Melricflash/CW_MedAbstractsAlt huggingface dataset:
A study of the comparative efficacy of four common analgesics in the control of postsurgical dental pain. Four common oral analgesics were tested in a single-blind trial to determine their relative efficacy in the management of postsurgical pain in 103 patients who had their impacted third molars surgically removed under general anesthesia. The analgesics tested were acetylsalicylic acid (26 patients), ibuprofen (26 patients), a paracetamol/codeine/caffeine combination (Solpadeine) (25 patients), and dihydrocodeine (26 patients). The paracetamol/codeine/caffeine combination, ibuprofen, and acetylsalicylic acid preparations produced equally effective analgesia. Dihydrocodeine was found to be a poor analgesic in this pain model. There were no adverse reactions to any of the preparations. 

Category: general pathological conditions
A surgical approach to the cervicothoracic spine. We describe a method for approaching the lower cervical and upper thoracic spine, the brachial plexus and related vessels. The method involves the elevation of the medial corner of the manubrium, the sternoclavicular joint, and the medial half of the clavicle on a pedicle of the sternomastoid muscle. We have used this exposure in 17 cases with few complications and good results. Its successful performance requires high standards of anaesthesia, surgical technique and postoperative care. 

Category: general pathological conditions
Hole preparation techniques for transpedicle screws. Effect on pull-out strength from human cadaveric vertebrae. In each of eight thoracolumbar human cadaveric vertebrae, a hole was made through one pedicle into the vertebral body with a drill bit and through the contralateral pedicle with a probe. Identical metal screws were implanted into the holes to equal depths, and maximum pull-out force was determined for each screw. Using a paired Student t test, no significant difference (P = 0.87) was found in pull-out strength between the screws implanted into drilled holes and those implanted into probed holes. In fact, the average pull-out strengths for the two groups differed by less than 2%. The pedicular cortex was broken through during hole preparation in 5 of the 16 pedicles: 3 as a result of drilling and 2 secondary to probing. The average pull-out strength of the screws in these five pedicles was 11.0% less than the average pull-out strength of the screws implanted into the contralateral intact pedicles. Although this does not represent a statistically significant difference (P = 0.15), it suggests that damaging the pedicular cortex may weaken pedicle screw fixation. 

Category: general pathological conditions
Left ventricular hypertrophy in elderly hypertensive patients: a report from the European Working Party on High Blood Pressure in the Elderly trial. In a double-blind, placebo-controlled trial, 840 elderly hypertensive patients were randomly assigned to treatment with a combination of hydrochlorothiazide and triamterene or placebo; methyldopa or matching placebo was added to the treatment regimen if blood pressures remained high. After adjustment for age, gender, and body mass index, initial electrocardiographic (ECG) voltage measures of RaVL and SV1 + RV5 were significantly related to systolic blood pressure; RaVL was also related to diastolic blood pressure. After one year of treatment, the decrease in RaVL and SV1 + RV5 in the treated patients, adjusted for age and body mass index, were not correlated with the changes in systolic blood pressure, but the decreases in SV1 + RV5 were positively related to the decrease in diastolic blood pressure. After four years of treatment, the decreases in RaVL and SV1 + RV5 were significantly and positively related to the decrease in systolic blood pressure after adjustment for age and changes in body mass index. In a four-year cohort of 222 patients, most of the decreases in ECG voltages in the treated patients and the increases in the placebo patients were found to have occurred during the first year of treatment. The type of treatment (diuretics alone or diuretics plus methyldopa) did not affect ECG voltages during the first year of follow-up. Total and cardiovascular mortality were related to initial amplitude of RaVL, but the significant correlation disappeared after adjustment for age. 

