Melricflash/CW_MedAbstractsAlt huggingface dataset:
Amphotericin B vs high-dose ketoconazole for empirical antifungal therapy among febrile, granulocytopenic cancer patients. A prospective, randomized study. We compared high-dose ketoconazole (800 mg/kg per day, orally) with amphotericin B (0.5 mg/kg per day, intravenously) for empirical antifungal therapy in a prospective, randomized study of persistently or recurrently febrile granulocytopenic cancer patients. Among 97 patients eligible for empirical antifungal therapy, 20 (21%) of these patients were ineligible for randomization to ketoconazole treatment because of their inability to tolerate oral medications. Among 72 patients eligible for randomization, 64 were assessable (32 in each arm of the study). Five of six patients with proved fungal infections who were randomized to receive ketoconazole treatment required crossover to amphotericin B treatment because of progressive infection. The conditions of three of these five patients improved after receiving amphotericin B. The frequency of transaminase elevation was higher in those receiving ketoconazole, while the frequency of azotemia was higher in those receiving amphotericin B. Bioavailability of ketoconazole was unpredictable. Amphotericin B remains the drug of choice for empirical antifungal therapy in granulocytopenic patients; whereas, lack of a parenteral formulation, ineffectiveness against proved mycoses, and unreliable bioavailability preclude high-dose ketoconazole from being an appropriate compound for this purpose. 

Category: general pathological conditions
Esthesioneuroblastoma with intracranial extension. The authors present five cases of olfactory neuroblastoma with intracranial extension operated on in the Department of Neurosurgery in collaboration with otorhinolaryngologists. This tumor is most frequently reported as growing inside the nasal cavities, and it can extend to the paranasal sinuses. Cases presenting initially as intracranial tumors have been infrequently reported. At present, histological diagnosis of this tumor is aided by the use of electron microscopy and immunocytochemistry. Total resection combined with radiation therapy remains the most satisfactory treatment. 

Category: neoplasms
Remote effect of deep-seated vascular brain lesions on cerebral blood flow. We measured regional cerebral blood flow using the xenon-133 inhalation method, at approximately 1 month after onset, in 60 stroke patients who had no evidence of major carotid artery stenosis or occlusion. Their single lesions (43 infarcts and 17 hematomas) were located in the capsulothalamolenticular region, sparing the cortex. Hemispheric mean cerebral blood flow was reduced on the side of the lesion in 25 patients and on both sides in 20. Regional hypoperfusion was observed in 46 patients (ipsilaterally in 34, bilaterally in 10, and contralaterally in two). Regional hypoperfusion was observed most frequently in the frontal lobe, particularly in the motor and premotor cortices of the prerolandic area. The 46 patients with regional hypoperfusion were compared with the 14 patients without regional hypoperfusion, considering the size and location of the lesion as well as the functional and analytic motor performances. As a rule, the lesion was slightly smaller and more posterior and the functional (p less than 0.001) and analytic (p less than 0.05) motor performances were significantly better in the 14 patients without regional hypoperfusion. Since the xenon-133 inhalation method examines cortical blood flow, we can attribute blood flow reductions resulting from deep-seated lesions to a functional depression akin to diaschisis. Interpretation of the clinical consequences and pathogenesis of this phenomenon requires further sequential and pathologic studies. 

Category: general pathological conditions
Cervical muscle myoelectric response to acute experimental sternocleidomastoid pain. A method is presented for investigating the response of passive and active muscle to experimentally induced deep muscle pain. Ten healthy adult males performed multiple, submaximal isometric neck flexion tasks before and after pain had been induced in the sternocleidomastoid (SCM) muscle by injecting 5 ml of a hypertonic (5%) saline solution. A similar volume of isotonic saline was injected into the contralateral muscle as a control. Cervical myoelectric signal (MES) root-mean-square (RMS) response to each injection was recorded from eight neck muscles over 8 minutes. The subject rated perceived pain at regular intervals using a visual analog scale (VAS). Sternocleidomastoid pain, which reached a mean of 36 mm on the 100-mm VAS 2 minutes after the injection, resulted in significantly increased (1-2 microV, P less than 0.05) RMS MES in the otherwise relaxed SCM muscle during the first 2 minutes. This was followed by a gradual return to control values after 5 minutes. A similar trend in MES was found for the active SCM muscle during a 10% maximum voluntary contraction (MVC) isometric neck flexion effort. Thus, acute deep muscle pain caused subtle, yet systematic, changes in motor output in both the relaxed and active painful muscle, and its synergists and antagonists. 

