Melricflash/CW_MedAbstractsAlt huggingface dataset:
Prolongation of ventricular refractoriness by class Ia antiarrhythmic drugs in the prevention of ventricular tachycardia induction. The effects of class la antiarrhythmic drugs (procainamide, quinidine) on the right ventricular effective refractory period (VERP) and intraventricular conduction time were assessed during serial invasive electrophysiologic studies for sustained monomorphic ventricular tachycardia (VT). In 47 patients with remote myocardial infarction, sustained VT was inducible by up to two extrastimuli after the basic drive at one of two basic cycle lengths at the right ventricular apex. With oral drug administration, sustained VT was no longer inducible (group I) in 27 patients but remained inducible (group II) in 20 with the same protocol. Class la drugs prolonged the VERP in both groups, but there was greater lengthening when drugs were effective (e.g., +32 +/- 14 msec in group I vs +12 +/- 19 msec in group II; p less than 0.005, basic cycle length 600 to 700 msec). Prolongation of the VERP by greater than 30 msec had an 88% positive predictive value for prevention of sustained VT induction. In all except one patient in group I, drugs prolonged the VERP such that the coupling intervals that had resulted in sustained VT induction under control conditions were no longer attainable. In contrast, conduction time through the ventricle (surface QRS duration) in sinus rhythm and during right ventricular pacing was prolonged similarly regardless of efficacy (e.g., +33 +/- 21 msec vs +27 +/- 27 msec at a cycle length of 400 msec). The presence of similar plasma levels of drug did not imply equivalent prolongation of the VERP in the two groups. These results suggest that greater prolongation of the VERP by oral procainamide or quinidine correlates with drug efficacy against VT induction and is a better predictor of drug effect than achievement of a "therapeutic plasma level.". 

Category: cardiovascular diseases
Pregnancy associated with Gorlin's syndrome. A pregnant woman with Gorlin's syndrome presented for the removal of malignant ovarian tumours. The main problem encountered by the anaesthetists was an unexpected increase in arterial blood pressure. This was most probably associated with surgical manipulation of the ovaries with an increase in prorenin/renin production. 

Category: general pathological conditions
Medical treatment and prevention of peptic ulcer disease. Many agents seem to be equally effective for the treatment of peptic ulcer disease. This is true despite the drugs' varied mechanisms of action, and this observation has caused investigators to shift their focus from aggressive to defensive factors when studying ulcer pathogenesis. Patients with a healed ulcer are always at risk for recurrence, and guidelines are available for management of these patients. Ulcer prevention becomes a crucial issue in intensive care units where critically ill patients have many known risk factors. Maintaining a gastric pH above 4.0 appears to reduce the morbidity and mortality associated with such stress-induced ulcers. Use of nonsteroidal anti-inflammatory drugs increases ulcer risk and complications in the elderly, in women with rheumatoid arthritis, and in smokers and abusers of alcohol. Prophylaxis with the synthetic prostaglandin analogue misoprostol (Cytotec) appears to reduce this risk. 

Category: general pathological conditions
Flow patterns in dilated cardiomyopathy: a pulsed-wave and color flow Doppler study. In 48 patients with dilated cardiomyopathy, pulsed-wave and color Doppler examination were performed. In addition, 14 normal patients served as control subjects. Peak inflow velocity at the level of the mitral valve, middle left ventricle, and apex and outflow velocity at the level of the apex, middle left ventricle, and subaortic area were measured. In normal patients there was brisk propagation of inflow velocity to the apex. Patients with dilated cardiomyopathy demonstrated delayed propagation and prolongation of the duration of inflow compared with control subjects (p less than 0.04). Continuous apical flow was visualized in 25% of dilated cardiomyopathies and in no normal patients. Apical velocities were significantly increased in cardiomyopathies with significant mitral regurgitation. Outflow velocities were decreased in dilated cardiomyopathy. In patients with dilated cardiomyopathy and apical dyskinesis, flow directed toward the base was measured in the middle left ventricle during isovolumic relaxation secondary to dyskinetic rebound. Patterns of abnormal flow in dilated cardiomyopathies are readily apparent by color M-mode and two-dimensional color Doppler. 

