Melricflash/CW_MedAbstractsAlt huggingface dataset:
Prediction of outcome by prenatal Doppler analysis in a patient with aortic stenosis. Stenosis of the aortic valve (pressure drop 50 mm Hg) was diagnosed prenatally by Doppler echocardiography in a 33 week old fetus. Measurement of time-velocity integrals through the tricuspid and mitral valves indicated a significantly higher flow in the right heart. The pressure drop across the aortic valve in the 3 hour old infant was 80 mm Hg. The findings in this patient suggest that the usually accepted theory that prenatally the ventricles function in parallel should take into account the chronology of filling and ejection. In this patient the ability of a ventricle to generate a prenatal transvalvar pressure gradient was evidence that the size, compliance, and contractility of the ventricle were sufficient to maintain good function. 

Category: cardiovascular diseases
Multimodality evoked potential testing in acute mild closed head injury. Multimodality evoked potential (MEP) testing, including brainstem auditory, visual, and somatosensory evoked potentials, have been reported to be useful in predicting outcome in severe closed head injury. Brainstem auditory evoked potentials have been demonstrated to be abnormal in 10% to 40% of acute mild head injury. A prospective study of 18 patients with mild closed head injury was undertaken to determine the usefulness of MEP screening within two weeks of the acute event. Long latency event-related potentials (P300s), in response to auditory stimuli with an oddball paradigm, were included in the screening. The subjects had several symptoms consistent with the postconcussive syndrome at the time of the evoked potential testing. Only one patient had an abnormal evoked potential response (greater than three standard deviations from the mean) from all the testing done. The standard methods of MEP testing were insensitive to quantifying the possible physiologic changes that are associated with memory deficits, lethargy, and emotional irritability after mild closed head injury. 

Category: general pathological conditions
New approaches to research on the long-term consequences of prenatal exposure to alcohol. As the summary presentation of a symposium on prenatal alcohol-induced brain damage and long-term postnatal consequences, this paper proposes the establishment of two main research priorities--to begin to correlate long-term behavioral effects with alterations in underlying neural substrates, and to explore the mechanisms of neuroteratogenicity. To reach these goals, three objectives are described. First, animal and human research must become more interrelated. Second, experimental observations should be integrated into formal models that incorporate both neural structure and function. Third, researchers should choose well-defined dependent measures that are derived from models of brain function based on modern concepts of cognitive neuroscience. Examples of neuropsychological tests that may serve as the bases for structure/function relationships are presented. Incorporating these objectives into future research will facilitate understanding of the fundamental issues concerning prenatal alcohol exposure and will begin to provide the bases for rational intervention or treatment. 

Category: nervous system diseases
Genotyping of macerated stillborn fetuses. It is generally impossible to collect blood or to culture tissue from a macerated stillborn fetus. Accurate genotyping of such a fetus may, however, be critical for the diagnosis of genetic diseases and appropriate genetic counseling. In the East Flanders Prospective Twin Study, placental tissue of twin and triplet sets, in some of which one or both members were stillborn and macerated, has been stored at -20 degrees C. Of all these fetuses, sex and zygosity could be determined accurately on the placental deoxyribonucleic acid. We tested the possibility of nongenetic changes in deoxyribonucleic acid that result from maceration or tissue degradation over time in storage on placental samples from monochorionic twins in which only one member was stillborn and macerated. The deoxyribonucleic acid variants in these monozygotic twins were identical whether or not either cotwin was macerated. Thus deoxyribonucleic acid variants can be determined accurately on the placental tissue of macerated fetuses, even after prolonged freezing. 

Category: general pathological conditions
Recovery from vegetative state of six months' duration associated with Sinemet (levodopa/carbidopa). Certain pharmacologic interventions may improve outcome for brain injury in animals and humans. Medications affecting the dopaminergic pathway appear to be important. We present the case of a 24-year-old man with traumatic brain injury who remained unresponsive to commands and unchanged for six months despite periodic aggressive therapy. Within days of beginning Sinemet (levodopa/carbidopa), the patient became conversant and responsive. The reported low likelihood of spontaneous recovery of cognition in patients who are vegetative for six months suggests that Sinemet was responsible for this patient's recovery. In this case, the relatively small risk of side effects from Sinemet was greatly outweighed by the change in functional outcome. 

