Melricflash/CW_MedAbstractsAlt huggingface dataset:
TGF-alpha is widely expressed in differentiated as well as hyperproliferative skin epithelium. Transforming growth factor-alpha (TGF-alpha) is a potent mitogen for epithelial cells that is expressed at low levels in normal epidermis and overexpressed in psoriasis. Epidermal growth factor (EGF) has been shown to inhibit hair growth but stimulate the growth of sebaceous and sweat glands, suggesting a potential role for a member of the EGF/TGF-alpha family in the normal development and function of skin appendages as well as epidermis. The present work demonstrates TGF-alpha protein in eccrine ducts, and eccrine, sebaceous, and apocrine glands. The proliferative dermal hair bulb does not express TGF-alpha in contrast to the differentiated outer root sheath hair follicle epithelia. In addition, hyperproliferative skin diseases including bullous congenital ichthyosiform erythroderma, squamous cell carcinoma, and psoriasis show increased TGF-alpha expression. Thus, TGF-alpha may play a role in the morphogenesis and function of normal skin appendages and its overexpression is common in benign and malignant hyperproliferative skin diseases. 

Category: neoplasms
A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. Pancreatic necrosis is now recognized as a principal determinant of survival in acute pancreatitis. However, it is currently unknown how frequently pancreatic necrosis develops in acute pancreatitis, how often pancreatic necrosis becomes secondarily infected, and whether sterile pancreatic necrosis represents an indication for surgery or can be treated by conservative means. In 194 patients with unequivocal acute pancreatitis, pancreatic necrosis developed in 38 (20%), as documented by dynamic pancreatography, and was confirmed by histologic diagnosis at surgery in 28. All patients were prospectively treated by medical means. Patients with pancreatic necrosis who remained persistently febrile underwent fine needle aspiration for bacterial culture. Infected pancreatic necrosis was demonstrated in 27 of the 38 patients (71%) with pancreatic necrosis and was treated by open drainage, yielding a mortality rate of 15%. All 11 patients with demonstrated sterile pancreatic necrosis, including 6 with pulmonary and renal insufficiency, were successfully treated without surgery. Pancreatic necrosis occurs in approximately 20% of patients with acute pancreatitis and is necessary for the development of secondary pancreatic infection. However, pancreatic necrosis by itself, even when accompanied by organ failure, is not an absolute indication for surgery. A trial of medical treatment for all patients with sterile pancreatic necrosis is in order. 

Category: digestive system diseases
Bacterial phagocytosis in obstructive jaundice. A microbiologic and electron microscopic analysis. Reticuloendothelial system dysfunction has been suggested as an explanation for the increased susceptibility to infection in patients with obstructive jaundice. In the present study, the response of cholestatic rats to a bacterial challenge was investigated and the uptake of bacteria by their Kupffer cells was examined with the electron microscope. Rats underwent bile duct ligation (BDL, n = 8) of sham celiotomy (SC, n = 8) and were allowed to recover for 10 days. They were then injected with 10(9) Staphylococcus aureus IV and killed at intervals of 15, 30, 60, and 180 minutes after injection. Two from each group were killed at each interval. Quantitative blood cultures were performed, and specimens of liver and lung were obtained for quantitative bacterial culture and processed for electron microscopy. Bacteria were rapidly cleared from the bloodstream of SC animals but persisted in BDL rats. Electron microscopy consistently demonstrated bacteria within Kupffer cell phagocytic vesicles of both SC and BDL animals at each interval selected. There was no morphologic difference in these vesicles between the two groups. Bacteremia persists in BDL rats subjected to a bacterial challenge despite rapid uptake of bacteria in apparently normal phagocytic vesicles. This study suggests a defect in intracellular killing of bacteria, an impairment of delivery of bacteria to RE cells, or a combination of these factors. 

