Melricflash/CW_MedAbstractsAlt huggingface dataset:
Usefulness of tomographic thallium-201 imaging for detection of restenosis after percutaneous transluminal coronary angioplasty. The role of tomographic thallium-201 exercise and redistribution imaging in the detection of restenosis after percutaneous transluminal coronary angioplasty (PTCA) was evaluated in 116 patients: 61 (53%) with 1- and 55 (47%) with multivessel PTCA, with a total of 185 dilated vessels. Complete revascularization was performed in 89 (77%) and partial revascularization in 27 (23%) of the patients. Restenosis was angiographically demonstrated in 69 (60%) of the patients and 85 (46%) of the vessels 6.4 +/- 3.1 months after PTCA. Disease progression in previously normal vessels was noted in 11 patients. The results were: (1) for detection of restenosis in the group of patients, single-photon emission computed tomographic (SPECT) versus exercise electrocardiographic sensitivity was 93 vs 52% (p less than 0.001), specificity 77 vs 64%, and accuracy 86 vs 57% (p less than 0.001). The results were similar in the complete and partial revascularization groups. (2) SPECT was 86% sensitive, specific and accurate for restenosis detection in specific vessels with comparable results for 1-versus multivessel PTCA and complete versus partial revascularization. Sensitivity, specificity and accuracy were: 89, 95 and 92% for the left anterior descending coronary artery; 88, 79 and 82% for the right coronary artery; and 76, 83 and 85% for the left circumflex coronary artery. Eighty-one percent of the diseased nondilated vessels were correctly identified. (3) Disease progression to greater than 50% stenosis was detected with 91% sensitivity, 84% specificity and 85% accuracy. SPECT thallium-201 imaging is an excellent tool for the detection of restenosis and disease progression after PTCA in the settings of 1- and multivessel angioplasty and complete and partial revascularization. 

Category: cardiovascular diseases
Postoperative hypertension: a prospective, placebo-controlled, randomized, double-blind trial, with intravenous nicardipine hydrochloride. Nicardipine hydrochloride, a new calcium channel blocker for intravenous use, has been compared with placebo in a prospective, randomized, double-blind trial on postoperative hypertension. Of 175 patients who signed preoperative consent, 24 (13.7%) met entry criteria. Hypertension was significantly better controlled in nicardipine-treated patients compared with those receiving placebo (93% versus 30%, p less than 0.05). All the placebo failures were subsequently successfully treated with nicardipine. There were no significant complications in either group. The authors conclude that nicardipine HC1 is an effective, safe therapy for postoperative hypertension. Further studies are now indicated comparing it with other drugs currently used to treat this condition. 

Category: cardiovascular diseases
Prune belly syndrome in females: a triad of abdominal musculature deficiency and anomalies of the urinary and genital systems. We describe seven female patients with deficient abdominal wall musculature and urinary tract and genital anomalies that represent the female equivalent of the prune belly syndrome. Urethral atresia, uterine duplication, and anorectal anomalies occurred frequently. The perinatal mortality rate was high; of the four surviving patients, renal failure developed in two and renal transplantation was required. The analysis of these cases suggests that urethral obstruction is an important factor contributing to the development of the prune belly syndrome in females. 

Category: digestive system diseases
Cervicography for evaluating the "atypical" Papanicolaou smear. A study was designed to compare various case-finding procedures in the evaluation of patients with an "atypical" Papanicolaou smear. Six hundred eighty-one consecutive patients were referred to the Denver General Hospital Colposcopy Clinic for smears showing evidence of atypical nuclear and/or cytoplasmic changes insufficient to justify a cytologic diagnosis of dysplasia. A full colposcopic evaluation with appropriate directed biopsies was carried out on all the patients. Fourteen percent of the patients demonstrated cervical intraepithelial neoplasia (CIN), and 29% had condyloma without CIN. Both cervicography and the colposcopist's impression, though not ideal, were superior to a repeat smear, human papillomavirus typing or both. Cost effectiveness criteria and ease of training appear to justify the use of cervicography in the evaluation and triage of patients with atypical Papanicolaou smears. 