Category: general pathological conditions
Glucose polymers as an alternative to glucose in oral rehydration solutions. Several issues involving glucose-based oral rehydration therapy may limit its acceptability and sustained use. Our studies suggest that defined short-chain glucose polymers (2 to 9 glucose units) are hydrolyzed and absorbed faster than isocaloric solutions of D-glucose in the small intestine of the rat. Glucose polymers, primarily from rice-based solutions, have been shown to be as effective as glucose-based solutions. They offer additional advantages in reducing the amount and duration of diarrhea with lesser volumes of solution, thereby reducing the costs of treatment. Rice-based solutions provide high caloric density and increase the absorption of sodium without an osmotic overload. The result is increased net absorption of glucose, sodium, and water. Glucose polymers from rice or other starches in oral rehydration solutions may be effective, inexpensive, easily used, and safe treatments for acute diarrhea. 

Category: digestive system diseases
Clinical significance of the "palpable mass" in patients with muscle-infiltrating bladder cancer undergoing cystectomy after pre-operative radiotherapy. Between 1976 and 1985, 132 patients with T2/T3/T4a bladder cancer underwent cystectomy after pre-operative radiotherapy (46 Gy: 67 patients; 20 Gy: 65 patients). After a median time of 41 months, 62 patients were alive; 51 had died from recurrent bladder cancer and 19 from intercurrent disease without recurrence of their malignancy. Distant metastases developed in 40 patients, accompanied in 5 cases by local recurrence. Local recurrence was the first sign of relapse in 11 patients. In 3 patients the localisation of the relapse remained unknown. The corrected 5-year survival rate was 60%. T category and a palpable bladder tumour were independent pre-treatment prognostic factors in a Cox regression analysis, together with the interval between initial diagnosis and cystectomy. The presence of a palpable tumour before the start of treatment was associated with a particularly poor prognosis in T3/T4a tumours, whereas the survival of patients with non-palpable T3/T4a tumours was similar to that of patients with T2 bladder cancer. Another important prognostic factor was post-irradiation stage reduction (no residual muscle infiltration in the cystectomy specimen). Significantly more patients with non-palpable bladder tumours experienced post-radiation stage reduction than did those with a palpable tumour. However, the prognostic value of stage reduction was statistically significant only in patients with palpable bladder tumours. 

Category: general pathological conditions
Assessment of functional gastrointestinal disease: the bowel disease questionnaire. A need exists for a self-report questionnaire that reliably and accurately measures symptoms and that distinguishes patients with functional gastrointestinal disease from those with other conditions. We have developed such an instrument, the bowel disease questionnaire, and herein describe details of its discriminatory validity. Data from 399 subjects were analyzed. Patients with gastrointestinal symptoms were ultimately diagnosed as having functional gastrointestinal disease (82 with the irritable bowel syndrome and 33 with functional dyspepsia) or organic gastrointestinal disease (N = 101). There were 145 healthy control subjects and 38 patients with a psychiatric disease, somatoform disorder (which includes those with a diagnosis of hypochrondriasis, psychogenic pain, and somatization or conversion disorder). All subjects completed the questionnaire before undergoing an independent diagnostic assessment by experienced physicians. Functional gastrointestinal disease could be distinguished from organic disease, somatoform disorder, and health by using models derived from logistic discriminant analysis. With use of these models, the estimated probability of functional gastrointestinal disease was then calculated. Descriptive symptom scores were of less value than the scores derived from the data sets by logistic discriminant analysis. Age did not significantly affect the responses to the questionnaire items. We conclude that, in the population studied, the bowel disease questionnaire is a valid measure of symptoms of functional gastrointestinal disease, and this instrument may have clinical and research applications. 

