Melricflash/CW_MedAbstractsAlt huggingface dataset:
Measurement of progressive cerebral ventriculomegaly in infants after grades III and IV intraventricular hemorrhages. To develop guidelines that might help predict prospectively which infants with severe intraventricular hemorrhage (IVH) would require intervention, we obtained serial cranial sonograms to measure the rate of growth of cerebral ventricular volumes in 48 preterm infants with and without IVH. The infants were divided into three groups: (1) those with no IVH (22 infants), (2) those with IVH with acute ventricular dilation (13 infants), and (3) those with IVH with progressive ventricular dilation requiring intervention (13 infants). The decision to intervene because of progressive ventricular dilation was based on clinical criteria and the subjective assessment of increasing ventricular size on weekly cranial sonograms. The rate of cerebral ventricular volume growth in infants with IVH who needed intervention was greater (4.2 +/- 3.3 ml/day) than that in infants without IVH (0.0 +/- 0.1 ml/day; p less than 0.001) and in infants with IVH and acute ventricular dilation (0.0 +/- 0.2 ml/day; p less than 0.001). Using these data, we generated guidelines for predicting prospectively which infants with IVH and ventricular dilation will need intervention for posthemorrhagic hydrocephalus. The guidelines were then confirmed prospectively in 10 infants. 

Category: general pathological conditions
Epidural haematoma requiring surgical decompression following repeated cervical epidural steroid injections for chronic pain. We report a case of epidural haematoma following a steroid injection into the cervical epidural space. The complication occurred on the seventh such injection over a 2 year period for chronic spinal pain. Surgical decompression over the seventh cervical and the upper 3 thoracic vertebrae was required to alleviate the symptoms of paralysis and anaesthesia. The patient subsequently required skin grafting to the surgical site and two trans-urethral resections of the prostate gland during his 6 week hospital admission. He made a full recovery. 

Category: general pathological conditions
The effects of phenylephrine on right ventricular performance in patients with pulmonary hypertension Pulmonary hypertension causes right ventricular ischemia and failure as a result of increased afterload combined with reduced coronary blood flow. Increasing coronary driving pressure by raising aortic pressure with phenylephrine has been shown to reverse right ventricular ischemia from pulmonary hypertension in animals. Since vasodilators often fail to reduce afterload, we tested whether raising the coronary driving pressure would improve right ventricular function in man. Ten patients with pulmonary hypertension had hemodynamics and right ventricular coronary driving pressure measured before and 10 minutes after a steady state was reached with a phenylephrine infusion titrated to raise aortic pressure by 25 percent. Phenylephrine caused a significant (p less than .01) increase in mean aortic pressure (84 to 108 mm Hg) and right ventricular coronary driving pressure (46 to 69 mm Hg). In response, there was a significant (p less than .01) rise in mean pulmonary artery pressure (58 to 67 mm Hg), right ventricular end-diastolic pressure (10 to 16 mm Hg) and wedge pressure (5 to 9 mm Hg), and an insignificant fall in cardiac output (3.26 to 3.09 L/min) and pulmonary artery O2 saturation (57 to 49 percent). Although phenylephrine increased right ventricular coronary driving pressure, it worsened right ventricular function as manifest by a rise in end-diastolic pressure and fall in cardiac output. Any benefit of raising right ventricular coronary driving pressure may have been offset by alpha vasoconstriction of right ventricular coronary blood flow and/or pulmonary arterial vasoconstriction. Phenylephrine does not appear to be a useful therapy of right ventricular failure from pulmonary hypertension in patients who fail vasodilators. 