Category: cardiovascular diseases
Effects of acute ethanol ingestion and burn injury on serum immunoglobulin. Previous studies have found that acute ethanol ingestion before burn injury caused further impairment of mitogenic response of B lymphocytes compared with burn injury alone. The principal role of B lymphocytes is immunoglobulin production. This study was designed to determine the effect of acute ethanol ingestion on circulating immunoglobulin levels before injury. Serum concentrations of IgG, IgM, and IgA in rats were measured with the use of radial immunodiffusion plates at 4 days after a 30% burn injury in animals that had received a single ingestion of 3.0 ml ethanol per kilogram of body weight. The immunoglobulin levels were compared with appropriate controls. A 30% burn injury produced significant decreases in serum IgG and IgA levels but not in IgM levels, whereas acute ethanol ingestion only decreased IgA levels. Acute ethanol ingestion before injury did not induce any further significant decrease than did burn injury alone. 

Category: general pathological conditions
HIV associated systemic necrotizing vasculitis. The spectrum of HIV associated rheumatic syndromes continues to expand as does our experience with the disease. The following is a case of HIV associated systemic necrotizing vasculitis documented by rectal biopsy. The patient was treated successfully with corticosteroids alone, and after 9 months of followup has no evidence of progression to frank AIDS. 

Category: general pathological conditions
Left atrial to femoral arterial bypass using the biomedicus pump for operations of the thoracic aorta. Left atrial to left femoral arterial bypass is an approach to operations of the thoracic aorta dating back to the late 1950s. Since that time, various modifications of the basic bypass circuit have evolved. In addition, temporary bypass shunts have also been described in a variety of positions. The goals of bypass of the thoracic aorta regardless of the technique include prevention of distal hypoperfusion, which can lead to paraplegia, limb loss, multiple organ failure, and sometimes death. Recently, there have been reports of the use of the biomedicus centrifugal pump in bypass circuits of the thoracic aorta. Our series, as well as the success of others, using this variation of a traditional bypass circuit of the thoracic aorta, establishes the biopump's capability of minimizing inherent complications in the bypass circuit. 

Category: general pathological conditions
Reduced allergen-induced nasal congestion and leukotriene synthesis with an orally active 5-lipoxygenase inhibitor BACKGROUND AND METHODS. The clinical importance of leukotrienes in human allergy has not been defined, in part because there have been no selective 5-lipoxygenase inhibitors that have been effective and safe for use in humans. To address the hypothesis that stimulated leukotriene synthesis causes symptoms of immediate-hypersensitivity reactions in vivo, I investigated the effects of a new 5-lipoxygenase inhibitor, A-64077, on provoked allergic nasal symptoms and mediator release in a double-blind, randomized, placebo-controlled study. Eight subjects with allergic rhinitis underwent nasal challenge on two occasions after an oral dose of 800 mg of A-64077 or an identical-appearing placebo. RESULTS. Allergen-induced nasal congestion was significantly attenuated (P less than 0.02) by A-64077; peak levels of leukotriene B4 (median, 684 pg per milliliter) and 5-hydroxyeicosatetraenoic acid (median, 704 pg per milliliter) in nasal-rinse fluids were markedly reduced (to 67 and 185 pg per milliliter, respectively; P less than 0.01), whereas levels of prostaglandin D2 were not. Histamine release and sneezing were not reduced significantly by A-64077, but there was a significant correlation (P less than 0.01) between the changes in these variables within subjects. The mean (+/- SEM) stimulated synthesis of leukotriene B4 in whole blood ex vivo was markedly reduced by A-64077 (from 153 +/- 19 to 20 +/- 9 ng per milliliter, P less than 0.01), and the specificity of A-64077 for 5-lipoxygenase inhibition was verified by its lack of effect on the synthesis of serum thromboxane B2 or 12-hydroxyeicosatetraenoic acid. CONCLUSIONS. These results provide direct evidence of an important role for the 5-lipoxygenase products of arachidonic acid in allergic rhinitis and support the notion that further experiments in this area may lead to new therapeutic approaches to allergic disorders. 

Category: general pathological conditions
Obstructed total anomalous pulmonary venous return. Toward neutralization of a major risk factor. Among 57 neonates undergoing repair of total anomalous pulmonary venous return with severe pulmonary venous obstruction from 1980 through 1989, date of operation (1980 to 1984), preoperative hemodynamic instability, and failure to monitor pulmonary artery pressure postoperatively were risk factors for death. Thus, among the 30 patients having repair between 1985 and 1989, the 55-month survival rate including hospital deaths was 83%. 

