Melricflash/CW_MedAbstractsAlt huggingface dataset:
Endocarditis due to ampicillin-resistant nontyphoid Salmonella: cure with a third-generation cephalosporin. A case of ampicillin-resistant salmonella bacteremia complicated by endocarditis in a 78-year-old man is presented. Previous rheumatic valvular heart disease and the lack of response to initial treatment with chloramphenicol prompted us to consider this diagnosis. There was a good clinical response after treatment with ceftriaxone alone and corresponding improvement on the echocardiogram. This case demonstrates the possible endovascular complications of salmonella bacteremia in elderly people and that endocarditis should be included among the invasive infections due to ampicillin-resistant Salmonella that could potentially be treated with the newer cephalosporins. 

Category: cardiovascular diseases
The Indian experience with hypertrophic pyloric stenosis. A study of 58 consecutive Indian infants operated for congenital hypertrophic pyloric stenosis revealed an accentuated male predominance in the incidence of the disease and far less preoperative hemetemesis as compared to that in their Western counterparts. 'Pyloric tumor' was palpable in 89% of cases. Only 34.5% of these infants were first born. Postoperative vomiting occurred in 13.8% of patients and wound sepsis was not encountered. Air contrast radiography confirmed the diagnosis in clinically doubtful cases. 

Category: digestive system diseases
Transcatheter oily chemoembolization in the management of advanced hepatocellular carcinoma in cirrhosis: results of a Western comparative study in 60 patients. Transcatheter oily chemoembolization is widely used as palliative therapy for inoperable hepatocellular carcinoma in high-incidence Asiatic areas. To assess its usefulness in the Western form of this cancer, 30 French patients were treated between 1987 and 1990 by intraarterial hepatic injection of a Lipiodol-doxorubicin emulsion followed by embolization with 0.5 to 1 mm gelatin sponge particles. The number of procedures ranged from one to five. All patients had advanced, symptomatic and inoperable hepatocellular carcinoma (Okuda's staging: I, n = 8; II, n = 14; III, n = 8); none was found under systematic screening. All had underlying cirrhosis (Child-Pugh's class: A, n = 15; B, n = 12; C, n = 3) that was alcoholic in origin in 27 cases and posthepatitic B in origin in 3 cases. The results of the treatment were assessed by comparison with a group of 30 untreated patients admitted to the same unit between 1984 and 1987. Patients of both groups were closely matched for clinical presentation, global disease staging and precise anatomical extension. The overall 1- and 2-yr survival rate was 59% and 30%, respectively, for the treated patients vs. 0% at 1 yr for the untreated patients. The latter all died from local disease with end-stage liver failure and/or uncontrollable variceal bleeding. In the former, the three patients with Child's class C cirrhosis died after the first procedure. During the follow-up (range = 3 to 26 mo), 11 additional patients died, 8 from metastatic generalization. 

Category: digestive system diseases
Frontal lobe utilization behavior associated with paramedian thalamic infarction. Disinhibited, exaggerated responses to objects and environmental cues (utilization behavior) occur predominantly with frontal lobe damage. We report a striking example associated with paramedian thalamic infarction suggesting a thalamofrontal component to environmental interactions that require inhibition, self-monitoring, and cognitive flexibility. 

Category: nervous system diseases
The changing direction of nystagmus in acute Meniere's disease: pathophysiological implications. The direction(s) and pathophysiologic basis of nystagmus during an acute attack of Meniere's disease have been subject to much debate in the world literature. Clinical recordings from two patients whose nystagmus was captured near the very beginning of the acute vertiginous episode are presented. Previous clinical observations in Meniere's disease, experimental animal models concerned with initiation of peripheral nystagmus, and the phenomenon of recovery are discussed. 

