Melricflash/CW_MedAbstractsAlt huggingface dataset:
Physiologic responses to prolonged electrically stimulated leg-cycle exercise in the spinal cord injured. This study determined the physiologic responses to prolonged functional neuromuscular stimulation (FNS) leg-cycle exercise in seven quadriplegic and seven paraplegic subjects. Each subject completed 30 minutes of continuous FNS leg cycling during which open-circuit spirometry, impedance cardiography, auscultation, and fingertip capillary blood sampling were used to assess metabolic and hemodynamic responses. Compared with resting values, oxygen uptake, carbon dioxide production, respiratory exchange ratio (RER), pulmonary ventilation, heart rate (HR), left ventricular stroke volume (SV), cardiac output (Qt), and blood lactate (La) concentration were significantly (p less than .05) elevated, whereas plasma volume, bicarbonate concentration, and pH were significantly decreased in both groups during prolonged FNS leg-cycle exercise. Mean arterial pressure remained unchanged in quadriplegic and paraplegic subjects during the prolonged FNS leg-cycle exercise bout. Persons with quadriplegia elicited significantly lower MAP and tended to have lower SV and Qt responses than persons with paraplegia, probably due to a higher degree of sympathetic dysfunction and circulatory hypokinesis during FNS leg-cycle exercise. All other physiologic variables responded similarly between groups. We speculate that the relative increases observed for HR (33% to 60%), SV (45% to 69%), and Qt (113% to 142%) during prolonged FNS leg-cycle exercise create a sufficient cardiac-volume load to promote central cardiovascular conditioning in persons with both quadriplegia and paraplegia. The La accumulation (4.7 to 5.2 mmol.L-1) in the spinal cord injured during prolonged FNS leg cycling is unusually high for the power output attained (5.2W and 6.1W for quadriplegia and paraplegia, respectively). 

Category: nervous system diseases
Ulcerative colitis and giant cell arteritis associated with sensorineural deafness Sensorineural deafness is rarely associated with both ulcerative colitis and giant cell arteritis. A patient is described in whom acute sensorineural deafness occurred in association with episcleritis, ulcerative colitis and clinical features suggesting giant cell arteritis. 

Category: nervous system diseases
Effects of two types of fish oil supplements on serum lipids and plasma phospholipid fatty acids in coronary artery disease. Fish oil has consistently been shown to lower triglyceride levels, but its effects on low-density lipoprotein (LDL) cholesterol remain controversial. The current study compares the long-term effects of 2 different fish oil preparations (ethyl ester and triglyceride) versus olive oil in patients with coronary artery disease. Eighty-nine subjects were randomly assigned to receive capsules containing 6 g/day (triglyceride group) or 7 g/day (ethyl ester group) of n-3 fatty acids, or capsules containing 12 g/day of olive oil for 6 months. Mean triglyceride levels decreased by 28% in the ester and 32% in the triglyceride fish oil groups (p less than 0.05 for both). LDL cholesterol levels increased by 3% (difference not significant) in the ester and 12% (p less than 0.05) in the triglyceride fish oil groups; in hypertriglyceridemic subjects the increase was 23% (p less than 0.01) and 14% (difference not significant), respectively. Plasma phospholipid fatty acid analysis showed a fivefold increase in eicosapentaenoic acid levels in both fish oil groups (p less than 0.001), and a long-term decrease in arachidonic acid levels (p less than 0.001). Achieved eicosapentaenoic acid level correlated with the degree of increase in LDL cholesterol (r = 0.38, p less than 0.05). These data suggest that fish oil administration is associated with an increase in LDL cholesterol levels in a diverse group of patients with coronary artery disease; this change appears to be correlated with n-3 fatty acid absorption. The impact of this increase in LDL is unknown, but should be considered as potentially adverse. 

Category: cardiovascular diseases
Association between neuroepithelial tumor and multiple intestinal polyposis (Turcot's syndrome): report of a case and critical analysis of the literature. We report a case of association of a brain tumor with multiple intestinal polyposis (Turcot's syndrome) and offer a critical analysis of the relevant literature with a view to revising the classification of the syndrome in relation to familial multiple polyposis and Gardner's syndrome. For this purpose, we considered only cases of intestinal polyposis associated with a primary neuroepithelial tumor (medulloblastoma, glioma, or glioblastoma) as originally described by Turcot. Differences emerged, depending on the central nervous system tumor type, which suggests that this neoplastic association may be classified as two distinct syndromes. 

