Melricflash/CW_MedAbstractsAlt huggingface dataset:
Impedance tympanometry and acoustic reflectometry at myringotomy [published erratum appears in Pediatrics 1991 Jun;87(6):945] A total of 220 ears undergoing myringotomy and pressure-equalizing tube placement were studied with impedance tympanometry and acoustic reflectometry in a direct comparison for detection of middle-ear effusion. Impedance tympanometry and acoustic reflectometry were equally accurate, detecting the presence or absence of middle-ear effusion in 73% and 72% of ears, respectively. The presence of effusion in ears with tympanographic patterns other than type A and type B was not consistently and reliably predicted. The higher sensitivity of impedance tympanometry (90%) compared with that for acoustic reflectometry (58%) contrasted with the opposite findings for specificities (54% vs 88%). It is concluded that impedance tympanometry and acoustic reflectometry measure different events at the tympanic membrane and their utility lies in the fact that they complement each other. These instruments can aid the experienced otoscopist in confirming a clinical impression and assist the less experienced clinician in validating or improving otoscopic skills. 

Category: general pathological conditions
General assay for phosphoproteins in cerebrospinal fluid: a candidate marker for paraneoplastic cerebellar degeneration. The components of protein phosphorylation systems (protein kinases, protein phosphatases, and their phosphoprotein substrates) are highly enriched in neuronal cells compared with other cell types. We exploited this relative neuronal enrichment of protein phosphorylation system components to develop a general assay technique for putative protein kinase substrates (phosphoproteins) in human cerebrospinal fluid. Using this cerebrospinal fluid phosphoprotein assay, we have detected a putative protein kinase C substrate protein of apparent Mr 60 kd in 6 of 14 patients with paraneoplastic cerebellar degeneration but not in any of 55 patients with a variety of other neurological diseases. Phosphoproteins in cerebrospinal fluid may provide novel and unique markers for the diagnosis or staging of neuronal diseases as well as offer potential insights into the biochemical characterization of affected neuronal populations. 

Category: nervous system diseases
Emphysematous gastritis: case report and review. Emphysematous gastritis is a condition involving gastric wall inflammation, radiologic or intraoperative evidence of intramural gas, and systemic toxicity. A recent case of emphysematous gastritis in a 57-year-old diabetic man is reported, and 27 cases published since 1889 are reviewed. Predisposing factors include ingestion of corrosive substances (37%) and alcohol abuse (22%). Diagnosis of emphysematous gastritis is based on the clinical presentation of an acute abdomen with systemic toxicity and on radiographs demonstrating gas bubbles within the stomach wall. For the case reported herein, computed tomography was useful both in establishing the diagnosis and in following the resolution of emphysematous gastritis. Organisms most commonly involved were Escherichia coli (six cases), Streptococcus species (six cases), Enterobacter species (five cases), and Pseudomonas aeruginosa (three cases). The mortality was 61% (17 of 28 patients), and morbidity with gastric contractures occurred in 21% of cases (6 of 28). Optimal therapy has not been defined; however, antimicrobial chemotherapy and surgery, when appropriate, may improve survival rates. 

Category: general pathological conditions
Diagnosis of left atrial thrombi in mitral valve disease by coronary arteriography. Arteriographic findings of neovascularity and fistula formation between coronary arteries and left atrium have occasionally been described in association with left atrial thrombosis in patients with mitral valve disease. The validity of these coronary arteriographic findings in diagnosis of atrial thrombi has been evaluated in 112 patients with mitral valve disease. Comparison was made with surgery. The study furnished these diagnostic values: sensitivity 70%, specificity 85%, positive predictive value 72%. Even if this angiographic finding is complementary in diagnosis of atrial thrombosis, its identification during coronary arteriography in patients with mitral valve disease is useful. Its detection could improve diagnostic prediction of thrombosis, especially in patients without previous embolic events or where echocardiography failed to reveal thrombi. 