Category: general pathological conditions
Transhepatic portal vein catheterization for localization of insulinomas: a ten-year experience. One of the most important factors in the management of insulinomas is the ability to localize the tumor accurately either before or during surgery. We prospectively carried out transhepatic portal venous sampling (THPVS) for tumor localization in 35 of 40 patients with organic hyperinsulinism during a 10-year period. In 32 patients who underwent THPVS and in whom a single tumor was subsequently identified surgically, the maximal insulin gradient was located in the vicinity of the tumor in 100% of cases. Specific regionalization of the tumor on the basis of the site of the maximal insulin gradient to one of three regions (the tail, the body/neck region, and the head/uncinate region) gave a sensitivity of 81% and a specificity of 91%. In contrast, the use of specific cutoff levels for the insulin gradient as a guide to the presence of a tumor in one of these three regions did not increase the accuracy, leading instead to a significant loss of sensitivity with no comparable increase in specificity. There were no major complications from the procedure in any patient. The initial use of computed tomographic/ultrasound scanning and selective angiography localized only 46% of tumors, whereas subsequent THPVS led to the accurate preoperative localization of 100% of all tumors submitted to surgery. Although the surgeon would have identified 81% of the tumors correctly at operation, in 19% (n = 6) he would have failed. Four tumors were in the uncinate and two were in the head. It seems that in patients with proved or established organic hyperinsulinism, THPVS may continue to be of value, if only to regionalize the tumor, especially those in the pancreatic head and uncinate process so as to preclude noncurative operations on the body and tail of the pancreas. 

Category: neoplasms
Long-term vascular access via the inferior vena cava. A prospective evaluation of long-term venous access catheters placed via the inferior vena cava was performed to determine their efficacy as well as short- and long-term morbidity. From June 1987 to May 1989, 31 catheters were placed in 26 patients, for a total of 3,503 catheter use days. All catheters were placed via an infraumbilical approach when the more conventional supraumbilical route was technically difficult, dangerous, or impossible to be used. There were a total of 14 complications in 12 episodes (one in every 701 catheter use days), six episodes of catheter occlusion or vessel thrombosis (one in every 583 catheter use days), one catheter malfunction, one episode of cuff erosion through the skin, and one catheter that migrated through the inferior vena cava into the retroperitoneum. These results compared favorably with our experience with long-term catheters of a similar type placed via a supraumbilical approach into the superior vena cava. We conclude that the infraumbilical route for long-term central venous access is safe and technically easy and should be strongly considered in patients in whom venous access via the supraumbilical approach will be technically difficult or have a high likelihood of failure. 

Category: cardiovascular diseases
Eosinophilia-myalgia syndrome associated with L-tryptophan ingestion. Analysis of four patients and implications for differential diagnosis and pathogenesis Four patients fulfilling the case definition for eosinophilia-myalgia syndrome are described, including one whose disease began in 1986. Each displayed a variety of symptoms: one suffered principally from myalgia and recovered spontaneously on discontinuation of L-tryptophan therapy; one exhibited progressive sclerodermiform skin changes, neuropathy, and myopathy; a third had prominent neuromuscular disease and sclerodermiform skin changes; and the fourth experienced profound weight loss, an axonal polyneuropathy, and perivascular lymphoid infiltrates simulating a lymphoma. Evidence of T-cell activation was present in peripheral blood and affected tissues during the clinically active progressive phase of disease. Among other manifestations pleural effusion, cutaneous vasculitis, joint contractures, and bloody diarrhea were observed. A history of L-tryptophan ingestion should be sought in patients with myalgia, fatigue, or the above outlined symptoms. 

Category: general pathological conditions
Chylous drainage from a stab wound to the neck. A 24-year-old man was assaulted and sustained a stab wound to the left lower neck. When he arrived at the emergency department, he was hemodynamically stable. Although the wound had penetrated the platysma, on initial evaluation the patient did not appear to have sustained significant injury. Closer examination of the wound revealed chylous drainage, indicating injury to the cervical portion of the thoracic duct. The patient was taken to the operating room for exploration of the wound, during which an injury to the left internal jugular vein was identified and repaired. The thoracic duct, which had been severed, was ligated. The remainder of the patient's hospital course was unremarkable. The consistent association between penetrating injury to the cervical portion of the thoracic duct and injury to neighboring vascular structures is discussed. 

Category: general pathological conditions
Scrotal inflammatory disease: color Doppler US findings. A study of 45 patients with 51 cases of hemiscrotal inflammatory disease was done to determine the color Doppler ultrasonographic appearance of scrotal inflammatory disorders. The diagnosis was ultimately established by means of appropriate response to antibiotic treatment (47 cases) or surgery (four cases). In all cases, there was evidence of hyperemia: an increased number and concentration of detectable vessels in the affected portion of the scrotum. In 17 cases, the gray scale images were normal, and the only evidence of inflammation was the presence of hypervascularity. Abnormally decreased epididymal vascular resistance was detected in 14 cases of epididymitis; abnormally decreased testicular vascular resistance was detected in six cases of orchitis. Spontaneous venous flow was present in 18 patients. The authors conclude that color Doppler can demonstrate the hyperemic response to scrotal inflammatory disease and that, in the proper clinical setting, it can supplement the gray scale findings and increase diagnostic confidence. 

