Melricflash/CW_MedAbstractsAlt huggingface dataset:
High-grade dysplasia in the columnar-lined esophagus. Abnormal columnar lining of the esophagus is a well-recognized premalignant condition. The management of patients with high-grade dysplasia without evidence of carcinoma remains controversial. Esophagectomy is proposed by some investigators, whereas others favor follow-up endoscopy and biopsy until microinvasive malignancy is documented. We reviewed our experience with nine patients referred with high-grade dysplasia on endoscopic biopsies without evidence of carcinoma. Eight patients had the columnar lining extending orad from the cardia, and one patient had heterotopic columnar epithelium in the cervical esophagus. All were white men ranging in age from 19 to 76 years (median: 47 years). Eight patients underwent esophagectomy with colon interposition. A sleeve resection of the cervical esophagus was done in one patient. Multifocal carcinoma was found in three patients, all of whom had severe dysplastic changes throughout the columnar lining. The patient with heterotopic columnar epithelium had microinvasive carcinoma. All four patients with carcinoma had negative nodes and are long-term survivors. No carcinoma was found in the resected specimens of the remaining five patients. High-grade dysplasia is an important marker of malignancy in patients with a columnar-lined esophagus. Esophagectomy is indicated in suitable candidates since carcinoma was found in 45% of our patients. 

Category: neoplasms
Serial CA 125 levels during chemotherapy for metastatic or recurrent endometrial cancer. The purpose of this study was to evaluate the role of serial CA 125 in monitoring disease status during chemotherapy in women with metastatic or recurrent endometrial cancer. CA 125 was measured in 21 women receiving cisplatin, etoposide, and Adriamycin for a total of 275 courses of chemotherapy (median eight). Eight of ten patients had elevated pre-therapy CA 125 levels (median 233 U/mL). CA 125 became and/or remained negative in all 20 women with responding or stable disease and was elevated in all nine patients who relapsed. The median level at the time of relapse was 56 U/mL. Levels were elevated before clinical relapse in five of nine patients (56%). Serial CA 125 may aid in the management of women receiving chemotherapy for advanced or recurrent endometrial cancer. 

Category: general pathological conditions
Papular-purpuric "gloves and socks" syndrome. We report five cases of an acute, self-limiting dermatosis that has not been previously described. It consists of a pruritic edema and erythema of the hands and feet in a gloves-and-socks distribution and is associated with oral lesions and fever. The clinical course is characterized by the rapid development of petechial purpura and clearing of lesions within 1 to 2 weeks. The disease appears to affect only young and otherwise healthy persons and occurs mostly during the spring. The etiology is unknown but might be of infectious origin. 

Category: general pathological conditions
Hoarseness as the sole presenting symptom of foramen magnum meningioma. Foramen magnum tumours are rare. They may present with bizarre symptoms and mimic many conditions. We report a presentation with the sole complaint of hoarseness, never previously described in the literature. Voice returned to normal after surgical removal of the foramen magnum meningioma. 

Category: nervous system diseases
Selective dopamine DA1 stimulation with fenoldopam in cirrhotic patients with ascites: a systemic, splanchnic and renal hemodynamic study. We studied the effects of fenoldopam, a selective dopamine DA1 agonist on systemic and splanchnic hemodynamics, renal blood flow and sodium excretion in 12 patients with alcoholic cirrhosis and ascites. Hepatic, azygos and renal veins were catheterized before and after intravenous administration of fenoldopam, 0.05 micrograms/kg/min for 1 hr and increased to 0.1 micrograms/kg/min for another hour. Mean arterial pressure progressively decreased (from 83 +/- 7 to a minimum of 77 +/- 8 mm Hg 100 min after starting the infusion) but returned to baseline level at 120 min. Plasma norepinephrine and renin activity increased (respectively from 567 +/- 297 to 919 +/- 375 pg/ml, p less than 0.05, and from 17 +/- 14 to 23 +/- 15 ng/ml/hr, p less than 0.05). Renal blood flow, urine output or sodium excretion did not change. Sodium output decreased at 1 hr from 6.9 mumol/min to 4.0 mumol/min, p less than 0.05. Both hepatic venous pressure gradient and azygos blood flow significantly increased by 21%. We conclude that the acute administration of fenoldopam did not improve renal hemodynamics or function in patients with cirrhosis and ascites. In addition, dopamine DA1 agonism caused further increases in norepinephrine concentration and plasma renin activity. Portal pressure also increased, probably because of an increase in mesenteric blood flow. These results question the renal benefit and raise concern about the use of dopamine agonists in patients with cirrhosis and ascites. 