Category: cardiovascular diseases
Aspiration pneumonia and the laryngeal mask airway A case of aspiration pneumonia is reported after the use of a laryngeal mask airway in a young woman undergoing an elective cholecystectomy. The case illustrates the hazards of regurgitation with the laryngeal mask airway and the need for further evaluation when used with controlled mechanical ventilation. 

Category: general pathological conditions
Sclerotherapy for esophageal varices. Endoscopic injection sclerotherapy (EIS) frequently is used for patients with esophageal varices, both for controlling acute hemorrhage and for prophylaxis. An old technique, interest in EIS increased when other methods did not improve patient outcomes. Clinical trials of EIS for acute hemorrhage demonstrated efficacy and improved outcome, although some researchers disagree with these findings. Recent data on prophylaxis with EIS fail to support the value of EIS for this indication. Ethanolamine oleate compares favorably with other sclerosing agents, and is the only one currently approved for EIS. The intravariceal method is used more frequently than the paravariceal method because it has better efficacy and can be performed more rapidly. The percentage of patients developing significant complications from EIS may be as high as 15 percent; common complications include retrosternal pain, pyrexia, and sepsis. EIS is currently an important clinical tool in the management of esophageal varices. 

Category: digestive system diseases
Local hypothermia to prolong safe tourniquet time. Local hypothermia was studied as a method to safely prolong tourniquet time for reconstructive procedures of the upper extremity. An ice blanket constructed of flannel cloth and cold gel packs was applied to the limb for 45 minutes preoperatively. Seventy-eight patients were evaluated for complications resulting from hypothermia and prolonged tourniquet application. The duration of continuous tourniquet ischemia averaged two hours and 25 minutes. Intraoperative muscle temperature recordings indicated that the iced limbs were an average of 12.9 degrees cooler than noniced limbs before tourniquet inflation. Electron microscopic studies of biopsied muscle showed no evidence of ischemic changes. There were no postoperative complications associated with prolonged tourniquet inflation or the hypothermia blanket technique. Local hypothermia appears to be a safe and effective method of decreasing the adverse effects of tourniquet ischemia and allowing continuous tourniquet inflation time to extend safely beyond the customary two-hour limit. 

Category: cardiovascular diseases
Ablation of the cystic duct and the gallbladder. Experimental basis and initial clinical observations. Bipolar radiofrequency electrocoagulation of the cystic duct by catheter can be performed safely and reproducibly using fluoroscopic control and induces endoluminal scar formation. The scar within the cystic duct forms a reliable barrier between the gallbladder and the biliary system and avoids recanalization of the cystic duct at a later date. Sclerotherapy of the isolated gallbladder with 95% ethanol and 3% STS can be performed without toxic or otherwise adverse effects and is suitable to ablate the porcine gallbladder. Initial clinical trials with this new technique on a small number of patients are promising and have demonstrated that the protocol can be applied safely to humans. The electrocoagulation technique by catheter appears suitable to ablate the human cystic duct. Follow-up evaluation of our first patients is under way and must determine whether our regimen is appropriate to ablate the human gallbladder on a long-term basis. Further development of this new approach may eventually enable definitive nonoperative treatment of cholecystolithiasis in selected patients. 

Category: digestive system diseases
Preliminary characterization of growth factors secreted by human pituitary tumors. To investigate the secretion of mitogenic factors by human pituitary tumors we have cultured cells from 54 adenomas in serum-free medium. Conditioned media from 28 (52%) elicited dose-dependent stimulation of [3H]thymidine incorporation into rat GH3 cells (22-338% above control), while 14 (26%) inhibited GH3 proliferation. Stimulating activity was observed more frequently in nonfunctional tumor-conditioned medium (73%; n = 22) than in secretory tumor-conditioned medium (37%; n = 32). Of 10 tumour-conditioned media with mitogenic activity for GH3 cells, only 4 produced modest stimulation of HEp2 (human laryngeal carcinoma) cells. In contrast, [3H]thymidine incorporation into A431 (human squamous carcinoma) and PC12 (rat adrenal pheochromocytoma) cells was enhanced by each of 15 tumor-conditioned media (up to 342% and 275%, respectively), 8 of which had shown stimulatory and 2 inhibitory effects on GH3 cells. Gel filtration of pooled conditioned media from 10 nonfunctional tumors showed significant growth-promoting activity for GH3 cells in fractions corresponding to mol wt of 2-3 and 11-18 kDa. Proliferative activity on A431 cells also eluted in two positions; one corresponded to the higher mol wt peak seen with GH3 cells, while the other, not observed with GH3 cells, was in the 3- to 6-kDa range. These findings suggest that cells derived from human pituitary adenoma tissue synthesize and secrete several growth factors, each of which may have its own target cell specificities. These factors have yet to be characterized, but we suggest that they may have a role in stimulating the development or maintenance of human pituitary adenomas. 

