Melricflash/CW_MedAbstractsAlt huggingface dataset:
Idiopathic biliary ductopenia in adults: a report of five cases. The clinical and pathological findings of five adult cases of idiopathic nonsyndromatic paucity of interlobular bile ducts are reported. Patients were 18-32 years old at the onset of the disease; four presented with pruritus and/or jaundice and one with bleeding of the esophageal varices. Two patients were siblings. Serum alkaline phosphatase counts ranged from 1 to 16 times the upper normal value, and total bilirubin counts ranged from 0.6 to 8.8 mg/dL (10 to 150 mumol/L). Initial liver biopsy showed portal and periportal fibrosis with cholangiolar proliferation and reduction in the number of interlobular bile ducts. Antimitochondrial antibodies were absent, and bile ducts were normal after opacification. The patients were observed for 3-11 years. Repeated liver biopsies in the five patients showed progression of the lesions, with development of biliary type cirrhosis in four. Two of the four patients with cirrhosis died of hepatic failure 3 and 11 years after onset of the disease. In the two other cases, liver transplantation was performed successfully. These cases suggest that chronic cholestasis with marked ductopenia resembling the nonsyndromatic paucity described in infancy and childhood may reveal itself at an adult age. This disorder, possibly familial, may rapidly progress to severe and even fatal liver disease and could be a new indication for liver transplantation. 

Category: digestive system diseases
Gallstones, cholecystitis and diabetes [published erratum appears in Surg Gynecol Obstet 1991 Jul;173(1):72] Findings from studies showing an increased incidence of gallstones in diabetic patients do not control for other variables, such as obesity. There is no proof that diabetic patients have more gallstones. Gallstones do not cause diabetes mellitus. The principal gallbladder pathologic feature in diabetic patients is a functional deficit of uncertain etiologic factors, creating a large, flaccid, poorly emptying organ. Bile acid and lipid composition are usually increased in diabetic patients. Cholecystitis seems to be a more serious disease in diabetic patients, with worse infectious sequelae and more rapid disease progression. This conclusion has not been examined statistically. Even with modern care, the complication rate for operations upon the biliary tract in patients with diabetes is increased. Those with diabetes are generally older than other patients requiring cholecystectomy. Systemic changes of aging partly explain increased morbidity and mortality. Diabetic patients with symptomatic gallbladder disease usually require operation. Risk of cholecystectomy in diabetic patients is similar to that in nondiabetics. Prophylactic cholecystectomy for diabetic patients with "silent" gallstones was formerly recommended because of an apparent high risk of cholecystitis. Until the natural history of gallstones in those with diabetes has been defined, such patients should be considered in danger of serious illness. The risk of acute cholecystitis in diabetic patients with stones is probably significant enough to warrant the performance of early cholecystectomy. 

Category: digestive system diseases
Aortocaval and iliac arteriovenous fistulas: recognition and treatment. Despite the well characterized physiologic effects of aortocaval or iliac arteriovenous fistulas, patients with such uncommon lesions may manifest a diverse array of symptoms, and diagnosis is often delayed or overlooked. To examine clinical features that facilitate recognition and allow successful repair, a 30-year experience with 20 such fistulas was reviewed. Fourteen fistulas were caused by aneurysm erosion, four followed iatrogenic injury during lumbar disk surgery, and two developed from abdominal gunshot wounds. The interval from presumed occurrence to diagnosis ranged from 3 hours to 8 years. The diagnosis was not recognized before surgery in five (25%) patients. Back pain (70%) was the most common symptom. The presence of a typical abdominal bruit (80%) was the most reliable physical finding, but its significance was occasionally overlooked or misinterpreted. Congestive heart failure was prominent in only seven (35%) patients. Severe lower extremity edema and mottling was the primary manifestation in eight cases, often causing initial confusion with venous thrombosis. Hematuria (5 patients) and oliguric renal failure (4 patients), both fully reversible after fistula repair, also caused diagnostic uncertainty. The mean preoperative cardiac output was 12.2 L/min, falling to 5.4 L/min with fistula repair. Mean blood loss was 5960 ml, supporting use of intraoperative autotransfusion. Two operative deaths (10%) occurred, both in patients not correctly diagnosed before surgery. Despite varied modes of presentation, prompt recognition and use of appropriate operative techniques should achieve successful repair. 