Category: general pathological conditions
Management of Brucella endocarditis with aortic root abscess. Three cases of Brucella endocarditis with aortic root abscess are reported. Two patients were successfully managed by a combination of medical therapy and surgery. The third patient died suddenly 36 hours after admission to hospital. 

Category: general pathological conditions
Regional blood flow supply and demand in heart failure. Heart failure results not only in a fall in cardiac output but also in a redistribution of blood flow favoring some regional beds (the brain and the heart) at the expense of others (the kidney and working skeletal muscle). The chronic resting hypoperfusion of striated muscle is further compromised with exercise. Maladaptive vasoconstrictor control mechanisms prevent the redirection of blood flow from nonworking muscle and liver to working muscle. This inappropriate preservation of nonworking organ perfusion further compromises the functional capacity of working muscle and is associated with evidence for metabolic deconditioning with reduced oxygen extraction and impaired oxidative phosphorylation. It is becoming increasingly clear that the clinical response to the inotropic and vasodilator therapy used in heart failure is in part dependent on the differing regional blood flow profiles of the various agents studied. The ability of the angiotensin-converting enzyme inhibitors to redirect blood flow away from nonworking regional beds to exercising muscle, and thereby to reestablish an appropriate physiologic response to changing metabolic needs, may be the overriding reason for their long-term efficacy. Certainly in the future the comprehensive therapy of heart failure will have to take into consideration not only central hemodynamic but also regional blood flow/supply and demand issues. 

Category: cardiovascular diseases
Oral contraceptives, lipoproteins, and atherosclerosis. A nonhuman primate model was developed to study the effects of oral contraceptives on lipoproteins and atherosclerosis. Cynomolgus macaques were selected because of their susceptibility to diet-induced atherosclerosis and because their reproductive physiology, menstrual cycle, and circulating sex hormone patterns are similar to those of human females. The first study compared a vaginal ring containing levonorgestrel and estradiol with an oral contraceptive containing norgestrel and ethinyl estradiol. A second study compared two oral combinations: norgestrel-ethinyl estradiol and ethynodiol diacetate-ethinyl estradiol. As predicted, use of all the contraceptives led to lowering of high-density lipoprotein cholesterol levels. However, contrary to what might be expected, use of the ethinyl estradiol-containing oral contraceptives did not lead to an increase in the prevalence or extent of atherosclerosis. We concluded that ethinyl estradiol neutralized the atherogenic influence of the progestin component of oral contraceptives. 

Category: cardiovascular diseases
Biliobiliary fistula: preoperative diagnosis and management implications. Experience with cholecystohepaticodochal and cholecystocholedochal fistulas as a result of an erosion of gallstones from the gallbladder into the adjacent common duct in five patients is presented. The incidence was 1.4% in a population of 350 patients undergoing cholecystectomy. The condition was indicated clinically on the basis of a symptom triad of jaundice, fever, and pain with cholelithiasis in a small contracted gallbladder. In addition, proximal intra- and extrahepatic ductal dilatation, calculus in the common duct, and normal-caliber (or unprofiled) distal common duct on ultrasound scan were present in all the patients. Endoscopic retrograde cholangiopancreatography proved to be the most useful means of investigation, and it confirmed the diagnosis in four patients before surgery. A modified antegrade cholecystectomy was performed with the gallbladder opened inferiorly at the fundus, and the stones were evacuated. A partial cholecystectomy and choledochoplasty were accomplished with gallbladder flaps whenever feasible. Other useful operative procedures are side-to-side hepaticodochojejunostomy and hepaticodochoduodenostomy. In the presence of high benign bile duct stricture, an approach to the left hepatic duct is now preferred for biliary bypass. 