Category: neoplasms
Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer's disease The brains of patients with Alzheimer's disease (AD) invariably exhibit neuropathology in the hippocampus and entorhinal cortex when examined postmortem. Magnetic resonance imaging (MRI) offers a noninvasive, high-resolution method for quantifying volumetric changes in the AD brain antemortem. Eight patients diagnosed with probable AD and 7 age-matched controls had MRI scans and were tested on a battery of cognitive and olfactory tests. The hippocampus and entorhinal cortex (parahippocampal gyrus) showed significant atrophy, with over 40% reduction in size. Areas of the brain that are not highly involved in the degenerative state of AD, such as the striatum, did not show significant volumetric changes. Hippocampal and parahippocampal gyrus volumes had the highest correlation with scores on the Mini-Mental State Examination (r = 0.89), with lower correlations for a smell identification test (r = 0.65), odor match-to-sample test (r = 0.72), and a visual match-to-sample test (r = 0.26). 

Category: general pathological conditions
Effect of hemodialysis on protein C, protein S, and antithrombin III levels. We studied the effect of hemodialysis on natural coagulation inhibitors including protein C (PC), protein S (PS), and antithrombin III (AT III), as well as the correlations between the antigen level (immunological activity) and functional activity of individual coagulation inhibitor. Plasma AT III, PS, and PC were measured in 20 uremic patients on maintenance hemodialysis immediately before, during, and after dialysis treatment. These values were compared with those obtained from 20 matched healthy controls. Plasma PC and total PS antigen levels were measured by enzyme immunoassay. The plasma AT III antigen level was determined by Laurell rocket immunoelectrophoresis. Functional activities of PC and AT III were determined by the amidolytic method. Free PS antigen level was quantitated by measuring the free PS-related antigen after the sample was treated with polyethylene glycol to remove the C4b-binding protein. Uremic patients on maintenance hemodialysis had a higher total PS antigen level, but a lower free PS antigen level compared with the controls. Both the antigen level and functional activity of AT III in uremic patients were significantly lower than those of controls. Their predialysis plasma PC antigen level and functional activity were not different from those of normal controls. A significant correlation between the antigen level and functional activity of PC, PS, and AT III was demonstrated in healthy controls, but not in hemodialysis patients. No significant change in the level of AT III or PS was observed with hemodialysis, but a progressive increase of functional activity of PC was documented with hemodialysis. Furthermore, the coefficient of correlation between the antigen level and functional activity of PC improved significantly with dialysis treatment. 

Category: cardiovascular diseases
Efficacy of transesophageal echocardiography as a perioperative monitor in patients undergoing cardiovascular surgery. Analysis of 149 consecutive studies. To evaluate the usefulness of transesophageal echocardiography as a perioperative monitor in patients undergoing cardiovascular surgery, 149 consecutive patients were studied since 1985. Left ventricular function was assessed by measurement of left ventricular dimension and ejection fraction in patients with valvular disease. This monitoring was useful in detecting the changes in left ventricular performance in patients with volume overload and in managing patients in the early postoperative period. Cardiac tamponade was clearly demonstrated before changes in electrocardiogram and hemodynamic data. In 27 patients, transesophageal color Doppler echocardiography was used to confirm that there was no residual regurgitation immediately after valvular reconstructive surgery. Transesophageal color Doppler echocardiography was also useful in detecting the entry of false lumen before surgery in 7 patients with dissecting aortic aneurysm. There were no unsuccessful introductions, no traumatic or thermal injuries, 18 patients (12.1%) with hoarseness and 5 patients (3.4%) with transient arrhythmia. In conclusion, transesophageal echocardiography provides a good imaging window to the heart and great vessels perioperatively. This expedient, safe informative imaging method can be used more routinely in patients during surgery. 

