. In young patients, the optimal management of complications is controversial. We studied 56 young adults (33 female and 23 male patients) with a diagnosis of essential thrombocythemia. The mean duration of follow-up was 4.68 years. The mean platelet count at diagnosis was 1,328,000/mm3. Platelet aggregation studies in 21 patients demonstrated hypoaggregation to epinephrine; spontaneous platelet aggregation was present in 4. At diagnosis, 39 patients were asymptomatic, and thrombocytosis was discovered incidentally. Throughout follow-up (up to 20 years), 24 patients remained asymptomatic. Thrombotic complications developed in 24 patients; they were life-threatening in only 3. The most common vaso-occlusive symptoms were migraine headache (in 12 patients) and erythromelalgia (in 3). Minor hemorrhagic complications occurred in six patients, and none was life-threatening. Serious complications (one cerebral and two myocardial infarctions) occurred in three patients, all of whom recovered. Two deaths occurred, neither of which was attributable to essential thrombocythemia. The treatment regimens used were chemotherapy in 9 patients, antiaggregating agents in 7, radioactive phosphorus in 1, the newer platelet-lowering agent anagrelide in 10, and only observation in 29. No treatment-related acute leukemias developed. This series of young patients with essential thrombocythemia, the largest to date, demonstrates a low incidence of life-threatening complications and a favorable long-term prognosis. Therapeutic recommendations should remain conservative, and potential leukemogens should be avoided unless serious complications develop. Anagrelide may be useful in young patients with thrombocythemia who are symptomatic. 

Category: cardiovascular diseases
Stress fractures of the femoral neck in athletes. The consequence of a delay in diagnosis. Twenty-three patients with stress fractures of the femoral neck were followed up at an average of 6.5 years after the injury. There were 16 recreational athletes and seven elite athletes. Most injuries (N = 15) occurred during running. The diagnosis was confirmed within 3 to 104 weeks (mean, 14 weeks) after the initial onset of symptoms. Sixteen of the patients were treated with internal fixation, the remaining seven were treated conservatively. Seven patients (30%) developed complications requiring major surgery. Five of these patients had Type 3 fractures (displaced) and four had been treated with internal fixation initially. The remaining two patients had Type 1 fractures (endosteal or periosteal callus without an overt fracture line); one was treated operatively and the other conservatively. Three patients developed avascular necrosis and two were treated by hip replacement. The third patient was treated with arthrodesis. Three refractures and one pseudarthrosis were treated by osteotomy. At followup, all elite athletes stated that they had to end their career as a result of the injury. Results were rated by the ability of the athlete to return to sports. There were 9 bad or fair results, 13 good, and 1 excellent result. No difference in activity level or subjective rating was observed between the surgically and conservatively treated group either preinjury or postinjury. The most important factor influencing the complication rate seems to be the type of fracture. The high incidence of displaced fractures (Type 3) could speculatively be caused by undiagnosed tension side stress fractures. If so, the delay in correct diagnosis may be disastrous. However, we could only objectively observe this in one of our cases. 

Category: general pathological conditions
Physicians' perspectives on cholesterol and heart disease. In early spring of 1988, questionnaires were mailed to 4,000 Midwestern physicians to survey their attitudes and practices regarding elevated serum cholesterol and their use of referrals for nutrition counseling; 633 physicians responded. Sixty-eight percent of the physicians thought that reducing high serum cholesterol levels would substantially affect heart disease; however, physicians attributed considerably less preventive value to reducing the cholesterol level than to reducing blood pressure (80.3%) or ceasing smoking (90.0%). The range of serum cholesterol for which diet therapy was most frequently initiated was 5.70 to 6.20 mmol/L. The most frequent range for initiation of drug therapy was 7.80 to 8.25 mmol/L. The physicians reported that although their medical school training did not prepare them adequately for providing diet counseling, they did feel prepared to provide, and were successful in, counseling on diet modifications for reducing serum cholesterol. Few (10%) of the total sample reported having registered dietitians available for dietary counseling, and most (88.8%) believed that it is the physician's responsibility to provide such counseling. Although the low response rate limits the conclusions of the survey, it is likely that those physicians most interested in the topic responded. We conclude that registered dietitians should explore the need for their special services further. More aggressive marketing of dietetic services could benefit both physicians and patients in the campaign to reduce serum cholesterol. 

