Melricflash/CW_MedAbstractsAlt huggingface dataset:
The Mansfield Scientific Aortic Valvuloplasty Registry: overview of acute hemodynamic results and procedural complications. Between December 1, 1986 and October 30, 1987, balloon aortic valvuloplasty was performed in 492 patients with aortic stenosis (mean age 79 +/- 8.4 years) enrolled in the Mansfield Scientific Aortic Valvuloplasty Registry. All procedures were performed from a femoral approach (92%), brachial approach (6%) or transseptal approach (2%) and utilized either a single balloon technique (72%) or a double balloon technique (28%). Valvuloplasty resulted in a significant improvement in aortic valve area (0.50 +/- 0.18 cm2 to 0.82 +/- 0.30 cm2), mean aortic valve gradient (60 +/- 23 mm Hg to 30 +/- 13 mm Hg) and cardiac output (3.86 +/- 1.26 to 4.05 +/- 1.31 liters/min). Serial aortography demonstrated a moderate or severe increase in aortic insufficiency in only 2.1% of patients. Statistical analysis of the procedural factors affecting acute valvuloplasty results demonstrated significant correlations of single versus double balloon technique, total number of balloon inflations and total number of balloon exchanges with respect to the absolute change in mean aortic valve gradient occurring during the valvuloplasty procedure. In addition, there was a significant correlation between the maximal time of valvuloplasty balloon inflation with aortic valve area measured after valvuloplasty, and there were significant correlations of the total number of balloon inflations and total number of balloon exchanges with the aortic valve mean gradient measured after valvuloplasty. The overall complication rate for the procedure was 20.5%, including vascular injury in 11%, embolic phenomenon in 2.2%, ventricular perforation resulting in tamponade in 1.8%, massive aortic insufficiency in 1%, nonfatal arrhythmia in 0.8% and myocardial infarction in 0.2%. 

Category: cardiovascular diseases
Postangiographic femoral artery injuries: nonsurgical repair with US-guided compression Ultrasound-guided compression repair (UGCR) of catheterization-related femoral artery injuries was evaluated as a possible new imaging-guided interventional procedure. Thirty-nine femoral artery injuries (35 pseudoaneurysms, four arteriovenous fistulas) were detected with color Doppler flow imaging in patients with enlarging groin hematomas and/or groin bruits 6 hours to 14 days after catheterization procedures. UGCR was not performed in 10 patients due to spontaneous thrombosis (n = 4), infection (n = 1) or skin ischemia (n = 1), unsuitable anatomy (n = 3), or excessive discomfort (n = 1). The remaining 29 patients underwent a full trial of compression therapy, and the lesion was eliminated in 27. Follow-up color flow scans were obtained after 24-72 hours in all 27 successful cases and at 1-15 months in 19; no recurrences or complications occurred. UGCR for acute injuries is safe and technically simple and is promising as a cost-effective, first-line treatment for uncomplicated catheterization-related femoral artery injuries. UGCR is probably not appropriate for long-standing injuries. 

Category: general pathological conditions
Treatment of fallopian tube carcinoma with cisplatin, doxorubicin, and cyclophosphamide. Primary carcinoma of the fallopian tube is uncommon and is often treated using regimens active in ovarian carcinoma. Evidence is scant that such therapies benefit patients with fallopian tube carcinoma. Between December 1979 and July 1988, we treated 18 patients who had adenocarcinoma of the fallopian tube with the combination of cisplatin (50 mg/m2), doxorubicin (50 mg/m2), and cyclophosphamide (500 mg/m2) administered intravenously on 1 day every 28 days. Histologic confirmation of fallopian tube carcinoma was obtained before entry in the study. Three patients had stage I disease, five had stage II, nine had stage III, and one had stage IV. Sixteen patients received the combination therapy as first-line treatment after cytoreductive surgery, and two patients received it for recurrent carcinoma. Seven patients had clinically measurable disease at the start of therapy. Two of these patients had a complete clinical response, two had stable disease, and three had progressive disease. Eight of the 15 patients with stages II-IV disease underwent second-look laparotomy; four had a complete response to therapy and four had a partial response, making the overall response rate 53%. The toxicity of the regimen was moderate. The median survival was 81 months. Patients with stages II-IV disease had a median survival of 43.9 months and a progression-free survival of 22.5 months. This regimen appears to be active in fallopian tube carcinoma and can result in response rates comparable to those reported for epithelial ovarian cancer. 

