Melricflash/CW_MedAbstractsAlt huggingface dataset:
Evaluation of the fine needle aspiration biopsy in the preoperative selection of cold thyroid nodules. From 1980 to 1988 the authors examined by fine needle aspiration biopsy (FNAB) 4609 patients with solitary thyroid nodules or multinodular goiters. A total of 5605 "cold" thyroid nodules were evaluated and classified, on the basis of the cytologic findings, as malignant, follicular lesions (probably malignant and probably benign) and benign. Then the authors compared the preoperative cytologic findings with the postoperative histologic results in 827 nodules from patients who underwent surgery. In the 805 thyroid nodules in which an adequate cytologic specimen was obtained, false-negative results were 2.3% and false-positive findings were 1.1% By comparing cytologic and histologic diagnoses, preoperative FNAB resulted in the ability to accurately assess the risk of cancer in a thyroid nodule; since 250 nodules were identified as malignant, the risk of a "cold" thyroid nodule being cancer was 4.46% in this series. 

Category: neoplasms
Dystonia in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Adult-onset dystonia-parkinsonism is a syndrome in search of a pathology. We therefore reviewed the literature on dystonic manifestations in autopsy-proven cases of multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and idiopathic Parkinson's disease (PD). Only 6 of 140 autopsy reports of MSA remarked on the presence of dystonia in life, but personal observations suggest prominent antecollis may develop at some stage in up to 1/2 of sufferers. Similarly, very few (15/118) clinicopathologic observations on PSP included convincing dystonic manifestations, in contrast to some clinical reports where blepharospasm and early limb dystonia were prominent. Virtually any form of focal and segmental dystonia may sometimes occur with clinically diagnosed PD, with occasional descriptions of hemidystonia-hemiparkinsonism. However, there is pathologic confirmation of this diagnosis in only 1 case. With many patients thought clinically to have PD proving pathologically to have another cause for their parkinsonism, the true frequency and the range of dystonic manifestations acceptable in PD remain unknown. 

Category: nervous system diseases
Determination of ventricular fluid outflow resistance in patients with ventriculomegaly. Resorption of the ventricular fluid was studied by measuring ventricular fluid outflow resistance during steady state 1.5 and 5.0 ml/min infusions in 26 patients with substantial enlargement of the supratentorial ventricular system. This test may avoid unnecessary use of shunts, but a shunt could be introduced during the same procedure. 

Category: general pathological conditions
Insulin-like growth factors are mitogenic for human keratinocytes and a squamous cell carcinoma. Normal adult human keratinocytes in monolayer culture and SCL-1, a skin-derived squamous-cell carcinoma cell line, were investigated for the expression of receptors for insulin-like growth factors (IGF) and insulin. As demonstrated by affinity crosslinking, radiolabeled IGF-1, IGF-2, and insulin bound specifically to both cell types. Each cell expressed type I IGF receptors, with affinity for IGF-1 greater than IGF-2 much greater than insulin. Insulin receptors, with highest affinity for insulin, were also present on both cells. However, keratinocytes and SCL-1 cells differed in 125I-IGF-2 binding. 125I-IGF-2-bound to both type I and type II IGF receptors in normal keratinocytes, but bound predominantly to membrane-associated IGF binding proteins in SCL-1. IGF-1 was slightly more potent than IGF-2 in stimulating growth of both keratinocytes and SCL-1 cells. In keratinocytes, concentrations of IGF-1 ranging from 5-100 ng/ml, and of IGF-2 from 50-100 ng/ml, resulted in a significant increase in cell number. At the maximum dose of 100 ng/ml, either IGF-1 or IGF-2 caused a 2.3-times increase in cell number. In SCL-1 cells, IGF-1 was more potent than IGF-2 or insulin at lower concentrations, but either IGF-1 or IGF-2 at the maximal concentration of 333 ng/ml stimulated a 4.7-times increase in thymidine incorporation. The stimulatory effect of insulin in SCL-1 was 10-50 times less potent than that of the IGF. The effect of either IGF on SCL-1 was completely inhibited by the type I IGF receptor antibody alpha IR-3, suggesting that both IGFs are mitogenic through the type I IGF receptor. Insulin action was partially blocked by alpha IR-3, suggesting that insulin can act through both the insulin and type I IGF receptors. It thus appears that IGF-1 and IGF-2 are mitogens for normal and transformed human keratinocytes and that their actions are primarily mediated through the type I IGF receptor, whereas insulin is a mitogen through both the IGF-1 receptor and the insulin receptor. 