Category: general pathological conditions
Calcium, parathyroid hormone, and vitamin D in the "prehypertensive" Dahl salt-sensitive rat. The purpose of this study was to determine if alterations of calcium and calcium regulating hormones precede the onset of NaCl-induced hypertension in the Dahl salt-sensitive (S) rat. After a 5-day balance study, serum ionized calcium, parathyroid hormone (PTH), and 1,25-dihydroxy vitamin D concentrations were measured in Dahl-S and salt-resistant (R) rats that had been maintained on a "normal" (1%) or high (7%) NaCl intake. Blood pressure was higher in Dahl-S than Dahl-R (P less than .01), but was not affected by 5 days of high NaCl. On both NaCl intakes, urine calcium excretion was increased, serum calcium was decreased, and serum PTH and 1,25 dihydroxy vitamin D were increased in Dahl-S compared to Dahl-R (P less than .01). On the high NaCl intake, fecal calcium was greater in Dahl-S than in Dahl-R, and net 5-day calcium balance was less positive in Dahl-S (P less than .05). Thus, alterations of calcium, PTH, and vitamin D precede NaCl-induced hypertension in Dahl-S. These alterations may contribute to the development of hypertension in this animal model. 

Category: cardiovascular diseases
Follow-up recatheterization after balloon aortic valvuloplasty. Mansfield Scientific Aortic Valvuloplasty Registry Investigators. The results of recatheterization were assessed in a select group of 95 patients enrolled in the Mansfield Scientific Aortic Valvuloplasty Registry to determine whether any procedural or patient-related variables at baseline predicted either initial immediate or follow-up (6.2 +/- 3.3 months) results. At the follow-up catheterization, 39 (41%) of the patients were in improved condition and 56 patients (59%) had recurrence of symptoms, allowing for analysis of the effect of the procedure in two symptomatic patient subsets. In the total group the aortic valve area increased initially from 0.56 +/- 0.16 to 0.87 +/- 0.27 cm2 but partial return to the baseline valve area was evident at follow-up (0.63 +/- 0.25 cm2). Similarly, the mean aortic gradient initially decreased from 72 +/- 30 to 35 +/- 16 mm Hg but then increased to 55 +/- 25 mm Hg at follow-up. Neither the initial nor the late hemodynamic results appeared affected by any definable procedural variable at the time of valvuloplasty, including the maximal diameter of balloons, number of balloons simultaneously used, mean inflation time or total number of inflations. Such technical concerns also did not seem to affect short- or long-term outcome. Similarly, no baseline hemodynamic variable clearly separated those who became increasingly symptomatic from those whose condition was improved at the 6 month interval. At recatheterization, a reduction in the aortic valve area toward baseline was observed in 24 (62%) of the 39 improved patients and in 45 (80%) of the 56 who were symptomatic. 

Category: general pathological conditions
Time of onset of supraventricular tachyarrhythmia in relation to alcohol consumption. It is widely believed but has never been proved that idiopathic supraventricular tachyarrhythmias beginning during or after weekends or winter holidays are frequently alcohol-related ("holiday heart" syndrome). The time of arrhythmia onset was therefore studied in relation to self-reported ethanol consumption and results of a screening test for alcoholism (CAGE questionnaire) in 289 patients aged less than 65 years admitted for supraventricular tachyarrhythmias. There were 102 patients having an etiologically idiopathic arrhythmia with a known time of onset. Among them, but not among those with disease-related arrhythmias, patients with arrhythmic episodes beginning on Saturdays or on Sundays were more often chronic alcohol abusers (9 of 19, 47%) than either patients with episodes beginning from Mondays through Fridays (18 of 83, 22%; p = 0.040) or control subjects from the out-of-hospital population (8 of 66, 12%; p = 0.002). In multivariate analysis, the time of arrhythmia onset was related to the CAGE response (G2 = 6.0, p = 0.014) but not to the most recent ethanol use. However, the increased frequency of problem drinkers among patients with weekend-onset idiopathic arrhythmias was only relative, and resulted from a decreased number of abstainers and non-problem drinkers. No conspicuous clustering of alcohol-related arrhythmias was seen after New Year's or May Day. Thus, although the present study confirms an association between heavy drinking and idiopathic arrhythmias beginning during weekends, it shows that the question may be of a relative rather than an absolute overrepresentation. The term holiday heart may also be somewhat misleading since no postholiday accumulation of alcohol-related arrhythmias was found. 

