Melricflash/CW_MedAbstractsAlt huggingface dataset:
Transient mitral regurgitation due to mitral valve prolapse accompanied by systolic anterior motion of the mitral valve. A grade 4/6 systolic murmur, systolic anterior motion of the mitral valve (SAM), and severe mitral regurgitation (MR) documented by two-dimensional Doppler echocardiography developed suddenly on the structurally normal heart of a patient with idiopathic portal hypertension. The patient did not have signs of congestive heart failure and the aforementioned phenomenon disappeared completely when the patient was in hepatic failure. This could be explained by a change in circulating blood volume either by gastrointestinal hemorrhage or hepatic failure. 

Category: cardiovascular diseases
Overview: renal physiology and pathophysiology of aging. Cross-sectional studies in humans have suggested that there is a progressive decline of renal function with age after 40 years. The decline in various functions (eg, tubular maximums, concentrating and diluting abilities, and acidification) tend to parallel the decreases in glomerular filtration rate (GFR) and renal blood (plasma) flow (RPF). Recent observations from the Baltimore Longitudinal Study of Aging suggest that not all individuals follow this pattern, and that, indeed, many show no decline and some even an increase in their renal function over time. Whether the observed decreases in renal function with aging are the results of intervening pathologic processes, eg, immunologic, infectious, and toxic injury and ischemia, or can be related to hyperperfusion and hyperfiltration with resultant glomerulosclerosis, or to some other relentless involutional process, remains unclear. The purpose of this report is to review the descriptive studies documenting the changes in renal morphology and physiology with age and to discuss what is known about mechanisms involved in these losses of renal substance and function. 

Category: cardiovascular diseases
Digoxin for atrial fibrillation: a drug whose time has gone? For over 200 years digitalis compounds have been used to treat atrial fibrillation. The rapid ventricular response to atrial fibrillation is frequently treated with digoxin to produce a controlled heart rate. Digoxin has also been proposed as a treatment for terminating recent-onset atrial fibrillation, for maintaining sinus rhythm after an episode of atrial fibrillation, and as prophylactic therapy in patients with paroxysmal atrial fibrillation to prevent excessive tachycardia during a paroxysm. Perhaps because it has been used for so long, few of these indications have been studied scientifically until recently. Studies now suggest that in patients with atrial fibrillation, digoxin is a poor drug for controlling heart rate during exertion, has little or no effect in terminating the arrhythmia, and may occasionally aggravate paroxysmal atrial fibrillation. Despite adequate digitalization, the heart rate at the onset of a paroxysm of fibrillation in patients receiving the drug does not differ from the heart rate in patients not receiving it. This article discusses the current role of digoxin in the management of patients with chronic, recent-onset, or paroxysmal atrial fibrillation. 

Category: cardiovascular diseases
Periprosthetic chronic inflammation characterized through the measurement of superoxide anion production by synovial-derived macrophages. Periprosthetic macrophages were isolated from the synovium of primary and revision arthroplasty patients. Inflammatory activity was determined by the level of superoxide (O2-) production de novo and in response to phorbol myristate acetate (PMA) stimulation. Nonstimulated primary arthroplasty-derived macrophages produced 2.54 +/- 2.04 pmoles of O2-/minute/10(5) cells. When identical reaction tubes were stimulated with PMA, O2- levels increased to 5.76 +/- 3.77 pmol of O2-/minute/10(5) cells. Nonstimulated revision arthroplasty-derived macrophages produced 3.26 +/- 2.02 pmol of O2-/minute/10(5) cells during this ten-minute time period. When identical reaction tubes were stimulated with PMA, O2- levels increased to 3.98 +/- 2.52 pmol of O2-/minute/10(5) cells. The difference in the ratio of O2- production in response to stimulation between primary and revision groups was statistically significant. The observation of a chronic moderate level of activation and the lack of responsiveness to a potent stimulator suggests that macrophage inflammatory activity is down-regulated in periprosthetic synovium. 

Category: general pathological conditions
Neuropathological changes in transgenic mice carrying copies of a transcriptionally activated Mos protooncogene [published erratum appears in Proc Natl Acad Sci U S A 1991 May 1;88(9):4060] Independent transgenic mouse lines carrying the mouse Mos protooncogene linked to a retroviral transcriptional control sequence display behavioral abnormalities including circling, head tilting, and head bobbing. This dominant phenotype shows various degrees of penetrance in different transgenic founder animals and lines. Neuronal and axonal degeneration, gliosis, and inflammatory infiltrates are found in all transgenic mouse lines in which behavioral traits are present. Recordings of auditory-evoked potentials in mice of one of these lines demonstrate that transgenic mice are deaf; in these mice spiral ganglia degenerate and most of the cochlear hair cells are absent. By using an S1 nuclease protection assay, we have detected RNA expression of the transgene in all tissues examined and, in particular, at high levels in brain. In situ hybridization experiments show that Mos expression can be detected in specific areas of the central nervous system. Lesions are present in areas with demonstrable overexpression of Mos. 

Category: general pathological conditions
Rupture of a benign mediastinal teratoma into the right pleural cavity. A 27-year-old woman with a ruptured mediastinal cystic teratoma had high levels of amylase and carcinoembryonic antigen in cystic fluid. The activity of the amylase is thought to be the most likely cause of the rupture. High levels of carcinoembryonic antigen in pleural fluid are not necessarily indicative of a malignant lesion but may suggest the presence of a ruptured teratoma in patients with mediastinal tumors. 