Category: cardiovascular diseases
Surgical complications of continuous ambulatory peritoneal dialysis. Surgical experience with 260 consecutive patients with chronic renal failure receiving continuous ambulatory peritoneal dialysis (CAPD) at one medical center from 1980 to 1989 is reviewed. Patients received CAPD for a mean of 24.2 months (range: 3 days to 91 months). Catheter longevity consistently improved in all but 1 year from 1984 to 1989, as did exit-site and tunnel infections. Of 311 catheters inserted, 151 (49%) required removal, of which 111 (74%) were attributed to peritonitis. Cumulative patient survival was 80%, 60%, and 53% at 1, 2, and 3 years, respectively. Diabetic patients had statistically significant lower survival rates. Additional complications including catheter leakage, catheter malposition, catheter obstruction, and abdominal wall hernias were negligible. Although CAPD is not free from serious complications, our data show remarkable improvement since 1980 in catheter longevity, hospital stay, and infection rates. 

Category: digestive system diseases
Preexposure of the peritoneum to live bacteria increases later mixed intraabdominal abscess formation and delays mortality. Intraabdominal infections are a major source of morbidity and mortality for the trauma and postoperative patient. Transient peritoneal contamination with bacteria after either intentional or unintentional violation of the gut are common. The effect of this intermittent antigen exposure upon later formation of intraabdominal abscesses is unclear. Previous experiments by others have demonstrated that repeated exposure to Bacteroides fragilis capsular polysaccharide can induce a T lymphocyte-mediated immunity to subsequent induction of pure B. fragilis abscess formation. In a murine mixed intraabdominal abscess model, preexposure to live Escherichia coli, B. fragilis, or both increased the number of later abscesses and in some cases their bacterial composition. Further, immunization with E. coli alone increased late mortality without altering overall mortality. These data suggest that the alterations of immune function produced by live, transient bacteria upon subsequent mixed intraabdominal abscess induction result in fundamentally different consequences from those observed after specific polysaccharide antigen exposure and subsequent monomicrobial abscess induction. 

Category: general pathological conditions
Pneumocystis carinii pneumonia complicating somatostatin therapy of Cushing's syndrome in a patient with metastatic pancreatic islet cell carcinoma and Zollinger-Ellison syndrome. Described is the case of a 73-yr-old woman with metastatic pancreatic islet carcinoma that manifested initially as Zollinger-Ellison syndrome followed by onset of endogenous Cushing's syndrome, who developed Pneumocystis carinii pneumonia while on therapy with a long-acting somatostatin analog. Although P. carinii pneumonia has been observed in patients with Cushing's syndrome associated with other conditions, this is the first reported case in a patient with Zollinger-Ellison syndrome. Heightened awareness of the possibility of opportunistic infections in patients receiving somatostatin therapy for Cushing's syndrome of any cause, particularly Zollinger-Ellison syndrome, may be warranted. 

Category: general pathological conditions
Stress and hypertension In susceptible persons emotional stress results in immediate sympathetic stimulation, with a vasomotor response that results in a high-output state and elevated blood pressure; the vasopressor response seems to be transient. There seems to be no longitudinal epidemiologic validation of the attractive hypothesis that transiently elevated blood pressures are the prelude to fixed hypertension, however. The acquisition of hypertension by populations abandoning their traditional mode of living has been attributed to the sociocultural stress inherent in westernization, but these studies usually have not taken into account concomitants of this type of acculturation, such as dietary changes and increased body weight. The inverse relationship of blood pressure levels to education could explain the development of hypertension when aspiration to upward mobility is thwarted. The severity of perceived occupational stress relates inversely to blood pressure, suggesting that familiarity with a job renders the demands made by the work environment more predictable and less threatening in terms of vasopressor response. 