Category: cardiovascular diseases
Clinicopathologic features of hepatocellular carcinoma in young patients. To investigate clinicopathologic characteristics of hepatocellular carcinoma (HCC) in young adults, excised tumors from 21 patients younger than 45 years (young group) were compared with findings in tumors from 204 patients older than 45 (old group). In the young group HCC showed (1) a high incidence of positive hepatitis B virus surface antigen (HBsAg) (young 71.4% versus old 20.1%); (2) relatively well-preserved hepatocellular function (indocyanine green test; young 10.7 +/- 8.8% versus old 20.6 +/- 10.8%); (3) low incidence of histologically verified concomitant cirrhosis (young 52.4% versus old 78.4%); and (4) a more advanced stage of the disease in TNM classification (Stage III; young 52.4% versus old 18.1%). With respect to survival rates achieved by surgery, there was no statistically significant difference between the two groups. Thus, hepatitis B virus may relate to the occurrence of HCC in the young patients. Despite the advanced stage in the young group, survival rate after surgery was comparable with that achieved in the old group. These observations mean that a close periodic surveillance of young adults with a positive HBsAg is required to detect HCC at an early stage. Treatment of patients with HBsAg using interferon or vidarabine and hepatitis B vaccine should be made to convert HBsAg to negative in these individuals. 

Category: digestive system diseases
Impact of echocardiography on the management of patients with mitral valve prolapse OBJECTIVE: To determine whether echocardiography affects the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients suspected of having mitral valve prolapse (MVP). DESIGN: Retrospective review of echocardiograms and clinical records. SETTING: Military tertiary care hospital. PATIENTS: 127 patients with clinically suspected MVP (105) or incidentally discovered MVP (22). MAIN RESULTS: Beta blockers were used more often in patients with suspected MVP and positive echocardiograms (45%) than in patients with normal echocardiograms (13%, p less than 0.001). Bacterial endocarditis prophylaxis was recommended more often in patients with suspected MVP and positive echocardiograms (65%) than in patients with normal echocardiograms (11%, p less than 0.001). Presence or absence of a murmur did not influence the decision to recommend bacterial endocarditis prophylaxis. Patients in whom MVP was incidentally discovered were unlikely to receive either beta blockers or the recommendation for bacterial endocarditis prophylaxis. CONCLUSIONS: The results of echocardiography affect the decisions to use beta blockers or to recommend bacterial endocarditis prophylaxis in patients with suspected MVP. 

Category: cardiovascular diseases
Clinical-computed tomographic correlations of lacunar infarction in the Stroke Data Bank. Lacunar stroke was diagnosed in 337 (26%) of the 1,273 patients with cerebral infarction among the 1,805 total in the Stroke Data Bank. We analyzed the 316 patients with classic lacunar syndromes. Among these, 181 (57%) had pure motor hemiparesis, 63 (20%) sensorimotor syndrome, 33 (10%) ataxic hemiparesis, 21 (7%) pure sensory syndrome, and 18 (6%) dysarthria-clumsy hand syndrome. No striking differences were found among the risk factors for the lacunar subtypes, but differences were found between lacunar stroke as a group and other types of infarcts. Compared to 113 patients with large-vessel atherosclerotic infarction, those with lacunar stroke had fewer previous transient ischemic attacks and strokes. Compared to 246 with cardioembolic infarction, patients with lacunar stroke more frequently had hypertension and diabetes and less frequently had cardiac disease. We found a lesion in 35% of the lacunar stroke patients' computed tomograms, with most lesions located in the internal capsule and corona radiata. The mean infarct volume was greater in patients with pure motor hemiparesis or sensorimotor syndrome than in those with the other lacunar stroke subtypes. In patients with pure motor hemiparesis and infarcts in the posterior limb of the internal capsule, there was a correlation between lesion volume and hemiparesis severity except for the few whose infarct involved the lowest portion of the internal capsule; in these patients severe deficits occurred regardless of lesion volume. Taken together, the computed tomographic correlations with the syndromes of hemiparesis showed only slight support for the classical view of a homunculus in the internal capsule. 