Category: general pathological conditions
Results of percutaneous transluminal coronary angioplasty of high-risk angulated stenoses. Percutaneous transluminal coronary angioplasty (PTCA) of angulated stenoses has been found in studies using older PTCA equipment to be associated with a heightened risk of procedure-related major ischemic events. To better understand the factors associated with procedural risk and to identify means of lessening that risk, 100 patients, treated sequentially from 1986 to 1989, who underwent PTCA of stenoses located at greater than or equal to 45 degrees bends, were characterized for 27 clinical, anatomic and procedural variables. Clinical outcome of angioplasty was related to these variables. In addition, results from 344 consecutive contemporary patients undergoing PTCA of nonangulated lesions were compared to those of the study group. Procedural success was achieved in only 70% of patients with angulated stenoses, compared with 306 of 344 (89%) nonangulated stenoses, and major ischemic complications (death, bypass surgery or myocardial infarction) occurred in 13% of patients with angulated stenoses compared with 12 of 344 (3.5%) with nonangulated stenoses (both p less than 0.001). The presence of associated thrombus, stenosis length greater than 10 mm or age greater than or equal to 65 years led to an even higher risk of major complications (9 of 44 = 20.5%), whereas highly experienced angioplasty operators and the use of polyethylene terephthalate balloons appeared to decrease risk and increase the likelihood of success. PTCA of such stenoses should be undertaken only cautiously and in carefully selected patients. 

Category: cardiovascular diseases
Tongue atrophy in mixed connective tissue disease. A case is reported of tongue atrophy in a patient with mixed connective tissue disease (MCTD) and major myositic involvement. The case highlights oropharyngeal aspects of MCTD, including inability to wear dentures, dysarthria, and dysphagia. To our knowledge this is the first report of major tongue involvement in myositis as part of MCTD. 

Category: nervous system diseases
Spinal anaesthesia in day-care surgery with a 26-gauge needle. We studied 106 day-care surgical patients (52 male) aged 18-70 yr (mean 49.6 yr) who received spinal anaesthesia with a 26-gauge spinal needle. The incidence of headache, back pain and patient acceptability were investigated after operation using a questionnaire. The incidence of postspinal headache was 7.5%, and 11.3% of patients developed back pain. One patient remained in hospital because of hypotension and dizziness. There were no major complications and patient acceptability was almost 100%. We conclude that spinal anaesthesia for day-care surgery is easy to perform and cost effective. 

Category: general pathological conditions
Modulation of fluid absorption and the secretory response of rat jejunum to cholera toxin by dietary fat. To study the effects of dietary fat on jejunal water and ion absorption and on cholera toxin-induced secretion, 3 week old Sprague Dawley rats were fed isocaloric diets. Forty per cent of the total calories were given as fat, as butter (high saturated fat), olive oil (high monounsaturated fat), or corn oil (high polyunsaturated fat), with one group on low fat (10% of calories) standard laboratory diet as controls. During in vivo jejunal perfusion studies we found that (i) a polyunsaturated fat (corn oil) supplemented diet improves jejunal absorption of water and electrolytes and these changes are independent of the observed concentrations of luminal prostaglandins; (ii) high dietary fat appreciably reduced the secretory response to cholera toxin, probably without fundamentally changing the mechanism by which cholera toxin induces secretion. We conclude that dietary fat composition altered the permeability and transport characteristics of the small intestine. This observation might have relevance to some human diarrhoeal disorders. 

Category: digestive system diseases
Capsular transgression of prostatic carcinoma: evaluation with transrectal US with pathologic correlation. One hundred twenty-five patients with biopsy proved clinical stage A or B prostatic carcinoma were evaluated with biplane transrectal ultrasonography (US) prior to radical prostatectomy. Sonograms were evaluated for capsular transgression of the tumor into the posterior and posterolateral aspects of the glands as manifested by local contour deformity and irregularity or interruption of the periprostatic fat echoes. Correlation of the findings at US with the findings at pathologic examination of the step sections was obtained, and the presence and depth of capsular penetration were assessed. Of the 250 halves or hemispheres of the prostate gland that were evaluated, capsular penetration was seen at pathologic examination in 86. US enabled correct identification of pericapsular tumor spread in 59 of the 86 hemispheres but did not depict pericapsular tumor spread in 27 hemispheres. Absence of pericapsular tumor spread was verified at pathologic examination in 149 of the 164 hemispheres that either did not have tumor or did not show pericapsular tumor spread. Pericapsular tumor spread was incorrectly diagnosed in 15 hemispheres. A positive US diagnosis of pericapsular tumor spread correlated moderately well with the depth of penetration demonstrated at pathologic examination. Transrectal US is an effective noninvasive procedure that demonstrates the presence of prostatic cancer. 