Category: neoplasms
Congenital monomelic hypertrophy with progressive myopathy. We describe a patient with congenital monomelic hypertrophy who later developed progressive footdrop due to a degenerative myopathy. The clinical, electrophysiologic, and pathologic features of the case are described and compared with those of a previously reported case. 

Category: general pathological conditions
Silent cerebrovascular disease in the elderly. Correlation with ambulatory pressure. Does the average daily blood pressure correlate with hypertensive cerebrovascular disease better than the casual pressure, as has been reported in other target organ involvement? We investigated the associations of two abnormal findings on brain magnetic resonance imaging suggestive of a vascular etiology, low intense foci (lacunae), and periventricular hyperintense lesions on T1- and T2-weighted images, with both office and average daily blood pressure values in a population of 73 healthy normotensive and hypertensive elderly individuals (70 +/- 6 years old). Lacunae were detected in 34 subjects (47%); the number per subject ranged from 0 to 19 and was significantly correlated with advancing age. Furthermore, these changes were supposedly related to the average of noninvasive ambulatory (24-hour and during awake and asleep periods) pressure recordings but not to office pressures. The grade of periventricular hyperintensity was also significantly associated with advancing age and the average of ambulatory systolic pressure recordings, particularly during sleep, but not with office blood pressure. In comparisons of normotensive, "office hypertensive," and hypertensive subgroups, abnormalities on magnetic resonance imaging were appropriate to the level of the 24-hour blood pressure measurements but not to that of clinic pressure. In hypertensive patients, the presence of electrocardiographic evidence of left ventricular hypertrophy was also associated with greater abnormalities on magnetic resonance imaging. We conclude that ambulatory blood pressure monitoring is superior to casual pressure measurements in predicting latent cerebrovascular disease, which is unexpectedly common in apparently healthy elderly subjects. 

Category: cardiovascular diseases
Regulation of insulin, epidermal growth factor, and transforming growth factor-alpha levels by growth factor-degrading enzymes. The mechanisms by which growth factors are degraded and the role this process plays in the regulation of cell growth are not well understood. Insulin degradation is believed to be mediated by a specific metalloprotease, insulin-degrading enzyme (IDE). We have previously shown that IDE can also degrade transforming growth factor-alpha (TGF alpha), but not epidermal growth factor (EGF), in vitro. This selectivity was surprising, since TGF alpha and EGF are structurally similar and bind to the same receptor with comparable affinities. Using a spectrum of protease inhibitors, we have now analyzed the degradation of TGF alpha, EGF, and insulin by human hepatoma HepG2 cells. The results suggest that bacitracin-sensitive metalloproteases are involved in the degradation of TGF alpha and EGF as well as insulin, and that the degradation of TGF alpha, but not EGF, is mediated in part by IDE. Inhibiting the activity of these metalloproteases decreased growth factor depletion, suggesting that these enzymes play an important role in the control of extracellular growth factor levels. The existence of separate degradative pathways for EGF and TGF alpha may explain how the two factors exert differential effects in some systems, and degradation of TGF alpha by IDE would provide a possible mechanism for interaction between the insulin and TGF alpha/EGF signalling systems. 

Category: neoplasms
Benign parotid tumors: a 24-year experience. The medical records of 125 patients benign parotid neoplasms surgically treated over a 24-year period were retrospectively reviewed; 128 tumors were excised. These included 90 pleomorphic adenomas, 33 Warthin's tumors, 3 benign lymphoepitheliomas, and 2 oncocytomas. The surgical procedures consisted of 2 local excisions, 6 enucleations, 88 superficial parotidectomies, 13 subtotal parotidectomies, and 3 radical parotidectomies. The morbidity rate was 49%. There was one total permanent facial nerve paralysis (0.7%), four (3%) partial permanent facial nerve paralysis, five (5%) transient total facial nerve paralysis, and 32 (25%) partial transient facial nerve paralysis. After a median follow-up of 84 months, there was one recurrence (0.7%). A superficial parotidectomy is the minimum procedure that should be performed for the treatment of a benign parotid neoplasm. 

