Melricflash/CW_MedAbstractsAlt huggingface dataset:
Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation. One hundred nine patients with long-bone fracture nonunion, chronic refractory osteomyelitis, or posttraumatic amputation were evaluated for the impact of chronic disability on quality of life, as measured by the Arthritis Impact Measurement Scale (AIMS) and the Psychosocial Adjustment to Illness Scale (PAIS). A self-administered PAIS for spouses assessed psychosocial adjustment of spouses or significant others. A final questionnaire ranked the reasons for either continuing medical therapy or accepting amputation. The PAIS scores differed significantly between osteomyelitis patients and both nonunion and amputation patients (p less than .05). The presence or absence of pain produced significant differences in AIMS and PAIS scores of nonunion and osteomyelitis patients (p less than .05). Subscale analysis of AIMS scores revealed significant differences among the three groups in health perception and scale of orthopedic problem: osteomyelitis patients were more severely affected than nonunion or amputation patients. The PAIS detected no statistically significant difference in psychosocial adjustment of spouses of patients in the three population groups. The most common reason for continuing medical and surgical management of nonunion and osteomyelitis was expectation for cure. The amputee group chose ablation to avoid further treatment. Differences in psychosocial and functional ability were related to disease diagnosis, pain, status of fracture healing, and timing of amputation. 

Category: nervous system diseases
Spontaneous bacterial peritonitis due to Salmonella enteritidis in cirrhotic ascites. Spontaneous bacterial peritonitis due to Salmonella is uncommon. We report three patients with ascites infected by Salmonella. All three patients had advanced chronic liver disease, typically cirrhosis with portal hypertension. Salmonella enteritidis grew in the ascite fluid culture of the three patients. There was no clinical or microbiological evidence of Salmonella infection other than in the ascitic fluid. One patient died before antibiotic treatment was started, but the other two were treated with different combinations of antimicrobial drugs. One of them died on the fourteenth day of hospitalization, and the other survived. 

Category: digestive system diseases
Scales for rating motor impairment in Parkinson's disease: studies of reliability and convergent validity. Study 1 examined the reliability of the ratings assigned to the performance of five sign-and-symptom items drawn from tests of motor impairment in Parkinson's disease. Patients with Parkinson's disease of varying severity performed gait, rising from chair, and hand function items. Video recordings of these performances were rated by a large sample of experienced and inexperienced neurologists and by psychology undergraduates, using a four point scale. Inter-rater reliability was moderately high, being higher for gait than hand function items. Clinical experience proved to have no systematic effect on ratings or their reliability. The idiosyncrasy of particular performances was a major source of unreliable ratings. Study 2 examined the intercorrelation of several standard rating scales, comprised of sign-and-symptom items as well as activities of daily living. The correlation between scales was high, ranging from 0.70 to 0.83, despite considerable differences in item composition. Inter-item correlations showed that the internal cohesion of the tests was high, especially for the self-care scale. Regression analysis showed that the relationship between the scales could be efficiently captured by a small selection of test items, allowing the construction of a much briefer test. 

Category: nervous system diseases
Isolated primary aldosteronism in a patient with adrenal carcinoma and XY/XXY mosaic Klinefelter's syndrome. Although breast cancer, germ cell tumors and other neoplasms are known to occur in patients with Klinefelter's syndrome, adrenal carcinoma has not yet been reported in such patients. We describe a rare case of severe primary aldosteronism as the unique manifestation of a large adrenocortical carcinoma in a patient with Klinefelter's syndrome. Complete biological and hormonal evaluation was performed. Surgical treatment was successful and the patient remained asymptomatic with normal biological and hormonal values after 1 year of followup. 

