Melricflash/CW_MedAbstractsAlt huggingface dataset:
Assessing clinical significance of apnea exceeding fifteen seconds with event recording. Using event recording, we determined how often apnea exceeding 15 seconds in duration was associated with bradycardia and how often patients with apnea resumed breathing spontaneously. Of 1306 documented apnea events exceeding 15 seconds (54 patients), 926 lasted 16 to 20 seconds, 262 lasted 21 to 25 seconds, and 118 exceeded 25 seconds. Of these episodes, 75.3% were isolated and 14.9% were associated with pulse deceleration, 4.4% with irregular transthoracic impedance, and 5.4% with bradycardia. Event recording provided data supporting discontinuation of monitoring in 50 of 54 patients: 36 spontaneously resumed breathing before the auditory alarm and 14 had a decreased incidence of apnea with maturation. Follow-up of 51 patients (three not located) showed that none had subsequent apparent life-threatening events or sudden infant death syndrome. Our results in these older infants and children (median age 6.7 months) provide substantiation that such patients with apnea of less than 20 seconds without bradycardia do not require continued monitoring. Further, these data suggest that in selected older infants, longer isolated apnea may be well tolerated; however, hemoglobin saturation during sleep and the ability to resume breathing after the apnea alarm delay is prolonged should be verified. Our patient population had a wide age range and heterogeneity of diagnoses, and was typically free of symptoms, so these results should not be extrapolated uncritically to premature infants, infants with chronic lung disease, and patients with symptomatic apnea. 

Category: nervous system diseases
Outpatient management of schizophrenia. As effective antipsychotic pharmacotherapy has become available, patients with schizophrenia are increasingly managed in an outpatient setting by primary care physicians. Pharmacotherapy is generally effective in treating "positive," or psychotic, symptoms and lessening the risks of relapse, but ineffective in improving "negative," or deficit, symptoms. Aggressive attempts to totally control positive symptoms and to ameliorate negative symptoms tend to increase side effects and may be detrimental to the patient. Intensive psychotherapeutic and rehabilitative approaches are generally unproductive. Attempting to obtain a cure is unrealistic. A moderate approach is recommended, taking into consideration the limitations of existing treatments, achieving control of extreme symptoms and minimizing social and occupational limitations. 

Category: nervous system diseases
Rapid induction of hepatic fibrosis in the gerbil after the parenteral administration of iron-dextran complex. The parenteral administration of iron-dextran complex to gerbils caused hepatic hemosiderosis and fibrosis after 6 wk. Type I and III collagen synthesis in the liver developed from perisinusoidal stellate cells that are often referred to as myofibroblasts. Immunohistologically these cells were shown to have large intracellular deposits of ferritin. The hepatic fibrosis appeared to be associated with aggregates of these cells rather than the aggregates of Kupffer cells, which also occur in hemosiderosis in the liver. No appreciable necrosis of hepatocytes to trigger the fibrotic response was found, so that the fibrosis appeared to be related to the accumulation of ferritin in the perisinusoidal stellate cells. In contrast, rats and mice did not accumulate ferritin in their perisinusoidal cells or develop hepatic fibrosis in response to parenterally administered iron, although they accumulated similar or greater amounts of total iron in their livers. The rapid induction of hepatic fibrosis in gerbils in response to parenterally administered iron will provide a model to investigate the mechanism of induction of collagen deposition in response to iron overload and a means of quickly evaluating therapeutic treatments for iron overload-induced fibrosis in vivo using iron-chelating drugs. 

Category: digestive system diseases
A rat model of esophageal varices. We have developed a new method for inducing portal hypertension and esophageal varices in rats--partial ligation of the portal vein after devascularization of the circumference of the left renal vein and complete ligation of the portal vein on the fifth day thereafter. Thirty rats were separated into groups of 10, control (sham operation), complete portal ligation only and complete portal ligation plus devascularization. Two weeks after the surgery, the presence of esophageal varices in rats with complete portal ligation plus devascularization was confirmed by portography and by the histological findings. The diameter (mean +/- SD) of the submucosal veins of the lower esophagus in the complete portal ligation plus devascularization group (219.4 +/- 86.6 microns) was significantly larger than that in the complete portal ligation group (99.8 +/- 53.4 microns) or in the control group (30.5 +/- 16.6 microns) (p less than 0.01). Vascular structures of the lower esophagus closely resembled those in humans with esophageal varices. This new technique is simple, rapid and reliable, and application can be made to various experimental studies on portal hypertension. 