Category: general pathological conditions
Gastrointestinal side-effects of octreotide during long-term treatment of acromegaly. Gastrointestinal side-effects of prolonged therapy (greater than 2 yr) with the long-acting somatostatin analog octreotide were studied in 10 acromegalic patients. After 2 yr of therapy, 6 of 10 patients had newly developed gallstones, complicated by cholangitis and jaundice in 1. Serum vitamin B-12 concentrations declined in all 10 patients [from 380 +/- 32 to 172 +/- 21 pmol/L (mean +/- SE); P = 0.023] and became abnormally low in 4. Gastric biopsy specimens, obtained during gastroscopy (9 patients), showed moderate to severe active gastritis, with damage to the superficial and deeper layers of the mucosa in 9 of 9 and focal atrophy in 7 of 9 patients. Campylobacter pylori was found in the antral mucosa in 8 of 9 patients. Although information is lacking on similar studies in untreated acromegalic patients, we suggest that patients receiving chronic octreotide therapy be closely monitored for these and possible other side-effects related to gastrointestinal actions of octreotide. 

Category: digestive system diseases
A prospective study of the incidence and natural history of femoral vascular complications after percutaneous transluminal coronary angioplasty. Over a 14-month period patients undergoing 144 percutaneous transluminal coronary angioplasty procedures were evaluated for the presence of complications at the femoral puncture site. After percutaneous transluminal coronary angioplasty each patient was examined by a surgeon, and then a color-flow duplex scan of the groin was obtained. On the initial scan eight pseudoaneurysms, three arteriovenous fistulas, one combined arteriovenous fistula-pseudoaneurysm, and one thrombosed superficial femoral artery were detected for a major vascular complication rate of 9%. Pseudoaneurysm formation was associated with the use of heparin after removal of the arterial sheath. Seven pseudoaneurysms (initial extravascular cavity size range 1.3 to 3.5 cm) were followed with weekly duplex scans, and all thrombosed spontaneously within 4 weeks of detection. The three patients with isolated arteriovenous fistulas were each followed for at least 8 weeks, and the arteriovenous fistulas persisted. Early surgical intervention for postcatheterization femoral pseudoaneurysms is usually unnecessary as thrombosis often occurs spontaneously. We would advocate an operative approach for pseudoaneurysms that are symptomatic, expanding, or associated with large hematomas. Iatrogenic femoral arteriovenous fistulas should be considered for elective repair, but this may be delayed for several weeks without adverse sequelae. 

Category: cardiovascular diseases
Discrepancies in the measurement of isovolumic relaxation time: a study comparing M mode and Doppler echocardiography. Mitral valve cusp separation on M mode echogram, the mitral valve opening artefact, and the onset of forward transmitral flow recorded by Doppler echocardiography have all been taken to mark the end of isovolumic relaxation, while its onset has been taken either as the aortic closure sound (A2) recorded phonocardiographically or the aortic closure artefact determined by Doppler technique. Possible differences in the measurement of the isovolumic relaxation time were studied when these landmarks were used in 44 healthy people, 14 patients with mitral stenosis, 21 patients with left ventricular hypertrophy, and 24 patients with dilated cardiomyopathy by recording M mode echograms of the mitral valve, and pulsed and continuous wave Doppler spectra of transmitral flow, with simultaneous electrocardiograms and phonocardiograms. A2 was effectively synchronous with the aortic artefact. However, when the onset of Doppler flow was regarded as the end of isovolumic relaxation, the interval was significantly longer than when mitral cusp separation on M mode echograms was used: by 25 (10) ms in healthy individuals, by 25 (15) ms in patients with left ventricular hypertrophy, and by 50 (35) ms in patients with dilated cardiomyopathy. In patients with mitral stenosis the interval was only 5 (5) ms longer. The mitral valve opening artefact consistently followed the onset of flow and corresponded much more closely to the E point on the M mode echogram. This shows that it occurred during the rapid filling period and well beyond isovolumic relaxation by any definition. Thus isovolumic relaxation time measured from A2 to the onset of transmitral flow or the mitral valve opening artefact differs from that derived from A2 to mitral valve cusp separation. These intervals cannot be used interchangeably to measure "isovolumic relaxation time". 