Category: cardiovascular diseases
Results of repeat percutaneous balloon valvuloplasty for pulmonary valvar restenosis. Follow-up cardiac catheterization studies were used to evaluate 105 patients who had undergone percutaneous balloon pulmonary valvuloplasty. Fifteen of those patients who had peak systolic pulmonary valve gradients greater than = 40 mm Hg at follow-up underwent repeat balloon valvuloplasty. For the initial balloon pulmonary valvuloplasty, the mean ratio of the balloon diameter to pulmonary valve annulus diameter was 0.98 +/- 0.2; at repeat valvuloplasty the mean was 1.19 +/- 0.12. The immediate post-repeat balloon valvuloplasty results showed a reduction in the peak systolic gradient from a mean of 70.2 +/- 17.8 to 29.1 +/- 19.0 mm Hg (p less than 0.001). This reduction in the gradient was maintained at a mean of 14.3 +/- 5.0 mm Hg in 8 of the 10 patients who underwent further follow-up studies. We conclude that successful repeat balloon pulmonary valvuloplasty with the use of larger sized balloons is feasible in patients who have restenosis after the initial percutaneous balloon valvuloplasty--including partial but not complete dysplasia of the pulmonary valve. 

Category: general pathological conditions
The radiologic morphology of painful temporomandibular joints. A high frequency of remodeling changes was demonstrated radiographically in a series of patients having pain in the temporomandibular joint region. Radiologic morphologic differences between painful and asymptomatic temporomandibular joints were in frequency rather than type. Caution should be taken not to overestimate the significance of radiologic abnormality in patients with pain in the temporomandibular joint region. 

Category: general pathological conditions
Intracranial hypertension in relation to memory functioning during the first year after severe head injury. The relationship between intracranial hypertension and residual memory deficit after closed head injury was evaluated using the 6-month and 1-year neurobehavioral outcome data obtained by the Traumatic Coma Data Bank. Intracranial pressure was analyzed using the percentage of time that it exceeded 20 mm Hg and the maximum value recorded during the first 72 hours after injury. Memory measures included recall of word lists, prose recall, and visual memory for designs that were obtained 6 months (n = 149) and 1 year (n = 132) after injury. Intracranial hypertension occurred in more than half of the Traumatic Coma Data Bank cohort who met the criteria for the neurobehavioral follow-up study. Linear regression analysis disclosed an effect of elevated intracranial pressure on some, but not all, measures of memory at 6 months, whereas the results were negative for the 1-year follow-up examination. We conclude that the elevation of intracranial pressure exerts little if any effect on later memory functioning, and that any effect it does have diminishes over 1 year in survivors of severe head injury. 

Category: nervous system diseases
Reflex sympathetic dystrophy after clavicle fracture: case report. Reflex sympathetic dystrophy (RSD) of the anterior chest wall is a rare entity. A MEDLINE search in all languages of the world's literature from 1966 to the present yielded no report of the association of clavicle fracture with this pain syndrome. Two cases are presented and the anatomic variations of the supraclavicular nerves in relation to the clavicle are discussed. 

Category: nervous system diseases
Optic nerve gliomas and meningiomas. Optic nerve gliomas are benign astrocytic neoplasms that primarily affect children. The ultimate prognosis for vision is poor. For lesions confined to the optic nerves, long-term survival is excellent, but with involvement of the chiasm and especially of the hypothalamus or third ventricle, prognosis falls significantly. For this group, no form of therapy has proven to be of any benefit. Optic sheath meningiomas are neoplasms arising from arachnoid cap cells. They primarily affect middle-aged adults. Like gliomas, the prognosis for vision is poor, but unlike gliomas, prognosis for life is excellent. 

Category: neoplasms
Immunoglobulins A, G, and M to cytomegalovirus during recurrent infection in recipients of allogeneic bone marrow transplantation. Occurrence and significance of specific IgA and IgM to cytomegalovirus (CMV) in recurrent CMV infection was evaluated in 21 allogeneic T lymphocyte-depleted bone marrow transplantation (BMT) recipients who had been previously CMV seropositive. Of 17 patients with CMV infection, viruria was detected in 94%, CMV-specific IgA in 88% and IgM in 76%, and a fourfold rise in IgG in 65%. The median time between BMT and detection of viruria was 69 days, of IgA 70, of IgM 62, and of IgG 88 days. The IgM and IgA responses lasted for 14 and 30 days (median time), whereas high IgG titers persisted. Twelve patients developed CMV disease; in these the appearance of viruria, IgA, and IgM preceded the rise of IgG (P less than .02). CMV-specific IgA and IgM are valuable diagnostic tools in BMT recipients with recurrent CMV infection. 