Category: neoplasms
Pulmonary artery-bronchus ratios in patients with normal lungs, pulmonary vascular plethora, and congestive heart failure. The pulmonary artery-bronchus ratio (ABR), defined as the external diameter of a pulmonary artery divided by the external diameter of its accompanying bronchus, was measured in the upper and lower lung zones on frontal chest radiographs in the following groups of subjects: erect healthy subjects, erect subjects with pulmonary vascular plethora, erect subjects with clinical evidence of decompensated left-sided congestive heart failure (CHF), supine normal subjects, and supine subjects with clinical evidence of decompensated CHF. Characteristic vascular patterns were found in each group. The positive predictive value of an abnormal vascular pattern determined by means of changes in the ABR on the erect chest radiograph was 100%, with the negative predictive value of a normal pattern being 97%. The erect chest radiograph was 93% accurate in distinguishing between plethora and CHF. The positive predictive value of an abnormal vascular pattern on the supine chest radiograph was 100%, with the negative predictive value of a normal vascular pattern being 97%. Measurements of ABR can be a helpful adjunct to the interpretation of supine and erect chest radiographs. 

Category: cardiovascular diseases
Late rupture of a superior intercostal artery following repair of aortic coarctation. Having had surgical repair of aortic coarctation at the age of 12 years, and re-operation at the age of 19 years for stenosis at the site of the previous repair, a 29 years old man presented as an emergency with a 24 hour history of interscapular pain, haemoptysis and collapse. At thoracotomy he was found to have a ruptured superior intercostal artery which was ligated. Spontaneous rupture of an intercostal artery has not been previously recorded. 

Category: cardiovascular diseases
Severe anaphylactoid reaction to hydroxyethyl starch. A case is presented of a severe anaphylactoid reaction to hydroxyethyl starch solution that occurred peri-operatively and required extended intensive management of the resultant bronchospasm and hypotension. Subsequent intradermal injection of hetastarch produced a delayed positive response, suggestive of a complement-mediated mechanism. 

Category: general pathological conditions
Myelopathy presenting decades after surgery for congenital cervical cutaneous lesions. We report on two patients in whom cervical myelopathy developed decades after they had undergone surgery for congenital cervical cutaneous lesions. Preoperative magnetic resonance imaging demonstrated dorsal tethering and cavitation of the cervical cord in the area of the previous surgery and was helpful in decision making regarding surgical exploration and in planning for it. We stress the importance of long-term follow-up by both clinical examination and magnetic resonance imaging in children who have been operated on for cervical cutaneous masses that may have central connections. 

Category: general pathological conditions
Is the treatment of metastatic carcinoid tumor with interferon not as successful as suggested? Eight patients with metastatic carcinoid tumor, seven of whom had symptoms of the carcinoid syndrome, were treated with either human leukocyte interferon (seven patients) or recombinant alpha-interferon (IFN alpha-2b) (one patient) at doses of 4.5 to 21 x 10(6) IU weekly for 1 to 21 (mean, 8.5) months. Tumor regression on computed tomography (CT) scan was found in one patient, the CT findings remained unchanged in three, and the tumor progressed in four patients. A clearcut and continuing decrease in urinary levels of 5-hydroxyindoleacetic acid (5-HIAA) was observed in one patient and a transient one in four patients. The symptoms improved in only two of seven patients. Four patients had leukopenia develop, which was circumvented by reducing the dose. The authors conclude that interferon therapy of the carcinoid tumor is not as successful as has been suggested in previous reports. 