Category: digestive system diseases
Subclinical vulvar papillomavirus infection. Eighty-eight cases of subclinical human papillomavirus (HPV) vulvar infection were detected in a consecutive colposcopic series of 968 women. Three patterns of acetowhite lesions had a 72% predictive value (88/122) for histologically assessed HPV. The prevalence of subclinical vulvar HPV in self-referred patients was 7.9% (73/918); it was 9% (88/968) in the overall series and significantly higher in younger patients (age less than 25 years: 21/106, or 19.8%) or in those with cervical HPV or cervical intraepithelial neoplasia (CIN) (40/100, or 40%). Routine inspection of the vulva after acetic acid lavage in association with a Papanicolaou test might help identify Papanicolaou-test-negative patients at high risk of developing cervical HPV or CIN. Treatment with beta-interferon (2,000,000 IU daily intramuscularly for 10 days) was given to 30 consecutive patients, but the results were poor: regression was observed in only 2 cases. 

Category: neoplasms
Mucogenic secondary open-angle glaucoma in diffuse epithelial ingrowth treated by block-excision. We treated a 40-year-old man with an acute, unilateral, open-angle glaucoma caused by a gelatinous translucent material in the anterior chamber. A clinical diagnosis of mucogenic secondary open-angle glaucoma caused by diffuse epithelial ingrowth after ocular trauma one year earlier was suspected, but a primary or secondary ciliary body or iris neoplasm could not be ruled out. A curative 9-mm block-excision was performed. Six years later, intraocular pressure was normal, and the visual function was unchanged. Light and electron microscopy disclosed an island of diffuse columnar epithelium with numerous goblet cells on the iris surface and copious mucinous material extending into the trabecular mesh-work. 

Category: neoplasms
Laboratory parameters to monitor safety and efficacy during thrombolytic therapy. Thrombolytic therapy is being used with increasing frequency in myocardial infarction (MI), pulmonary embolism, deep venous thrombosis (DVT), and peripheral arterial occlusion. Use of these agents, however, is hampered by concerns regarding safety and efficacy. Numerous laboratory parameters have been evaluated for monitoring the risk of bleeding complications, with levels of fibrinogen (and percentage of decrease) and fibrin/fibrinogen degradation products (FDPs) correlating to a variable extent with clinical bleeding. The bleeding time (BT) test has also been proposed as a potential predictor of bleeding during thrombolytic therapy. With respect to efficacy, the D-dimer fragment of FDPs, when corrected for soluble fibrin polymers, has been shown to correlate with clot lysis in venous thromboembolism but not MI. The BT also is being considered as a marker of lysis in patients with DVT. Given the increasing concomitant use of antiplatelet agents during thrombolytic therapy, the BT, as an in vivo test of hemostasis and platelet function, has potential utility as a noninvasive, adjunctive marker of thrombolytic efficacy. 

Category: general pathological conditions
Learning a unimanual motor skill by partial commissurotomy patients. A series of motor tests on four Chinese partial commissurotomy patients is reported. The single-stage commissurotomy in all four patients included the anterior commissures and two-thirds or four-fifths section of the corpus callosum with sparing of the splenium. There was no demonstrable ability to transfer hand posture in these patients. This was the major evidence for functional deconnexion. A newly learned task of one-hand knotting revealed right hand impairment in all four patients. There was no dyspraxia in the right hand for over-learned object-handling tasks in these patients. It is suggested that there might be right hemisphere specialisation for the initial acquisition of unimanual object-handling skills and that the spared callosal fibres in the splenium alone are insufficient to mediate task control under these conditions. This is supported by the finding that one of these patients, who was the only one who had a right parietal lesion, was unable to perform the newly learned task with either hand. 