Category: cardiovascular diseases
Comparison of functional and structural brain disturbances in Wilson's disease. We assessed the functional and structural brain disturbances in Wilson's disease (WD) by evoked potentials (EPs) and magnetic resonance imaging (MRI). All the 25 neurologically symptomatic and 44% of the 16 asymptomatic patients, assessed by both EPs (n = 48) and imaging (n = 41), had at least 1 abnormality of either prolonged EP conduction times, imaging-outlined presence of cerebral lesions, or brain atrophy. Our findings indicate that EPs and MRI are sensitive techniques for the evaluation of brain involvement in WD. 

Category: nervous system diseases
Giant lymph node hyperplasia of the lung (Castleman's disease) associated with recurrent pleural effusion. A case of giant lymph node hyperplasia (Castleman's disease) of the lung presented with pleural effusion (which was recurrent), an unusual complication. The patient was treated with pneumonectomy and has survived for three years without relapse. This is the first report of the disease from black Africa. 

Category: general pathological conditions
Acute respiratory failure. Pregnancy entails many unique physiologic changes that make the management of ARDS both challenging and unique. Most of these women are young and in excellent health before their acute injury, and their survival should exceed that of the general population who develop ARDS. We advocate aggressive management of the suspected lung injury including early intubation and the institution of invasive hemodynamic monitoring. This approach ensures the most thorough assessment of the extent of the initial injury and allows rapid assessment of therapeutic maneuvers and their subsequent adjustment. Our goal is to reverse the initial insult early while avoiding further iatrogenic injury. Optimal management of the maternal-fetal pair requires the cooperation of an obstetrician well versed in cardiopulmonary physiology and physicians skilled in intensive care medicine. 

Category: general pathological conditions
Practical aspects of pulsatile gonadotropin-releasing hormone administration. Pulsatile administration of gonadotropin-releasing hormone represents a major advance in the treatment of anovulation in women who fail to ovulate with clomiphene citrate and is an alternative for many women who currently receive human menopausal gonadotropin. Four issues must be addressed before administering pulsatile gonadotropin-releasing hormone: (1) safety, (2) efficacy, (3) convenience, and (4) cost. Each of these issues will be affected by the three major decisions a physician makes with gonadotropin-releasing hormone therapy: (1) patient selection, (2) route of administration, and (3) dose of gonadotropin-releasing hormone. The ideal candidate for gonadotropin-releasing hormone therapy is a patient with an absence of endogenous pulsatile gonadotropin-releasing hormone, as seen in hypothalamic amenorrhea. Although women with polycystic ovarian disease can be treated with pulsatile gonadotropin-releasing hormone, a decreased ovulation rate should be expected. The route of administration, intravenous or subcutaneous, and the degree of monitoring can be tailored by the physician to fit each patient's needs. Pulsatile gonadotropin-releasing hormone therapy is a safe, effective, convenient, and economical alternative to human menopausal gonadotropin for ovulation induction in women resistant to clomiphene. 

Category: general pathological conditions
Comparison of algorithms of testing for use in automated evaluation of sensation. Estimates of vibratory detection threshold may be used to detect, characterize, and follow the course of sensory abnormality in neurologic disease. The approach is especially useful in epidemiologic and controlled clinical trials. We studied which algorithm of testing and finding threshold should be used in automatic systems by comparing among algorithms and stimulus conditions for the index finger of healthy subjects and for the great toe of patients with mild neuropathy. Appearance thresholds obtained by linear ramps increasing at a rate less than 4.15 microns/sec provided accurate and repeatable thresholds compared with thresholds obtained by forced-choice testing. These rates would be acceptable if only sensitive sites were studied, but they were too slow for use in automatic testing of insensitive parts. Appearance thresholds obtained by fast linear rates (4.15 or 16.6 microns/sec) overestimated threshold, especially for sensitive parts. Use of the mean of appearance and disappearance thresholds, with the stimulus increasing exponentially at rates of 0.5 or 1.0 just noticeable difference (JND) units per second, and interspersion of null stimuli, Bekesy with null stimuli, provided accurate, repeatable, and fast estimates of threshold for sensitive parts. Despite the good performance of Bekesy testing, we prefer forced choice for evaluation of the sensation of patients with neuropathy. 