Category: nervous system diseases
Lower extremity weakness as the initial manifestation of lung cancer [published erratum appears in Arch Phys Med Rehabil 1991 Jan;72(1):61] A 55-year-old woman had progressive lower extremity weakness. She had an 80-pack-per-year history of cigarette smoking. Electromyographic findings were consistent with the Lambert-Eaton myasthenic syndrome. Despite a normal chest x-ray, normal laboratory studies, and negative bronchoscopy, investigation for lung cancer was pursued. The final thoracotomy and pathology reports indicated a diagnosis of oat cell carcinoma. After treatment with chemotherapy and radiation therapy, clinical and electrophysiologic findings have resolved. Two years after diagnosis, the patient remains in good health without evidence of recurrence. 

Category: neoplasms
A complex ileovaginal fistula with associated obstructive uropathy in a patient with Crohn's disease: technical considerations and review of the literature. A high index of suspicion of an ileogenital fistula should be aroused by a patient with Crohn's disease, weight loss, malnutrition, and a persistent vaginal discharge. Preoperative gastrointestinal and genitourinary evaluation should be used in an attempt to localize the fistulous origin as well as concomitant fistulae. The principles of surgical therapy include preoperative ureteral catheters, resection of the diseased bowel and fistulous segment of bowel, and interposition of healthy tissue (ie, omentum) between the bowel anastomosis and the vaginal cuff. 

Category: digestive system diseases
Suicidal ligature strangulation with an elastic band. An unusual case of self-strangulation with an elastic band is described. The victim was a young Hispanic male with a complicated psychiatric history, including suicide attempts. Mechanisms of strangulation and mechanical asphyxial death are discussed briefly. 

Category: general pathological conditions
Human macrophage colony-stimulating factor induces macrophage colonies after L-phenylalanine methylester treatment of human marrow. Macrophage-colony stimulating factor (M-CSF) has well-known effects on murine bone marrow, but its colony stimulating activity for human bone marrow is controversial. After treatment of human bone marrow with L-phenylalanine methylester (PME), macrophage-colonies (CFU-M) were induced by M-CSF in a dose-dependent fashion. The optimal concentration of recombinant human-macrophage colony stimulating factor (rhM-CSF) was 1,000 U/mL. Purified human urine M-CSF had colony stimulating activity similar to rhM-CSF. Further studies were performed to determine the factors responsible for the enhanced CFU-M formation from PME treated marrow. Compared with nylon wool and carbonyl iron monocyte depletion methods, PME eliminated significantly more monocytes and myeloid cells. This observation suggested that these cells may release hematopoietic inhibitory factors for CFU-M. Low concentrations (1%) but not normal (10%) concentrations of blood monocytes were inhibitory (mean inhibition, 48%) to CFU-M. High concentrations of monocytes (50%) augmented CFU-M colonies. HL-60 conditioned media was used to simulate secretory products of early myeloid cells. HL-60 conditioned media (1%) inhibited CFU-M formation but not granulocyte macrophage or granulocyte colonies. We conclude that M-CSF has colony stimulating activity for human marrow that can be recognized after removal of inhibitory cells by PME treatment. 

Category: neoplasms
Spinal cord hemangioblastoma with subarachnoid hemorrhage. A case of subarachnoid hemorrhage caused by a cervical hemangioblastoma is presented. The clinical picture was indistinguishable from that of a subarachnoid hemorrhage from an intracranial lesion. The diagnosis was established by angiography and water-soluble contrast myelography followed by cervical computed tomographic scan. At surgery, the tumor was completely removed, and no neurological deficit was observed after the operation. 

Category: neoplasms
Atrial fibrillation in the elderly: management update. Non-valvular atrial fibrillation is associated with a markedly increased risk of embolic stroke in elderly persons. Evidence is accumulating that anticoagulation with warfarin or aspirin may be effective in reducing this risk. 