Category: nervous system diseases
Renal oncocytoma: long-term follow-up and flow cytometric DNA analysis. We report a retrospective study on the clinicopathologic features and flow cytometric DNA analysis of ten renal oncocytomas compared with a control group of ten randomly selected renal cell carcinomas. Among the oncocytoma patients, no recurrences or metastases were noted over an average follow-up of 6.7 years (range = 6 months to 16 years). Reproducible, high-quality DNA histograms were obtained on the paraffin-embedded specimens by using our modified flow cytometric procedure. One aneuploid (10%) and two hyperdiploid tumors (20%) were found in the oncocytoma group. There was no correlation between these abnormal DNA histographic patterns and survival or tumor stages. On the contrary, a good correlation was found between tumor grades and DNA ploidy in the controls. We conclude that renal oncocytoma is a clinically benign tumor, yet it may exhibit varying degrees of flow cytometric DNA abnormalities, which have no predictive value on survival and probably reflect the characteristics of oncocytes rather than its malignant potential. 

Category: neoplasms
Measurement of resistance versus flow in assessing efficiency of aortocoronary bypass grafts. Measurement of flow in saphenous bypass grafts with an electromagnetic flowmeter is complicated and poorly reproducible. Since coronary flow is largely dependent on variable factors the stable value of resistance seems more appropriate for comparison. A simple method has been developed for intraoperative measurement of resistance in the respective coronary bed. Pressure is recorded in the saphenous graft by an electromanometer during continuous flushing with known amounts of blood, and resistance is calculated instantaneously. The procedure is very simple and takes less than one minute. The quality of the saphenous vein itself can be assessed simultaneously by the same method. Resistances were measured during coronary surgery in over 500 saphenous grafts. The results were highly reproducible and comparable. Excellent flows can be expected if resistance is below 200 Peripheral Resistance Units (PRU); if this is over 800 PRU flow is very poor. 

Category: general pathological conditions
Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. OBJECTIVE: To assess the prognostic significance of left ventricular mass and geometry in initially healthy persons with essential hypertension. DESIGN: An observational study of a prospectively identified cohort. SETTING: University medical center. PATIENTS: Two hundred and eighty patients with essential hypertension and no pre-existing cardiac disease were evaluated using echocardiography between 1976 and 1981. Two hundred and fifty-three subjects or their family members (90%) were contacted for a follow-up interview an average of 10.2 years after the initial echocardiogram was obtained; the survival status of 27 patients lost to follow-up was ascertained using National Death Index data. MEASUREMENTS AND MAIN RESULTS: Left ventricular mass exceeded 125 g/m2 in 69 of 253 patients (27%). Cardiovascular events occurred in a higher proportion of patients with than without left ventricular hypertrophy (26% compared with 12%; P = 0.006). Patients with increased ventricular mass were also at higher risk for cardiovascular death (14% compared with 0.5%; P less than 0.001) and all-cause mortality (16% compared with 2%; P = 0.001). Electrocardiographic left ventricular hypertrophy did not predict risk. Patients with normal left ventricular geometry had the fewest adverse outcomes (no cardiac deaths; morbid events in 11%), and those with concentric hypertrophy had the most (death in 21%; morbid events in 31%). In a multivariate analysis, only age and left ventricular mass--but not gender, blood pressure, or serum cholesterol level--independently predicted all three outcome measures. CONCLUSIONS: Echocardiographically determined left ventricular mass and geometry stratify risk in patients with essential hypertension independently of and more strongly than blood pressure or other potentially reversible risk factors and may help to stratify the need for intensive treatment. 

Category: cardiovascular diseases
Events associated with rupture of intra-aortic balloon counterpulsation devices. Nineteen intra-aortic balloon (IAB) ruptures occurred in sixteen patients during a three-year period. Perforation occurred secondary to abrasion with material failure or mishandling of the device during insertion. To avoid serious sequelae, it is important to be aware of the possibility of IAB rupture and to remove any defective device immediately upon recognition of an event. 