Category: neoplasms
Tropical neuromyelopathies and retroviruses: a review. Debilitating disorders of the nervous system have a relatively high prevalence in the tropics, a geographic region that is often deficient in specialists in the fields of neurology and epidemiology. During World War II, attention was called to a possible nutritional origin for most of these diseases. Recently, however, human T lymphotropic virus type I (HTLV-I), formerly linked only to a rare form of leukemia (adult T cell leukemia), has been associated with a spastic paraplegia observed mostly in tropical areas and referred to as tropical spastic paraparesis. This entity is also observed in nontropical areas endemic for HTLV-I, including Japan, South America, and the southern United States. Viruses of the HTLV family are being associated increasingly with pathology in humans. The pathogenesis of HTLV-I-associated tropical spastic paraparesis remains to be understood. However, future research is expected to favor a multidisciplinary approach, with exciting potential insights derived from the fields of neurology, immunology, and infectious diseases. The aim of this review is to summarize contemporary research related to the viral etiology of this clinical entity. 

Category: general pathological conditions
Otological manifestations of a new familial polyostotic bone disorder. Fifty members of a family with a unique autosomal dominant bone disease were investigated. Nineteen of the family members were either known to have, or were strongly suspected of having the disease. All but one of these had a hearing loss which was conductive in the younger age group and mixed in the older members. The common finding in those who had middle ear surgery was replacement of the long process of incus by a fibrous band. The histological features were similar to those found in Paget's disease. The age of onset, distribution of lesions and radiographic findings, however, were not typical of this disorder. 

Category: general pathological conditions
Clinoidal meningiomas. Anterior clinoidal meningiomas are frequently grouped with suprasellar or sphenoid ridge meningiomas, masking their notorious association with a high mortality and morbidity rate, failure of total removal, and recurrence. To avoid injury to encased cerebral vessels, most surgeons are content with subtotal removal. Without total removal, however, recurrence is expected. Recent advances in cranial-base exposure and cavernous sinus surgery have facilitated radical total removal. The author reports 24 cases operated on with vigorous attempts at total removal of the tumor with involved dura and bone. This experience has distinguished three groups (I, II, and III) which influence surgical difficulties, the success of total removal, and outcome. These subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels. The presence or absence of arachnoid membranes depends on the origin of the tumor and its relation to the naked segment of carotid artery lying outside the carotid cistern. Total removal was impossible in the three patients in Group I, with postoperative death occurring in one patient and hemiplegia in another. Total removal was achieved in 18 of the 19 patients in Group II, with one death from pulmonary embolism. In the two patients in Group III, total removal without complications was easily achieved. 

Category: nervous system diseases
The effects of nonthyroid disease and drugs on thyroid function tests. Serious nonthyroid illness and caloric deprivation, which so often accompany systemic illness, have diverse and still incompletely understood effects on thyroid hormone economy. We have discussed the pathophysiologic basis for the most common pattern of alterations in routine thyroid function tests: a decreased serum T3 concentration; normal or, in critically ill patients, a low total serum T4 level; and a normal free T4 concentration. Another, less frequent pattern (high total and free T4 with a normal serum T3) can be encountered transiently in the acutely ill medical or psychiatric patient. With the recent advent of sensitive assays for TSH and better methods for serum free T4, it is now possible to define more quickly and accurately the thyroid-metabolic status of most of these sick patients; the vast majority are euthyroid. Certain drugs confound the picture. The most important of these include dopamine and high-dose glucocorticoids, both of which suppress TSH secretion from the pituitary and may actually cause a state of central hypothyroidism. Other drugs have multiple effects on thyroid hormone indices (e.g., amiodarone). Knowledge of all of the ways in which systemic illness, starvation, and certain drugs may influence thyroid function tests is crucial in assessing the thyroid status of patients with serious nonthyroid disease. 