Category: cardiovascular diseases
Endoscopic palliative intubation of the esophagus invaded by lung cancer. Thirty-two patients with esophageal involvement by lung cancer were managed by endoscopic intubation. In 22 patients with extrinsic esophageal strictures, the success rate of intubation was 91%, and 82% were discharged with their dysphagia relieved and esophageal patency restored. The mean survival rate was 4.4 months. In 10 patients with esophago-bronchial fistulas, 3 had the fistulous tract obliterated and lived a mean of 5 months. This low success rate of closing fistulas is due to failure to seal off the space between the stent and the fistula because of absence of tumor-associated stenosis. The overall morbidity rate was 28.1% (18.8% perforation, 6.3% hemorrhage, and 3.1% tracheal obstruction). The overall mortality rate was 18.8%. Although complications were more frequent than in primary esophageal tumors, endoscopic intubation was the only way to palliate this desperate condition and provided 66.6% of patients with relief of symptoms, nutritional improvement, and a mean survival time of 4.5 months. 

Category: neoplasms
Alcohol-dependent unilateral vestibular impairment persisting after a closed head injury. A 20-year-old man suffered a closed head injury followed by symptoms of right-sided labyrinthine concussion with complete clinical recovery within 3 weeks. Episodic vertigo and ataxic gait occurred after the ingestion of small amounts of alcohol over the next 2 years. Electro-oculography revealed a right-sided peripheral type vestibular lesion, only after taking alcohol. This was interpreted as an alcohol-induced impairment of central compensation following an incomplete recovery from right-sided labyrinthine trauma. 

Category: nervous system diseases
Psychologic and behavioral aspects of chronic headache. It is important for physicians to be aware of the expectations and psychologic needs patients have, to understand how psychologic and personality variables can impact care, to realize the importance of patient education, and to be cognizant of how environmental factors can influence headache pain behaviors. Empirical data indicate that the nonpharmacologic treatments of biofeedback, relaxation, and stress coping training can serve as useful adjunctive or alternative procedures, and that the combined use of medication and nonpharmacologic treatments yields the greatest clinical outcome. Certain headache types show minimal response to nondrug therapies alone (cluster, menstrual, and post-traumatic headache). Age and personality variables have a bearing on nondrug treatment outcome as well. 

Category: nervous system diseases
Kinin/prostaglandin system: its therapeutic value in surgical stress. Multiple system organ failure as a consequence of injury or sepsis remains the major reason for death in critically ill patients. One of the treatment concepts that has recently attracted clinical attention is the administration of kinins and prostaglandins (PGs). On the basis of experimental data, there is reason to believe that these compounds may have the potential to manipulate favorably certain processes and mechanisms (such as inflammatory or ischemic reactions) thought to be important in the pathophysiology of surgical stress. However, thus far, information on those effects in humans is still scarce. On the other hand, administration of kinins and PGs is technically possible and can be performed safely, even in intensive care patients. Therefore, different techniques, effects, and side-effects of kinin/PG therapy deserve clinical testing. It remains to be seen whether this concept will be useful in the treatment of critically ill surgical patients. 

Category: general pathological conditions
Intravascular ultrasound imaging of an acute dissecting aortic aneurysm: a case report. A case of acute dissecting aortic aneurysm is described in which intravascular ultrasonography was used at the time of aortography to produce real-time, 360 degree cross-sectional images of the aorta. The transmural vessel morphology visualized by this new catheter-based technology allowed confirmation of the diagnosis and identification of distal extension to the aortic bifurcation. The case demonstrates the unique potential of this modality in diagnosis and possible therapy in vascular diseases. 

