Melricflash/CW_MedAbstractsAlt huggingface dataset:
An adult with common acute lymphoblastic leukaemia (C-ALL) presenting with skin infiltration. A 22-year-old man presented with multiple raised erythematous skin lesions, pyrexia and epistaxis. A diagnosis of common acute lymphoblastic leukaemia (C-ALL) was made by morphological, cytochemical, immunological and cytogenetic examination of peripheral blood and bone marrow. Biopsy of the skin revealed leukaemic infiltration by similar cells. 

Category: neoplasms
Polyamines and ornithine decarboxylase during repair of duodenal mucosa after stress in rats. This investigation shows whether polyamines and ornithine decarboxylase have a role in duodenal mucosal repair following stress-induced microscopic damage. Rats were fasted for 22 hours, placed in restraint cages, and immersed in water to the xiphoid process for 6 hours. Animals were killed either immediately after the period of stress or at 2-hour intervals up to 24 hours thereafter. Duodenal mucosa was examined histologically, and ornithine decarboxylase and polyamine levels were measured. Ornithine decarboxylase activity was increased significantly up to 6 hours following stress, peaking at 4 hours at a level 10 times the prestress control. By 8 hours, enzyme activity had returned to near normal. Increases in mucosal putrescine, spermidine, and spermine content paralleled the changes in ornithine decarboxylase activity and peaked 4 hours after stress. Stress resulted in microscopic damage evidenced by a nearly complete absence of villi. Significant macroscopic lesions were not present following stress. Mucosal repair was evident 12 hours after stress and almost complete by 24 hours, although the restituted villi were short and blunted. The decreases in mucosal DNA, RNA, and protein content caused by stress were restored and reached near-normal levels 12 hours after the period of stress. In animals given the specific inhibitor of ornithine decarboxylase, alpha-difluoromethylornithine, increases in duodenal mucosal ornithine decarboxylase activity and polyamine levels were inhibited and mucosal repair was almost completely prevented following stress. alpha-Difluoromethylornithine also prevented the recovery of DNA, RNA, and protein content of the duodenal mucosa. These results indicate that duodenal mucosal damage following stress is repaired rapidly; the repair process is accompanied by significant increases in ornithine decarboxylase activity and polyamine levels; and the increases in ornithine decarboxylase and polyamines are absolutely required for the normal repair of the mucosa. 

Category: general pathological conditions
The effect of established and gestational diabetes on pregnancy outcome. OBJECTIVE--To study the prevalence and type of glucose intolerance in pregnancy and the effect of different types on perinatal mortality and fetal size. DESIGN--A prospective case-control study with data collected by patient interview and examination of all available records during a 16-months period between 1984 and 1986. SETTING--A large maternity hospital in Kuwait where diabetes in pregnancy is common. SUBJECTS--The cases were a consecutive sample of 731 women, delivered during the study period, recorded in the labour ward register as being diabetic or having abnormal glucose tolerance, the control group was formed from the next woman in the register (provided she was not known to be diabetic). MAIN OUTCOME MEASURES--Type of diabetes followed the WHO classification, with subdivision depending on level of fasting plasma glucose. Type of perinatal death was examined in detail and birthweight centile calculated. RESULTS--Of the 731 cases, 22% were established diabetics, most were treated with oral hypoglycaemic drugs before pregnancy and insulin during pregnancy. Of those discovered during pregnancy, 43% were classified as gestational diabetes and the remainder as impaired glucose tolerance. Overall, 50% of cases were treated with insulin. Established diabetics had a perinatal mortality rate nearly four times greater than non diabetics (RR, 3.7, 95% CI 2.6 to 6.4) and for gestational diabetics RR was 2.0 95% CI 1.2 to 3.7). Unexplained deaths were particularly common, both in established diabetics (RR, 18.4, 95% CI 3.9 to 85.7) and in gestational diabetics (RR, 13.4, 95% (CI 2.9 to 61.6). Cases with impaired glucose tolerance had no stillbirths and had a lower perinatal loss than the controls, though this was not statistically significant. Heavier babies were seen in all case groups compared with controls, though the impaired glucose tolerance group had lower birthweights than the other two case groups. CONCLUSIONS--Type 2 diabetes was found to be common, most cases being diagnosed in pregnancy. Under the conditions found in Kuwait, diabetes, in the sense of a raised fasting glucose, is accompanied by a high rate of perinatal loss from unexplained stillbirth. This applies whether the condition was present before pregnancy or was discovered during pregnancy. Fetal macrosomia was also common in both situations. Impaired glucose tolerance, where fasting levels remain normal, does not appear to increase fetal loss, but may be associated with fetal macrosomia. As these women age they are likely to develop overt diabetes in the non-pregnant state, and subsequently to develop serious complications of this disease. Improving glycaemic control, both during preg. 