Category: neoplasms
Boronate affinity chromatography of gamma-glutamyltransferase in patients with hepatocellular carcinoma. We analyzed the serum gamma-glutamyltransferase (gamma-GT) by boronate affinity chromatography to ascertain the presence or absence of any changes in the binding properties of gamma-GT toward boronate gels in patients with hepatocellular carcinoma and liver cirrhosis, and in normal controls. The mean gamma-GT activity ratio of the bound (peak 2) and nonbound (peak 1) fraction in patients with hepatocellular carcinoma was significantly higher than that in patients with liver cirrhosis or in normal controls. Thus, the gamma-GT, which has adjacent cis-hydroxyl groups in its carbohydrate moieties, was found to increase in the serum of patients with hepatocellular carcinoma. The positivity rate was examined in patients with hepatocellular carcinoma and liver cirrhosis, using a cut-off level for the peak 2:peak 1 ratio of 1.05 (mean + 2 SD of liver cirrhosis). Nineteen (42.2%) patients with hepatocellular carcinoma had a ratio of peak 2:peak 1 higher than 1.05. Nine of the 19 patients who had serum alpha-fetoprotein levels below 100 ng/ml had an elevated peak 2:peak 1 ratio. In total, 77.8% of the occurrence of hepatocellular carcinoma could be detected by a combination of these two markers. Three patients who had developed hepatocellular carcinoma during the course of cirrhosis but remained negative for alpha-fetoprotein throughout the course developed higher levels of peak 2:peak 1 ratio when hepatocellular carcinoma occurred. These results indicate that the two markers, the peak 2:peak 1 ratio of serum gamma-GT activity and serum alpha-fetoprotein level, may be considered to serve as complementary markers for the diagnosis of hepatocellular carcinoma. 

Category: neoplasms
Mechanisms in heart failure and the role of angiotensin-converting enzyme inhibition. The four major diagnostic criteria for the syndrome of congestive heart failure are left ventricular dysfunction, exercise intolerance, pulmonary congestion or edema and ventricular arrhythmias. Activation of norepinephrine, angiotensin II, vasopressin and atrial natriuretic peptide may be a key factor in the vasoconstriction and increased impedance to left ventricular ejection in heart failure. Interventions that interfere with these vasoconstrictor mechanisms should have a salutary effect on left ventricular performance. Treatment with angiotensin-converting enzyme (ACE) inhibitors, alpha-adrenoceptor blockers and vasopressin antagonists has resulted in hemodynamic benefits, but it has been more difficult to demonstrate long-term clinical effectiveness. Reductions in mortality have been demonstrated in patients with heart failure treated with vasodilators and ACE inhibitors. Improvement in the quality of life and prolongation of life are the only two appropriate goals in the management of heart failure. Further understanding of the role of angiotensin II and its interference by ACE inhibition in the tissue processes of heart failure is needed. 

Category: cardiovascular diseases
Surgical repair of Wolff-Parkinson-White syndrome complicated with myocardial bridging. Myocardial bridging causes myocardial ischemia during supraventricular tachycardia. We present a case of Wolff-Parkinson-White syndrome combined with myocardial bridging. The patient complained of angina pectoris during paroxysmal supraventricular tachycardia because of severe constriction of the left anterior descending coronary artery during systole. A myocardial scintigram revealed myocardial ischemia in the anteroseptal wall during paroxysmal supraventricular tachycardia. Myotomy to prevent myocardial bridging and interruption of the accessory conduction pathway was successfully accomplished in a one-stage operation. 