Category: cardiovascular diseases
Familial hypobetalipoproteinaemia complicated by cerebellar ataxia and steatocystoma multiplex. A 55-year-old man with cerebellar ataxia and steatocystoma multiplex was found to have reduced serum concentrations of total cholesterol, betalipoprotein and apolipoprotein B. Computed tomography revealed atrophy of the cerebellum and brain stem. Of the six family members examined, four had hypobetalipoproteinaemia, and one had mild ataxia. Similar skin lesions were noted in five male relatives. This case represents a rare combination of familial hypobetalipoproteinaemia, cerebellar ataxia and steatocystoma multiplex. 

Category: nervous system diseases
Pearson syndrome and mitochondrial encephalomyopathy in a patient with a deletion of mtDNA. A patient is described who has features of Pearson syndrome and who presented in the neonatal period with a hypoplastic anemia. He later developed hepatic, renal, and exocrine pancreatic dysfunction. At the age of 5 years he developed visual impairment, tremor, ataxia, proximal muscle weakness, external ophthalmoplegia, and a pigmentary retinopathy (Kearns-Sayre syndrome). Muscle biopsy confirmed the diagnosis of mitochondrial myopathy. Analysis of mtDNA from leukocytes and muscle showed mtDNA heteroplasmy in both tissues, with one population of mtDNA deleted by 4.9 kb. The deleted region was bridged by a 13-nucleotide sequence occurring as a direct repeat in normal mtDNA. Both Pearson syndrome and Kearns-Sayre syndrome have been noted to be associated with deletions of mtDNA; they have not previously been described in the same patient. These observations indicate that the two disorders have the same molecular basis; the different phenotypes are probably determined by the initial proportion of deleted mtDNAs and modified by selection against them in different tissues. 

Category: digestive system diseases
Chronic diarrhea in essential mixed cryoglobulinemia: a manifestation of visceral vasculitis? Gastrointestinal involvement occurs frequently in essential mixed cryoglobulinemia, and most often involves the liver and spleen. Intestinal involvement is much less common and is generally felt to be a late and often catastrophic manifestation of the disease due to severe vasculitis. Occasionally, the disorder mimics inflammatory bowel disease, both clinically and radiographically. We recently cared for a patient with essential mixed cryoglobulinemia who developed persistent diarrhea. Endoscopic evaluation revealed scattered petechial lesions in the duodenum and colon as well as prominent lymphoid hyperplasia in the terminal ileum. Mucosal biopsies disclosed the presence of diffuse inflammation. We suggest that this patient's diarrhea was due to intestinal vasculitis and that prominent ileal lymphoid hyperplasia may be a manifestation of essential mixed cryoglobulinemia. 

Category: cardiovascular diseases
Possible etiologic heterogeneity of vulvar intraepithelial neoplasia. A correlation of pathologic characteristics with human papillomavirus detection by in situ hybridization and polymerase chain reaction. A correlated histopathologic and molecular virologic study of 30 cases of vulvar intraepithelial neoplasia Grade 3 (VIN 3) and six associated invasive vulvar carcinomas was performed. Paraffin sections were examined for human papillomavirus (HPV) types 6, 11, 16, and 18 by in situ hybridization for viral transcripts and by polymerase chain reaction (PCR) for amplification of HPV and of the beta-globin gene. Vulvar intraepithelial neoplasia Grade 3 was histologically subclassified into warty (bowenoid) (20 cases) and basaloid (undifferentiated) (ten cases) types. Warty VIN characteristically was composed of squamous cells displaying abnormal proliferation and maturation and an undulating or spiked surface creating a "condylomatous" appearance whereas basaloid VIN had a smooth surface and was composed of undifferentiated basaloid cells resembling carcinoma in situ of the cervix. Human papillomavirus-16 was the only type detected in 16 of 30 VIN 3 and in five of six invasive carcinomas. The HPV-positive women were younger than HPV-negative women (mean age at diagnosis, 49 versus 60 years), their lesions more frequently demonstrated koilocytotic atypia (94% versus 43%), and they were more likely to have warty compared with basaloid VIN lesions (65% versus 30%). These findings suggest that there are at least two different types of VIN which have differing clinical, pathologic, and viral profiles. 