Category: neoplasms
Balloon expandable stent implantation in stenotic right heart valved conduits. Although valved conduits have been used successfully in severe forms of right ventricular-pulmonary artery discontinuity, progressive valved conduit stenosis is an important clinical problem. To determine the feasibility of reducing right heart valved conduit stenosis with a balloon expandable stent, a baboon model was used, in which the pulmonary artery was ligated and a right ventricular to pulmonary artery 14 mm bioprosthetic Dacron valved conduit implanted. In five baboons, at an average of 40 months after valved conduit implantation, fibrointimal stenosis at the valve site resulted in narrowing and a mean transconduit pressure gradient of 49 mm Hg (range 33 to 65). A tubular slotted steel stent (1.2 cm long) was deployed within the valved conduit after inflation of an 8 to 15 mm diameter balloon catheter that was introduced through the femoral vein. A stent was delivered to all valved conduits; however, in two baboons, balloon undersizing resulted in stent dislodgment. In the remaining three baboons, the transconduit gradient was reduced by 59% (49 to 20 mm Hg) and right ventricular systolic pressure decreased acutely by 35% (77 to 50 mm Hg). It is concluded that stent deployment is feasible in right ventricular to pulmonary artery stenotic valved conduits and may result in significant hemodynamic improvement. However, successful stent delivery is critically dependent on the proper selection of stent length and balloon diameter. 

Category: general pathological conditions
Strapless oral-nasal interface for positive-pressure ventilation. A custom-fabricated strapless oral-nasal interface (SONI) is described. It was used in the long-term administration of intermittent positive-pressure ventilation (IPPV) by 18 patients with paralytic or restrictive pulmonary insufficiency. This interface is an acrylic shell which is firmly fixed to an orthodontic bite plate; it is designed to form a seal over the nose and mouth for the entry of IPPV. Eight patients were ventilator dependent 24 hours a day. The ten patients who required only nocturnal aid had improvement in daytime arterial blood gases. Although nine of these patients could manage less than 15 minutes of unassisted breathing (free time) supine, all slept supine on SONI IPPV. The 13 patients who underwent sleep monitoring maintained a mean oxygen saturation of 95.3% +/- 1.7% and acceptable end-tidal pCO2 (30 to 45 mmHg). These 13 patients have used SONI IPPV for an average of 22 months (range = 3 to 63 months). Impediments to successful long-term use of a SONI include the presence of a hyperactive gag reflex or stimulation of excessive oral secretions. When combined with mouth IPPV, glossopharyngeal breathing, the intermittent abdominal pressure ventilator, or the cuirass ventilator for daytime use, SONI IPPV is an option for the patient who prefers total ventilatory support by noninvasive means. 

Category: nervous system diseases
Hemodynamic effects of nebivolol at rest and on exertion in patients with heart failure. Nebivolol is a novel B-1-adrenoceptor-blocking drug with an unusual hemodynamic profile unlike classical B-blockers. In dogs and in healthy volunteers it decreases blood pressure and heart rate but improves left ventricular function. The authors studied 10 male patients with coronary artery disease and heart failure (ejection fraction mean = 46%). A Swan-Ganz catheter was placed into the pulmonary artery, and the mean blood pressure, the heart rate, the pulmonary artery pressure, the pulmonary wedge pressure, the right atrial pressure, the cardiac output, and the stroke volume were measured at rest and on exertion before and after seven days' treatment with oral nebivolol (5 mg/day). While the blood pressure and the heart rate decreased significantly, the pulmonary artery and wedge pressures, as well as the right atrial pressure and the cardiac output, did not change during treatment. The stroke volume increased significantly. The maintained cardiac output cannot be explained by any changes in preload or afterload; instead a positive inotropic mechanism must be assumed. Unlike other B-blockers it seems to be possible to treat patients with heart failure with nebivolol without causing the hemodynamic situation to deteriorate. 