Category: general pathological conditions
Quantification of rate of coronary artery disease progression by a new method of angiographic analysis. To assess the rate and variability of atherostenosis progression in patients with coronary artery disease at baseline angiography, we used a simplified quantitative method of analysis to study single angiograms in 54 patients and paired angiograms in 29 patients. All discrete lesions were identified, then traced and digitized to determine lumen diameter (LD), and summed to give the total LD; the differences in LD for paired angiograms were summed to give total stenosis change (TSC). The following results were obtained: Correlation between LD measured by our method and LD determined by the Brown/Dodge method was excellent (r = 0.99, N = 54). There also was a high correlation between interobserver (r = 0.98, N = 54) and intraobserver (r = 0.99, N = 54) findings. Short-term TSC (N = 9, angiograms paired at less than 1 week) was negligible (0.03 +/- 0.38 mm). Long-term (N = 20, angiograms paired at 0.6 to 4.3 years) total LD differed significantly from baseline total LD (4.1 +/- 2.5 mm vs 6.0 +/- 3 mm; p less than 0.001), and TSC (2.0 +/- 1.3 mm) in long-term patients differed significantly from TSC in short-term patients (p less than 0.001). These results show that true coronary disease progression occurring over 1 to 4 years can be distinguished from intraobserver, interobserver, and interstudy variability by means of a simplified method and provide approximate rates and variability of progression. These results will be useful for power calculations in therapeutic trials aimed at slowing progression. Further prospective studies with the use of this method appear indicated. 

Category: cardiovascular diseases
Broad spectrum penicillin as an adequate therapy for acute cholangitis. In a previous study of patients with acute cholecystitis, we demonstrated equal efficacy with a broad spectrum penicillin (piperacillin) and a penicillin plus amino-glycoside combination. Whether a single agent broad spectrum penicillin is adequate treatment for more severe infections, such as acute cholangitis, however, is still unclear. We, therefore, conducted a three center, prospective, randomized trial to determine whether or not a broad spectrum penicillin alone is adequate therapy for patients with acute cholangitis. During a 36 month period, 96 patients with sepsis and biliary obstruction were randomly assigned to receive either piperacillin (n = 49) or ampicillin plus tobramycin (n = 47). The two groups receiving antibiotics were similar with respect to all clinical and laboratory parameters. The incidence of blood cultures with positive results (20 versus 21 per cent) and underlying malignant lesions (51 versus 62 per cent) was also similar between the two groups. The percentage of patients with a clinical cure or significant improvement was the same in the two groups (69 versus 70 per cent). However, there was a significant difference in the cure rate between patients with benign and malignant biliary obstructions (83 versus 59 per cent, p less than 0.01). No significant differences were noted between the two antibiotic groups with respect to drug toxicity, but patients with malignant conditions were more prone to antibiotic related toxicities (2 versus 19 per cent, p less than 0.05). These data suggest that outcome of treatment in patients with acute cholangitis is similar with either a broad spectrum penicillin or a penicillin plus aminoglycoside combination and is dependent upon the nature of the biliary obstruction. 

Category: neoplasms
Left ventricular pseudoaneurysm complicating mitral valve replacement in a 4-year-old child with acute bacterial endocarditis. A 4-year-old child with acute bacterial endocarditis required mitral valve replacement. A left ventricular pseudoaneurysm developed following surgery. The etiology and diagnosis of this complication are discussed. 