Category: neoplasms
Pain experiences of intensive care unit patients. The purpose of this study was to describe various dimensions of the pain experiences of intensive care unit (ICU) patients. A purposive, primarily surgical sample of 24 ICU patients from two hospitals was interviewed after transfer from ICU. All but one patient remembered their ICU stay. Although this and six other patients had no recall of pain, 63% of the sample rated their pain as being moderate to severe in intensity. In a subgroup of nine patients having cardiac surgery, mean morphine sulfate administration during the first three postoperative days was 14 mg/day. This group of patients reported a lack of total pain relief from analgesics. Patients also described various sources of their pain, difficulties they had in communicating their pain, and nonpharmacologic methods that helped relieve their pain. Results of this study clearly indicate that not only pain but its communication and treatment were significant problems for a substantial portion of this ICU sample. Further descriptive and experimental research of pain characteristics and treatment practices for ICU patients is urgently needed. Improvements in nursing practice that result from such research may make a substantial difference in the comfort and well-being of critically ill patients. 

Category: nervous system diseases
Cholinergic deficiency and frontal dysfunction in Parkinson's disease. To investigate the influence of central cholinergic deficit on cognitive function in Parkinson's disease (PD), we compared the neuropsychological performance of a group of 20 patients who were treated with anticholinergic drugs (mean daily dose, 10.2 mg) with that of a group of 20 patients who received no anticholinergics. The two groups were matched for all the variables of parkinsonism and levodopa therapy. At the dose used, there was no significant difference between the two groups of patients for intellectual, visuospatial, instrumental, and memory function. In contrast, in the group that received anticholinergics severe impairment was observed on tests believed to assess frontal lobe function. These results suggest that the lesion of the ascending cholinergic neurons, which has been demonstrated post mortem in PD, may play a role in the subcorticofrontal behavioral impairment of this disease. 

Category: nervous system diseases
Long-term follow-up comparing subclavian flap angioplasty to resection with modified oblique end-to-end anastomosis The definitive surgical procedure for correction of aortic coarctation remains controversial. Therefore, we retrospectively reviewed a total of 56 children under 4 years of age with coarctation repair between 1977 and 1986. Thirty-four had the subclavian flap angioplasty technique and 22 had resection with oblique end-to-end anastomosis. The group was further subdivided to include only the 23 infants less than 3 months of age--eight infants with resection with oblique end-to-end anastomosis (less than or equal to 3ETE) and 15 infants with subclavian flap angioplasty (greater than or equal to 3SFA). The remaining 33 patients older than 3 months of age were divided into 14 patients with resection and oblique end-to-end anastomosis (greater than 3ETE) and 19 patients with the subclavian flap angioplasty technique (greater than 3SFA). The overall mortality was not significantly different between techniques. Postoperative hypertension was significantly more prevalent with end-to-end anastomosis than with the subclavian flap angioplasty technique (p less than 0.01). Seven patients had recurrent coarctation. The 6-year actuarial freedom from recoarctation was 93% +/- 6% in the less than or equal to 3SFA group compared with 53% +/- 20% in the less than or equal to 3ETE group (p less than 0.02), but there was no significant difference in those children operated on at a later age regarding the type of coarctation repair. Therefore, we recommend subclavian flap angioplasty in patients less than 3 months of age. In those older than 3 months either procedure is safe and the risk of recoarctation is similar. 