Category: digestive system diseases
Aminoglycosides: assessing the potential for nephrotoxicity. Although aminoglycosides have been a mainstay of antibiotic therapy in postsurgical infections, certain patients may be at risk for potential aminoglycoside induced toxicities. Aminoglycoside nephrotoxicity is one of the most frequent causes of iatrogenic renal failure. A narrow toxicity to therapeutic ratio, a relatively long serum half-life and concentration in the renal cortex all contribute to renal dysfunction. Patients at greatest risk for aminoglycoside-induced nephrotoxicity include the elderly, patients with pre-existing renal disease and those who are volume depleted. Calculations based on the results of a multicenter study demonstrate that the average additional cost incurred for each patient who had aminoglycoside-related nephrotoxicity was $2,501. Methods are reviewed for prospectively assessing the potential for development of nephrotoxicity to identify patients for whom effective therapeutic substitutes for aminoglycosides should be sought. 

Category: general pathological conditions
Pathological classification and follow-up of prostatic lesions initially diagnosed as "suspicious of malignancy". Sections from a series of prostatic specimens (n = 44) in which the initial diagnosis implied a suspicion of malignancy were reviewed and the patients followed up (group 1). The aim was to categorise the morphological appearances according to current criteria and to determine the natural history of any pre-malignant lesions within this group. A "control" series of patients (n = 40) in whom the primary diagnosis was benign were also reviewed and their course followed (group 2). The heterogeneity of the abnormalities in group 1 was striking. Of the 44 cases, pre-malignant lesions were seen in 8, microinvasive adenocarcinoma in 11 and lesions not now considered pre-malignant in the remaining 25. None of the 8 patients with pre-malignant lesions developed clinical evidence of carcinoma over a follow-up period of 8 to 12 years. In contrast, 3 of the 11 diagnosed on review as having microscopic invasive adenocarcinoma developed clinically evident tumour within 5 years of surgery. Of the 25 patients whose prostatic lesions were considered benign, 2 developed carcinoma 12 and 13 years after surgery. Only 1 of the 40 patients in group 2 had a pre-malignant lesion and he did not develop tumour within 10 years. However, adenocarcinoma was diagnosed incidentally in 1 patient 3 years after surgery. It was concluded that there is a need to standardise interpretation and reporting of pre-malignant lesions and microscopic foci of adenocarcinoma in the prostate. The limited results on the course of pre-malignant lesions diagnosed incidentally in patients over 60 years of age do not indicate that follow-up would have prompted the early diagnosis of invasive disease. 

Category: neoplasms
Granular cell tumors of the vulva. Granular cell tumor (GCT), although nearly ubiquitous, is seen infrequently in the vulva. A review of the surgical pathology files from Grady Memorial Hospital, Atlanta, Georgia, from 1983 through 1987 identified eight cases of vulvar GCT. Five of the eight patients had more than one skin and soft tissue lesion. Two of the five had biopsy-proven multicentric GCT with a unique clinical course. One of the patients was a 32-year-old woman with multiple vulvar, lingual, laryngeal, bronchial and pulmonary GCT, necessitating multiple excisions and ultimately pneumonectomy. The second patient had multiple GCTs in the vulva and inguinal area and finally in both lungs, resulting in her death at age 39. No dependable microscopic features could be identified to distinguish benign GCT from its more aggressive variant. However, Feulgen DNA histomorphometry demonstrated aneuploidy in the patient with apparent lung metastases, whereas the tumors from patients with a benign course as well as from the patient with multiorgan involvement were diploid. In three of five patients who could be interviewed there was a history of soft tissue tumors in members of the family. The multifocal nature and possible familial component of GCT need to be explored further. 