Category: general pathological conditions
The pathology of heart allograft rejection. The pathologist plays an important role in the care of cardiac transplant recipients. Day-to-day management of immunosuppression is largely dependent on the diagnosis and grading of acute rejection. While noninvasive methods have been tried experimentally, the endomyocardial biopsy remains the gold standard in monitoring the rejection status of the heart allograft. The diagnosis of rejection, however, is complicated by a variety of other histologic findings, which may be procedural or processing related, due to sampling, or specifically related to transplantation. Failed allografts, whether from autopsy or explantation, provide the opportunity to study short- and long-term changes in the transplanted heart. Allograft arteriopathy, or graft atherosclerosis, is the major limiting factor in long-term recipient survival. While the morphological features of graft arteriopathy have been well described, the mechanism and factors contributing to its development remain unclear. 

Category: neoplasms
Effects of uvulopalatopharyngoplasty on sleep architecture and patterns of obstructed breathing. In this retrospective study, 72 obstructive sleep apnea patients with polysomnograms taken before and after uvulopalatopharyngoplasty were evaluated. Postoperatively, there was a significant improvement of sleep architecture and respiratory indices. In addition, a second group of 17 patients also had position recordings with their polysomnograms. Time spent in supine and lateral sleep positions changed postoperatively. There was significant decrease of the apnea plus hypopnea index in the lateral position. This study indicates that there is significant improvement of sleep architecture and respiratory indices in the majority of patients after uvulopalatopharyngoplasty, particularly in the lateral sleep position. 

Category: nervous system diseases
Loss of chromosome 22 alleles in human sporadic spinal schwannomas. Acoustic neuromas occur either as sporadic solitary tumors in the general population or as inherited bilateral tumors typically in patients with neurofibromatosis type 2. Loss of heterozygosity for markers on the long arm of chromosome 22 has been reported in both instances, and neurofibromatosis type 2 has been genetically linked to a marker on the long arm of this autosome, suggesting that a unique locus on chromosome 22 is implicated in tumorigenesis of both sporadic and inherited acoustic neuromas. To determine whether the locus for neurofibromatosis type 2 might also be responsible for tumorigenesis of those schwannomas distinct from acoustic neuromas in people without neurofibromatosis type 2, we studied the DNA content of three sporadic spinal schwannomas. In all three, we found loss of heterozygosity for at least three markers on the long arm of chromosome 22, indicating a partial or total monosomy 22 in the tumor. Our results suggest that a locus on chromosome 22 is responsible for tumorigenesis in schwann cells regardless of their location in the central nervous system, and that some other mechanism (genetic or nongenetic) might account for the relative high proportion of schwannomas developing from the eighth cranial nerve. 

Category: neoplasms
The natural history of intimal flaps in a canine model. The natural history of arterial intimal flaps has not been well defined. This study characterizes the natural history of unrepaired intimal flaps. Thirty-nine 1-, 2-, and 3-mm hemispheric, distally based intimal flaps were made in 4- to 5-mm diameter canine femoral and carotid arteries. Twenty arteries had 2- and 3-mm intimal flaps and were monitored for short-term arterial thrombosis and flap extension. Nineteen had 1- and 2-mm intimal flaps and were monitored for thrombosis, long-term development of neointimal hyperplasia, arterial stenosis, and persistence of the flap. While 40% of the arteries with 3-mm intimal flaps developed thrombosis in 3 to 5 days, only 3% of the arteries with 1- or 2-mm intimal flaps developed thrombosis. Most 1- to 2-mm intimal flaps resolved and the subsequent development of neointimal hyperplasia or arterial stenosis was minimal. Arteries with hemodynamically significant stenoses from intimal flaps warrant repair, while arteries with smaller intimal flaps may not require repair. 