Category: cardiovascular diseases
Hyperglycemia presenting with occipital seizures. Seizures are common in hyperglycemia and are often the first manifestation, particularly in nonketotic hyperglycemia (NKH). Published reports emphasize partial motor seizures almost exclusively. In a 3-year period, we observed three patients in whom occipital seizures, documented by ictal EEG recording, were the initial symptom of hyperglycemia. One patient was mildly ketotic at first. Seizures were visual in two patients and visual and adversive in the third. Seizures regressed with correction of abnormal glucose levels and did not recur during follow-up of less than or equal to 1 year despite discontinuation of antiepileptic drugs (AEDs) in two. Computed tomography (CT) scans did not show correlative abnormalities. Although published reports suggest that frontal lobe structures are particularly susceptible to the epileptogenic effects of NKH, our experience indicates that in NKH epileptic foci may originate in other cortical areas, such as occipital. 

Category: nervous system diseases
Propafenone treatment of symptomatic paroxysmal supraventricular arrhythmias. A randomized, placebo-controlled, crossover trial in patients tolerating oral therapy. OBJECTIVE: To test the hypothesis that propafenone, administered orally, prevents symptomatic paroxysmal supraventricular arrhythmias. DESIGN: a 6-month, open-label, dose-finding phase followed by a randomized, double-blind, placebo-controlled, crossover phase, with each treatment period lasting up to 60 days. SETTING: An outpatient clinic. PATIENTS: Thirty-three patients with either paroxysmal supraventricular tachycardia (n = 16) or paroxysmal atrial fibrillation (n = 17) were enrolled. Their arrhythmias were documented by electrocardiogram before enrollment. Twenty-three patients (14 with paroxysmal supraventricular tachycardia and 9 with paroxysmal atrial fibrillation) were randomized and the data obtained from these patients were used in the efficacy analysis. INTERVENTION: Propafenone (300 mg three times daily in 19 patients, 300 mg twice daily in 3 patients, and 150 mg twice daily in 1 patient) and matching placebo tablets were administered in a randomized sequence. MEASUREMENTS: Symptomatic arrhythmia was documented by telephone transmission of the electrocardiogram. MAIN RESULTS: The time to first recurrence was prolonged for the overall group of 23 patients while they received propafenone (P = 0.004). The recurrence rate of arrhythmia during treatment with propafenone was estimated to be approximately one fifth of the recurrence rate during treatment with placebo. CONCLUSIONS: Propafenone is effective in reducing symptomatic paroxysmal supraventricular arrhythmias. 

Category: general pathological conditions
The effect of spine fusion on respiratory function in Duchenne muscular dystrophy. Serial measures of respiratory function were made in 17 patients with Duchenne muscular dystrophy who underwent segmental spine fusion and in 22 patients who did not. No significant differences were observed between the 2 groups (operated vs. nonoperated) in terms of declining respiratory function. Nonetheless, all operated patients reported either improved sitting comfort, appearance, or both. Thus, our results suggest that there are distinct benefits from segmental spine fusion; however, there was no salutary effect upon respiratory function either in the short term or after up to 5 years follow-up. 

Category: general pathological conditions
Common headaches: type, duration, frequency and implications. Questionnaires completed by 327 preclinical medical and dental students showed that 97.9% had experienced headaches, most frequently attributed to insufficient sleep (38.8%), mental stress (38.8%), alcohol (38.5%), excess heat (36.7%), reading (31.5%), excess noise (29.9%) or light (27.7%), and sleeping too long (23.5%). The frequency and duration of these and other headaches are listed. 8% of the headache group had consulted a doctor. Only 2.1% of all students had never experienced a headache. Two hypotheses are examined: (1) can headaches be normal?--delineated by their disappearing soon after the noxious stimulus has ceased; (2) can pain in the head, as elsewhere in the body, act as a warning and therefore have protective, even survival value?. 