Category: cardiovascular diseases
Follicular cell predominance in the cytologic examination of dominant thyroid nodules indicates a sixty percent incidence of neoplasia. The interpretation of aspiration cytologic smears that contain a predominance of follicular components often presents a dilemma to the clinician who is treating a patient who has a dominant thyroid nodule, especially when thyroid-stimulating hormone suppression does not produce any significant involution of the dominant nodule. We reviewed a consecutive series of 555 fine-needle aspiration cytologic examinations of dominant thyroid nodules. All specimens that contained colloid or follicular cells mixed with lymphocytes or Hurthle cells were excluded from this review. Additionally, nine aspirates contained degenerated follicular cells with insufficient material for cytologic diagnosis. The remaining 76 specimens contained a predominance of follicular cells: 27 specimens were interpreted as containing "normal" follicular cells, and the remaining 49 specimens were read as "atypical" follicular cells. Histopathologic examination of the resected specimens indicated a 60% incidence of neoplasia (30% carcinoma, 30% adenoma) in which the aspiration cytologic study was interpreted as "normal" follicular cells. On the other hand, a 63% incidence of neoplasia (27% carcinoma, 36% adenoma) occurred in which the cytologic study was read as "atypical." In conclusion, aspirates showing a predominance of follicular cells, whether "normal" or "atypical" indicate a 60% incidence of neoplasia in dominant thyroid nodules that do not decrease significantly in size with thyroid-stimulating hormone suppression. 

Category: neoplasms
Recurrent prolonged erections and priapism as a sequela of priapism: pathophysiology and management. Veno-occlusive priapism may be associated with prolonged corporeal ischemia, subsequent fibrosis of the corpora and impotence. We report on 6 patients who presented with an unusual sequela of veno-occlusive priapism, recurrent episodes of prolonged erections or priapism. In all cases the subsequent episodes were idiopathic and veno-occlusive, occurred with a frequency ranging from several times per day to once per month and were symptomatically disabling. Pharmacocavernosometry ruled out mechanical occlusion of corporeal venous drainage by demonstrating elevated flows to maintain intracavernosal pressures following smooth muscle contraction and markedly decreased flow rates following smooth muscle relaxation. Treatment of the recurrent episodes with intracavernous self-injection of phenylephrine resulted in successful detumescence. The use of oral phenylpropanolamine reduced the frequency and duration of the recurrences, and markedly reduced the need for adrenergic self-injection. It is proposed that this syndrome may develop secondary to the initial ischemic episode, resulting in a functional alteration of the adrenergic and/or endothelial-mediated mechanisms that control penile tumescence and maintain penile flaccidity. 

Category: general pathological conditions
Intraepithelial bodies in colorectal adenomas: Leuchtenberger bodies revisited. The presence of intraepithelial inclusion bodies (Leuchtenberger bodies) was recorded in rectal or colonic specimens from 130 patients. Large to moderate number of intraepithelial bodies were recorded in 81.8 percent of 55 colorectal adenomas from patients with familial adenomatous polyposis (FAP). Conversely, none of the 55 non-FAP adenomas or of the 20 specimens with ulcerative colitis (10 with dysplasia) had similar amounts of intraepithelial granules. Feulgen studies demonstrated that the granules contain DNA and are probably nuclear fragments of destroyed lymphocytes. Although the pathogenesis of this phenomenon remains obscure, it appears that the presence of large to moderate number of intraepithelial bodies in colorectal adenomas should strongly raise the suspicion of FAP. 

Category: neoplasms
Adjuvant chemotherapy for primary lymphoma of the central nervous system. Ten immunocompetent patients with primary non-Hodgkin's lymphoma of the central nervous system were treated by the neuro-oncology service at the University of California at San Francisco (UCSF). After undergoing surgery for biopsy or removal of their tumors, these patients (group 1) received irradiation with hydroxyurea followed by adjuvant chemotherapy with the combination of procarbazine, lomustine (CCNU), and vincristine. The outcome of treatment in this group was compared with that in three other groups of patients with primary CNS lymphoma: patients treated at the UCSF Cancer Research Institute who underwent surgery and radiation therapy (RT) (group 2); patients described in the literature who had surgery and RT (group 3); or patients described in the literature who had surgery, RT, and chemotherapy (group 4). Median and quartile survival times were greater in patients who received adjuvant chemotherapy (group 1, 30 and 50 months; group 4, 20 and 25 months) than in patients who did not receive chemotherapy after RT (group 2, 13 and 20 months; group 3, 15 and 24 months). These results suggest that adjuvant chemotherapy is useful in the treatment of primary CNS lymphoma. 