Category: general pathological conditions
Hypocalcemia and hypercalcitoninemia in critically ill children. To study Ca metabolism in critically ill children, we measured ionized Ca (Ca2+), parathyroid hormone (PTH), calcitonin, 25 hydroxycholecalciferol (25[OH] D3), 1-25 dihydroxycholecalciferol (1-25[OH]2D3, and gastrin levels in critically ill children and in healthy controls. Patients were considered hypocalcemic if Ca2+ was less than 1.1 mmol/L. Six (14%) of 45 patients were hypocalcemic. Five hypocalcemic patients were studied and were found to have higher calcitonin levels than normocalcemic patients and healthy controls and higher PTH levels than healthy controls. 25(OH)D3 and 1-25(OH)2D3 were not significantly different in the three groups of patients. Gastrin levels were low in critically ill patients, whether or not they were hypocalcemic. We conclude that hypocalcemia occurs frequently in critically ill children. It is associated with raised levels of calcitonin and PTH. The mechanism for the increase in calcitonin is unknown. 

Category: general pathological conditions
Stroke rehabilitation: a geropsychological perspective. Rehabilitation medicine and geriatric medicine are similar in their concern for functional improvement in the face of chronic medical conditions. Although many patients served by rehabilitation medicine fall within the geriatric age range, a knowledge of normal aging does not necessarily inform clinical decision making or research practices in rehabilitation. Using stroke as an example of a disorder affecting primarily geriatric patients and requiring the technology of rehabilitation, ways in which age might affect assessment of outcome are examined. Three areas dealing with conceptual and methodologic issues--depression, neurochemical interventions, and family--are highlighted. The final section outlines recommendations for research on rehabilitation outcome of geriatric stroke patients. 

Category: nervous system diseases
The natural history of peripheral vascular disease. Implications for its management. The durability and the eventual complication rate of endovascular therapy (percutaneous transluminal angioplasty, laser-assisted angioplasty, and atherectomy) are not yet entirely clear, especially with respect to the treatment of atherosclerotic lesions in the femoropopliteal or distal arterial segments. Therefore, the indications for its use have not been firmly established and must take into consideration the natural history of the occlusive disease itself. Although some type of procedural intervention clearly is warranted in the presence of ischemic rest pain or tissue necrosis, intermittent claudication is the only complaint in approximately 70% of patients who present with either aortoiliac or femoropopliteal involvement. Most nondiabetic patients experience substantial symptomatic improvement with a daily exercise program, and their long-term risks for either abrupt deterioration (20-25%) or amputation (less than 10%) are relatively low. In comparison, the 5-year mortality rate ranges from 20-40% even in claudicants, and as many as 40% of those with clinical indications of associated coronary artery disease have been shown angiographically to be candidates for myocardial revascularization. These observations suggest that traditional indications for surgical treatment (truly disabling claudication and/or limb salvage) also should be applied to endovascular therapy until its success is confirmed beyond speculation, and that incidental coronary disease deserves particular attention in patients with lower extremity ischemia. 

Category: cardiovascular diseases
Response of the Lambert-Eaton myasthenic syndrome to treatment of associated small-cell lung carcinoma. We evaluated the outcome in 16 patients with Lambert-Eaton myasthenic syndrome (LEMS) associated with histologically verified small-cell carcinoma (SCC). Thirteen patients received specific tumor therapy (chemotherapy, radiation therapy, or resection) and most also received pharmacologic and immunologic treatment for LEMS. Seven of 11 patients surviving for more than 2 months after tumor therapy showed substantial neurologic improvement (1 patient being in complete remission at 7 years); in 3 of 11 improvement was transient. An EMG index of disease severity (compound muscle action potential amplitude in abductor digiti minimi) was significantly increased at final follow-up (p less than 0.01; n = 11). A pretreatment amplitude greater than 3.0 mV was a good prognostic sign. We conclude that a combined treatment approach in SCC-LEMS usually results in neurologic improvement. 