Category: neoplasms
Colonic stenoses: use of oral barium when retrograde flow is completely obstructed on barium enema studies. Forty patients with complete obstruction to retrograde barium flow on barium enema examinations, without clinical or radiographic evidence of obstruction, were studied further with orally administered barium in the same session. All patients had undergone aborted double-contrast barium enema studies and had received antispasmodics intramuscularly before the examination. The authors describe the technique, as well as the clinical and radiologic findings, that allows the safe ingestion of oral barium in patients with stenotic lesions of the colon. In all patients, oral barium passed through the small bowel and the stenotic site in an average of 148 minutes, with no complications. In seven patients, there were synchronous lesions in the colon and small bowel, and the findings were determined better with oral barium studies in 19 patients. If a barium enema study is done and retrograde passage of barium is obstructed by a lesion in the left side of the colon, additional diagnostic information can be obtained by giving the patients oral barium. This practice is safe if precise criteria are applied. 

Category: general pathological conditions
Pathophysiology, monitoring, and management of the ventilator-dependent patient: considerations for drug therapy, emphasis on stress ulcer prophylaxis. Adult respiratory distress syndrome (ARDS), or noncardiac pulmonary edema, is a form of acute hypoxemic respiratory failure. The goals of treatment for patients with ARDS are to provide supportive therapy, to reverse the underlying etiology or pathology, and to prevent subsequent complications. Supportive therapy consists of supplemental oxygen, positive end-expiratory pressure, and, often, mechanical ventilation. The reversal of the underlying pathology varies according to the etiologic origin of ARDS. Complications from ARDS include stress ulcers, which occur when gastric aggressive and defensive functions become unbalanced. Antacids and cytoprotective agents are used for stress ulcer prophylaxis, but histamine H2-receptor antagonists are now regarded as the standard of care. Because all the marketed H2-receptor antagonists are efficacious, choice of the agent is based on the adverse effect profile and drug interactions. No definitive data currently exist linking stress ulcer prophylaxis regimens that raise intragastric pH to a significant risk for nosocomial pneumonia. 

Category: digestive system diseases
Atlanto-occipital disarticulation. Accident characteristics. A retrospective study of cases of atlanto-occipital disarticulation was conducted to describe incident characteristics: 24 cases were identified, including nine motor vehicle drivers, two passengers, seven pedestrians, and five motorcyclists; one other person had fallen four stories. The highest rates were found among motorcyclists and pedestrians. Atlanto-occipital disarticulations occur in high-energy impacts and collisions and are associated with aortic laceration in 25% and basilar skull fracture in 21% of such cases. Current restraint systems and motorcycle helmets do not appear to prevent this generally rapidly fatal injury. 

Category: nervous system diseases
Relapse of infant botulism. We report on 3 infants who had relapse of infant botulism after apparent resolution of clinical symptoms. This group represented 5% of the infants with confirmed infant botulism who were treated at our institution since 1976. The exact cause for these relapses was unclear, but three potential mechanisms are examined. There were no historical, clinical, or electrophysiological predictors of relapse. Although at the time of writing recovery from relapse appeared complete, close follow-up of patients recovering from a bout of infant botulism is necessary. 

Category: general pathological conditions
Reflux nephropathy and primary vesicoureteric reflux in adults We have studied the clinical features and course of adults with reflex nephropathy and/or primary vesicoureteric reflux, paying particular attention to the differences between males and females, and the presenting features that influence prognosis. In our series of 293 patients, females outnumbered males in the ratio 5:1 and most presented with urinary infection, whereas males most commonly presented with features of renal damage such as proteinuria, hypertension or renal failure. Males more commonly had bilateral scarring and persistent reflux. One hundred and forty-seven patients were followed for two years or more (range 2-19 years); deterioration in renal function occurred in 55 (37 per cent). Risk factors for a rise in plasma creatinine were, in descending order, the presence of proteinuria, an elevated plasma creatinine concentration, bilateral scarring, male sex and the presence of hypertension. Stepwise multiple regression analysis showed that the independent risk factors were proteinuria, elevated plasma creatinine concentration and hypertension; gender and the presence of persistent reflux had no independent influence on the course of renal failure. 