Category: neoplasms
Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988. Potentially curative radical pancreaticoduodenectomy for ampullary adenocarcinoma was performed in 24 patients over a 35-year period. The overall operative mortality was 12.5%. Actuarial survival rate at 5 years was 61% +/- 13.4 standard error of the mean (SEM) and subsequently remained unchanged. In the same time period, 21 patients underwent potentially curative radical pancreaticoduodenectomy for periampullary tumors of pancreatic origin. Similar analysis showed an overall operative mortality of 23.8% and a survival rate at 5 years of 27% +/- 12.5 SEM. The results of radical pancreaticoduodenectomy for ampullary carcinoma in the most recent years (1976 to 1988) were compared with those of former years (1953 to 1975). There were no statistically significant differences in the 5-year survival rate; however, the operative mortality decreased from 25% in the former period to 6.3% in the recent period. Survival was dependent on nodal status. The 5-year survival rate was 78% +/- 11.5 SEM in the absence of nodal metastasis versus 50% +/- 25 SEM in the presence of regional nodal metastasis. These findings support the concept that radical pancreaticoduodenectomy offers a realistic probability for cure in a selected group of patients with carcinomas of the ampulla of Vater. 

Category: neoplasms
Dynamic analysis of the Harrington system using a spinal simulator. The authors constructed a spinal simulator for the thoracolumbar spine with mechanical properties similar to those of cadaver specimens, and studied the effectiveness of the Harrington system in unstable fractures of the thoracolumbar spine. Distraction and compression rods were applied under various conditions. External bending moment was applied to the model to measure the internal bending moment on the vertebral body and ligaments. Optimal spinal stability was obtained when the distraction system was combined with the compression system with hooks at laminas three levels above and below the fracture. 

Category: general pathological conditions
Anomalous origin of the left coronary artery from the pulmonary artery. Surgical alternatives depending of the age of the patient. Four cases of anomalous origin of the left coronary artery from the pulmonary artery, three of which were operated upon in our Centre, are presented. An aortocoronary bypass with reversed autologous saphenous vein was carried out in both of the children; and in the adult, the anomalous ostium was closed from the interior of the pulmonary artery. After 84, 72, and 4 months of evolution, respectively, they were found to be asymptomatic, the mitral insufficiency had disappeared and the venous graft remained patent. In this paper, the clinical form of presentation, diagnostic possibilities and surgical treatment are analysed. 

Category: cardiovascular diseases
Candidal infection in oral lichen planus. The prevalence of candidal infection in lichen planus (LP) and its possible association with ulceration were independently examined in two archived series of 108 and 77 cases derived from two separate populations. To ensure that similar material was being compared, each case was histopathologically reassessed and confirmed as LP or reclassified as nonspecific lichenoid stomatitis (NSLS), lichenoid dysplasia (LD), or other (O). Three further sections, cut at 25 microns intervals, were stained with periodic acid-Schiff reagent for the identification of intraepithelial candidal pseudohyphae. As control specimens, 61 normal and 59 hyperkeratotic mucosal samples were similarly processed and examined. Candidal infection was found in 17.4% and 16.4% of ulcerated and nonulcerated LP cases, respectively, and in 40.0% and 16.7% of ulcerated and nonulcerated NSLS cases, respectively. One case of LD was infected. Each control series contained one infected case. The results indicate that candidal infection occurs more readily in LP and NSLS, with no apparent association with ulceration in LP. The comparatively marked increase in the infection prevalence of ulcerated NSLS cannot be statistically confirmed, and its significance remains uncertain. 