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: neoplasms
Progressive inflammatory lesions of the brain parenchyma in localized scleroderma of the head. A patient with localized scleroderma of the head, uveitis, and Raynaud's phenomenon presented with generalized seizures, spastic hemiparesis, and local IgG production in the cerebrospinal fluid. Magnetic resonance imaging revealed progressive cortical and subcortical brain parenchymal lesions mainly adjacent to the cutaneous and bony lesions and probably of inflammatory origin. 

Category: general pathological conditions
Acute arsenical myopathy: morphological description. We describe the histological findings of the muscle in a case of acute voluntary massive arsenic intoxication resulting in severe rhabdomyolysis. The main features on muscle biopsy were perifascicular hypercontracted fibers, myofibrillar disruption, mitochondrial abnormalities and abundant cytoplasmic vacuoles containing lipids. 

Category: general pathological conditions
Assessment of cataracts from photographs in the Beaver Dam Eye Study. Presence and severity of age-related cataract was determined in adults 43 to 84 years of age in Beaver Dam, Wisconsin. Duplicate photograph gradings for nuclear sclerosis (n = 1160), cortical opacities (n = 1159), and posterior subcapsular cataract (n = 1137) were performed. There are five levels of nuclear sclerosis. Exact agreement occurred in 64.7% of the cases; agreement within one category in 99.8%. For cortical opacities, graders estimate involved area in nine segments of the lens. When the continuous scale is divided into 12 categories of severity, exact agreement varied between 73.5 and 82.4%; for agreement within one category, rates varied between 84.6 and 89.9%. For posterior subcapsular cataracts, exact agreement for involvement of the central circle occurred in 95.0% and agreement within one category occurred in 97.7%. Intraobserver comparisons disclosed similar concordance. These grading schemes are semiquantitative, reproducible, and can be performed for the large numbers of photographs from population-based studies. 

Category: general pathological conditions
Randomized, double-blind, placebo-controlled trial of somatostatin for variceal bleeding. Emergency control and prevention of early variceal rebleeding. A randomized, double-blind, placebo-controlled trial of somatostatin was conducted among 120 patients admitted for bleeding esophageal varices (59 placebo, 61 somatostatin). An initial 250-micrograms bolus of somatostatin followed by a 5-day continuous infusion of 250 micrograms/h and an identical administration of placebo were evaluated for both the control of bleeding and prevention of early rebleeding from varices. Failure to control bleeding occurred in 22 (36%) somatostatin patients vs. 35 (59%) placebo patients, with time to failure occurring earlier with placebo (P = 0.036). blood and plasma transfused per hour during drug infusion of trial drug was reduced in the somatostatin group: median 0.033 vs. 0.105 unit/h (P = 0.025). Use of balloon tamponade was halved in somatostatin-treated patients. The average effect of somatostatin was a 41% reduction in the hazard of failure (95% confidence interval, -1% to 65%, P = 0.0545) after adjustment for the severity of liver disease, which was the only other variable having a significant influence on time to failure. There was no difference in 30-day mortality per admission (7 placebo, 9 somatostatin) or complications. It is concluded that somatostatin is safe and more effective than placebo for the control of variceal bleeding. 

Category: general pathological conditions
Starch peritonitis. A case report and clinicopathologic review. A case of starch peritonitis is presented with a review of the history of this continuing problem. The syndrome's presentation, diagnosis, histopathology and treatment are discussed. The rarity of starch peritonitis today may be due to more attention to glove washing by surgeons, fewer impurities in the glove powder or lack of recognition of the syndrome. In order to prevent a resurgence of the starch peritonitis syndrome we must continue to emphasize the importance of washing gloves, maintain the quality control and purity of the powder used, and be cognizant of the signs and symptoms so that such cases may be managed nonoperatively. 

