Melricflash/CW_MedAbstractsAlt huggingface dataset:
The role of resection in the management of melanoma metastatic to the adrenal gland. Melanoma metastatic to the adrenal gland diagnosed before death was exceedingly rare before the development of computed tomographic (CT) scanning. The records of 28 patients with melanoma metastatic to the adrenal gland seen since 1975 were reviewed. Eighteen patients were men and 10 were women. Twenty-three patients had unilateral disease. Four patients were diagnosed only at autopsy, leaving 24 for analysis of treatment and survival. Twenty-one patients had received specific active immunotherapy, four had received chemotherapy (dacarbazine, lomustin, bleomycin, and vincristine), and three had received both before the diagnosis of their adrenal disease. Adrenal metastases were diagnosed by CT scanning in 14 patients with symptoms, 10 (91%) of whom had pain. Ten patients were diagnosed by CT before entry into a chemotherapy protocol. Of eight patients who underwent resection of all known disease, five underwent unilateral adrenalectomy, two underwent unilateral adrenalectomy and bowel resection, and one underwent bilateral adrenalectomy. Two patients underwent partial resection of large unilateral tumors. Fourteen patients with adrenal metastases and disease elsewhere were initiated or continued with chemotherapy or were treated symptomatically. Mean survival in the group that underwent resection for cure was 59 months (3 to 112 months), whereas survival in the group with unresectable tumors was 15 months (1.5 to 132 months). Four of eight patients who underwent resection for cure lived more than 5 years after detection of adrenal metastasis, whereas in only one of 14 patients with unresectable tumors was the same true. Patients with metastatic melanoma localized to one or both adrenal glands may benefit from early detection and surgical intervention. 

Category: neoplasms
The pharmacology of aspirin, heparin, coumarin, and thrombolytic agents. Implications for therapeutic use in cardiopulmonary disease. The modern treatment of cardiopulmonary disease is increasingly predicated on the goal of dissolving the offending clot to establish vascular patency as rapidly as possible and then preventing rethrombosis. The availability of thrombolytic agents has made this therapeutic approach possible and the adjunctive use of heparin, coumarin, and aspirin has increased the efficacy of lytic drugs. The administration of any of these medications is associated with inherent risks, which are enhanced when they are used concomitantly. An understanding of coagulation and an appreciation of the pathophysiologic processes of the thrombotic events occurring in cardiopulmonary disease states are critical to the formulation of innovative therapeutic regimens that maximize efficacy and safety. Furthermore, knowledge of the comparative pharmacology of the various thrombolytic agents is useful in explaining the benefits and complications observed in clinical trials. 

Category: cardiovascular diseases
Different patterns of gene expression in ras-resistant and ras-sensitive cells. We have shown previously that nontumorigenic NIH 3T3 cells can be made tumorigenic and metastatic by transfection and expression of activated ras, whereas in LTA cells, which are tumorigenic but nonmetastatic, the degree of malignancy is not altered by ras. To investigate possible mechanisms of natural ras resistance, we compared the expression patterns of several genes thought to be involved in ras-induced metastatic progression in LTA (ras-resistant) and NIH 3T3 (ras-sensitive) cells, before and after constitutive expression of transfected T24-H-ras. We examined the expression of the nuclear "early-response" genes jun and fos and the "tumor-suppressor" retinoblastoma (Rb) gene, as well as genes involved in invasion (major excreted protein [MEP], tissue inhibitor of metalloproteinases [TIMP]), and cell adhesion (secreted phosphoprotein 1 [SPP1; also known as osteopontin]). We found distinct differences in both the basal and ras-induced levels of expression of most of these genes in LTA versus NIH 3T3 cells. High levels of MEP and low levels of TIMP were induced in ras-transfected NIH 3T3 cells, whereas LTA cells showed intermediate levels of MEP and high levels of TIMP that were only marginally affected by the expression of transfected ras. Similarly, SPP1 expression was strongly induced by ras in NIH 3T3 cells but was repressed by ras in LTA cells. Enzymogram assays for functional gelatinase activity showed an increase in 67-kd and 62-kd bands in NIH 3T3 cells in the presence of ras. LTA cells showed no gelatinolytic activity in the presence or absence of ras. Data from an in vitro assay for chemoinvasiveness showed a pattern as predicted from the expression of invasion-related genes; chemoinvasiveness in ras-transfected NIH 3T3 was greater than in LTA and ras-transfected LTA cells, which was greater than in NIH 3T3 cells. Differences in expression of the genes examined are believed to contribute to the ras responsiveness of NIH 3T3 cells and the ras resistance of LTA cells. 