Category: cardiovascular diseases
Fetal and maternal response to intravenous infusion of a thromboxane synthetase inhibitor. Pharmacologic inhibition of thromboxane synthetase activity has reversed the clinical manifestations of toxemia in the ovine model. To investigate placental transfer and fetal effects of a selective thromboxane synthetase inhibitor, CGS13080 (Ciba-Geigy, Summit, N.J.) was intravenously infused into eight singleton- or twin-bearing ewes near term. During CGS 13080 infusion (0.1 mg/kg/hr), maternal steady-state CGS 13080 levels of 102 +/- 18 ng/ml were achieved within 30 minutes and maternal serum thromboxane generation decreased significantly (13 +/- 3 to 4 +/- 1 ng/ml). However, fetal serum levels of CGS 13080 were only 4% of peak maternal concentrations and fetal serum thromboxane generation did not change. There was no evidence of change in uterine blood flow, maternal or fetal blood pressure, heart rate, blood gas values, or fetal or maternal metabolites of prostacyclin or prostaglandin E2 during the study. We speculate that CGS 13080 may be efficacious in the treatment of human pregnancy-induced hypertension. 

Category: cardiovascular diseases
Parathyroid hormone secretion and target organ response in experimental acute pancreatitis. To determine changes in parathyroid hormone secretion and target organ response caused by acute pancreatitis before the development of systemic toxic conditions, experimental acute pancreatitis was induced in rats with a choline-deficient, ethionine-supplemented diet. After 7 days, the rats were weighed and bled, and one kidney was assayed for 25-hydroxyvitamin D1 hydroxylase activity. Several manifestations of pancreatitis were observed in rats given the diet: weight loss (from 29.6 to 26.3 g vs that for control rats, from 29 to 52.8 g) and lower dietary intake (15.5 vs 47 g per rat per 7 days). Serum amylase levels fell from 1794 to 350 U/L in rats given the choline-deficient, ethionine-supplemented diet compared with levels of 1800 to 2100 U/L in control rats. The pancreases of rats given the choline-deficient, ethionine-supplemented diet showed degeneration, necrosis, and hemorrhaging. Serum levels of calcium, phosphorus, chloride, and parathyroid hormone did not change significantly throughout the experiment. Renal 25-hydroxyvitamin D1 hydroxylase activity was higher than in control rats (8.9 +/- 0.8 vs 7.6 +/- 0.6 fmol/mg of kidney per minute). Acute pancreatitis in this experimental animal model does not alter serum levels of calcium and parathyroid hormone or reduce target organ responsiveness to the hormone. 

Category: general pathological conditions
Neurologic complications in chronic renal failure: a retrospective study. We have retrospectively examined 324 patients with chronic renal failure and evaluated the probable underlying causes of neurologic complications, laboratory data and therapeutic interventions. The common neurologic problems in our patients were alterations in consciousness (40.7%) and convulsions (35.1%). When BUN concentration was above 135 mg/dl and creatinine clearance was below 8 m/min/1.73 m2, alteration of consciousness was observed and when BUN concentration was 200 mg/dl and creatinine clearance was below 7 m/min/1.73 m2, abnormal convulsives appeared. Changes in deep tendon reflexes and pathologic reflexes were associated with hypertension. All of the patients with cortical atrophy using computerized cranial tomography aluminum hydroxide at least for 18 months, and six of them had hemodialysis. Fourteen patients who underwent dialysis developed convulsions and were thought to have disequilibrium syndrome. These findings are consistent with the suggestion that the metabolic and biochemical derangements associated with CRF may be particularly detrimental to the still developing CNS of the child. 