Category: digestive system diseases
Effect of pentoxifylline on hemodynamics, alveolar fluid reabsorption, and pulmonary edema in a model of acute lung injury. We investigated the effect of pentoxifylline (PTX) on the development of pulmonary edema in a model of adult respiratory distress syndrome in rabbits. Lung injury was induced by repeated saline lavages in adult rabbits weighing 2.5 to 3.5 kg. Rabbits pretreated with PTX (20 mg/kg bolus followed by 20 mg/kg/h infusion) developed significantly lower amounts of lung edema 4 h after saline lavage (extravascular lung water to dry weight ratio [W/D], 6.9 +/- 0.6 SD versus 8.9 +/- 0.5 in control animals). PTX produced a 25% increase in cardiac output, but there were no differences between treated and untreated groups in calculated pulmonary vascular resistance or microvascular pressure. To determine whether PTX could have lowered pulmonary venous resistance and thus lowered effective microvascular pressure for fluid filtration, we directly measured pulmonary artery and left atrial pressures, and measured by micropuncture the pressure in 20 to 40 microns subpleural venules in four open-chested rabbits 3 to 4 h after lavage. Venous resistance was low (venous pressure drop 0.9 +/- 0.1 mm Hg) and was unchanged by PTX infusion. To determine if PTX decreased lung water by accelerating active alveolar fluid reabsorption, a single 60-ml aliquot of saline was instilled into the lungs of normal rabbits treated with saline or PTX. Both groups had a similar decrease in lung water content 1 and 4 h later. Our data indicate that PTX reduces edema formation in rabbits after saline lavage, not by lowering microvascular pressures for fluid filtration or by acceleration alveolar fluid reabsorption, but possibly by its anti-inflammatory effect on neutrophil function. 

Category: general pathological conditions
Grinspan's syndrome: a drug-induced phenomenon? Three cases of apparently drug-induced Grinspan's syndrome involving the triad of oral lichen planus, diabetes mellitus, and hypertension are reported. Because drug therapy for diabetes mellitus and hypertension is capable of producing lichenoid reactions of the oral mucosa, the question arises as to whether Grinspan's syndrome is an iatrogenically induced syndrome. 

Category: cardiovascular diseases
Trends in thirty years of vaginal hysterectomy. Vaginal hysterectomy, as currently performed at the University of Vienna, was first described by Halban in 1932. From 1955 to 1985, a total of 9,967 hysterectomies were performed. The vaginal route was used for 6,078 (60.9 per cent) of these procedures. Sixty-four per cent of the women operated upon were multiparous, 27 per cent were uniparous and 8 per cent were nulliparous. A comparison of the periods 1955 to 1975 and 1976 to 1985 revealed the following trends: the incidence of uterine myomas (30.6 to 27.1 per cent), in situ carcinoma of the cervix (6.5 to 7.9 per cent) and endometrial carcinoma (1.4 to 0.6 per cent) remained largely constant. In the past decade, indications for positional abnormalities (uterine descent and prolapse) were encountered more often (27.6 to 41.6 per cent) than in the first observation period, while the incidence of recurrent metrorrhagia was found to decline (33.9 to 22.8 per cent). The most common complications included hemorrhage during the operation, lesions of the bladder, hemorrhage until 48 hours after surgical treatment and hemorrhage from days 2 to 14 postoperatively (around 0.5 per cent, respectively). During the second observation period, no postoperative fistulas developed. Two instances of tubal prolapse were seen. Laparotomy was done in four of 6,078 instances. Two patients died of septic complications. Whenever possible, we prefer vaginal hysterectomy because of its low complication rate, low mortality rate and low postoperative morbidity. 

Category: neoplasms
Management of postoperative inflammation: dexamethasone versus flurbiprofen, a quantitative study using the new Flare Cell Meter. A consecutive, random, prospective study was conducted to compare the effect of topical dexamethasone and flurbiprofen drops on postoperative inflammation in patients undergoing extracapsular cataract extraction with lens implantation. Objective, quantitative measurements were made postoperatively, using the Kowa FC-1000 Flare Cell Meter. The two treatments were equally effective. 

Category: general pathological conditions
Infectious mononucleosis in older adults. Infectious mononucleosis as a manifestation of primary Epstein-Barr virus infection occurs uncommonly in adults over age 40. While fever is almost universal, older patients with the disease often present without lymphadenopathy, pharyngitis, splenomegaly, lymphocytosis or atypical lymphocytes. Jaundice and hepatomegaly occur more commonly in older patients than in adolescents and create diagnostic confusion. Often, infectious mononucleosis in this age group is confused with lymphoma, leukemia or biliary obstruction, or is classified as "fever of unknown origin.". 