Category: general pathological conditions
The role of chemotherapy for node-negative breast cancer. Approximately 25% of women with early stage breast cancer and negative axillary nodes will eventually die of metastatic disease. Some studies have shown a recurrence rate of 40% or more at 10 years in this relatively good prognostic group. The incidence of breast cancer continues to increase approximately 1% per year with a great increase in the frequency of early stage disease (particularly in situ carcinoma). The increased use of mammography and physical examination with appropriate follow-up will increase the frequency of diagnosis of node-negative patients compared with those with more advanced stages. Women with positive axillary nodes who are premenopausal benefit from adjuvant chemotherapy, whereas those who are postmenopausal have shown a clear reduction in mortality when treated with tamoxifen. It is even more reasonable to speculate that women with node-negative disease could have an even greater benefit from adjuvant therapy because they have a lower tumor burden at the time of diagnosis. Compared with earlier clinical adjuvant trials, more recent studies (1981-89) have shown a disease-free survival advantage for node-negative breast cancer patients treated with adjuvant chemotherapy. Hopefully, the differences noticed in disease-free survival will show a similar survival advantage with further observations. The results of these clinical trials suggest that adjuvant chemotherapy may be of benefit to patients with node-negative disease but do not support the contention that all node-negative patients with breast cancer should receive adjuvant chemotherapy. Some prognostic subgroups (tumor size greater than 2 cm) have shown an overall 10-year survival rate of 92% for women who have not received adjuvant therapy. The benefits versus toxicities of adjuvant therapy should be carefully evaluated before the initiation of adjuvant therapy. 

Category: neoplasms
An interdisciplinary nutrition assessment and intervention protocol for children with disabilities. Because of the multifactorial nature of the nutrition problems associated with developmental disabilities, a well-organized, interdisciplinary effort is necessary to deal with such problems. A team composed of professional and support staff, the client, and the family needs to be involved in an integrated approach to service. The team members share their knowledge and expertise in developing an individual program plan to meet identified needs. This article describes the development and implementation of a prototype for interdisciplinary nutritional evaluation and intervention in an outpatient setting. In 1987, a Regional Nutrition and Feeding Diagnosis and Evaluation Clinic was established through a contractual agreement between the University of Georgia University Affiliated Program and St. Mary's Hospital in Athens, GA. The purposes of the clinic are twofold: to offer direct services to developmentally disabled infants and children who require outpatient services and to provide a unique community-based interdisciplinary training experience for graduate students in nutrition and other health disciplines. The interdisciplinary treatment protocol is based on current knowledge in the treatment of developmental disabilities. 

Category: general pathological conditions
Neuroleptic malignant syndrome in Parkinson's disease after withdrawal or alteration of dopaminergic therapy. Neuroleptic malignant syndrome is characterized by altered consciousness, fever, extrapyramidal signs, autonomic instability, elevated creatine kinase level, and leukocytosis. Although originally described in patients receiving neuroleptic drugs, this syndrome may also occur in patients with Parkinson's disease during withdrawal or reduction of levodopa therapy or other dopaminergic drug therapy. We have encountered three cases of neuroleptic malignant syndrome related to withdrawal of levodopa therapy. These cases illustrate the variety of circumstances in which alteration of therapy with dopaminergic drugs can cause this syndrome and the relative unfamiliarity of the neuroleptic malignant syndrome-levodopa relationship among physicians who do not treat large numbers of patients with Parkinson's disease. An understanding of the role of brain dopamine in the pathogenesis of neuroleptic malignant syndrome and an appreciation of the great variety of drugs whose manipulation can result in this potentially fatal syndrome will aid its proper and timely recognition, especially when the offending pharmacologic manipulation does not involve neuroleptic drugs. 

Category: nervous system diseases
Biliary lithotripsy: in vitro analysis of gallstone fragmentation for equivalent stone volumes. The relationship between gallstone fragmentation during extracorporeal shock wave lithotripsy (ESWL) and gallstone volume is poorly understood. Clinical results of ESWL show that the highest stone-free rate at 6 months occurs with radiolucent single gallstones 20 mm or less in diameter. In an in vitro study, individual gallstones from cholecystectomy specimens were divided by size and composition into nine single- and nine multiple-stone groups; the stones were then paired on the basis of similar volume. ESWL was performed in a phantom and the size of the largest fragment was measured at 500, 1,000, and 1,500 shock waves. At 1,500 shock waves, sandlike particles were present in six of nine single stones versus two of nine multiple stone groups; the mean size of the largest fragment at 1,500 shock waves was 2.1 mm (single) and 4.4 mm (multiple) in diameter. When corrected for volume, the authors' data suggest that single stones are more easily broken into fragments smaller than 5 mm in diameter than multiple gallstones. The implication, especially when spark-gap technology is used, is that more shock wave energy (ie, an increased number of shock waves at a higher kilovoltage) will be necessary to achieve the same results when treating patients with multiple stones versus a single gallstone with a similar stone volume. 