Category: general pathological conditions
Queuine, a tRNA anticodon wobble base, maintains the proliferative and pluripotent potential of HL-60 cells in the presence of the differentiating agent 6-thioguanine. 6-Thioguanine (6-TG)-induced differentiation of hypoxanthine phosphoribosyltransferase (IMP: pyrophosphate phosphoribosyltransferase, EC 2.4.2.8)-deficient HL-60 cells is characterized by 2 days of growth, after which morphological differentiation proceeds. Addition of the tRNA wobble base queuine, in the presence of 6-TG, maintains the proliferative capability of the cells. The ability of 6-TG to induce differentiation correlates with c-myc mRNA down-regulation, but queuine has no effect on this parameter. Treatment with 6-TG for 2-3 days commits HL-60 cells to granulocytic differentiation, and, once committed, these cells do not respond to the monocytic inducer phorbol 12-myristate 13-acetate. Nonetheless, when cells are treated with queuine and 6-TG, they maintain the promyelocytic morphology and are capable of being induced down the monocytic pathway by phorbol 12-myristate 13-acetate as indicated by stabilization of c-fms mRNA and cell adherence. In the absence of queuine, phorbol 12-myristate 13-acetate is incapable of inducing monocytic markers in the 6-TG-treated cells. The data presented indicate that 6-TG-induced differentiation of HL-60 cells is a tRNA-facilitated event and that the tRNA wobble base queuine is capable of maintaining both the proliferative and pluripotent potential of the cells. 

Category: neoplasms
Nicotine impairs reflex renal nerve and respiratory activity in deoxycorticosterone acetate-salt rats. Smoking exacerbates the increase in arterial pressure in hypertension. The effect of nicotine on the baroreceptor-mediated reflex responses of renal nerve activity (RNA), heart rate, and respiratory activity (minute diaphragmatic activity [MDA]) after bolus injections of phenylephrine was compared in deoxycorticosterone acetate (DOCA)-salt sensitive and normotensive rats. Osmotic minipumps that dispensed either nicotine (2.4 mg/kg/day) or saline were implanted in DOCA and normotensive rats for 18 days. Anesthetized DOCA-nicotine, DOCA-saline, control-nicotine, and control-saline rats had mean arterial pressures (MAP) of 117 +/- 3, 110 +/- 9, 90 +/- 3, and 89 +/- 5 mm Hg, respectively. Nicotine decreased the sensitivity (p less than 0.05) of baroreceptor reflex control of RNA (% delta RNA/delta MAP) in the DOCA-nicotine rats (-0.92 +/- 0.08) compared with the DOCA-saline (-1.44 +/- 0.16), control-nicotine (-1.45 +/- 0.08), or control-saline (-1.45 +/- 0.21) rats. The reflex decrease in respiratory activity (% delta MDA/delta MAP x 100) was impaired (p less than 0.01) in both control-nicotine (-24.5 +/- 3.3) and DOCA-nicotine (-18.2 +/- 4.6) rats compared with control-saline (-59.2 +/- 9.1) and DOCA-saline (-52.5 +/- 9.9) rats. The reflex decrease in heart rate (absolute delta HR/delta MAP) in both DOCA-nicotine (1.56 +/- 0.17) and control-nicotine (1.54 +/- 0.24) rats was augmented compared with DOCA-saline and control-saline rats (0.91 +/- 0.12 and 0.97 +/- 0.14). 