Category: nervous system diseases
Prognosis and prognostic factors of retinal infarction: a prospective cohort study. OBJECTIVE--To determine the prognosis and adverse prognostic factors in patients with retinal infarction due to presumed atheromatous thromboembolism or cardiogenic embolism. DESIGN--Prospective cohort study. SETTING--University hospital departments of clinical neurology. PATIENTS--99 patients with retinal infarction, without prior stroke, referred to a single neurologist between 1976 and 1986 and evaluated and followed up prospectively until death or the end of 1986 (mean follow up 4.2 years). INTERVENTIONS--Cerebral angiography (55 patients), aspirin treatment (37), oral anticoagulant treatment (eight), carotid endarterectomy (13), cardiac surgery (six), and peripheral vascular surgery (two). MAIN OUTCOME MEASURES--Death, stroke, coronary events, contralateral retinal infarction; survival analysis confined to 98 patients with retinal infarction due to presumed artheromatous thromboembolism or cardiogenic embolism (one patient with giant cell arteries excluded), and Cox's proportional hazards regression analysis, including age as a prognostic factor. RESULTS--During follow up 29 patients died (21 of vascular causes and eight of non-vascular or unknown causes), 10 had a first ever stroke, 19 had a coronary event, and only one developed contralateral retinal infarction. A coronary event accounted for more than half (59%) of the deaths whereas stroke was the cause of only one death (3%). Over the first five years after retinal infarction the actuarial average absolute risk of death was 8% per year; of stroke 2.5% per year (7.4% in the first year); of coronary events 5.3% per year, exceeding that of stroke; and of stroke, myocardial infarction, or vascular death 7.4% per year. Prognostic factors associated with an increased risk of death were increasing age, peripheral vascular disease, cardiomegaly, and carotid bruit. Adverse prognostic factors for serious vascular events were increasing age and carotid bruit for stroke, and increasing age, cardiomegaly, and carotid bruit both for coronary events and for stroke, myocardial infarction, or vascular death. CONCLUSIONS--Patients who present with retinal infarction due to presumed atherothromboembolism or cardiogenic embolism are at considerable risk of a coronary event. The risk of stroke, although high, is not so great. Not all strokes occurring after retinal infarction relate directly to disease of the ipsilateral carotid system, although this is probably the most common cause. Few patients experience contralateral retinal infarction. Non-arteritic retinal infarction should be diagnosed or confirmed by an ophthalmologist, and the long term care of patients with the condition should involve a physician who has an active interest in managing vascular disease. 

Category: nervous system diseases
Non-vesicular release of glutamate from glial cells by reversed electrogenic glutamate uptake. Glutamate uptake into nerve and glial cells usually functions to keep the extracellular glutamate concentration low in the central nervous system. But one component of glutamate release from neurons is calcium-independent, suggesting a non-vesicular release that may be due to a reversal of glutamate uptake. The activity of the electrogenic glutamate uptake carrier can be monitored by measuring the membrane current it produces, and uptake is activated by intracellular potassium ions. Here we report that raising the potassium concentration around glial cells evokes an outward current component produced by reversed glutamate uptake. This current is activated by intracellular glutamate and sodium, inhibited by extracellular glutamate and sodium, and increased by membrane depolarization. These results demonstrate a non-vesicular mechanism for the release of glutamate from glial cells and neurons. This mechanism may contribute to the neurotoxic rise in extracellular glutamate concentration during brain anoxia. 

Category: nervous system diseases
Flow cytometric DNA content of adenoid cystic carcinoma of submandibular gland. Correlation of histologic features and prognosis. Flow cytometric analysis of nuclear DNA content was performed in 26 adenoid cystic carcinomas of the submandibular gland using archived, paraffin-embedded tissues. The DNA content was compared with multiple histologic parameters and clinical course. Ten carcinomas (38%) were aneuploid and 16 (62%) diploid. Aneuploid carcinomas demonstrated a higher frequency of solid cytoarchitecture, lymph node metastases, and advanced clinical stage, as compared with diploid carcinomas. Other histologic features predicting aggressive clinical behavior also correlated with abnormal DNA content and included invasion of nerves larger than 0.25 mm and intravascular extension. Our data suggest that DNA content analysis can be an effective objective parameter in the clinicopathologic assessment of adenoid cystic carcinoma. 