Category: cardiovascular diseases
Esophageal motility in children with Hirschsprung's disease. Esophageal motility was studied in 12 children with Hirschsprung's disease to see if extracolonic motor dysfunction was present in this disorder. Manometric tracings were compared with those from eight children with idiopathic megacolon and from 10 children without esophageal disease or constipation. Amplitude of esophageal contraction waves was significantly higher in children with Hirschsprung's disease than in the other two groups. Swallows that were followed by simultaneous contractions or double-peaked waves were also more common in the group with Hirschsprung's disease (subjects with Hirschsprung's disease, subjects with megacolon, and controls; 57%, 10%, and 8%, respectively). Lower esophageal sphincter characteristics did not differ among the three groups. The increase in simultaneous contractions and double-peaked waves persisted in those children who were reexamined following surgery for Hirschsprung's disease, whereas wave amplitudes fell to a level similar to that observed in the other groups. These data suggest that gastrointestinal motor dysfunction in persons with Hirschsprung's disease is not restricted to the colon, and that some of the observed abnormalities in esophageal motility do not reflect nonspecific responses to megacolon or colonic obstruction. 

Category: digestive system diseases
Selective nonoperative management of patients referred with abnormal mammograms. Screening mammography provides a means of detecting clinically occult breast carcinoma, but the question of whether all abnormal mammograms require biopsy remains unanswered. We retrospectively reviewed records of 214 women referred over an 8-year period for abnormal mammograms. They were selectively assigned to biopsy or mammographic follow-up based on specific mammographic criteria. Of 114 women initially observed mammographically, 2 were later found by biopsy to have carcinoma. Initial assignment to mammographic observation delayed the recommendation for biopsy 3 and 12 months, respectively, in these patients, but no effect on outcome was documented. Because they have benign lesions by clinical and mammographic criteria, 102 women (53%) have been spared biopsy; they continue to be monitored closely. We believe these data support the use of a selective approach to biopsy based on specific mammographic criteria. 

Category: neoplasms
Granulomatous vasculitis in Crohn's disease [published erratum appears in Gastroenterology 1991 Aug;101(2):595] This study investigated a possible vascular origin for granulomas in Crohn's disease. Twenty-four consecutive resected specimens of small and large intestinal Crohn's disease were preserved by arterial perfusion-fixation with 10% formol saline, at mean arterial pressure (100 mm Hg). Fifteen specimens contained granulomas on routine examination of H&E-stained sections. These 15 specimens were examined in detail using a range of immunohistochemical staining techniques to identify vascular structures and granulomas. A total of 485 granulomas were found, 85% of which were identified as being directly involved in vascular injury. The majority (77%) of granulomas were deep to the mucosa; they were found most frequently in the submucosa (42%). The techniques used in this study enhanced the recognition of granulomatous vasculitis. The results suggest that the majority of granulomas in Crohn's disease form within walls of blood vessels. Vascular localization of granulomatous inflammation suggests that the intestinal microvasculature contains an early element in the pathogenesis of Crohn's disease. 

Category: general pathological conditions
Herniation of the antral membrane through an extraction site. Report of a case. A case of herniation of the antral membrane through a recent extraction site is presented. The lesion was initially diagnosed as a tumor by the referring dentist. Oroantral fistulas are not an uncommon finding after dental extractions. It is rare, however, to see herniation of the antral membrane with large polyps extending through the fistula into the oral cavity. A search of the literature revealed only two other such cases. Surgical removal of the polyps and closure of the oroantral fistula by means of a buccal sliding flap technique is discussed. 