Category: cardiovascular diseases
Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis. To investigate the cause of valgus deformity of the hindfoot in patients who have rheumatoid arthritis and to characterize the effects of the deformity on gait, two groups of patients were evaluated clinically, radiographically, and with gait analysis in the laboratory. Group 1 consisted of seven patients who had seropositive rheumatoid arthritis and normal alignment of the feet and Group 2, of ten patients who had rheumatoid arthritis and valgus deformity of the hindfoot. In Group 2, the disease was of longer duration and the feet were more painful than in Group 1. There was no evidence of muscular imbalance, equinus contracture, valgus deformity of the tibiotalar joint, or isolated deficiency of the tibialis posterior (such as weakness, tenosynovitis, or rupture of the tendon) that could have contributed to the development of the valgus deformity. In the patients who had valgus deformity, quantitated electromyography demonstrated that the intensity and duration of activity of the tibialis posterior was significantly increased, apparently in an effort to support the collapsing longitudinal arch of the foot. Gait studies revealed decreases in velocity, stride length, and single-limb-support time, as well as delayed heel-rise in both groups, but the decreases were more marked in the patients who had valgus deformity. The results of this study suggest that valgus deformity of the hindfoot in rheumatoid patients results from exaggerated pronation forces on the weakened and inflamed subtalar joint. These forces are caused by alterations in gait secondary to symmetrical muscular weakness and the effort of the patient to minimize pain in the feet. Radiographs also suggested an association between the valgus deformity of the feet and valgus deformity of the knees in patients who have rheumatoid arthritis. 

Category: nervous system diseases
Simplified hepatic resection with the use of prolonged vascular inflow occlusion. Ten consecutive patients scheduled to undergo liver resection were studied prospectively with the use of a standard protocol, which included routine vascular inflow occlusion to reduce blood loss and blood transfusion requirements. Fibrin sealant was sprayed on the raw liver surface, and abdominal drainage was not performed. No deaths occurred, and the postoperative course was remarkably smooth. The normothermic liver ischemic times of 30 to 122 minutes (mean, 73 minutes) were well tolerated. The amount of blood transfused was reduced to a mean of 2 U (range, 0 to 4 U). The occurrence of infected intraabdominal bile collections in two patients with preexisting biliary tract infection suggested that abdominal drainage should be performed in such patients. Vascular inflow occlusion is recommended for all liver resections. 

Category: general pathological conditions
Heritability of symptoms in an experimental model of neuropathic pain. Male and female rats underwent transection and ligation of the sciatic and saphenous nerves, and the development of autonomy was monitored. The deafferented animals were then interbred, always selecting males and females that expressed relatively high and, alternatively, relatively low levels of autotomy. Offspring were similarly operated and interbred. By the sixth generation of selective breeding, lines were achieved in which autotomy was consistently high (HA) or consistently low (LA). There was no indication of sex linkage. Thermal and mechanical nocifensive responsiveness co-selected with propensity to express autotomy following nerve injury: response thresholds were lower in HA than in LA rats. F1 hybrids formed by crossing homozygous HA and LA animals showed low levels of autotomy, similar to LA stock. This indicates recessive inheritance of the autotomy trait. Backcrossing F1 hybrids onto the LA line yielded a low autotomy phenotype in almost all cases; backcrossing F1 hybrids onto HA stock yielded about 50% high autotomy and 50% low autotomy. These ratios are consistent with simple mendelian inheritance of a single gene. Taken together, the data suggest that autotomy is inherited as a single-gene autosomal recessive trait. 

Category: nervous system diseases
Collagenous colitis: report of nine cases and review of the literature. Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by a distinctive band of collagen deposited below the colonic epithelium and an inflammatory cell infiltrate of the lamina propria. Since 1976, more than 100 cases have been described. We report an additional nine cases occurring in five women and four men ranging in age from 18 to 80 years. Diarrhea was present before diagnosis for 2 to 4 months in four cases and for 1 to 25 years in another four cases. One patient did not have diarrhea. Results of radiologic and stool studies were normal in all cases. All patients had flexible sigmoidoscopy or colonoscopy. Microscopic examination of biopsy material was interpreted as characteristic of collagenous colitis. Two cases resolved with psyllium mucilloid therapy alone. Of the five patients treated with azulfidine, three had marked improvement, one had partial response, and one had no change. 