Category: general pathological conditions
Lumbar spinal nerves in the neural foramen: MR appearance. The appearance of the proximal lumbar spinal nerves at magnetic resonance (MR) imaging has not, to the authors' knowledge, been described. MR images and exactly corresponding sections obtained from four cadavers by means of a freezing microtome were correlated to characterize the MR appearance of the proximal spinal nerves. The junction of the dorsal and ventral rami with the dorsal and ventral roots consists of a group of six to 15 fascicles measuring 2-6 mm in length. These fascicles appear in MR images obtained with short repetition times as small foci of lower signal intensity than that of surrounding fat. The proximal spinal nerve and its relationship to the intervertebral disk and osseous margins of the neural foramen can be demonstrated effectively with MR imaging. 

Category: general pathological conditions
Endotoxin requirements for alveolar macrophage stimulation. Acute pulmonary failure or ARDS in severely injured patients continues to be a significant problem. The most important clinical risk factor identified is sepsis syndrome. Sepsis syndrome is the clinical correlate of a malignant systemic inflammatory process and is directed in large part by the tissue-fixed macrophage (M phi), such as the alveolar M phi. The M phi is capable of producing most of the central inflammatory mediators responsible for the pathophysiology seen during sepsis and organ injury. Two major mediators are procoagulant activity (PCA), leading to diffuse microvascular thrombosis, and tumor necrosis factor (TNF), causing much of the physiologic derangement of sepsis. Endotoxins (LPS) derived from Gram-negative bacterial cell walls are the primary inflammatory stimulus for the tissue-fixed M phi production of inflammatory mediators. It is not completely known how LPS interacts with its various cellular targets, but it is hoped that knowledge of the molecular interactions involved in stimulation of the M phi by endotoxin will lead to therapies to modulate the response and prevent deleterious processes such as ARDS. In the present studies, LPS from E. coli 0111:B4 was shown in a dose response to stimulate large levels of both PCA and TNF in alveolar M phi. LPS from Bacteroides fragilis and Lipid X (the monosaccharide precursor of endotoxin) were unable to cause stimulation of the M phi in vitro. However, both moieties, B. fragilis LPS and Lipid X, were able to effectively and specifically compete with E. coli LPS and block M phi stimulation. 

Category: general pathological conditions
Nonendoscopic percutaneous gastrostomy. Tight peritoneal adherence of the stomach to the abdominal wall as a prerequisite of percutaneous gastrostomy can be achieved by a newly developed cannula. It serves for puncture and fixation of the gastric wall. Thus, percutaneous gastrostomy can be established safely even in instances of an endoscopically nonaccessible stomach. Further applications of the device for the purpose of intestinopexy and facilitation of endoscopic procedures are being evaluated. 

Category: neoplasms
Surgical treatment of the retethered spinal cord after repair of lipomyelomeningocele. In a series of 75 patients with surgically treated lipomyelomeningoceles, the neurological condition of six patients deteriorated 6 months to 14 years after the operation due to repeat tethering of the spinal cord. The tethering resulted from postoperative dense adhesion between the cord and the overlying dura mater. Two of the six patients underwent conventional repeat untethering procedures, and the remaining four were successfully treated with a new surgical technique developed by the authors to prevent such dural adhesion. For this procedure, after complete untethering of the spinal cord, the lumbosacral cord is retained in the center of the dural sac by fine stay sutures between the pia mater of the conus medullaris and the ventral dura mater. In addition, the dura mater is tacked to the posterior arch which is reconstructed with bone grafts at one or two bifid vertebral levels. During a postoperative follow-up period of 1 to 3 years, no further deterioration has been observed and magnetic resonance studies have demonstrated a space filled with cerebrospinal fluid (CSF) around the lumbosacral cord. The authors conclude that long-term observation, both neurological and radiological, is essential even after successful repair of a lipomyelomeningocele. This new surgical procedure can maintain a CSF bath around the lumbosacral cord, thus preventing dural adhesion. Application of this technique will hopefully be beneficial in lipomyelomeningocele patients with a high risk of cord retethering after initial repair. 

Category: nervous system diseases