Category: nervous system diseases
Postischemic (S)-emopamil therapy ameliorates focal ischemic brain injury in rats. (S)-Emopamil is a calcium channel blocker of the phenylalkylamine class, having potent serotonin S2 antagonistic properties and high blood-brain barrier penetrability. Previous studies have documented cerebroprotective effect in animal models of both focal and global ischemia. The present study was undertaken to define the postischemic "window" of therapeutic efficacy for this agent. Sprague-Dawley rats were subjected to permanent proximal middle cerebral artery occlusion, combined with an initial 30-minute period of halothane-induced hypotension (50 mm Hg). (S)-Emopamil (20 mg/kg) was administered intraperitoneally either 20-30 minutes prior to middle cerebral artery occlusion or 1 hour, 2 hours, or 3 hours following occlusion. Treated groups received a second similar dose 2.5 hours later and twice daily for 2 days thereafter. Brains were perfusion-fixed on the third day. Planimetric analysis of hemotoxylin and eosin-stained coronal brain sections documented a cortical infarct averaging 72.9 +/- 33.3 mm3 (mean +/- SD) in untreated rats. Cortical infarct volume was reduced by 48% (to 37.6 +/- 27.6 mm3) when therapy was initiated 1 hour postischemia (p less than 0.05). When treatment was deferred to 2 hours postichemia, mean cortical infarct volume was reduced by 34%, but this difference did not attain statistical significance. Infarct volume in rats with treatment initiated at 3 hours postischemia was indistinguishable from that in controls. Striatal infarct volume was similar in all groups. These results document a postischemic therapeutic window of cerebroprotection for (S)-emopamil lying between 1 and 2 hours after middle cerebral artery occlusion. 

Category: nervous system diseases
Transient renal acidification defect during acute infantile diarrhea: the role of urinary sodium. We studied urinary acidification daily during the hospital course of 16 infants with acute gastroenteritis and metabolic acidosis. Urine pH value on admission was higher than 5.5 in 14 (87%) patients. We hypothesized that inappropriate urinary acidification was due to sodium deficiency and inadequate sodium delivery to the distal nephron. Forty-one urinary samples were collected during metabolic acidosis. The mean pH of 24 urine samples with sodium concentration less than 10 mmol/L was significantly higher than the pH of 17 samples with sodium concentration greater than 10 mmol/L (6.04 +/- 0.06 vs 5.19 +/- 0.1; p less than 0.001). The urine ratios of titratable acid to creatinine and of total acidity to creatinine were significantly higher in urine samples containing more sodium (p less than 0.02), whereas the ammonium/creatinine ratio was not. After administration of furosemide or correction of the sodium deficit, appropriate acidification was observed. We conclude that impaired urinary acidification is frequently found during metabolic acidosis in infants with acute gastroenteritis and results from a sodium deficit rather than from transient distal renal tubular acidosis. 

Category: digestive system diseases
Future directions for etoposide therapy. Etoposide is an important chemotherapeutic agent in the treatment of selected patients with germ cell tumors, lymphomas, and small cell lung cancer (SCLC). Its optimal use is continuing to evolve. It is clear that schedule dependency is of critical importance. Recently, preliminary studies have suggested that a prolonged schedule of etoposide administration (21 days) may be more effective than the standard 3- to 5-day schedule. Results of several Phase II studies show chronic oral etoposide administration induces occasional responses in resistant tumors and higher-than-expected response rates in patients with germ cell tumors and SCLC. Preliminary data show nearly 90% etoposide absorption when given in a low-dose schedule (50 mg/m2/d) for 21 days. These observations indicate that etoposide may be a "new drug" when given in the chronic schedule. Further exploration of the schedule dependency of etoposide is indicated. Etoposide has recently been proven useful in selected patients with gastric, ovarian, and poorly differentiated carcinoma of unknown primary site. Several other drugs are either synergistic or additive and will be explored in combination chemotherapy. The possibility of adding topoisomerase I inhibitors and modulating etoposide's activity by inhibiting drug resistance is now within the realm of human testing. 

Category: neoplasms
Intestinal pseudoobstruction secondary to amyloidosis responsive to cisapride. A case of chronic intestinal pseudoobstruction secondary to systemic amyloidosis in a patient with multiple myeloma is described. Gastrointestinal symptoms and indices of nutrition improved markedly after commencing treatment with cisapride, which may have been responsible for relatively prolonged survival compared with similar reported cases. 