Category: general pathological conditions
Pancreatic ascites presenting in infancy, with review of the literature. We report a 4-month-old boy with massive ascites in whom a diagnosis of pancreatitis was made on a raised ascitic amylase level after two inconclusive laparotomies. He developed a pseudocyst which was managed with repeated percutaneous needle aspirations, nutrition being maintained intravenously. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a congenital intra-pancreatic cyst. He thrived after operation drainage for recurrent pseudocyst, but repeat ERCP shows that the cyst in the head of the pancreas remains. Pancreatic ascites is rare in children and diagnosis is frequently delayed. A third of reported cases in childhood present in the first year of life. A search for the underlying cause should include an ERCP to demonstrate abnormalities of the pancreaticobiliary ducts. 

Category: neoplasms
Administered dose and tumor dose of bleomycin labeled with cobalt-57 in mice and men. Tumor concentrations of the chemotherapeutic drug, bleomycin, labeled with cobalt-57 (Co-bleo) were compared in mouse tumor models and in human lung tumors using quantitative single-photon emission computed tomography. Drug concentrations in histologically similar human tumors showed marked variability for the same injected dose (ID). Small cell carcinomas showed concentrations between 1.09 and 8.85 %ID/cc x 10(-3) while non-small cell lung tumors showed a concentration variation between 0.36 and 6.75 %ID/cc x 10(-3). In contrast to the situation in human tumors, uptake in mouse tumors showed only slight variability in animals with the same tumor model. EMT-6 tumors in mice showed at 6 hr significantly higher uptake of Co-bleo (p less than 0.001) and significantly higher tumor-to-lung ratio (p less than 0.001) when compared to murine fibrosarcomas. The EMT-6 tumors in contrast to the fibrosarcomas responded to bleomycin treatment in a dose dependent manner. The results indicate that while in mice the tumor dose closely follows the administered dose, in humans, the tumor dose and the tumor-to-lung ratio in the individual patient cannot be predicted from the administered dose. 

Category: neoplasms
The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? We critically appraised the medical literature to evaluate whether there is a point beyond which blood pressure reduction in hypertensive subjects is no longer beneficial and possibly even deleterious. Thirteen studies that stratified cardiovascular outcomes by level of achieved blood pressure in treated hypertensive subjects who had been followed up for at least 1 year were critiqued by four independent reviewers. Data addressing population, protocol, and methodological characteristics were evaluated. Studies did not show a consistent J-shaped relationship between treated blood pressure and stroke, but they did demonstrate a consistent J-shaped relationship for cardiac events and diastolic blood pressure. The beneficial therapeutic threshold point was 85 mm Hg. We conclude that low treated diastolic blood pressure levels, ie, below 85 mm Hg, are associated with increased risk of cardiac events. 

Category: cardiovascular diseases
Colonic glycoproteins in monozygotic twins with inflammatory bowel disease. Colonic glycoprotein composition was evaluated in monozygotic twins with inflammatory bowel disease using ion-exchange chromatography. Fifty-three individuals, 12 pairs and 1 single twin with ulcerative colitis and 14 pairs with Crohn's disease, were evaluated. Seven twin pairs were concordant for the presence of ulcerative colitis or Crohn's disease, whereas twin siblings of 10 ulcerative colitis probands and 9 Crohn's disease probands were not known to have inflammatory bowel disease. Content of one chromatographically defined component of colonic mucin, designated HCM species IV, was reduced in both patients with ulcerative colitis (1040 +/- 300 cpm/10,000 cpm total HCM) and their apparently healthy twins (1340 +/- 540 cpm/10,000 cpm total HCM) compared with control subjects (4030 +/- 1,000 cpm/10,000 cpm total HCM). Composition of mucin in Crohn's disease patients and their nonaffected twins was not significantly different than in controls. These observations suggest that altered profiles of mucin glycoprotein may be present before the onset of ulcerative colitis and may be genetically defined. Conversely, it appears that alterations in glycoproteins only are not sufficient to initiate mucosal inflammation. 