Category: neoplasms
Aggressive therapeutic amniocentesis for treatment of twin-twin transfusion syndrome. Acute severe twin-twin transfusion syndrome occurs in about 1% of monochorionic twin gestations. In the most severe form, acute hydramnios develops in the recipient twin's sac and fetal hydrops may be present. The donor twin is anemic and oligohydramnios is present, so that the donor appears "stuck" in a cocoon made by its adherent amnion. In this report, aggressive therapeutic amniocentesis restored amniotic fluid volume to normal in both sacs in all pregnancies. Fetal hydrops resolved in three of five (60%) of the fetuses affected. Pregnancy was extended a mean 80 +/- 33 days (+/- 2 SD) and perinatal survival was 79%. These findings contrast dramatically with the virtual 100% mortality reported in the literature with no therapy. Repeated aggressive amniocentesis effectively reversed the physiology of twin-twin transfusion syndrome and should be the treatment of choice for acute hydramnios, which previously had no recommended therapy. 

Category: general pathological conditions
Young's syndrome (obstructive azoospermia and chronic sinobronchial infection): a quantitative study of axonemal ultrastructure and function. The ultrastructure and function of nasal cilia and sperm tails were examined in 23 men with Young's syndrome and compared with data previously collected from 10 normal subjects. Quantitative electron microscopic assessment showed that sperm tails from patients with Young's syndrome contained significantly fewer central pair microtubules, radial spokes, and inner dynein arms, and their cilia contained less inner dynein arms than normal subjects. The Young's syndrome patients had normal in vitro ciliary beat frequency (11.4 +/- 0.9 Hz), and 12 of the 23 had normal nasal mucociliary clearance (15.0 +/- 5.0 minutes). However, the remaining 11 had markedly abnormal nasal mucociliary clearance in vivo. In these patients, the deficiency of ciliary inner dynein arms did not appear to affect ciliary function in vitro but may under mucus loading lead to abnormal in vivo ciliary function. The consistent abnormalities shown in cilia and sperm tails, though apparently minor, constitute a common factor in both the reproductive and respiratory tracts which may, in combination with abnormalities in the in vivo environment, lead to the features of Young's syndrome. 

Category: general pathological conditions
Phenotypic and functional characterization of T cells from patients with myasthenia gravis. A study of cell surface phenotypes of PBL of myasthenia gravis (MG) patients showed that their T cells had a significantly higher percentage of 4B4+ T cells (the helper/inducer subset) than age- and sex-matched controls. The PBL of MG patients proliferated significantly higher than those of normal subjects (NS) in response to the purified alpha chain of the acetylcholine receptor (AChR). Anti-AChR antibody was present in sera of 88% of MG and none of the NS. The PBL B cells from MG only, when cultured with autologous T cells and stimulated with either pokeweed mitogen (69%), or AChR-alpha chain (38%), secreted antibody to AChR-alpha chain, whereas T and B cells alone secreted no antibody. T cells from PBL of MG patients were more readily cloned than T cells of NS, by limiting dilution, in the presence of recombinant IL-2 and in the absence of AChR-alpha chain. About 50% of T cell clones from MG patients, compared to none from NS, proliferated to AChR-alpha chain. This response was HLA-DR restricted. MG T cell clones did not display significant cytotoxic activity, as compared to control T cell clones. Our results indicate that in MG, 4B4+ regulatory T cells play their role in the pathogenesis of MG, not by cytotoxicity, but more likely by their ability to stimulate specific antibody production by B cells. 

Category: nervous system diseases
Comparison of standard one-minute treadmill exercise and strandness test (absolute walking distance) in relation to site of lesion, walking distance, and diastolic blood flow velocity (Doppler curves). In 215 outpatients suffering from occlusive arterial disease of the lower limbs the authors compared the decrease in the ratio of ankle systolic pressure to brachial systolic pressure according to whether the treadmill exercise was limited to one minute or extended until pain forced the patient to stop. After a one-minute walk the pressure index always decreased significantly, especially when walking was restricted. The decrease in the pressure index was generally greater when the exercise was continued until the absolute walking distance, and the recovery time was usually twice as long. The fall in the pressure index was significantly greater for patients with single and multiple iliac stenoses than for those with stenoses at lower levels. In patients having a diastolic blood flow velocity on Doppler curves at rest, not modified by walking, a maximum drop in peripheral pressure was recorded after walking for one minute. In this instance there was no intensification of the decrease in peripheral pressure, unlike in patients without a diastolic blood flow velocity at rest. This one-minute test is not a maximal hemodynamic response, but it is sufficient for the appreciation of ischemia during exercise, according to the different parameters measured. 

Category: cardiovascular diseases