Category: cardiovascular diseases
Adverse impact of fibrin clot inhibitors on intravesical bacillus Calmette-Guerin therapy for superficial bladder tumors. Although intravesical bacillus Calmette-Guerin therapy has proved to be efficacious in the treatment and prophylaxis against tumor recurrence of superficial bladder tumors, its mechanism of action has not been fully elucidated. Previous work has suggested that bacillus Calmette-Guerin organisms attach to the matrix protein, fibronectin, during fibrin clot formation at sites of urothelial disruption and that this attachment was required for the antitumor effect of bacillus Calmette-Guerin to be expressed. Furthermore, drugs inhibiting clot formation were found to abrogate the antitumor effect of intravesical bacillus Calmette-Guerin therapy in a murine bladder tumor model. To examine the effect of inhibitors of fibrin clot formation on the results of intravesical bacillus Calmette-Guerin therapy, a retrospective analysis of 149 evaluable patients receiving intravesical bacillus Calmette-Guerin for superficial bladder tumors was performed. The over-all response rate free of tumor for 29 patients who concomitantly received inhibitors of fibrin clot formation with bacillus Calmette-Guerin therapy was 48%, as compared with 67% for 120 patients who were not receiving these medications (p = 0.0655, chi-square). The most striking difference was noted for patients who failed with recurrent superficial disease. Of the patients who received fibrin clot inhibitors during intravesical bacillus Calmette-Guerin therapy 35% had recurrent superficial tumors compared to only 8% of those who did not receive these drugs during a mean followup of 29.8 plus or minus 11 months (p = 0.005, chi-square). Our study suggests that inhibitors of fibrin clot formation may have an adverse influence on the results of intravesical bacillus Calmette-Guerin therapy for superficial bladder tumors. 

Category: neoplasms
Reappraisal of the mechanism for cerebrospinal fluid hypertension during aortic surgery. Cerebrospinal fluid (CSF) hypertension during aortic surgery is a poorly understood, multifactorial event that may increase the risk of spinal cord injury. To assess the factors that may contribute to changes in CSF pressure during aortic surgery, measurements of ascending arterial and CSF pressures were made in 17 anesthetized mongrel dogs. Changes in CSF patterns were monitored under several conditions tested in random sequence. These included systemic hypertension produced by an infusion of phenylephrine, cross-clamping of the descending thoracic aorta, and manual, superior displacement of the transverse aortic arch (arch elevation), either alone or in conjunction with the cross-clamp. Hypertension, cross-clamping, and cross-clamping combined with arch elevation all produced significant increases in ascending mean arterial pressure (204 +/- 20, 170 +/- 8, and 158 +/- 11 mm Hg, respectively, vs. 117 +/- 8 mm Hg [control]; (p less than 0.01). Small, nonsignificant increases in CSF pressure were detected in the cross-clamp group, but none were detected with hypertension alone, despite significant increases in ascending arterial blood pressure in both groups. Thus, neither arterial hypertension nor cross-clamping alone could be demonstrated directly to cause significant CSF hypertension. However, when aortic elevation (displacement) was combined with cross-clamping, the rise in CSF pressure increased to significant levels, even though the ascending arterial hypertension was least severe in this group. In contrast, arch elevation alone did not produce any significant increase in ascending arterial pressure but did produce an approximately 114% increase in CSF pressure (15.2 +/- mm Hg vs. 7.7 +/- 1 mm Hg [control]; p less than 0.01. 

Category: general pathological conditions
Diagnostic evaluation of syncope Syncope is a common medical problem and is caused by a wide variety of diseases ranging from physiologic derangements with few consequences to conditions that may be immediately life-threatening. Because of the large differential diagnosis, many diagnostic tests are available for its evaluation. However, a cause of syncope is not established in 38% to 47% of patients despite these tests. In those patients in whom a diagnosis can be assigned, the history and physical examination identify a potential cause in 49% to 85%. Furthermore, in 8% of additional patients, history and physical examination are suggestive of causes that need confirmation by specific tests. Routine blood tests rarely yield diagnostically helpful information. In those patients in whom a potential cause for syncope is identified, arrhythmias are diagnosed by electrocardiogram in 2% to 11% of patients, cardiac monitoring in 3% to 27% (telemetry or Holter), stress test in less than 1%, carotid massage in less than 1%, and electrophysiologic studies in less than 3%. Diagnosis of arrhythmias as a cause of syncope is problematic because symptomatic correlation during electrocardiographic monitoring is rarely found (approximately 4%), and as a result, there is no uniform agreement on diagnostic criteria for abnormalities. Similar problems exist in the use of electrophysiologic studies. Upright tilt testing and psychiatric examination may be useful in evaluation of recurrent syncope of unknown cause in patients without organic heart disease. Based on the results of recent studies, strategies for evaluation of patients with syncope are possible that utilize selective and goal-directed diagnostic testing. 