Category: digestive system diseases
Nephrotoxicity of allopurinol is enhanced in experimental hypertension. Hyperuricemia is present in 20-40% of pediatric and adult patients with essential hypertension. This metabolic abnormality may represent an additional risk factor for the development of cardiovascular disease. Therefore, we performed the following studies to determine 1) whether hyperuricemia is more prevalent in the spontaneously hypertensive rat (SHR) and 2) whether allopurinol treatment has a beneficial effect on the development of hypertension in this strain, based on its capacity to lower the serum uric acid concentration and to act as an antioxidant agent. SHR and control Wistar-Kyoto (WKY) rats were assigned to two groups, one given tap water to drink and the other provided water containing allopurinol (400 mg/l) to furnish an approximate daily dose equal to 100 mg/kg body wt. This treatment was maintained for 15 weeks. The serum uric acid levels were similar in untreated SHR and WKY rats (1.85 +/- 0.10 versus 1.66 +/- 0.14 mg/dl; p = 0.28). In the control WKY rat strain, allopurinol therapy did not adversely affect weight gain or hematocrit and did not cause an increase in mortality. It resulted in a moderate decrement in kidney function (creatinine clearance: allopurinol-treated group 0.32 +/- 0.09 versus control group 0.46 +/- 0.04 ml/min/100 g body wt, in conjunction with mild-to-moderate tubulointerstitial inflammation (allopurinol-treated group 0.9 +/- 0.4 versus control group 0). 

Category: cardiovascular diseases
Managing prostatitis in the elderly. Bacterial prostatitis is primarily a disease of elderly men, and it is the most common urinary tract infection seen in this age group. Urosepsis from prostatitis or prostatic abscess occurs less frequently than with urological manipulation, but must always be considered in elderly men with prostatitis. This article focuses on the diagnosis and antibiotic treatment of bacterial prostatitis in the elderly. 

Category: general pathological conditions
Acute complications of percutaneous transluminal coronary angioplasty for total occlusion. The incidence of major complications after percutaneous coronary angioplasty (PTCA) of a totally occluded artery was assessed retrospectively. A total of 1649 PTCA procedures were analyzed. After exclusion of procedures for acute myocardial infarction or total occlusion that resulted from restenosis, 90 patients were selected. Forty-four patients (49%) had stable angina and 46 (51%) had unstable angina. The estimated duration of occlusion was 87 +/- 78 days in patients with stable angina, as compared with 10 +/- 8 days in patients with unstable angina (p less than 0.001). Abrupt vessel closure during PTCA occurred only in patients with unstable angina (0% versus 17%, p less than 0.05). The major complication rate was 2.5% in the stable angina group, and 20% in unstable angina group (p less than 0.01). This rate was also significantly higher than the complication rate of 8% observed in 442 procedures that were performed during the same period in patients with the unstable angina and nonocclusive stenosis (p less than 0.01). Patients with unstable angina who undergo PTCA of a totally occluded artery represent a subset of high risk for major complications. 

Category: cardiovascular diseases
Renal effects of cyclosporine. Renal dysfunction is a frequent consequence of cyclosporine administration, even when cyclosporine blood concentrations are maintained within proper therapeutic levels. As dermatologic indications for this compound expand, it is important for clinicians to understand the relevant pharmacology and physiology that underlie cyclosporine-induced renal dysfunction. This article reviews the clinical pharmacology of cyclosporine, the principles of renal function testing, and the clinical manifestations of this drug's effects on the kidney. Sudden declines in kidney function, long-term cyclosporine nephrotoxicity, hemolytic-uremic syndrome, and hypertension are discussed from a clinical and experimental standpoint. Finally, practical suggestions are provided to aid the dermatologist in managing cyclosporine-treated patients. 

Category: cardiovascular diseases
Antiepileptic medication in pregnancy: late effects on the children's central nervous system development. In a follow-up study long-term effects of antenatal exposure to two anticonvulsant drugs, phenobarbital and carbamazepine on central nervous system development were evaluated. Children aged 6 to 13 years of epileptic mothers who used phenobarbital (n = 13), carbamazepine (n = 12), phenobarbital plus carbamazepine (n = 12), or no medication (n = 24) during pregnancy were studied. None of the mothers had seizures during pregnancy. A control group carefully matched for confounding variables was selected of children of nonepileptic mothers (n = 61). Minor and major congenital anomalies appeared to be more related to mother's epilepsy than to maternal medication. There were no neurologic differences between the groups. Exposure to phenobarbital was associated with smaller head circumference. An accompanying negative effect of phenobarbital on cognitive development was suggested. Further research on this intriguing phenomenon seems warranted. 