Category: neoplasms
Intussusception encephalopathy: an underrecognized cause of coma in children. Intestinal intussusception is a common cause of bowel obstruction in infancy and early childhood. Typically the presenting signs and symptoms are referable to the abdomen. On occasion the most prominent presenting feature is depressed level of consciousness. We describe 3 patients who presented with coma associated with intussusception. 

Category: digestive system diseases
Severe tricuspid regurgitation after mitral valve repair: diagnosis by intraoperative transesophageal echocardiography. Transesophageal echocardiography facilitates the evaluation of valvular repair in the operating room. The functional valvular morphology and degree of valvular regurgitation can be assessed before and after repair. This technique can also identify unsuspected findings--in this case, severe tricuspid regurgitation complicating cardiopulmonary bypass. We report a previously undescribed cause of traumatic tricuspid regurgitation. 

Category: general pathological conditions
Infantile form of carnitine palmitoyltransferase II deficiency with hepatomuscular symptoms and sudden death. Physiopathological approach to carnitine palmitoyltransferase II deficiencies. Reported cases of carnitine palmitoyltransferase II (CPT II) deficiency are characterized only by a muscular symptomatology in young adults although the defect is expressed in extra-muscular tissues as well as in skeletal muscle. We describe here a CPT II deficiency associating hypoketotic hypoglycemia, high plasma creatine kinase level, heart beat disorders, and sudden death in a 3-mo-old boy. CPT II defect (-90%) diagnosed in fibroblasts is qualitatively similar to that (-75%) of two "classical" CPT II-deficient patients previously studied: It resulted from a decreased amount of CPT II probably arising from its reduced biosynthesis. Consequences of CPT II deficiency studied in fibroblasts differed in both sets of patients. An impaired oxidation of long-chain fatty acids was found in the proband but not in patients with the "classical" form of the deficiency. The metabolic and clinical consequences of CPT II deficiency might depend, in part, on the magnitude of residual CPT II activity. With 25% residual activity CPT II would become rate limiting in skeletal muscle but not in liver, heart, and fibroblasts. As observed in the patient described herein, CPT II activity ought to be more reduced to induce an impaired oxidation of long-chain fatty acids in these tissues. 

Category: digestive system diseases
Epidemiology of acute respiratory tract infections among Guatemalan ambulatory preschool children. Acute respiratory tract infections (ARI) were studied during a 2-year period in 521 preschool children living in a marginal area of Guatemala City. There were 3,646 episodes of ARI detected during 26,329 child-weeks at risk, for an incidence of 14 per 100 child-weeks or 7.2 episodes per child per year. The median duration of ARI episodes was 11 days. The highest incidence of ARI was observed in children 6-23 months old. Boys had more respiratory tract illnesses than did girls; the presence of a cigarette smoker in the household was associated with higher morbidity. Acute lower respiratory tract illnesses (ALRI) were more common among younger infants 0-5 months old, with nutritional status having no apparent effect. Parental formal education and crowding in households were found to be directly related to the incidence of ALRI. In general, ARI morbidity interfered with appropriate physical growth. 

Category: general pathological conditions
Surgical management of renal cell carcinoma with extensive intracaval involvement using a venous bypass system suitable for rapid conversion to total cardiopulmonary bypass. Renal cell carcinoma involves the vena cava in approximately 4% of the patients. Presently surgical extirpation is the only form of therapy that can result in cure. Recently management of extensive vena caval involvement has involved the use of cardiopulmonary bypass with circulatory arrest and hypothermia. We describe a technique using a venous bypass pump system (femoral vein to right atrium) for resection of renal cell carcinoma with suprahepatic vena caval extension (type II), which avoids the risks and complications of cardiac arrest and hypothermia but allows for rapid conversion to total cardiopulmonary bypass should the intraoperative need arise. 