Category: general pathological conditions
Skeletal muscle following tonic overload: functional and structural analysis. Functional overloading of skeletal muscle induces a compensatory hypertrophy as an adaptive response to increased functional demand. Overload of the extensor digitorum longus (EDL) muscle (129 ReJ strain male mouse) was induced by unilateral surgical removal of a synergistic muscle, tibialis anterior (TA). Response of the EDL to overload for 7, 21, and 42 d was analyzed for changes in 1) muscle weight, 2) myofiber type distribution, 3) myofiber cross-sectional area by fiber type, 4) speed of contraction and relaxation of the muscle, 5) force of contraction, and 6) myofiber morphologic integrity. The weight of the EDL significantly increased. The overload caused no impairment of muscle contractility and did not have a significant effect on isometric twitch contraction time to peak tension or the time to one-half relaxation of the twitch. Overloaded muscles demonstrated a transient shift in fiber type profile with preferential hypertrophy of Type IIA fibers that occurred in the early phase of overload while type IIB fibers were recruited by 42 d. No significant increase in myofiber number in overloaded muscles occurred. Some morphologic changes in over-loaded muscles parallel those found in patients with neurogenic muscular disorders. However, overloaded muscle did not exhibit a significant occurrence of fiber branching from controls in the midbelly region of the muscle. 

Category: general pathological conditions
An analysis of randomized trials evaluating the effect of cholesterol reduction on total mortality and coronary heart disease incidence. The primary aim of this study was to estimate the relation between cholesterol reduction and total mortality and coronary heart disease (CHD) incidence. Secondarily, the clinical issues of whether the efficacy of cholesterol lowering is dependent on the treatment modality, presence of CHD at baseline, or the simultaneous introduction of other interventions was explored. All randomized clinical intervention trials of cholesterol reduction were used in an overview analysis of total mortality rate and CHD incidence; analysis was performed with weighted linear regression. The trials include those that used primary and secondary intervention, diet and drugs, and single or multifactor design. Nineteen trials were analyzed for total mortality, and of the 19, 16 were analyzed for CHD incidence rate. Net difference in cholesterol change between study groups was used as the independent variable, and the three previously mentioned dichotomous design characteristics were used as additional independent variables. For every 1% reduction in cholesterol, an estimated 2.5% reduction in CHD incidence is indicated (95% CL: 1.1, 3.9). With regard to CHD drug trials tended toward better efficiency in cholesterol lowering than did dietary trials. With regard to total mortality, this efficiency was higher in secondary than in primary preventive trials. The efficiency was also somewhat dependent on the baseline cholesterol level. This study shows that cholesterol reduction is effective in lowering CHD incidence, but cholesterol reduction must be at least 8-9% to be effective in lowering total mortality. 

Category: cardiovascular diseases
Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases. Five consecutive unstable fractures of the distal third of the clavicle were treated by indirect open reduction and internal fixation using a temporary Bosworth-type screw. Coracoclavicular fixation provided and maintained reduction of the fracture. Healing occurred uneventfully within nine weeks in all cases. The screw was removed under local anaesthesia after healing of the fracture and there were no surgical complications. Shoulder function was restored to the pre-injury level. Temporary coracoclavicular screw fixation appears to be a valuable alternative for the treatment of type II fractures of the distal third of the clavicle. 

Category: general pathological conditions
Eosinophil infiltration and degranulation in Helicobacter pylori-associated chronic gastritis. Eosinophil granules contain cationic proteins, including the major basic protein, which are toxic to mammalian tissue. While eosinophils have been observed to comprise part of the inflammatory reaction in acute Helicobacter pylori gastritis, the role of the eosinophil in the pathogenesis of chronic gastritis is unknown. We evaluated whether eosinophil infiltration and degranulation are associated with chronic gastritis and H. pylori infection. We studied eight patients with chronic H. pylori antral gastritis, three with chronic antral gastritis in the absence of H. pylori, 11 healthy age-matched volunteers without antral gastritis, and eight patients with H. pylori-negative chronic specific gastritis (three Crohn's antral gastritis and five Menetrier's disease). Serial sections were stained with hematoxylin and eosin, with Giemsa, and by a specific indirect immunofluorescence technique for eosinophil granule major basic protein. Specimens were graded independently by three observers and scores of 0-3 were given for eosinophil infiltration and degranulation (0 = none to 3 = confluent infiltration and/or degranulation). In H. pylori antral gastritis, significantly greater eosinophil infiltration and degranulation were found compared to the normal group, Menetrier's disease, and chronic H. pylori-negative gastritis. There was no significant difference between gastric Crohn's disease and H. pylori gastritis. The severity of chronic gastritis was significantly correlated with the eosinophil score. Eosinophil degranulation did not appear to be greater at or near sites of bacterial colonization in the H. pylori gastritis specimens. The results suggest that eosinophil infiltration and degranulation may be associated with H. pylori gastritis. We postulate that the release of toxic cationic proteins from eosinophils contributes to the inflammatory changes present in H. pylori gastritis. 

Category: digestive system diseases