Category: general pathological conditions
Pleuritis as a manifestation of reactivation tuberculosis. PURPOSE: The purpose of this study was to determine the frequency with which tuberculous pleuritis is a manifestation of reactivation tuberculosis and to compare the clinical manifestations of reactivation tuberculous pleuritis with "classic" tuberculous pleuritis, in which chest roentgenograms reveal no parenchymal infiltrates. PATIENTS AND METHODS: We evaluated the medical records of 59 patients in whom tuberculous pleuritis was confirmed by histologic findings or mycobacterial culture. Twenty-seven patients (46%) had typical chest roentgenographic findings of reactivation tuberculosis, whereas 32 (54%) had classic tuberculous pleuritis. The clinical and laboratory features of these two groups were compared. RESULTS: Symptoms were more prolonged and pleural fluid glucose and lactate dehydrogenase concentrations were more markedly abnormal in patients with reactivation pleuritis than in those with classic pleuritis, suggesting a more chronic inflammatory process in the former group. Compared with patients with classic tuberculous pleuritis, those with reactivation pleuritis had a lower frequency of reactive tuberculin skin tests (61% versus 88%) and granulomatous pleural inflammation (25% versus 72%), but a higher bacillary burden, manifest by a higher frequency of positive sputum smears for acid-fast bacilli (50% versus 0%) and positive mycobacterial cultures from sputum (60% versus 23%) and pleural fluid (91% versus 66%). CONCLUSIONS: In contrast to previous reports, tuberculous pleuritis was a manifestation of reactivation tuberculosis in 46% (27 of 59) of patients. Tuberculous pleuritis is a more chronic process in patients with reactivation disease than in those with classic pleuritis. The lower frequency of reactive tuberculin skin tests and granuloma formation, combined with the higher bacillary burden in patients with reactivation pleuritis, suggest that these patients mount a less effective immune response to Mycobacterium tuberculosis infection than do patients with the classic form of tuberculous pleuritis. 

Category: general pathological conditions
Prolonged confusion following convulsions due to generalized nonconvulsive status epilepticus. Among patients with a prolonged confusional state after convulsive seizure, we diagnosed 8 cases as generalized nonconvulsive status epilepticus. Six had a history of seizures, and 2 had new onset. The convulsive seizures were generalized in 6 and focal in two. The postictal confusion lasted up to 36 hours in the most prolonged case, and a delayed response to anticonvulsant medications occurred in all cases. The clinical symptoms ranged from mild confusion to coma. Psychiatric manifestations or automatisms were rare. The presumed etiology was due to diverse causes, but a withdrawal state was the most common. EEG demonstrated continuous or nearly continuous generalized ictal discharges of variable morphology. These cases call attention to the fact that some prolonged confusional states following convulsive seizures are in fact due to persistent seizure activity that can be diagnosed by EEG. 

Category: general pathological conditions
L-glutamine stimulates jejunal sodium and chloride absorption in pig rotavirus enteritis. Rotavirus enteritis is the leading cause of diarrhea in infants worldwide. A research priority of the World Health Organization is to develop oral rehydration solutions containing amino acids or other additives that will stimulate intestinal absorption more efficiently than the current glucose-based oral rehydration solutions. Glutamine is the principal metabolic fuel of the small bowel and a putative stimulator of mucosal repair. This report describes the transport response to mucosal L-glutamine following intestinal injury caused by porcine rotavirus. Peak symptoms and mucosal damage were observed 2-7 days after oral rotavirus inoculation. In vitro transport studies of the maximally injured region, the midjejunum (80% reduction in lactase), surprisingly, showed transport responses to L-glutamine (30 mmol/L) and L-alanine (30 mmol/L) that were similar qualitatively and quantitatively to those observed in control tissue. Subsequent application of mucosal D-glucose (30 mmol/L) caused additional stimulation of electrogenic Na+ transport, but the response to glucose was blunted (P less than 0.05) in the infected tissues. Glutamine and alanine enhanced Na+ absorption to a similar degree (2-2.5 muEq.cm-2.h-1), but glutamine stimulated equal amounts of electrogenic and electroneutral NaCl absorption, whereas alanine had no significant effect on net Cl- flux. Glutamine is a potentially useful substrate for investigation in oral rehydration solutions for infant diarrhea. 