Category: digestive system diseases
The influence of extracorporeal circulation on erythrocytes and flow properties of blood. The influence of extracorporeal circulation on red blood cells and flow properties of blood was studied in 10 patients undergoing aorta-coronary bypass grafting. Blood samples were drawn on admission, under general anesthesia before the operation, during extracorporeal circulation, immediately after extracorporeal circulation, and 24 hours after extracorporeal circulation. Echinocytes were found during and shortly after extracorporeal circulation, but disappeared within 24 hours. Washing the cells in buffer restored the normal discocytic shape, which indicated that a plasma factor was responsible. Red cell membrane lipids were not affected. Analysis of the membrane proteins revealed a decrease of ankyrin after extracorporeal circulation, which was prevented by protease inhibitors during preparation. This suggests an increased proteolytic activity of the plasma after extracorporeal circulation. Red cell deformability was not altered. Plasma viscosity and hematocrit were markedly reduced by hemodilution with the priming solution. Their low levels resulted in a low blood viscosity during extracorporeal circulation, which was even lower at 26 degrees C than before or after the operation at 37 degrees C. We conclude that the red cell is affected by extracorporeal circulation. The flow properties of blood, however, are not impaired, but are improved by hemodilution. 

Category: cardiovascular diseases
Results of stereotactic brachytherapy used in the initial management of patients with glioblastoma. Recent studies have shown a survival benefit for patients with recurrent glioblastomas treated with stereotactic brachytherapy. On the basis of these encouraging results, we began a prospective study in 1987 to evaluate the use of brachytherapy in patients with newly diagnosed glioblastoma. Patients were considered eligible for this study if they met the following criteria: Karnofsky performance status 70% or greater; tumor size not greater than 5 cm in any dimension; a radiographically well delineated, supratentorial lesion not involving the ependymal surfaces; and pathologically confirmed glioblastoma. We treated 35 such patients between 1987 and 1990 with stereotactic brachytherapy as part of their initial therapy. The treatment protocol involved surgery, partial brain external-beam radiotherapy (59.4 Gy in 33 fractions), and stereotactic brachytherapy with temporary high-activity iodine 125 sources giving an additional 50 Gy to the tumor bed. Chemotherapy was not used in the initial management of these 35 patients. To compare our results with those obtained in a matched control group, we identified 40 patients with glioblastoma treated with surgery and external radiotherapy, with or without chemotherapy, between 1977 and 1986 at our institution. These patients had clinical and radiographic characteristics that would have made them eligible for the brachytherapy protocol. Survival rates at 1 and 2 years after diagnosis were 87% and 57%, respectively, for patients receiving brachytherapy versus 40% and 12.5%, respectively, for the controls (P less than .001). We conclude that stereotactic brachytherapy improves the survival of patients with glioblastoma when it can be incorporated into the initial treatment approach. Unfortunately, only about one in four patients with glioblastoma are suitable candidates for brachytherapy at the time of initial presentation. 

Category: neoplasms
Acute obstructive jaundice in the multiple trauma patient. The appearance of acute jaundice in the multiple trauma patient may result from obstruction of the common bile duct by clot. Management of this problem may be hindered by a delay in diagnosis, especially where alterations in pigment load and hepatic clearance may have produced the jaundice. A high index of suspicion combined with the judicious use of various noninvasive imaging modalities may be helpful in making the diagnosis. The progression of jaundice in a patient suspected of having acute obstructive hemobilia should prompt rapid operative intervention. At laparotomy, cholangiography or common bile duct exploration should be done. Persistent bleeding should be managed initially with angiographic localization and transcatheter embolization; its failure would necessitate surgical control of the source. 

Category: general pathological conditions