Category: cardiovascular diseases
Penetrating craniocerebral trauma. The authors review the pathophysiology of penetrating and perforating cranial wounds. Radiologic evaluation includes computed tomography and angiography. Operative technique and perioperative critical care are discussed, with special emphasis on the control of the intracranial pressure. Other problems such as fluid and electrolyte disorders and nutrition are discussed in relation to neurosurgery. 

Category: nervous system diseases
Babies born before arrival at hospital. OBJECTIVE--To establish the prevalence of babies born before arrival at two local hospitals. To identify women at risk of giving birth before arrival, and the morbidity and mortality associated with such births. DESIGN--A case control study. Each baby born before arrival and its mother were compared with the next born in the hospital (random control), and one matched for gestation and birthweight, together with their mothers. SETTING--Two maternity units serving East Birmingham and Solihull. SUBJECTS--All babies (and their mothers) born before arrival at these hospitals from January 1983 to December 1987. MAIN OUTCOME MEASURES--Perinatal mortality rates, patterns of perinatal morbidity, demographic, social and obstetric features of the mothers. RESULTS--137 (0.44%) of 31,140 consecutive births were before arrival at hospital (BBA group). The perinatal mortality rate in the BBA group was 58.4/1000 (8 deaths) compared with 10.1/1000 for all inborn babies (relative risk 5.8, 95% confidence interval 2.9-11.4). In the BBA group the mean birthweight of 3008 g was 212 g (95% CI 50-374 g) less than that in the random control group; the mean gestation of 266 days was 10 days less (95% CI 5.9-14.1 days) than in the random control group. Hypothermia was the commonest morbidity. Women delivered before arrival tended to be either multigravid inner city Asians living a long way from the hospital or unmarried unbooked younger white Europeans. CONCLUSIONS--The high perinatal mortality was related to immaturity and low birthweight, rather than to birth before arrival itself. Although groups of mothers at risk of delivery before arrival can be identified more information is needed to establish whether additional antenatal care would be beneficial for these women and their babies. 

Category: general pathological conditions
Health perceptions and survival: do global evaluations of health status really predict mortality? Self-evaluations of health status have been shown to predict mortality, above and beyond the contribution to prediction made by indices based on the presence of health problems, physical disability, and biological or life-style risk factors. Several possible reasons for this association are discussed: (a) methodological shortcomings of previous studies render the association spurious; (b) other psychosocial influences on mortality are involved and explain the association; and (c) self-evaluations of health status have a direct and independent effect of their own. Four-year follow-up mortality data from the Yale Health and Aging Project (N = 2812) are used to explore these possibilities. The analysis controls for the contribution of numerous indicators of health problems, disability and risk factors, and also makes adjustments of standard errors for the complex sample design. The findings favor the third possibility, an independent effect, to the extent that the particular set of psychosocial factors examined did not explain the basic association, and to the extent that the control variables were an adequately comprehensive set. 

Category: general pathological conditions
Secondary prevention with verapamil after myocardial infarction. The Danish Study Group on Verapamil in Myocardial Infarction. The effect of verapamil on death and major events (i.e., death or reinfarction) after an acute myocardial infarction was studied in a double-blind, randomized, placebo-controlled, multicenter trial, the Danish Verapamil Infarction Trial II (DAVIT II). Eight hundred seventy-eight patients started treatment with verapamil 360 mg/day and 897 patients with placebo. Treatment continued for up to 18 months (mean 16 months). Ninety-five deaths and 146 major events occurred in the verapamil group and 119 deaths and 180 major events in the placebo group. Eighteen-month mortality rates were 11.1 and 13.8% (hazard ratio 0.80, 95% confidence limits 0.63 to 1.05, p = 0.108), and major event rates 18.0 and 21.6% (0.80, 0.64 to 0.99, p = 0.027) in the verapamil and placebo groups respectively. When combining the results of this trial with the results of the first Danish study on verapamil in myocardial infarction, the meta-analysis demonstrated that treatment with verapamil from the second week after an acute myocardial infarction resulted in a reduction of pooled odds ratios of 0.22 (95% confidence interval 0.01 to 0.37, p = 0.04) for death, 0.21 (0.05 to 0.35, p = 0.02) for major events, and 0.27 (0.06 to 0.43, p = 0.02) for first reinfarctions. It is concluded that long-term treatment with verapamil after an acute myocardial infarction is associated with a significant reduction in overall mortality as well as major event and reinfarction rates. 