Category: nervous system diseases
A critical analysis of the largest reported mass fecal occult blood screening program in the United States. Fecal occult blood testing for the detection of colon cancer remains controversial. We performed a mass screening program from January 24, 1988, to February 19, 1988, with intensive media promotion, including 121 minutes of televised air time. A total of 5,000 primary practitioners were notified by mail. Hemoccult-II tests were distributed to 156,000 individuals; 55,051 (35%) were returned. Ninety-five percent of the respondents were informed of the program by television. A total of 3,375 persons (6%) tested positive for fecal occult blood; of these, 2,469 (73%) informed the center that they saw their physician to initiate a work-up. Information from physicians regarding work-ups was returned on only 1,356 (55%) patients. Diagnostic tests numbered 2,227 (1.6 tests per patient). However, 5% had no testing, 16% had a repeat Hemoccult only, and 35% had neither a barium enema nor colonoscopy performed. Thirty-six colorectal cancers and 212 polyps were identified. The predictive value (i.e., number of cancers per number of patients who tested positive) increased directly by decade. Thirty-three of 36 patients (92%) with cancer underwent either a barium enema or colonoscopy versus only 185 of 438 (42%) patients with a "negative" work-up. Cancers found were carcinoma in situ in 10 patients (29%), Dukes A in 12 (35%), Dukes B in 4 (12%), and Dukes C in 8 (24%); distant metastases were not found in any participant. Thirty-six percent of the tumors were located in either the right or transverse colon. We conclude that: (1) Screening identified early cancers. All were potentially curable and 64% were limited to the bowel wall. (2) Massive Hemoccult distribution was possible over a short interval, but patient and physician compliance was disturbingly low. (3) Total colonic evaluation is mandatory, since at least 36% of tumors were beyond the reach of the flexible sigmoidoscope. (4) Many work-ups were unnecessary (repeat Hemoccults) or inadequate, indicating a need for physician education. 

Category: neoplasms
The "natural history" of segmental wall motion abnormalities in patients undergoing noncardiac surgery. S.P.I. Research Group. Intraoperative segmental wall motion abnormalities (SWMA) detected by transesophageal echocardiography (TEE) are sensitive, but not always specific, markers of myocardial ischemia. To determine their incidence, characteristics, and relation to postoperative cardiac morbidity, we continuously recorded the left ventricular short-axis view and 12-lead ECG in 156 high-risk patients undergoing non-cardiac surgery. Monitoring was clinically blinded. Wall motion was scored at predefined clinical, hemodynamic, and ECG events and at periodic intervals (26 +/- 11 samples per patient). We detected 44 episodes of new or worsened SWMA in 32 patients (20%). The severity of most episodes was limited to severe hypokinesis (24/44, 55%) followed by akinesis (16/44, 36%) and dyskinesis (4/44, 9%). The remaining 124 patients had normal wall motion or only mild hypokinesis (56/156, 36%) or chronic SWMA (68/156, 44%). The incidence of new SWMA did not differ for patients with known coronary artery disease (CAD) and those with cardiac risk factors only (22% vs. 19%, P = not significant), although CAD patients had a significantly greater incidence of chronic SWMA (62% vs. 41%, P = 0.02). The incidence of new or worsened SWMA was significantly greater during aortic vascular surgery (38% vs. 17%, P = 0.05). Approximately 40% of all new TEE changes occurred in the absence of either an apparent clinical event or a significant change in systolic blood pressure or heart rate. Ten patients had new or worsened SWMA persisting until the end of surgery, 8 with new akinesis, only 1 developing myocardial infarction. The distribution of new or worsened SWMA and significant intraoperative ST-T changes (n = 19) in this cohort was discordant: temporal overlap between modalities was present in only 5 patients. Major cardiac complications occurred in 5 patients (3.2%), all of whom underwent peripheral vascularization. All patients with cardiac complications and new or worsened SWMA also had intraoperative or early postoperative ST-T changes. We conclude that: 1) continuous TEE recording with offline analysis in this high-risk group of patients revealed a relatively low incidence of new or worsened SWMA (20%), most episodes of which were characterized by severe hypokinesis (55%); 2) episodes were more common in patients undergoing aortic vascular surgery; 3) approximately 40% of episodes were unaccompanied by clinical events or significant hemodynamic changes; 4) episodes were poorly correlated with postoperative cardiac complications; and 5) the discordant relation between TEE and ECG changes observed here necessitates careful monitoring of the ECG when TEE is used clinically. 

Category: cardiovascular diseases