Category: general pathological conditions
Transient hyperprolactinemia is associated with a midcycle luteinizing hormone surge. This study demonstrates that LH surge cycles in IVF patients were associated with significantly higher serum PRL concentrations than cycles in which a spontaneous LH surge did not occur. Our findings support the hypothesis of concomitant LH and PRL release at the time of the midcycle gonadotropin surge, as well as that of estrogen sensitization of pituitary lactotropes, and suggest a possible mechanism for transient midcycle hyperprolactinemia. 

Category: nervous system diseases
Comparison of pulse oximeters: accuracy at low arterial pressure in volunteers. A laboratory model was developed of limb hypoperfusion in volunteers, using parital occlusion of the brachial artery with consequent reduction in radial artery pulse pressure. This was used to compare the function of 13 pulse oximeters and the effect of reduced pulse pressure and mild hypoxia on these devices. With the exception of one device, all the pulse oximeters studied demonstrated similar accuracies at pulse pressures exceeding 20 mm Hg. There were however, significant differences between several of the pulse oximeters in both ability to display readings and accuracy of readings displayed when brachial artery occlusion reduced radial artery pulse pressures equal to or less than 20 mm Hg. 

Category: general pathological conditions
Predicting the severity of cocaine-associated rhabdomyolysis. STUDY OBJECTIVES: The syndrome of rhabdomyolysis associated with cocaine use has been recently described, but the incidence, severity, risk factors, and complications are unknown. This study sought to describe the spectrum of the syndrome and identify clinical features of patients at risk. DESIGN: Retrospective case series with analysis of common clinical features. SETTING: Medical emergency department of an urban teaching hospital serving an indigent population. TYPES OF PARTICIPANTS: ED patients with acute cocaine intoxication and a serum creatine kinase (all MM) of more than 500 U/L (8.3 ukat/L) who were admitted for in-hospital management. MEASUREMENTS AND MAIN RESULTS: Twenty-nine patients, representing 5% of cocaine-related patient visits, were identified over 20 months. Patients were divided into three groups: mild, characterized by anxiety, tachycardia, diaphoresis, dyspnea, or chest pain; moderate, characterized by delirium, agitation, fever, leukocytosis, or an elevated serum creatinine; and severe, characterized by seizure, coma, hypotension, arrhythmia, or cardiac arrest. There was a significant association between the rating system for level of intoxication and the severity of rhabdomyolysis and its complications (P less than .01). Patients at highest risk for complications of rhabdomyolysis were those in the moderate or severe groups. CONCLUSION: This classification system may be useful for the management of patients with acute cocaine intoxication, predicting those patients in whom aggressive therapy should be initiated in the ED to minimize the complications of rhabdomyolysis. 

Category: general pathological conditions
Steal-prone coronary anatomy and myocardial ischemia associated with four primary anesthetic agents in humans. To examine the relationship between myocardial ischemia in patients with steal-prone coronary anatomy and the administration of isoflurane anesthesia, we reviewed coronary angiograms of 955 patients who had participated in a randomized trial of the use of one of four primary anesthetics for coronary artery bypass operations. Steal-prone anatomy was found in 31.8% of patients who had received enflurane; 40.0%, halothane; 32.6%, isoflurane; and 31.7%, sufentanil. Detected by greater than or equal to 0.1 mV ST segment displacement, ischemia during anesthesia occurred in 290 (30.4%) of all patients with no difference in the incidence among the four primary anesthetics (27.5%-32.9%). Patients with steal-prone anatomy did not suffer more ischemia than patients who needed coronary artery bypass surgery but with other varieties of coronary anatomy. In patients with steal-prone coronary anatomy, the incidence of myocardial ischemia by primary anesthetic was 24.0% with enflurane, 34.4% with halothane, 32.1% with isoflurane, and 38.2% with sufentanil. Systolic blood pressure less than 90 mm Hg during anesthesia occurred in 416 (45.6%) patients and was twice as common during administration of volatile anesthetics than during that of sufentanil. Hypotension did not increase ischemia frequency in patients with steal-prone anatomy with use of any of the four primary anesthetics including isoflurane. Ischemia was temporally related to hypotension in only 9 patients (0.9%). In none of the 42 patients who had steal-prone anatomy and hypotension during isoflurane anesthesia was ischemia temporally related to hypotension. 

Category: general pathological conditions