Category: general pathological conditions
Multimodality cisplatin treatment in nonresectable alpha-fetoprotein-positive hepatoma. Twenty-eight patients with alpha-fetoprotein-positive (AFP+) nonresectable hepatoma have been enrolled in a new multimodality Phase I, II program. Induction therapy consisted of 50 mg/m2 intravenous cisplatin followed by 2100 cGy irradiation to the tumor volume in seven fractions over 10 days. Hepatic arterial infusion of 50 mg/m2 cisplatin (IA-CDDP) was then administered at monthly intervals. Twenty-one patients have completed induction and at least two cycles of IA-CDDP. Twelve-month cumulative survival was 52% for all 28 patients and 69% for the 21 patients completing induction and IA-CDDP. Median survival has not yet been reached. Response rate (complete and partial) was 36% overall and 48% among the 21 patients who completed treatment. The improved survival of the present series of patients as well as the minimal hematologic toxicity suggests possible further integration of new modalities for therapy. 

Category: general pathological conditions
Musculoskeletal abnormalities in a patient with juvenile hypothyroidism. Abnormalities in growth and development are the most striking clinical features of juvenile acquired hypothyroidism. Therefore, physicians should consider the diagnosis of hypothyroidism in any child with musculoskeletal growth dysfunction. Drs Kilpatrick and Fincher describe a case demonstrating the severe and potentially irreversible effects of prolonged, untreated hypothyroidism. 

Category: general pathological conditions
Fertility-sparing treatment of patients with ovarian cancer. The variety of malignant neoplasms produced by the ovary are legion. Each must be considered individually in the young woman with early disease who wishes to preserve her childbearing capability. The risks of conservative surgery are often low, and the patient can be so advised. Careful monitoring of this group of patients is essential regardless of the approach. 

Category: neoplasms
Steroid anabolic drugs and arterial complications in an athlete--a case history. Serious side effects and complications have been attributed to anabolic and androgenic steroids when used for medical reasons or when taken in sports in hopes of increasing strength and, hence, performance. The author presents a case of an athlete who experienced two metachronous arterial complications after taking these drugs: a cerebrovascular accident caused by a carotid artery thrombus that partially embolized to the brain and, later, a severe ischemic episode in a lower limb caused by a diffused distal arterial thrombosis. This patient represents the first reported case of vascular events in an otherwise healthy athlete taking androgens to increase his skeletal muscle mass. 

Category: nervous system diseases
Psychosomatic factors in borderline hypertensive subjects and offspring of hypertensive parents. Psychosomatic factors, sympathoneural and sympathoadrenal as well as cardiovascular mechanisms, were studied in 24 patients 18-24 years of age with borderline hypertension, 50 age-matched normotensive offspring of hypertensive parents, and 49 controls with no family history of hypertension. They were compared by projective and questionnaire-based psychological tests and their circulatory and neurohormonal reactivity to mental (Stroop color-word conflict test and arithmetic test) and physical stressors (orthostasis and bicycle ergometry test) were measured. Borderline hypertensive subjects externalized aggression less (p less than 0.05) but internalized it more (p less than 0.05) and were more submissive (p less than 0.05) when compared with controls. Offspring of hypertensive parents showed a similar but weaker pattern. Both risk groups reported more positive interactions with their parents (genetic risk subjects versus controls, p less than 0.05; borderline hypertensive patients versus controls, p = 0.08) and had higher state-anxiety levels (p less than 0.05). There were more subjective symptoms of beta-adrenergic receptor-mediated functions (e.g., tachycardia, tremor) in borderline hypertensive subjects and offspring of hypertensive parents, elevated heart rates (analysis of repeated measures, p less than 0.001), and enhanced plasma norepinephrine concentrations (p less than 0.05) when compared with controls. These findings in subjects at risk for the development of hypertension suggest that psychosomatic factors and sympathetic overactivity are involved in the early phase of hypertension. 

Category: general pathological conditions