Category: general pathological conditions
Reversal of chronic hepatic encephalopathy by colonic exclusion: poor correlation with blood GABA levels. Previous studies have suggested that the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) is a key factor in the syndrome of portasystemic encephalopathy. We report the case of a patient with medically intractable portasytemic encephalopathy after portacaval shunt who had marked clinical improvement after creation of an end ileostomy. Plasma GABA and serum ammonia levels were measured before and after ileostomy. Although the clinical syndrome and the EEG improved markedly after the ileostomy, the plasma GABA levels remained markedly elevated. Preoperative and postoperative GABA levels were 865 and 633 pmol/ml, respectively (nl = 100-180 pmol/ml). Our findings confirm previous reports of the efficacy of colonic exclusion in patients with intractable portasystemic encephalopathy. However, our results conflict with the hypothesis that GABA itself is the key mediator of the syndrome. 

Category: general pathological conditions
Elapsed time from symptom onset and acute myocardial infarction in a community hospital. STUDY OBJECTIVE: Previous reports have emphasized that thrombolytic therapy for acute myocardial infarction should be initiated within three or four hours of symptom onset to obtain the best clinical outcomes. However, our clinical impression was that late arrivers, who often do not receive thrombolytic therapy, have a good short-term prognosis. Therefore, we investigated the relationships among the elapsed time from symptom onset, thrombolytic therapy, and short-term prognosis in acute myocardial infarction patients. The research hypothesis was that late arrivers have a better in-hospital prognosis because they have less severe disease that may involve spontaneous thrombolysis. DESIGN: Observational cohort study based on reviewing medical records and emergency department service logs. SETTING: 500-bed teaching hospital with medical school affiliation in northeastern Ohio. TYPE OF PARTICIPANTS: Four hundred consecutive patients with acute infarction confirmed by chest pain and positive ECGs or elevated cardiac enzymes. MEASUREMENTS AND MAIN RESULTS: Patients arriving early (elapsed time less than or equal to 1.5 hours) were more likely to be in Killip class III or IV (P = .04) or to have hypotension (P = .0004); and they experienced twofold increased odds of ventricular tachycardia (P = .007), cardiac arrest (P = .03), or death (P = .01). Patients arriving late (elapsed time greater than 3.5 hours) were more likely to have a history of angina (P = .002) and had a better short-term prognosis. CONCLUSIONS: Time of ED arrival after onset of acute myocardial infarction symptoms distinguishes two patient groups that differ in their risk of in-hospital complications. Late arrivers have better short-term prognoses and less (acutely) severe disease, and may have less need for thrombolytic therapy because of possible spontaneous thrombolysis. Patients with prior angina may need education on seeking care if their symptoms change. 

Category: cardiovascular diseases
Pulmonary tolerance of prophylactic aerosolized pentamidine in human immunodeficiency virus-infected patients. The effects of primary and secondary long-term prophylaxis of Pneumocystis carinii pneumonia with aerosolized pentamidine on pulmonary function in HIV+ patients were evaluated. Eighty-one patients, none of whom were drug addicts or had pulmonary Kaposi's sarcoma, were studied. Fifty patients were receiving AP as secondary prophylaxis, 36 monthly and 14 twice-monthly; eight patients with a history of PCP served as control subjects. Twenty-three patients were receiving AP as primary prophylaxis, 12 monthly and 11 twice-monthly. Pulmonary function tests, including spirometry, lung transfer capacity for carbon monoxide (Tlco) and alveolar-arterial oxygen gradient (P[A-a]O2) were evaluated at M1, ie, one month after the diagnosis of PCP, or at the beginning of the AP prophylaxis, and then at three-month intervals (M4 to M13). No differences were observed in the results of spirometry or P(A-a)O2. Among the patients receiving secondary prophylaxis, a significant increase (paired Student's t-test) in Tlco occurred at M7 compared to M1 in the group receiving monthly administrations (p less than 0.01) and in the untreated control group (p less than 0.05); there was no significant difference in Tlco at M13 compared to M1 in the 12 patients who received monthly administrations for this period or at M7 in the 14 patients receiving AP twice-monthly. No significant difference in Tlco was observed at M7 in the primary prophylaxis groups. These results indicate that pulmonary tolerance of AP, as reflected by pulmonary function tests, is good. 

Category: general pathological conditions