Category: nervous system diseases
Complications of flaps. Flaps are susceptible to the same complications as side-to-side closures. However, as the blood supply to a flap is more precarious, the complication may have a more dire effect. This article catalogues the various acute complications with an emphasis on early recognition and management. 

Category: general pathological conditions
HiC-COM: a 2-month intensive chemotherapy regimen for children with stage III and IV Burkitt's lymphoma and B-cell acute lymphoblastic leukemia. We designed a protocol that included 2 months of intensive Cytoxan (cyclophosphamide; Bristol-Myers Co, Evansville, IN), high-dose methotrexate (MTX), high-dose cytarabine (ara-C), and vincristine (HiC-COM) to improve event-free survival (EFS) for patients with advanced-stage Burkitt's lymphoma and B-cell acute lymphoblastic leukemia (ALL). We also wished to test the feasibility of rapidly cycling Cytoxan and high-dose ara-C based on signs of early marrow recovery. Twenty patients including 12 with stage III Burkitt's lymphoma and eight with stage IV Burkitt's lymphoma or B-cell ALL were entered onto this pilot study. The rate of complete remission was 95%. Four patients have relapsed. The 2-year actuarial EFS was 75% (median follow-up, 37 months). Two of the initial five patients developed transverse myelitis, which we believe may have been secondary to the concomitant administration of intrathecal (IT) and high-dose systemic ara-C. We conclude that this short but intensive regimen is highly effective for patients with advanced Burkitt's lymphoma and B-cell ALL. EFS has improved over previous less intensive regimens, and is comparable to regimens of longer duration. 

Category: neoplasms
Polyglucosan body disease. Adult polyglucosan disease has been described in 15 cases. All had signs of peripheral neuropathy, upper motor neuron signs, and 12 of the 15 had sphincter problems. Dementia was prominent in 8 of 15 cases. We reported 2 cases that contained these clinical features. Electrophysiological studies showed axonal neuropathy. Somatosensory evoked potentials on the second patient were abnormal. Sural nerve biopsy showed clusters of polyglucosan bodies. Although the presence of polyglucosan bodies in biopsy is nonspecific, the number as well as the clinical features are necessary to make the diagnosis. Branching enzyme activity in muscle extracts of the muscles were normal. Hence, a specific enzyme abnormality is not yet known. 

Category: general pathological conditions
Prognostic factors in stage IB squamous cervical cancer patients with low risk for recurrence. About one-half of cervical cancer patients whose tumors recur after radical surgery have negative lymph nodes and clear resection margins. We evaluated 95 patients with squamous cell tumors who underwent radical hysterectomy and pelvic lymphadenectomy between January 1975 and December 1985 and who were thought to be at low risk for recurrence to see whether other clinical or histopathologic factors were predictive of tumor recurrence. Detailed retrospective record review and complete pathology review were accomplished for each case. The 5-year actuarial survival rate was 89%. Nine patients developed recurrent disease (9.5%), of whom eight died. Several clinical features were evaluated as possible prognostic factors: patient age (P = .26), patient race (P = .60), cervical diameter (P = .24), extent of gross cervical involvement (P = .36), and presence of contact bleeding (P = .82). Histopathologic features were examined: depth of invasion (P = .31), number of mitoses (P = .42), character of the tumor-stromal border (P = .15), histologic differentiation (P = .02), lymph-vascular space invasion (P = .56), and width of tumor (P = .23). Depth of invasion did correlate with increasing tumor width (P less than .001). Once node- and margin-positive patients are excluded, differentiation may be the only feature useful in identifying patients at risk for recurrence. Because almost one-half of our patients had poorly differentiated tumors, sole use of this feature as a criterion for adjuvant therapy would have resulted in overtreatment of low-risk patients. 