Category: cardiovascular diseases
Prosthetic arthroplasty of the knee after resection of a sarcoma in the proximal end of the tibia. A report of sixteen cases. The results of a specific type of prosthetic reconstruction of the knee (total replacement arthroplasty) after resection of a sarcoma of the proximal part of the tibia in sixteen patients were retrospectively reviewed. The diagnosis was stage-IIB osteogenic sarcoma in nine patients, stage-IIB malignant fibrous histiocytoma in three patients, and stage-IB sarcoma of various types in four patients. The length of tibial resection ranged from 100 to 257 millimeters. Of the eleven patients who were available for functional examination (mean duration of follow-up, sixty-three months), three patients had an excellent result, seven had a good result, and one had a fair result. Of the five patients who were not available for functional testing, one who was doing well was lost to follow-up at eighty months, one had died of metastases at sixteen months, and three had had a secondary amputation for infection or for loosening of the prosthesis. 

Category: general pathological conditions
Deep vein obstruction and leg swelling caused by femoral ganglion. We present a case of a rare ganglion cyst originating from the hip joint and compressing the common femoral vein producing signs and symptoms that mimicked a deep vein thrombosis. Excision of the mass promptly restored normal venous return. This condition has not been previously reported in the English-language medical literature. 

Category: cardiovascular diseases
Fulminant hepatitis B: induction by hepatitis B virus mutants defective in the precore region and incapable of encoding e antigen. Clones of hepatitis B virus were propagated from 10 cases of fulminant hepatitis B after amplification by polymerase chain reaction and their nucleotide sequences of the precore region were determined. All 113 clones from 9 cases had a point mutation from guanine to adenine at nucleotide 83 in the precore region, which converted codon 28 for tryptophan (TGG) to a stop codon (TAG) and prohibited the synthesis and secretion of hepatitis B e antigen. Precore-region defects were not detected in any of 23 clones from the remaining 1 case. By contrast, precore-region defects were not found in any of 180 clones from 8 cases of acute hepatitis B without hepatic failure serving as controls. The source of infection was traceable in 3 cases. The same precore-region defect, along with the sequence identity of 435 nucleotides, was observed in clones from the case of a baby and his grandmother, who carried the virus and was implicated in the transmission, and also in clones from two pediatricians and the carrier patients they attended. These findings support the hypothesis that precore-defective mutants have stronger activity to induce fulminant hepatitis than nondefective viruses. 

Category: digestive system diseases
Morphine-induced transactivation of HIV-1 LTR in human neuroblastoma cells. Infection by human immunodeficiency virus (HIV) is followed in many cases by a clinically quiescent or latent phase that appears to continue as long as host antiviral defense is intact. This has raised the possibility that certain host susceptibility factors (i.e., environmental cofactors) might influence the progression of the disease. In this study we demonstrate that morphine can function to activate HIV/LTR-CAT fusion gene (HIV-long terminal repeat-chloramphenicol acetyltransferase) when transfected into undifferentiated human SH-SY5Y neuroblastoma cells. The stimulatory effect of morphine is amplified in SH-SY5Y cells that have been induced to differentiate first with phorbol 12-myristate 13-acetate (PMA) and is much less in cells differentiated with retinoic acid (RA). Morphine does not appreciably activate HIV/LTR-CAT expression in human MOLT-3 and other T cells. Morphine activation of HIV/LTR-CAT in the SH-SY5Y cells is not reversible by naltrexone and appears to involve a Fos/Jun signaling system. Our results suggest that narcotics such as morphine may lead to activation of latent HIV infection. This may be particularly important in tissues, such as brain, which can host latent HIV infection and which is uniquely damaged in patients with acquired immunodeficiency syndrome (AIDS) as evidenced by neuronal degeneration and dementia. We also predict that these findings may have important implications for the pathogenesis of AIDS, particularly in opiate drug abusers. 

Category: neoplasms