Category: digestive system diseases
Autologous antibodies eluted from membrane fragments in human ovarian epithelial neoplastic effusions. III. Cytotoxic potential in vitro and characterization of antigen(s). Cyst and ascites fluids from patients with ovarian epithelial neoplasms contain immunoglobulins with antitumor activity. Autologous antibodies bound to the cellular membrane fragments obtained from human ovarian neoplastic effusions react with cell-surface antigens on different human ovarian cell lines, surgical specimens of human ovarian adenocarcinoma, and human ovarian tumors grown in athymic Balb/c mice. The antibodies do not react with tissue preparations from normal human ovaries, other nonovarian normal or neoplastic tissues, and nonovarian human cell lines. These studies indicate that these antibodies are capable of complement-mediated lysis of human ovarian tumor cell lines in vitro. Preliminary characterization of the autologous ovarian tumor-associated antigen(s) indicates that it may be composed of three large-molecular-weight proteins of 182,000, 164,000, and 122,000 d. 

Category: neoplasms
Pharyngoesophageal perforation after blunt neck trauma. Pharyngoesophageal perforation secondary to blunt neck trauma is an uncommon injury that can cause serious morbidity and mortality if not recognized and treated. Pharyngeal perforation secondary to blunt trauma sustained while boxing is reported. Review of the world literature found 10 cases of pharyngoesophageal perforation secondary to blunt neck trauma. Analysis of these cases indicates that perforations less than 2 cm and limited to the pharynx may be treated medically with close observation. Large perforations and those perforations that extend to the esophageal inlet or involve the esophagus exclusively are best treated surgically. 

Category: digestive system diseases
A comparative study of gastrointestinal infections in United States soldiers receiving doxycycline or mefloquine for malaria prophylaxis. A double blind study of daily doxycycline (100 mg) vs. weekly mefloquine (250 mg) was performed on United States soldiers training in Thailand to assess the effect of doxycycline malaria prophylaxis on the incidence of gastrointestinal infections. During a 5 week period, 49% (58/119) of soldiers receiving doxycycline and 48% (64/134) of soldiers receiving mefloquine reported an episode of diarrhea. Infection with bacterial enteric pathogens was identified in 39% (47/119) of soldiers taking doxycycline and 46% (62/134) of soldiers taking mefloquine. Forty-four percent (59/134) of soldiers receiving mefloquine and 36% (43/119) of soldiers receiving doxycycline were infected with enterotoxigenic Escherichia coli (ETEC), while 9% (12/134) of soldiers receiving mefloquine and 4% of soldiers receiving doxycycline were infected with Campylobacter. Side effects from either medication were minimal. After 5 weeks in Thailand, the percent of non-ETEC strains resistant to greater than or equal to 2 antibiotics increased from 65% (77/119) to 86% (95/111) in soldiers on mefloquine and from 79% (84/106) to 93% (88/95) in soldiers on doxycycline. Doxycycline prophylaxis did not prevent or increase diarrheal disease in soldiers deployed to Thailand where ETEC and other bacterial pathogens are often resistant to tetracyclines. 

Category: digestive system diseases
Venous air embolism. Diagnosis by spontaneous right-sided contrast echocardiography. This report describes the definitive diagnosis of venous air-embolism by documentation of spontaneous echo contrast in the right cardiac chambers following removal of a jugular venous catheter in a patient with hepatic failure. This complication was potentiated by the presence of concurrent hepatic coagulopathy which prejudiced effective hemostasis at the central venous puncture site. 

Category: cardiovascular diseases
Detection of primary colorectal cancer with indium 111 monoclonal antibody B72.3. B72.3 is a murine monoclonal antibody of the immunoglobulin subclass IgG1 directed against TAG-72, a cell surface antigen present on colorectal carcinoma cells. We investigated the utility of scanning with indium 111-labeled B72.3 in 16 patients with a high clinical suspicion of or biopsy-proven primary colorectal cancer. Each patient received 1 or 2 mg of B72.3 monoclonal antibody labeled with 152 MBq of indium 111. Patients underwent scanning 2 to 3 days and 7 days after infusion by planar and emission computed tomography. Nineteen lesions were confirmed in 12 patients. Three patients with benign polyps had true-negative monoclonal antibody scans. Indium 111-labeled imaging of B72.3 detected nine of 19 lesions. Unsuspected tumor sites were identified by monoclonal antibody scan in three patients. By detection of additional abdominal disease and extra-abdominal spread, indium 111-labeled scanning of B72.3 directly affected treatment in 18% of patients. 