Category: general pathological conditions
Spontaneous aorto-left renal vein fistula: the "abdominal pain, hematuria, silent left kidney" syndrome. Spontaneous aorto-left renal vein fistula (ALRVF) is a rare occurrence; with this case, only 16 have been reported to date. Common features in patients with ALRVF include abdominal pain (81%), hematuria (100%), impaired renal function (85%), and nonvisualization of the left kidney (100%). Less common but also present in the majority of cases are a left sided bruit (73%), pulsatile abdominal mass (63%), and proteinuria (50%). Also important, 94% have a retroaortic left renal vein, unlike the six cases of traumatic ALRVF that have been reported. This magnifies the diagnostic value of contrast abdominal computed tomographic scanning, which demonstrates not only the anomalous location of the left renal vein but also the abdominal aortic aneurysm and poor enhancement of the left kidney. These findings rule out the possibility of the "nutcracker syndrome" (left renal vein compression between aorta and superior mesenteric artery). Although confirming the presence of a fistula by early caval opacification, aortography does not always distinguish ALRVF from the more common aortocaval fistula. This can be accomplished by Duplex scanning with deep probes and even preferably color coding of velocity signals. With such precise preoperative localization, surgical repair is relatively easy and safe. 

Category: digestive system diseases
Predictability and prognosis of PTCA-induced coronary artery aneurysms. The natural history of coronary aneurysms, defined as local dilatations exceeding the diameter of the normal adjacent vessel segments by at least 1.5 times, is not significantly different from the natural history of nonaneurysmal coronary disease. However, little is known about the prognosis of percutaneous transluminal coronary angioplasty (PCTA)-induced coronary aneurysms. Therefore, we investigated the occurrence and the medium long-term prognosis of such aneurysms in 728 patients who, after successful PTCA, underwent repeat coronary angiography at mean 4.5 months post-PTCA. A coronary aneurysm at the site of PTCA ws noted in 3.9% of patients (n = 28). Of the potentially predictive factors analyzed, only a coronary dissection at the time of PTCA had statistically significant influence. The long-term prognosis of PTCA-induced coronary aneurysms was excellent. One patient underwent (unrelated) cardiac surgery, all other 27 patients remained eventfree. We conclude that the same benign nature of coronary aneurysmal disease holds true for those aneurysms that develop after PTCA. 

Category: cardiovascular diseases
Parathyroid hormone-like peptide in normal and neoplastic mesothelial cells. Mesothelioma has not been commonly reported as a cause of hypercalcemia of malignancy. We have studied a patient with malignant mesothelioma and hypercalcemia in association with elevated plasma concentrations of parathyroid hormone-like peptide (PLP). Immunohistochemical analysis of the tumor and seven of eight other mesotheliomas that were not associated with hypercalcemia revealed the presence of PLP cytoplasmic immunopositivity. PLP immunopositivity was also detected in normal and reactive mesothelial cells. The results of these studies suggest that PLP immunoreactivity is common in normal and neoplastic mesothelial cells and raises the possibility that PLP production may play a role in the pathogenesis of hypercalcemia associated with mesothelioma. 

Category: neoplasms
Assessment and treatment of children's headaches from a developmental perspective. Childhood headache is a common pediatric problem. Clinical researchers have evaluated several behavioral treatment, such as biofeedback and relaxation training, that may be viable interventions. Adding a developmental perspective to the evaluation and treatment of childhood headache is a likely way to increase the effectiveness of these strategies. This paper presents developmental issues related to the assessment and treatment of childhood headache. Three major areas of development are examined and the impact of these areas on the treatment and assessment of headache are discussed. The three major areas are cognitive development, self-regulation and psychosocial development. Provided are practical suggestions for the application of child development principles to assessment and intervention practices that may be more developmentally appropriate. 

Category: nervous system diseases
Acquired childhood aphasia. Outcome 1 year after onset. The effects of the variables age at onset, cause, severity and bilaterality of lesion, and type of aphasia on course and outcome were investigated in a group of 28 aphasic children. Analysis of spontaneous speech and tests of auditory verbal comprehension were used to determine the presence of aphasia. The severity of the cerebral lesion was assessed using a rating scale for computed tomographic scans. Most of the children had not recovered completely 1 year after onset. Recovery was significantly different according to etiological categories. Complete recovery was seen in the majority of traumatic cases. 