Category: neoplasms
Dysphagia as a manifestation of occult hypoxemia. The role of oximetry during meal times. A 25-year-old woman with severe kyphoscoliosis reported a six-month history of increasing dysphagia to both liquids and solids. A barium swallow and esophageal motility studies showed no significant gastrointestinal abnormalities. Trials of antispasmodic agents were unsuccessful in relieving her symptoms. Pulmonary function tests showed a severe restrictive ventilatory defect (vital capacity = 0.67 L) with adequate oxygenation and alveolar ventilation as reflected by arterial blood gas testing during quiet wakefulness. However, continuous noninvasive oximetry demonstrated desaturation to 85 percent while eating. These transient episodes of desaturation were abolished by the administration of supplemental oxygen delivered by nasal prongs. Following the prescription of supplemental oxygen, dysphagia resolved immediately, with weight gain following over several weeks. We conclude that dysphagia may be a presenting feature of hypoxemia. This case report draws attention to the usefulness of continuous noninvasive monitoring of oxygenation and the clinical importance of at least some transient hypoxemic events. 

Category: digestive system diseases
Indications for thymectomy in myasthenia gravis. Fifty-six board-certified neurologists with interest and expertise in myasthenia completed a survey of indications for thymectomy in myasthenia gravis. Thymectomy was advocated for virtually all patients with thymoma, for a variable subset of patients with generalized myasthenia without thymoma, and occasionally for selected patients with disabling ocular myasthenia. 

Category: nervous system diseases
Patency rate of implantable devices during long-term intraarterial chemotherapy. Intraarterial implantable drug delivery systems have been considered as an alternative method for treating patients with unresectable liver malignancies. However, catheter problems with external implanted devices have resulted in limited application of chemotherapy. The introduction of subcutaneous devices offers an opportunity for long-term locoregional chemotherapy. Twelve external intraarterial catheters were implanted into 12 patients and 52 subcutaneously placed devices into 51 patients, all with various hepatic malignancies. Retrospective analyses comparing those two intraarterial systems were conducted taking into account the function and complication rate (hepatic artery thrombosis, infection, leaking, hemorrhage, and dislocation). The follow-up time for the external system was two to eight months (median five weeks), the thrombosis rate 33.3%, and the infection rate 25%. One instance of severe bleeding from the hepatic artery occurred during chemotherapy. One catheter dislocated. For the subcutaneously implanted intraarterial devices the follow-up time was five to forty-one months (median sixteen months), the thrombotic complication rate 17.3%, and the infection rate 7.6% (all patients with simultaneous bowel surgery). Catheter dislocation one year later required reimplantation; in 1 patient therapy had to be discontinued because of a catheter leak. The overall function rate was 71.3% with a median follow-up time of eight months. Anticoagulation therapy for subcutaneously implanted devices starting from the beginning of intraarterial chemotherapy is recommended to achieve long-term patency. No implantation should be preformed simultaneously with bowel surgery. The subcutaneously placed intraarterial devices had a higher function rate and were available for a longer period as compared with external implanted catheters. 

Category: cardiovascular diseases
Regression of the left main trunk lesion by steroid administration in Takayasu's aortitis. A 62-year-old man with unstable angina due to severe narrowing of the left main trunk (LMT) was examined. Emergency bypass surgery was performed with an internal mammary artery graft, instead of a saphenous vein graft, because of the thickened, edematous ascending aorta. Postoperative coronary angiography showed the lesion of the LMT markedly regressing. Presumably, this stenotic lesion of the LMT was caused by active aortitis and was partially reversible by steroid administration both during and after surgery. Steroid therapy can be added to the list of treatments for cases of LMT disease associated with Takayasu's aortitis, if signs of active inflammation are present. 

Category: cardiovascular diseases
Pemoline-associated hepatic injury. Among 100 cases of hepatic injury attributed to the administration of pemoline, 43 had sufficient accompanying information to permit analysis. All but two patients were less than 20 years old, and 80% were less than 12 years old. Males predominated the study. Injury appeared as early as 1 week or as late as greater than 1 year of taking the drug. The injury was uniformly hepatocellular as judged by the high values for aminotransferases and by death in massive necrosis in one patient. Mechanism was judged to be idiosyncratic, and the idiosyncrasy was probably metabolic rather than immunologic. 