Category: neoplasms
Characteristics of natural antibody responses to the circumsporozoite protein of Plasmodium vivax. The antibody response to the prototype circumsporozoite (CS) protein of Plasmodium vivax (CSPV) was studied in Thai soldiers experiencing occupational malaria. Seventy-four (65%) of 114 men followed during assignment to a malaria transmission area developed blood-stage infection with P. vivax. IgG antibodies against the central repeat region of the CSPV protein were quantitated by ELISA using the recombinant protein, NS181V20, as the capture antigen. One quarter of the subjects had detectable anti-CSPV antibodies at the beginning of the study. CSPV antibody seroconversion was documented in 16 of 26 subjects assessed during their first observed episodes of vivax malaria. This antibody response was of moderate magnitude, fell off after the first week post-diagnosis and appeared, at the low levels observed, to be unassociated with protection. Continued assessment of anti-CSPV antibody after subjects left the transmission area found no increase associated with release of P. vivax. These findings indicate that CS antibody responses to P. vivax during occupational malaria share many characteristics with responses to P. falciparum. 

Category: general pathological conditions
Supplemental emergent chest computed tomography in the management of blunt torso trauma. The efficacy of conventional chest X-ray (CXR) in comparison to chest computed tomography (CCT) in acutely injured blunt trauma patients was examined. Over a 21-month period, 50 patients underwent CXR and CCT according to a standard protocol, and their films and records were reviewed retrospectively. Hemo- and/or pneumothorax (HPTX) was noted in 12 patients (five by CXR, 12 by CCT). Pulmonary contusion (PC) was identified in ten patients (four by CXR, ten by CCT). Three additional false positive PC were diagnosed by CXR. Therapy changes based upon CCT findings occurred in seven of seven HPTX and five of six PC. The two imaging techniques were complementary in detecting fractures. Atelectasis was a common CCT finding (58% incidence). Chest X-ray is less sensitive than chest computed tomography in the detection of HPTX (42% vs. 100%) and PC (40% vs. 100%). Emergent chest computed tomography is recommended in stable patients with: 1) blunt high-energy torso trauma, 2) "cross-body" injury pattern, and/or 3) a mechanism of injury suggestive of chest trauma. 

Category: general pathological conditions
Divergent efficacy of antibody to tumor necrosis factor-alpha in intravascular and peritonitis models of sepsis. The role of tumor necrosis factor-alpha (TNF alpha) in the lethal consequences of intravascular lipopolysaccharide (LPS) or Escherichia coli sepsis was compared with that in bacterial peritonitis. Intravenous administration of E. coli LPS or E. coli (live or dead) resulted in large transient increases in serum TNF alpha levels, peaking at 90 min at 10,000-30,000 units/ml. In contrast, the serum TNF alpha response following the induction of bacterial peritonitis was substantially less, peaking at 200-500 units/ml. Sterile peritonitis (essentially nonlethal) and bacterial peritonitis (greater than 60% lethal) elevated TNF alpha levels to 1000-2000 units/lavage within the peritoneal cavity 2 h after challenge. Passive immunization with neutralizing goat anti-TNF alpha IgG improved survival from 8% to 75% in rats administered LPS intravenously but was completely ineffective in protecting rats from lethal E. coli peritonitis. Thus significant differences exist in the role TNF alpha plays in systemic intravascular models of sepsis and bacterial peritonitis. 

Category: digestive system diseases
An analysis of the results of mammographically guided biopsies of the breast. Three hundred and fifty-three women underwent 358 biopsies of the breast for nonpalpable mammographic lesions during a five year period. Cancer was identified in 95 (27 per cent). Mammographic findings in the patients with cancer were calcifications only (54 per cent), a mass (27 per cent), a mass with calcifications (15 per cent), an asymmetric distortion (1 per cent) and an asymmetric distortion with calcifications (3 per cent). Cancer was identified in 29 per cent of the biopsies done for calcifications, 20 per cent of those done for a mass with calcifications, 6 per cent of those done for an asymmetric distortion and 38 per cent of those done for an asymmetric distortion with calcifications. Forty-nine per cent of the mammographically suspicious calcifications were cancer, while 100 per cent of the indeterminate calcifications were benign. Forty-five per cent of the spiculated masses were cancerous, while only 3 per cent of the circumscribed masses were malignant. For those patients with carcinoma undergoing axillary lymph node dissection, 13 per cent had one or more positive nodes. A strategy for increasing the effectiveness of mammographically guided biopsies of the breast is presented. 