Category: neoplasms
Influence of dietary cod liver oil on fatty acid composition of plasma lipids in human male subjects after myocardial infarction. A randomized crossover study was carried out to investigate the fatty acid profile and concentrations of plasma lipids in male patients with myocardial infarction (MI) who supplemented their diet with 20 ml cod liver oil daily for 6 weeks. Subjects were divided into two groups, A and B. Group A received cod liver oil daily for 6 weeks after hospital discharge, but none for the subsequent 6 weeks. Group B did not start taking cod liver oil until 6 weeks after hospital discharge, and they then took cod liver oil for 6 weeks. Diet, medication or smoking habits were kept as constant as possible during the study. During the period of cod liver oil intake, eicosapentaenoic acid (20:5 (n-3), EPA) and docosahexaenoic acid (22:6 (n-3), DHA) increased significantly in phospholipids (PL), triglycerides (TG) and cholesterol esters (CE), whereas linoleic acid (18:2 (n-6), LA), dihomo-gamma-linolenic acid (20:3 (n-6), DHGLA) and arachidonic acid (20:4 (n-6), AA) were significantly decreased in phospholipids. The plasma level of TG was significantly decreased during the cod liver oil intake. Total cholesterol, high density lipoprotein (HDL) cholesterol, and levels of apolipoproteins A1 and B were not affected by cod liver oil in these MI patients. 

Category: cardiovascular diseases
A randomized double-blind crossover comparison of four rate-responsive pacing modes. The aim of this study was to compare, both subjectively and objectively, four modern rate-responsive pacing modes in a double-blind crossover design. Twenty-two patients, aged 18 to 81 years, had an activity-sensing dual chamber universal rate-responsive (DDDR) pacemaker implanted for treatment of high grade atrioventricular block and chronotropic incompetence. They were randomly programmed to VVIR (ventricular demand rate-responsive), DDIR (dual chamber demand rate-responsive), DDD (dual chamber universal) or DDDR (dual chamber universal rate-responsive) mode and assessed after 4 weeks of out-of-hospital activity. Five patients, all with VVIR pacing, requested early reprogramming. The DDDR mode was preferred by 59% of patients; the VVIR mode was the least acceptable mode in 73%. Perceived "general well-being," exercise capacity, functional status and symptoms were significantly worse in the VVIR than in dual rate-responsive modes. Exercise treadmill time was longer in DDDR mode (p less than 0.01), but similar in all other modes. During standardized daily activities, heart rate in VVIR and DDIR modes underresponded to mental stress. All rate-augmented modes overresponded to staircase descent, whereas the DDD mode significantly underresponded to staircase ascent. Echocardiography revealed no difference in chamber dimensions, left ventricular fractional shortening or pulmonary artery pressure in any mode. Cardiac output was greater at rest in the dual modes than in the VVIR mode (p = 0.006) but was similar at 120 beats/min. Beat to beat variability of cardiac output was greatest in VVIR mode (p less than 0.0001), with DDIR showing greater variability than DDD or DDDR modes (p less than 0.05). Mitral regurgitation estimated by Doppler color flow imaging was similar in all modes, but tricuspid regurgitation was significantly greater in VVIR than in dual modes (p less than 0.03). Subjects who preferred the DDDR mode and those who found the VVIR mode least acceptable had significantly greater increases in stroke volume when paced in the DDD mode than in the ventricular-inhibited (VVI) mode at rest (22%) when compared with subjects who preferred other modes (2%, p = 0.03). No other objective variable was predictive of subjective benefit from any rate-responsive pacing mode. Thus, dual sensor rate-responsive pacing (DDDR) is superior objectively and subjectively to single sensor (VVIR, DDIR and DDD) pacing and subjective benefit from dual chamber rate-augmented pacing is predictable echocardiographically. 

Category: general pathological conditions
An evolutionary perspective on salt, hypertension, and human genetic variability. Natural selection for electrolyte conservation has likely been the norm throughout human evolutionary history. However, the current patterns of excessive dietary salt intake create the potential for salt overload. Under these conditions, hypertension may be considered an expected pathological response to an evolutionarily new constraint. The transatlantic Middle Passage may have created a genetic bottleneck for salt conservation in African-Americans. Although the initial consequences of this important historical event probably constricted genetic variability and further magnified the potential for salt-sensitive hypertension, the Middle Passage undoubtedly also served as a more generalized major source of environmental stress and may have stimulated subsequent hereditary diversity in the survivors of this holocaust and their descendants. Accelerated rates of mutation, genetic recombination, and transposable genetic elements in conjunction with enhanced opportunities for gene flow, new selective pressures, and drift have all contributed to the tremendous heterogeneity of contemporary African-Americans. It is unlikely that a single genetic event, even of the severity of the Middle Passage, can account comprehensively for the apparent susceptibility of this macroethnic group to high blood pressure and hypertension. 