Category: digestive system diseases
Isoperistaltic intestinal lengthening for short bowel syndrome. Because of improvements in supportive care, many infants now survive massive intestinal loss and have short bowel syndrome. Unfortunately, some survivors are left with an insufficient amount of intestine and cannot be weaned from total parenteral nutrition. An isoperistaltic intestinal lengthening procedure was used to treat surgically two such infants with 25 centimeters of remaining small intestine and absent ileocecal valves. This surgical technique longitudinally divides the short, dilated small intestine into two smaller, parallel lumens that are anastomosed end to end. This procedure preserves all mucosa, prolongs transit time by doubling intestinal length and corrects the ineffective peristalsis by tapering the dilated intestine. The lengthening technique can be performed because of the anatomic division of the intestinal vasculature within two leaves of the mesentery. Longitudinal division between the two leaves maintains vasculature to each side of the intestine. The isoperistaltic intestinal lengthening procedure, as it was successfully applied to two infants, is described in detail. 

Category: digestive system diseases
Transpalpebral decompression of endocrine ophthalmopathy (Graves' disease) by removal of intraorbital fat: experience with 147 operations over 5 years. From 1984 to October 1989 at the Plastic Surgery Unit in Wesseling, we carried out 147 operations on 75 patients with Graves' disease. Intraorbital fat was removed through a transpalpebral incision to achieve decompression. The average amount of fat was 6.0 cm3. We have made a long-term follow-up (more than 6 months postoperatively) study of 57 patients who experienced 108 operations. The first results were published in September 1988. When we compared the results to a traditional decompression operation (with resection of one or two orbital walls), we found that the postoperative complication rate was significantly lower and that the success rate was much higher. Thus the range of indications for surgery may be much wider than previously considered. Patients who are about to lose their vision as well as those experiencing lesser symptoms can be much improved with this operation. At the beginning, before the technique was fully developed, complications such as supraorbital nerve palsy occurred. 

Category: general pathological conditions
Endothelial markers in malignant vascular tumours of the liver: superiority of QB-END/10 over von Willebrand factor and Ulex europaeus agglutinin 1. A new monoclonal antibody, QB-END/10, raised against the CD34 antigen in human endothelial cell membranes and haemopoietic progenitor cells, was studied for its usefulness as a marker of neoplastic vascular cells in 21 angiosarcomas and seven malignant haemangioendotheliomas of the liver. QB-END/10 was both more sensitive and more specific than Von Willebrand factor (VWF) and Ulex europaeus 1 agglutinin (UEA-1) in labelling endothelial cells and it did not cross react with epithelia as UEA-1 often does. Staining was uniformly strong and clear in all histological variants of these two tumours. QB-END/10 should prove particularly useful in the differential diagnosis of malignant vascular tumours of the liver. 

Category: neoplasms
The perineal artificial sphincter for acquired incontinence--a cut and dried solution? Sixteen males with stress incontinence due to sphincter damage were investigated with videourodynamic studies after implantation of a perineal artificial urinary sphincter. Twelve patients were rendered dry; 4 remained incontinent, all of whom were shown by cystometry to have incontinence from detrusor instability. Of these, 2 also had stress incontinence proven by videourography. Detrusor instability was present in 9 patients before implantation; the instability worsened considerably in 2 patients and new instability was shown in another 2 patients. The limitations of the artificial urinary sphincter and the implications of detrusor instability in patients with an artificial sphincter are discussed. The artificial urinary sphincter is an extremely successful device for the treatment of acquired stress incontinence. 

Category: general pathological conditions
Does paramedic-base hospital contact result in beneficial deviations from standard prehospital protocols? We reviewed written and audio records of paramedic-base hospital radio contact to determine whether care differed from that suggested in standard prehospital care protocols. Records of all 659 contacts for seizure, syncope, abdominal pain, or altered mental state during 1987 (28.4% of all contacts) were scored for the use of standard therapies (such as intravenous access, oxygen, naloxone hydrochloride) and unanticipated therapies (intubation, nitroglycerin). Cases that involved unanticipated treatments were reviewed to determine whether they could have been prospectively identified by simple clinical findings. Standard therapies were used in the majority of patients. Unanticipated therapies were administered to 13 patients, all of whom had abnormal vital signs, diaphoresis, respiratory distress, or a second prominent symptom. Data suggest that protocols could replace radio contact for most patients and that the few who might benefit from radio contact can be easily identified. A 90% reduction in radio contacts in Los Angeles county could save $3 million each year. 