Category: digestive system diseases
Passage of a colon 'cast' after anoabdominal rectal resection. Report of a case. The authors report a case of the passage of a total colonic J-pouch "cast" per anus after anoabdominal rectal resection and colonic J-pouch-anal anastomosis. This occurred without development of cuff abscess and was not due to occlusion of the inferior mesenteric artery. This was successfully treated, with preservation of anal function, with resection of the colonic J-pouch by transanal approach. 

Category: general pathological conditions
The role of interleukin-2 in cancer immunotherapy. The arena of cellular immunotherapy is an emerging field of study. The field has strong foundations in numerous animal tumor models, which provide avenues of research for refinements in human immunotherapy. Experience from a number of research centers can be generalized: LAK cell trials in humans have demonstrated that PBMCs activated with IL-2 possess reproducible antitumor activity in vitro. Exogenous IL-2 administration to patients is required to maintain the biologic activity of the activated cells, although the requirement for LAK cells in tumors like melanoma is not clear-cut. Overall, the response rate to immunotherapy in humans is approximately 30%. The toxicity of immunotherapy, which is related to the dose of systemic IL-2, can be significantly reduced. The next generation of trials of cellular immunotherapy in humans will use TILs. Murine experiments indicate that this population of cells is more powerful and potentially more specific for tumor than LAK cells. Like LAK cells, TILs also require exogenous IL-2 for optimum performance in vivo. The difficulty in reproducible TIL growth can be overcome by the use of monoclonal antibody activation and IL-2. Improvements in TIL therapy are anticipated from the use of TILs combined with hybrid antibodies, the addition of other biologic response modifiers, and the implementation of genetically engineered cells and cell products. 

Category: neoplasms
Forces of change in the health care system. Implications for cancer care in the 1990s. Dramatic changes will occur in the health care system during the 1990s which will profoundly affect the delivery of care for cancer. Perhaps the most important factor is the aging of the population. As the proportion of people who achieve old age increases, the absolute prevalence and incidence of cancer will increase despite improved treatment techniques. This phenomenon will increase health care expenditures despite ongoing efforts to control costs. Second, there will be continuing efforts at cost control and increased emphasis on quality assurance and outcomes by third party payers. Providers will be scrutinized and compared with one another. The large payers of the nation's health care bills will demand proof of outcome and cost leading to bidding by providers and payment only to those who have the best outcome for the least money. Third, there will be an increasing emphasis on prevention and screening, in public health policy, an approach that may conflict with personal freedom. Fourth, there will be increasing deliberations and questions about the ethics of the health care system and treatment decisions. There will be continuing debate about the need for a rationing of health care and the right of individual privacy versus the states' right to preserve life. These changes will impact on all health care professionals whose practice includes patients with cancer. 

Category: neoplasms
The trauma triage rule: a new, resource-based approach to the prehospital identification of major trauma victims. STUDY OBJECTIVE: To develop a new trauma decision rule. DESIGN: Retrospective clinical review. SETTING: Level I trauma center. TYPE OF PARTICIPANTS: 1,004 injured adults. MEASUREMENTS AND MAIN RESULTS: A new trauma decision rule was derived from 1,004 injured adult patients using a new operational definition of major trauma. The rule, termed the Trauma Triage Rule, defines a major trauma victim as any injured adult patient whose systolic blood pressure is less than 85 mm Hg; whose motor component of the Glasgow Coma Score is less than 5; or who has sustained penetrating trauma of the head, neck, or trunk. Using the operational definition of major trauma, the rule had a sensitivity of 92% and a specificity of 92% when tested on the 1,004-patient cohort. CONCLUSION: The Trauma Triage Rule may significantly reduce overtriage while only minimally increasing undertriage. This approach must be validated prospectively before it can be used in the prehospital setting. 

Category: general pathological conditions