Category: nervous system diseases
Neurological and ophthalmological phenomena after aortic conduit surgery. Transient neurological and visual signs have been observed in some patients after valved conduit replacement of the aortic valve and ascending aorta. Twenty-seven patients having valved conduit replacement between February 1982 and October 1988 were compared with 21 patients having combined aortic valve replacement (AVR) and ascending aorta (AA) graft replacement. Follow-up in 100% of both groups was obtained for 0.3-6.6 years (mean, 2.6 +/- 0.3 years). Among 20 surviving valved conduit patients, 10 (50.0%) experienced repetitive neurological and visual signs, including scotomata (seven), transient motor ischemic attacks (two), amaurosis fugax (four), and recurring attention lapses suggesting petit mal seizures (one). No patient with AVR + AA graft experienced any events (p = 0.004). All valved conduit and seven (53.8%) of AVR + AA graft patients were on warfarin (p = 0.0016). These events retained the same pattern although they diminished in frequency after 12 months in seven patients (70.0%) and after initiation of dipyridamole in two patients. Rehabilitation was similar in both groups: 18 of 20 (90.0%) valved conduit and 12 of 16 (75.0%) AVR + AA graft patients (p = NS). Transient, repetitive, nonprogressive neurological and ophthalmological phenomena are frequent after valved conduit replacement. The pathophysiological mechanism is unclear, but antiplatelet therapy may provide symptomatic control. 

Category: general pathological conditions
Cerebral metastases from ovarian carcinoma. Apart from choriocarcinoma, involvement of the central nervous system (CNS) by gynecologic malignancy is rare. A 10-year retrospective review at the University of Washington Medical Center (Seattle, WA) and Swedish Hospital and Medical Center Tumor Registry (Seattle, WA) identified 14 patients with cerebral metastases from ovarian carcinoma. Median age at diagnosis of cerebral metastases was 52.5 years. Median interval from the diagnosis of ovarian carcinoma to the diagnosis of CNS metastases was 14.5 months. Seven patients had received cisplatin therapy before CNS relapse. Seven patients underwent second-look procedures before developing CNS metastases; in three, results were negative. Eight patients had evidence of extraperitoneal spread to other sites at the time of CNS relapse. Clinical manifestations included motor weakness, seizures, headache, confusion, and speech disturbance. All lesions were contrast enhancing on computed tomography (CT) scans and were located in the cerebral hemispheres. Nine patients had single lesions, five of whom underwent surgical resection of the lesion with histologic confirmation of metastases from the primary site. Median survival was 2 months in patients receiving radiation therapy alone and 17 months in patients who received surgery and radiation. Median survival of the entire series was 3 months. The presence of multiple cerebral metastases or evidence of extraperitoneal spread elsewhere in the body was adversely associated with survival. The prognosis of patients with cerebral metastases from ovarian carcinoma appears poor. However, early diagnosis by routine CT scanning followed by surgical resection and radiation may improve overall survival in a select group of patients. 