Category: digestive system diseases
Defining the role of subtotal colectomy in the treatment of carcinoma of the colon. Seventy-two patients with colon cancer were treated by primary subtotal colectomy, including 23 patients with acute and subacute left colon obstruction. There were two operative deaths and no cases of disabling diarrhea. One death occurred in the group with colon obstruction. Other indications for subtotal colectomy included multiple polyps associated with the primary tumor (32), synchronous carcinomas (15), a previous transverse colostomy for obstruction (8), associated severe sigmoid diverticular disease (2), age less than 50 years with a positive family history (3), adherence of the sigmoid loop to a cecal tumor (2), and metachronous carcinoma (2). There were multiple indications in several patients. Subtotal colectomy has a defined role in a wide variety of clinical settings associated with colon cancer, including management of obstruction of the left and sigmoid colon, particularly if the proximal colon cannot be evaluated before operation by colonoscopy or barium enema. Segmental or regional colonic resections are appropriate if the entire colon can be evaluated before operation and no associated neoplasms are revealed. 

Category: general pathological conditions
Anorectal varices--their frequency in cirrhotic and non-cirrhotic portal hypertension. Anorectal varices in portal hypertension have been little studied: Seventy eight per cent of 72 patients with portal hypertension had anorectal varices shown at flexible sigmoidoscopy. Significantly more patients with noncirrhotic portal hypertension had these varices than patients with cirrhosis (89% v 56%, p less than 0.01). 

Category: general pathological conditions
Magnetic resonance imaging in the preoperative evaluation of cervical radiculopathy. Forty patients with cervical radiculopathy were examined preoperatively with magnetic resonance imaging (MRI). MRI was used alone in 27 (68%) of the 40 patients; the remainder also had computed tomography in conjunction with myelography. The primary criterion on MRI for a clinically significant lesion was asymmetrical narrowing of the subarachnoid space in the region of the nerve root. Surgical confirmation of the abnormality was obtained in all 40 cases. The operative findings were a herniated nucleus pulposus (32 of 40 patients), spondylosis (2 of 40 patients), or a combination of the two (6 of 40 patients). MRI identified a surgical lesion (herniated nucleus pulposus, spondylosis, or both) in 37 of the 40 (92%) patients. We think MRI is the only preoperative imaging examination necessary in most cases of cervical radiculopathy. 

Category: nervous system diseases
Phase I and imaging trial of indium 111-labeled anti-epidermal growth factor receptor monoclonal antibody 225 in patients with squamous cell lung carcinoma Murine monoclonal antibody (MAb) 225 (IgG1) against the epidermal growth factor (EGF) receptor competitively blocks EGF binding and inhibits EGF-induced activation of receptor tyrosine kinase and cell proliferation. The effect of MAb 225 was studied in a phase I trial in patients with inoperable squamous cell carcinoma of the lung, which invariably expresses high levels of EGF receptors. Groups of three patients received total doses of MAb 225 ranging from 1 mg to 300 mg. Except at the lowest dose, each infusion included 4 mg of indium 111 (111In)-labeled MAb 225. No toxicity was observed. Tumors were imaged in all patients who received doses of 20 mg or greater. Presumed metastases greater than or equal to 1 cm in diameter were imaged with doses of 40 mg or greater. Single-photon-emission-computed tomography could be carried out at the 120-mg and 300-mg doses and significantly improved tumor visualization. All patients produced anti-murine antibodies. We conclude that treatment with an MAb that inhibits EGF receptor function is safe at the doses and schedule studied. 111In-labeled MAb images squamous cell lung carcinoma; tumor uptake of the labeled MAb is dose dependent. Further studies are warranted to explore the potential therapeutic efficacy of anti-EGF receptor MAbs and other agents that act in a comparable manner. 

Category: neoplasms