Category: nervous system diseases
Symptomatic pineal cyst: case report. Pineal cysts are being described with increasing frequency since the advent of magnetic resonance imaging. Although pineal cysts are incidental findings in as many as 4% of magnetic resonance imaging studies, symptomatic pineal cysts are quite rare. We present a case of pineal cyst causing aqueductal obstruction with symptomatic hydrocephalus and resultant headache and syncope, which was treated by surgical resection. A review of the relevant literature and discussion follow. 

Category: nervous system diseases
Immune-competent cells of regional lymph nodes in colorectal cancer patients: II. Immunohistochemical analysis of Leu-7+ cells. Distribution of Leu-7+ cells in cancer tissues and regional lymph nodes was immunohistochemically examined to estimate the role of NK cells in colorectal cancer patients. Leu-7+ cells were rarely observed both in the primary and distant metastatic lesions, but the number of these cells was large in the germinal center of the lymph nodes. Studies of Leu-7+ cell population in the lymph node indicated that intermediate nodes in n0 and n1 groups showed significantly higher values than those in the control group. Comparative study of the population in identical patients revealed a significantly higher rate in the intermediate nodes than in the paracolic nodes both in n0 and n1 groups. These data suggest that Leu-7+ cells might be related to the defense mechanism of regional lymph nodes against tumor. 

Category: neoplasms
Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results. We report the improving surgical results in a consecutive series of 690 patients referred to one of us (E.S.C.) for aortic dissection between December 1956 and September 1989, a substantial portion of whom had dissection as a complication of either previous aortic (n = 113, 16) or previous cardiac (n = 54, 8%) operation. Our initial operation of choice in patients requiring multiple operations in this group of 690 patients was based on the most life-threatening or symptomatic aortic segment involved, which was ascending aorta and/or aortic arch (Asc/Arch) in 301 (44%) patients, descending thoracic aorta (Desc) in 195 (28%) patients, and thoracoabdominal aorta (TaA) in 194 (28%) patients. As detailed below, considerable improvement occurred in the 30-day survival rates over time, particularly for acute dissection: [table; see text] The independent determinants of both early and long-term mortality were identified. Independent determinants of late fatal rupture, reoperation, and neuromuscular dysfunction for distal dissectors were also identified. In our experience, continued aggressive surgical intervention for aortic dissection with modern operative techniques has resulted in markedly improved 30-day operative survival (approaching 95% including those patients with acute dissection) and significant improvement in late results. 

Category: cardiovascular diseases
Chronic illness and depressive symptoms in the elderly: a population-based study. A cross-sectional study of the distribution of depressive symptoms and association between depressed mood and chronic illness was conducted in a geographically defined population in southern California of 1617 men and women aged 65 years and older. The prevalence of depressed mood for the total population was 5.2%. Women exhibited a significantly higher mean depressive symptom score and a prevalence rate almost twice that of men. Depressive symptoms were associated with several risk factors in both sexes, including age, self-perception of current health status, number of reported chronic diseases and medications and amount of exercise. However, the relationship between physical illness and depressive symptoms appeared to differ by sex with respect to the nature of the disease or disability and the type of medication currently used. These findings indicate that the risk of depression does not diminish with age among the elderly as other studies have suggested. 

Category: general pathological conditions
Intermittent obstruction of an incarcerated hiatal hernia with a total thoracic stomach. A case of intermittent obstruction of a sliding hiatal hernia is presented. The obstruction occurred when the patient's stomach was totally above the diaphragm. The anatomy of sliding hiatal hernias is discussed, as well as the presenting signs and symptoms of obstruction in sliding hiatal hernias. 

Category: digestive system diseases