Category: nervous system diseases
Emergent saphenous vein graft stenting for acute occlusion during percutaneous transluminal coronary angioplasty. This report describes the initial use in the United States of emergency intravascular stenting for the treatment of acute coronary occlusion complicating elective saphenous vein graft angioplasty. This case adds further support to the role of the balloon expandable stent as an effective "bail out" device for failed angioplasty. 

Category: general pathological conditions
On the metallothionein, glutathione and cysteine relationship in rat liver. Stress and starvation increased liver metallothionein (MT) and decreased liver glutathione (GSH) levels. Serum cysteine plus cystine levels were increased by stress. The exogenous administration of GSH, while not modifying hepatic GSH content, increased liver MT levels in basal and starved rats but not in stressed rats. Liver and serum cysteine levels were increased by GSH administration, a process partially reverted by the irreversible inhibitor of gamma-glutamyl transpeptidase, alpha-amino-3-chloro-4,5-dihydro-5-isoxazoleacetic acid. Mouse and rat liver MT levels were also increased by buthionine sulfoximine, an inhibitor of GSH synthesis, indicating that GSH is not a necessary precursor of MT. In addition, the hepatic MT content was increased by the administration of cysteine in a dose-response manner. These results suggest that hepatic MT synthesis is elevated by increased cysteine pools, and that MT, GSH and cysteine levels are somehow inter-related. MT, besides GSH, may be contemplated as a putative intracellular reservoir of cysteine in the liver of adult rats. 

Category: general pathological conditions
Predicting treatment outcome in nocturnal enuresis. A presenting sample of 127 consecutive referrals to a community based enuresis clinic were evaluated after treatment with baseline behavioural recording and the enuresis alarm. Almost one in five became dry after baseline recording only while 81 of 96 (84%) enuretics who used the alarm achieved the initial dryness criterion. Successful outcome was associated with the absence of adverse environmental factors and psychiatric disorders in the child. A logistic regression procedure enabled a risk score to be created so that successful outcome could be predicted. Psychiatric disorder in the child, family stress, and the degree of concern shown by the child emerged as the most important prognostic factors in the treatment of enuresis. The favourable success rates with baseline recording and the enuresis alarm confirm the role of conditioning treatment at the forefront of management of enuresis and the risk score allows outcome to be predicted for the first time. 

Category: general pathological conditions
Effect of local inhibition of gamma-aminobutyric acid uptake in the dorsomedial hypothalamus on extracellular levels of gamma-aminobutyric acid and on stress-induced tachycardia: a study using microdialysis. Previous studies involving local microinjection of drugs that interfere with gamma-aminobutyric acid (GABA)A receptor-mediated synaptic inhibition have led to the suggestion that endogenous GABA suppresses the activity of a sympatho-excitatory mechanism in the dorsomedial hypothalamus in rats. In this study, microdialysis was used to assess and to alter pharmacologically extracellular-levels of GABA within this region while simultaneously monitoring heart rate and blood pressure. In anesthetized rats, local microdialysis for 15 min with 2.5, 10 and 40 mM nipecotic acid, an inhibitor of GABA uptake, caused concentration-related increases in GABA and taurine in the extracellular space, but no significant change in heart rate or arterial pressure. Similar perfusion with 37.5, 75 and 150 mM KCl caused concentration-related increases in GABA as well as aspartate, glutamate, taurine, glycine and alanine. Only modest, variable increases in heart rate and no effect on arterial pressure were observed during the perfusions with high potassium. In conscious rats, unilateral microdialysis of the dorsomedial hypothalamus with 0.5 mM nipecotic acid for 2 to 2.5 hr before stress coupled with contralateral microinjection of muscimol (88 pmol/250 nl) 5 min before stress significantly reduced air stress-induced tachycardia; this reduction in tachycardia was associated with markedly elevated levels of GABA in dialysates collected from the dorsomedial hypothalamus. Neither treatment alone significantly influenced stress-induced increases in heart rate, although perfusion with nipecotic acid alone evoked similar elevations in extracellular GABA. These results suggest that extracellular levels of endogenous GABA in the dorsomedial hypothalamus may regulate the cardiovascular response to stress. 

Category: general pathological conditions