Category: neoplasms
Extended hepatectomy for hepatocellular carcinoma. The results of extended hepatectomy in 25 patients with hepatocellular carcinoma performed over a 16 year period have been reviewed, analysed and compared with those of 144 patients who underwent lesser liver resection. Five left and 20 right extended hepatectomies were performed for tumours ranging from 3 to 20 cm in diameter. Seventeen (68 per cent) of the patients had non-cirrhotic livers. The major postoperative complications were: haemorrhage in five cases, major bile duct injury in three, subphrenic abscess in two, liver failure in one and wound dehiscence in one. The 30-day (operative) mortality rate was 12 per cent and the median survival duration, including operative mortality, was 9.7 (range 0.2-32.1) months. The survival rate was 46 per cent at 1 year, 33 per cent at 2 years and 22 per cent at 3 years. The morbidity, mortality and survival data of extended hepatectomy were comparable with the results of lesser hepatic resections for hepatocellular carcinoma. We conclude that extended hepatectomy is a worthwhile operation for large hepatocellular carcinomas and a viable alternative to liver transplantation. 

Category: general pathological conditions
Enteroglucagon and peptide Y-Y response after construction of a pelvic reservoir in humans. The results of an investigation of plasma levels of gastrointestinal hormones in patients after the construction of a pelvic reservoir are reported. Enteroglucagon (EG) and peptide tyrosine-tyrosine (PYY), two hormones believed to play a relevant role in the adaptive response to bowel resection, were investigated using a specific radioimmunoassay in basal conditions and after a standard meal. Pouch patients showed a statistically significant increase in basal levels of both enteroglucagon and PYY compared with control subjects (P less than 0.02 and P less than 0.001, respectively). The response of enteroglucagon to food ingestion, evaluated by means of the total integrated response, was similar in patients and controls. Conversely, the response of PYY was significantly increased in pouch patients compared with control cases (P less than 0.02). Results of this investigation suggest that gut hormones may be involved in mediating the adaptive response of the intestine to pouch construction. Changes of gut peptides may explain, at least in part, the functional results observed after pouch construction. 

Category: digestive system diseases
Perioperative myocardial ischemia in patients undergoing noncardiac surgery--II: Incidence and severity during the 1st week after surgery. The Study of Perioperative Ischemia (SPI) Research Group. Because of the importance of postoperative myocardial ischemia and because substantial physiologic changes can occur for prolonged periods postoperatively, the incidence, severity and temporal course of myocardial ischemia were studied in 100 high risk patients during the 1st week after major noncardiac surgery. Electrocardiographic (ECG) changes consistent with ischemia were continuously monitored using ambulatory solid state ECG in the 100 patients with or at risk for coronary artery disease. Ischemic episodes were defined as reversible ST segment depression greater than or equal to 1 mm or elevation greater than or equal to 2 mm above the baseline value, with the baseline adjusted for respiratory and positional variation and temporal drift. All ischemic episodes were confirmed by three independent blinded investigators using hard-copy recordings. Total ECG monitoring time was 10,445 h. Twenty-seven patients (27%) developed 437 episodes of ischemia during the 1st week after surgery. The total duration of ischemia was 18,658 min, or 1.8 min of ischemia/h monitored. Ischemia was most severe during the early (days 0 to 3) versus late (days 4 to 7) postoperative period: 284 versus 153 episodes; 2.2 versus 1.2 min of ischemia/h. The greatest severity occurred on postoperative day 3: 109 episodes, 3.4 min of ischemia/h monitored, 1.5 mm mean ST change and 130 min mean duration. However, in 8% of patients, severe episodes also occurred late: postoperative day 6 = 44 episodes, 1.7 min of ischemia/h monitored, 1.3 mm mean ST change (59% greater than or equal to 2 mm) and 92 min mean duration. Most ischemic episodes (57%) were associated with tachycardia. 

Category: general pathological conditions