Category: general pathological conditions
Outcome in Mania. A 4-year prospective follow-up of 75 patients utilizing survival analysis. A 4-year follow-up of 75 patients was conducted to investigate outcome after recovery from an episode of mania. Predictors of an unfavorable outcome included poor occupational status prior to index episode, history of previous episodes, history of alcoholism, psychotic features and symptoms of depression during the index manic episode, male gender, and interepisode affective symptoms at 6 months' follow-up. The mortality risk during the follow-up period was 4%. The identification of specific risk factors depended on the definition of outcome and the length of follow-up. 

Category: general pathological conditions
Neurologic complications of cocaine abuse. The neurologic complications of cocaine toxicity are responsible for a major portion of the morbidity and mortality associated with cocaine. Most of the complications appear to be related to the hyperadrenergic state induced by cocaine and may be treated symptomatically. Diazepam is the most effective drug for cocaine-induced seizures. 

Category: nervous system diseases
Comparison of lymphangiography and computed tomography scanning in evaluating abdominal disease in stages III and IV Hodgkin's disease. A Southwest Oncology Group study. The authors reviewed the records of 139 patients who had laparotomy plus computed tomography (CT) and/or lymphangiograms (LAG) as part of a their staging workup for Hodgkin's disease, in accordance with Southwest Oncology Group (SWOG) protocol 7808. They evaluated the relative ability of CT and LAG to detect disease in the abdomen. Two regions of the abdomen were designated, the upper and the lower, to further examine the capabilities of CT and LAG in the lower abdomen and CT in the upper abdomen. A LAG was more sensitive (P less than 0.05) than CT in detecting positive lower abdominal nodes. In the upper abdomen, CT scan had low sensitivity for detecting positive nodes, liver, or spleen. This study suggests that LAG of the lower abdomen provided more information than CT, and therefore should not be abandoned as a valid method for detecting nodal disease. 

Category: neoplasms
Posterior colporrhaphy and perineorrhaphy: separate and distinct operations. Posterior vaginal repair is often poorly understood and ineffectively performed. The goals of reconstructive surgery emphasize relief of symptoms and restoration of normal anatomic relationships and of function. A useful method to preoperatively determine posterior vaginal wall weakness is outlined along with a surgical description of important steps in surgical reconstruction. 

Category: digestive system diseases
Familial autosomal recessive rigid spine syndrome with neurogenic facio-scapulo-peroneal muscle atrophy. Two sisters and a first cousin presented with rigid spine and facio-scapulo-peroneal muscle atrophy. The patients belonged to a family with two first-cousin marriages. Electromyography, muscle and nerve biopsy showed neurogenic muscle atrophy without peripheral nerve involvement. Follow up did not show progression of the disease. This is the first observation of an association of neurogenic facio-scapulo-peroneal and rigid spine syndrome. The double first-cousin marriage suggests autosomal recessive inheritance. 

Category: nervous system diseases
Pelvic pain: lessons from anatomy and physiology. Pelvic pain is often a difficult differential diagnosis in the emergency department. For physiologic reasons, pain in the pelvis is difficult to localize to a specific organ, and pelvic peritonitis is hard to recognize. On the other hand, differences in types of pain can be very useful in arriving at a correct diagnosis. The clinician must learn to recognize superficial and deep somatic pain, and differentiate between various types of visceral pain which originate from inflammation, ischemia, or colic. A review of the anatomy and physiology of pelvic pain helps identify some of the problems as well as potential aids in approaching the patient with pelvic pain. 

Category: neoplasms