Category: digestive system diseases
Wound infection following early repeat sternotomy for postoperative bleeding. An experience utilizing intraoperative irrigation with povidone iodine. A prospective observational study of median sternotomy wound infection was carried out in two consecutive groups of unselected patients undergoing early repeat sternotomy for postoperative haemorrhage. In Group A the pericardial cavity and sternotomy wound layers were irrigated with aqueous povidone iodine prior to repeat closure, while Group B did not receive povidone iodine. No median sternotomy infections were recorded in Group A compared to 5 cases in Group B (0 out of 22 vs 5 out of 21 patients, p less than 0.05). Amongst the patients with wound infection, three developed sternal dehiscence and mediastinitis with one death. The data suggests that povidone iodine irrigation may be effective in reducing wound infection in patients undergoing early repeat sternotomy after cardiac surgery. 

Category: general pathological conditions
Human liver regeneration after major hepatectomy. A study of liver volume by computed tomography. Regeneration of the remnant liver after major hepatectomy in humans was studied by computed axial tomography (CT) in 12 noncirrhotic and five cirrhotic patients. Liver volumes were measured by abdominal CT 3 days, 10 days, 3 months, 6 months, 1 year, and 1.5 years after resection. Of the 17 patients, liver remnant volume was increased in 21.2% +/- 6.7% and 30.6% +/- 12.7% at 3 months and 6 months after resection, respectively. Noncirrhotic livers were 28.4% +/- 9.5% and 48.4% +/- 17.8% larger at 3 and 6 months. For cirrhotic livers, the increase was 8.5% +/- 3.6% and 12.9% +/- 4.5%. In five patients with right hepatectomy (65% resection), the liver remnant volumes were increased 38.4% +/- 11.7%, 48.0% +/- 16.2% and 95.1% +/- 4.5% at 3 months, 6 months, and 1 year after resection, respectively. In seven patients with right partial hepatectomy (30% to 35% resection), the percentages were 7.4% +/- 3.2%, 21.8% +/- 8.4%, and 63.9% +/- 18.3% and in five patients with left lateral segmentectomy (15% resection), they were 15.6% +/- 8.2%, 27.8% +/- 12.2%, and 33.0% +/- 14.5% 3 months, 6 months, and 1 year after resections, respectively. Noncirrhotic livers showed better regeneration than cirrhotic livers. Complete regeneration took about 1 year. The noncirrhotic liver that underwent right lobectomy also needed 1 year to double its postresection volume. 

Category: general pathological conditions
Cardiovascular risk factors and the effects of intervention. Cardiovascular risk factors can be substantially modified by changes in life-style such as diet, exercise, smoking cessation, and moderation of alcohol consumption. In turn, these can reduce blood pressure, heart rate at rest, and blood lipid concentrations. Epidemiologic evidence shows that for every 1% change in serum cholesterol levels, there is a 3% change in the likelihood of developing coronary heart disease. In addition, a long-term (5-year) change of 5 to 6 mm Hg in diastolic blood pressure can reduce the chances of stroke by 35 to 40% and of coronary heart disease by 20 to 25%. The full impact of this broad range of interventions on population health has still to be fully realized in many countries, including the United Kingdom, however it is likely to be considerable. Some of the recent evidence in support of such cardiovascular risk factor modification is selectively reviewed. 

Category: cardiovascular diseases
Salvage from cardiogenic shock by atherectomy after failed emergency coronary artery angioplasty. In this case report of a patient undergoing angioplasty for cardiogenic shock during acute myocardial infarction, recurrent occlusion resulted in recurrence of shock. Atherectomy reestablished lasting patency and reversed the patient's hemodynamic collapse. Atherectomy deserves further investigation as a means to salvage vessel patency during unsuccessful coronary angioplasty. 