Category: neoplasms
Perinatal transmission of human papillomavirus. Human papillomavirus infection is probably the most prevalent sexually transmitted disease in the United States. In adults, it is associated with condylomata acuminata and with neoplastic changes ranging from dysplasia to carcinoma. Infected mothers may transmit human papillomavirus during the perinatal period; affected children face prolonged, difficult treatment for respiratory papillomatosis. Prevention of infection remains the best approach, since diagnostic and therapeutic methods are suboptimal. 

Category: neoplasms
Thyrotoxicosis induced by topical iodine application. We describe an elderly man who was admitted with congestive cardiac failure and found to have thyrotoxicosis. He did not have goiter, and he had normal radioiodine uptake in his neck. Serum iodine levels were elevated, explaining the lack of increase in radioiodine uptake in the thyroid gland. He had multiple pressure sores, which were treated with povidone-iodine (Betadine) soaks. Biochemical data were consistent with Graves' disease unmasked by topical iodine application. Povidone-iodine soaks are commonly used in decubitus ulcer care and warrant special attention in patients with preexisting thyroid disorders. We have reviewed the literature on this unusual complication. 

Category: cardiovascular diseases
Nontropical pyomyositis as a cause of subacute, multifocal myalgia in the acquired immunodeficiency syndrome. We report a case of nontropical pyomyositis in a patient with acquired immunodeficiency syndrome and disseminated Mycobacterium avium infection, in which severe myalgia was the presenting symptom over several weeks. Multifocal muscle lesions were identified by gallium scanning and magnetic resonance imaging techniques. The epidemiology, possible pathogenesis, clinical features, diagnostic imaging, and therapy are reviewed. Early suspicion of nontropical pyomyositis in severely immunocompromised patients with "cryptic" myalgia is recommended. 

Category: nervous system diseases
The natural history of non-arteritic anterior ischaemic optic neuropathy. Seventy one patients with non-arteritic anterior ischaemic optic neuropathy were studied retrospectively. Sixty three (89%) were followed to the end of the study or death, mean follow up time was 5.3 years. Whilst twenty (28%) had diabetes or hypertension, in thirty nine (55%) no predisposing condition was identified. In those who had monocular disease at presentation (68), subsequent involvement of the second eye occurred in seventeen (25%), seven within the first year. Nineteen patients died within the study period. Of these, nine died from myocardial infarction and four from cerebrovascular disease. This is a significant increase above figures calculated from the Office of Population Census and Surveys (p less than 0.001 for all causes, p less than 0.002 for myocardial infarction and cerebrovascular disease). Such an increase in mortality has not been previously reported, and implies that this condition carries a more sinister systemic prognosis than is frequently supposed. 

Category: cardiovascular diseases
Infection in the myelodysplastic syndromes. PURPOSE: To determine the incidence, characteristics, and outcome of infection in patients with myelodysplastic syndromes (MDS) and risk factors that may lead to infection. PATIENTS AND METHODS: We reviewed infections that occurred in 86 consecutive patients with MDS who received care from 1968 to 1986 at a university-affiliated Veterans Affairs Medical Center. Time lines charting the course of each patient with MDS were created and included infections, MDS subgroup at the time of presentation and at the time of each infection, peripheral neutrophil counts, and therapies for MDS. RESULTS: Infections occurred at a rate of nearly one per patient year of observation. Infection rates were associated with MDS subgroup as follows: refractory anemia with or without ringed sideroblasts (RA +/- RS) less than refractory anemia with excess blasts (RAEB) less than RAEB in transformation (RAEB-T). The group of RA +/- RS patients who had erythroid abnormalities but minimal or no dyspoiesis of other cell lines had the lowest rate of infections. Infection rates were higher in patients with less than or equal to 1,000 neutrophils/microL blood than in patients with greater than 1,000 neutrophils/microL blood for each classifiable MDS subgroup. Neutrophil concentration and MDS subgroup were independent risk factors for infection in patients with MDS. Bacterial pneumonias and skin abscesses were the most common infections. Infection was the most common cause of death during MDS, accounting for 64% of deaths, and was more common than transformation to acute leukemia as a cause of death. CONCLUSION: Infection is a common, life-threatening problem in patients with MDS. Neutropenia and MDS subgroup are each risk factors for infection. Clinicians should aggressively evaluate patients with fever and MDS for infection, especially pneumonia and skin infections. 

Category: general pathological conditions