Category: neoplasms
Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. The first superior vena cava-pulmonary artery shunt (Glenn shunt) in our series was performed in February 1958. From then through September 1988, 91 patients have undergone this procedure for a wide variety of congenital defects. We here report follow-up data available on all patients. Ages ranged from 2 days to 46 years (mean 6.8). Diagnoses were as follows: tricuspid atresia, 27; single ventricle, 22; tetralogy of Fallot, 14; D-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis, 9; D-transposition, 5; Ebstein's anomaly, 4; pulmonary atresia + intact septum, 4; and others, 6. The hospital mortality rate was 7.7% (one death in the last 53 patients, 1.9%). Five deaths occurred in patients less than 6 months old. There were 20 late deaths (22%) with actuarial survival rates of 84% and 66% at 10 and 20 years, respectively. Pulmonary arteriovenous fistula formation was seen in 18 patients (19.7%), six of whom have undergone therapeutic embolization with improvement in saturation. The prevalence of pulmonary arteriovenous fistula increases with time after shunt. No long-term shunt thrombosis or stricture formation was seen. Fifty percent of shunts were still functioning at 20 years. Palliation was limited because of decrease in blood flow to the contralateral pulmonary artery, collaterals between the inferior and superior venae cavae, and pulmonary arteriovenous fistula formation. Improvement in saturation was obtained in eight otherwise inoperable patients by creation of a right axillary arteriovenous fistula up to 19 years after the Glenn shunt. Three patients had conversion of a Blalock-Taussig shunt to a Glenn shunt with improvement in congestive heart failure. Twenty-six patients have undergone a Fontan procedure with two deaths. Compared with the group having a Fontan procedure without a prior Glenn operation, there was no difference in early or late mortality. Thirty years after a Glenn shunt, the first patient in this series is working full time after having undergone a modified Fontan procedure in 1981. We conclude that the Glenn connection, usually with supplemental procedures to enhance oxygenation, has provided excellent physiologic palliation with low mortality up to 30 years with no late thrombosis or stricture formation. The incidence of pulmonary arteriovenous fistula increases with time and can be effectively treated with embolization. Physiologic repair after the Glenn shunt carries a low mortality. Although currently used infrequently, superior vena cava-pulmonary artery shunting remains a useful method of palliation in selected patients.(ABSTRACT TRUNCATED AT 400 WORDS). 

Category: general pathological conditions
Continuous extracorporeal fluid removal in children with low cardiac output after cardiac operations. Eleven hypervolemic and oliguric children with low cardiac output after cardiac operations were treated by slow continuous ultrafiltration or continuous arteriovenous hemofiltration. A mean negative fluid balance of 1.63 +/- 0.37 ml/kg/hr (standard error of the mean [SEM]) significantly improved the hemodynamic status within 59 +/- 6.1 hours (SEM). Although the central venous pressure decreased significantly from 15.2 +/- 0.84 to 8.8 +/- 0.92 mm Hg (p less than 0.0001), the mean arterial pressure increased significantly from 41.5 +/- 2.54 to 53.5 +/- 2.21 mm Hg (p less than 0.001). In addition, pH increased significantly from 7.31 +/- 0.01 (SEM) to 7.43 +/- 0.001 (SEM) (p less than 0.001) and oxygenation index (arterial oxygen tension/inspired oxygen fraction) from 119 +/- 15.2 (SEM) to 214 +/- 27.0 (SEM) (p less than 0.001). Hemodynamic improvement during slow continuous extracorporeal fluid removal allowed a significant decrease of the catecholamine infusion rate. After normovolemia had been achieved, continuous arteriovenous hemofiltration had to be continued in four children because of persistent anuria. Eight patients could be weaned from artificial ventilation and vasopressor support. Two patients died without recovery of renal function and one with restored renal function. Slow continuous ultrafiltration and continuous arteriovenous hemofiltration improve the cardiovascular function in children with low cardiac output by optimizing the preload conditions of the failing heart. In addition, they improve acid-base balance and pulmonary gas exchange. 

Category: cardiovascular diseases
A randomized controlled evaluation of a psychosocial intervention in adults with chronic lung disease. The effect of a stress management program on morbidity and psychosocial and physical function in patients with chronic lung disease was assessed. Adults attending either a VA pulmonary clinic or university hospital pulmonary rehabilitation clinic who met criteria for obstructive or restrictive pulmonary disease were randomly assigned to receive the intervention or to a control group. The intervention was provided by a nurse and included one to three teaching sessions, reading material, audiotapes, and telephone follow-up. The program focused on stress management techniques such as cognitive restructuring, progressive relaxation, breathing exercises, and visual imagery. The 45 experimental subjects were similar to the 49 controls with respect to baseline characteristics. Experimental and control subjects had similar rates of mortality, hospital days, bed-disability days, restricted-activity days, and physician visits during the 12-month follow-up. There were no differences between the two groups in physical or psychosocial function at six months or in levels of stressful life changes, social supports, and self-esteem at six and 12 months. Intervention recipients had better function at 12 months, suggesting a possible benefit of the intervention. 

Category: general pathological conditions