Category: cardiovascular diseases
Squamous cell carcinoma in situ arising in an ovarian mature cystic teratoma. Report of one case with histopathologic, cytogenetic, and flow cytometric DNA content analysis. A squamous cell carcinoma in situ arose in an ovarian mature teratoma (ie, dermoid cyst) in a 62-year-old woman. Flow cytometric DNA content analysis of paraffin-embedded in situ carcinoma showed a normal DNA content with moderate to high proliferative activity (S-phase fraction estimate, 16% to 18%). Cytogenetic analysis of the in situ cancer and the benign cystic portion of the tumor revealed a 46,XX karyotype. In addition, the benign cystic portion of the tumor revealed homozygous chromosomal heteromorphisms, compared with heterozygous markers found in peripheral blood lymphocytes. These results show that this squamous cell carcinoma in situ was euploid and suggest that the mature cystic teratoma was derived from a single germ cell after meiosis I. 

Category: neoplasms
Surgical treatment of active native valve endocarditis. A report is presented of 24 patients (23 male), mean age 38 years, who underwent surgery for active native valve endocarditis of the left heart in 1975-1988. The aortic valve was affected in all patients, and also the mitral valve in five. Pre-existing aortic valve disorder was present in 17 cases (13 congenitally bicuspid 4 rheumatic affection). There were five hospital deaths (20.8%). Staphylococci as causal organism and extensive infection predicted the highest mortality and morbidity. The mean follow-up time was 39.7 (range 2-114) months. Two reoperations because of prosthetic valve dehiscence revealed endocarditis of the implanted valve. Strong correlation was found between favourable postoperative course and rapid normalization of C-reactive protein levels, which did not fall in patients with persistent infection. Early surgery is recommended if the course of bacterial endocarditis is severely complicated. 

Category: general pathological conditions
The association between Type A behavior and change in coronary risk factors among young adults. The association of Type A/B behavior pattern and changes in blood pressure, total serum cholesterol, serum triglyceride, body mass, and smoking was estimated in a cohort of 375 young Black and White men and women from a rural county in Central Kentucky between 1978-79 and 1985-88. Type A participants experienced significant increases in systolic (2.90 +/- 1.29 mmHg) and diastolic (3.80 +/- 1.17 mmHg) blood pressure and in cigarette smoking (3.26 +/- 0.89 cigarettes per day) over the eight-year follow-up period, but Type B participants experienced no change. Type A and B individuals showed similar changes in total serum cholesterol, serum triglyceride, or body mass. Differences between behavioral types in blood pressure were present for women but not men, and for Blacks but not for Whites. These findings suggest a possible significance of the Type A pattern for the development of cardiovascular risk of young adults. 

Category: cardiovascular diseases
Dipyridamole technetium-99m-2-methoxy isobutyl isonitrile tomoscintigraphic imaging for identifying diseased coronary vessels: comparison with thallium-201 stress-rest study. A same-day double injection protocol employing 99mTc-methoxyisobutyl isonitrile (MIBI) and myocardial single-photon emission computed tomography (SPECT) for detecting coronary artery disease (CAD) was assessed in 30 patients. SPECT was performed 1 hr after a first injection (250 MBq) of 99mTc-MIBI, given after 0.56 mg/kg dipyridamole (DPD) infusion. Patients were then reinjected at rest (750 MBq) and were reimaged 1 hr later. Within 1 wk, all patients underwent a complete stress-rest SPECT thallium study. Of the 330 myocardial segments evaluated, 25 were judged ischemic by both techniques, while persistent defects were demonstrated in 50 and in 47 with 99mTc-MIBI and 201TI, respectively. Six regions were considered for diseased vessels identification. Sensitivity and specificity for CAD were 100% and 75%, respectively, for both 201TI and 99mTc-MIBI. Sensitivity for identification of diseased vessels by 201TI was 68% for LAD, 89% for RCA, and 80% for LCX as opposed to 75%, 89% and 80%, respectively, by 99mTc-MIBI. Specificity was 93% in both cases for LAD, 73% and 63% for RCA, and 53% and 46% for LCX. 

Category: cardiovascular diseases