Category: neoplasms
Prognostic implications of DNA histogram, DNA content, and histologic changes of regional lymph nodes in patients with lung cancer. Forty-six cases of resected lung cancer, including 20 cases at Stages I and II and 26 cases at Stage III (N2), were subdivided into two groups: a good prognosis group with a longer survival period and a poor prognosis group in which the patients died earlier of the cancer. From paraffin-embedded lymph node tissues of these patients, the authors examined DNA histogram pattern and DNA content, using flow cytometry, and histologic hyperplasia of germinal center and paracortical area; they also evaluated their correlation with the prognosis. In the good prognosis group at Stages I and II, paracortical hyperplasia (PH) of the lymph nodes was observed significantly more frequently. In the good prognosis group at Stage III, the incidence of PH, G2M phase in the DNA histograms, and DNA content were all significantly higher. DNA content was positively correlated with the grade of PH. 

Category: neoplasms
Patient-related variables and restenosis after percutaneous transluminal coronary angioplasty--a report from the M-HEART Group. As part of a randomized prospective study designed to investigate the restenosis process after percutaneous transluminal coronary angioplasty (PTCA), the relation between patient-related variables and restenosis rate was examined. A total of 722 patients had successful PTCA. Angiographic follow-up was scheduled for 6 +/- 2 months after the procedure and achieved in 510 patients (71%), yielding 598 lesions for analysis. The overall restenosis rate was 40%. The rate was higher in patients undergoing early restudy for a clinical event than in those undergoing routinely scheduled follow-up restudy (71 vs 22%, p less than 0.0001). Age, sex, cigarette smoking history, diabetes mellitus and history of previous myocardial infarction were not associated with restenosis rate. Angina duration and severity before PTCA were also unrelated to restenosis rate. In summary, these variables, many of which have been previously implicated in restenosis, were not found to be predictors of restenosis. The decision to perform PTCA in individual patients should not be negatively influenced by the presence of these factors. 

Category: cardiovascular diseases
Comparison of collagen propeptides as growth markers in children with inflammatory bowel disease. The serum concentrations of the carboxy-terminal propeptide of type I procollagen and the amino-terminal propeptide of type III procollagen as biochemical markers of growth activity were compared in 46 children and adolescents with inflammatory bowel disease. Significant correlations were noted between growth velocity and type I procollagen (r = 0.65; P less than 0.001) and type III procollagen concentrations (r = 0.64; P less than 0.001). Although the serum concentration of type I procollagen was generally about 15 times greater than that of type III, the respective serum concentrations were highly correlated (r = 0.66; P less than 0.001) at all growth velocities. The use of daily corticosteroid therapy was associated with significantly lower concentrations of both propeptides (P less than 0.01) than was alternate-day or no corticosteroid therapy, respectively. Children with growth arrest (0.0 cm/mo) had type I and type III procollagen concentrations similar to those found in adults. These observations indicate that the serum concentrations of both collagen propeptides reflect growth activity in children with inflammatory bowel disease and suggest that routine measurement of collagen propeptides may have clinical value in monitoring normal and abnormal growth. The data suggest that the measurement of one propeptide does not offer an advantage over the other. 

Category: general pathological conditions
Dacron fabric-enveloped hydroxyapatite prosthesis for sternal tumor defect: an autopsy report. A 38-year-old housewife with solitary plasmacytoma of the manubrium who underwent a subtotal sternectomy treated by resection of the lesion is reported. This was followed by replacement with a Dacron fabric-enveloped hydroxyapatite prosthesis. The Dacron fabric was sutured to the surrounding tissues, and then the clavicle was passed through the cylindrical-shaped Dacron fabric to form a sternoclavicular joint capsule. The patient returned to her daily life 3 months after the operation. She had no trouble in her daily living, without any dislocation of the sternoclavicular joints or any displacement of the artificial sternum. The autopsy examination about 1 year after the operation showed that the Dacron fabric enveloping the artificial sternum became stronger with time. The sternoclavicular joint also was stably fixed, and the Dacron fabric fulfilled its function as an artificial articular capsule and biologic fixation of the surrounding supporting tissues. 

Category: neoplasms