Category: general pathological conditions
Stance duration under sensory conflict conditions in patients with hemiplegia. Standing balance was evaluated in ten subjects with hemiplegia using a sensory organization balance test (SOT). The SOT is a timed balance test which evaluates somatosensory, visual, and vestibular function for maintenance of upright posture. The duration of bilateral stance was assessed using combinations of three visual and two support surface conditions. Stance time was measured with eyes open, eyes closed, and with each patient wearing a visual dome to produce inaccurate visual information. The support surface conditions involved stance on a hard flat floor followed by attempted stance on a compliant foam surface. Visual deprivation or visual conflict conditions did not cause a loss of balance when stance was performed on a stable surface. However, a lower stance duration was found when patients stood on a compliant surface (p less than .05). Visual compensation was evident during the compliant-surface condition because stance duration showed the greatest reductions with eyes closed and with the visual dome. These findings suggest that the ability to integrate somatosensory information from the lower extremities for balance is compromised after cerebrovascular disease. The implications for diagnosing the specific cause of balance dysfunction and for developing sensory-specific therapeutic interventions are discussed. 

Category: nervous system diseases
Hemodynamic efficacy of rapid saline infusion and dobutamine versus saline infusion alone in a model of cardiac rupture. Despite recent reports describing survival after cardiac rupture, the effectiveness of circulatory support while awaiting definitive surgical treatment is controversial. To assess the efficacy of volume expansion and pharmacologic support in cardiac tamponade due to cardiac rupture, a model of hemorrhagic cardiac tamponade was developed and treatment with rapid saline infusion and dobutamine was compared with rapid saline infusion alone in 15 closed chest dogs. A right ventricular wound of reproducible size was produced by deflating an aortic valvuloplasty balloon that had previously been passed by way of the internal jugular vein into the pericardial space and through a stab wound in the right ventricular free wall. Hemodynamic values were compared at baseline, during tamponade and after a rapid infusion (1 liter at 100 ml/min) of either saline solution alone or saline solution plus dobutamine (20 micrograms/kg per min). Atrial and pericardial pressures increased significantly in both groups. Mean arterial pressure, cardiac output and stroke volume increased with combined saline and dobutamine infusion to values similar to those at baseline (91 +/- 19%, 114 +/- 43% and 94 +/- 37% of baseline, respectively). In contrast, saline infusion alone caused a small increase in cardiac output but failed to significantly increase mean arterial pressure or stroke volume (76.8 +/- 14.2%, 55 +/- 18% and 51 +/- 17% of baseline, respectively). Combined rapid infusion of saline solution and dobutamine infusion has a more beneficial hemodynamic effect and may be more effective than rapid saline infusion alone in resuscitating patients with hemorrhagic cardiac tamponade due to cardiac rupture. 

Category: cardiovascular diseases
Effect of obesity on safe duration of apnea in anesthetized humans. Obese patients have a decreased functional residual capacity and, hence, a reduced oxygen supply during periods of apnea. To determine whether obese patients are at greater risk of developing hypoxemia during induction of anesthesia than patients of normal weight, 24 patients undergoing elective surgical procedures were studied. Group 1 (normal) were within 20% of their ideal body weight. Group 2 (obese) were more than 20% but less than 45.5 kg over ideal body weight. Group 3 (morbidly obese) were more than 45.5 kg over ideal body weight. Patients were preoxygenated for 5 min or until expired nitrogen was less than 5%. After induction of anesthesia and muscle relaxation the patients were allowed to remain apneic until arterial saturation as measured by pulse oximetry reached 90%. The time taken for oxygen saturation to decrease to 90% was 364 +/- 24 s in group 1, 247 +/- 21 s in group 2, and 163 +/- 15 s in group 3; these times are significantly different at P less than 0.05 between groups. Regression analysis of the data demonstrated a significant negative linear correlation (r = -0.83) between time to desaturation and increasing obesity. These results show that obese patients are at an increased risk of developing hypoxemia when apneic. 

Category: general pathological conditions
Malignant adenolymphoma of the parotid gland: report of carcinomatous transformation. Malignant transformation of an adenolymphoma (Warthin's tumour) is a rare event. This paper presents a case of carcinoma arising in an adenolymphoma of the parotid gland. 

Category: neoplasms
Variants of intestinal metaplasia in the evolution of chronic atrophic gastritis and gastric ulcer. A follow up study. A follow up study with biopsy was initiated in 1982 to define the relations between variants of intestinal metaplasia and the evolution of chronic atrophic gastritis and gastric ulcer. All patients (58 with chronic atrophic gastritis and 66 with gastric ulcer) had intestinal metaplasia at the start of the study. In the six year period to 1988 a total of 241 biopsies were performed on the patients with chronic atrophic gastritis and 243 on the patients with gastric ulcer. Initially, 81% of the patients with chronic atrophic gastritis presented with type I intestinal metaplasia and 14% with type III intestinal metaplasia. During follow up type I was predominant, often associated with grades 2 and 3 active disease (81%) and 45% of these patients reverted to a non-intestinal metaplasia status by the third year of follow up. In contrast, type III metaplasia was more common in the absence of appreciable inflammation (78% of biopsy specimens), being persistent in five of seven patients in the third year of follow up, and was found to be associated with dysplasia in three of these patients. Similarly, the initial biopsy specimen showed type I metaplasia in most patients with gastric ulcer (82%) and type III in only 4%. Type I metaplasia was also predominant in these patients (80%), particularly in active disease (68%), gradually regressing with healing. In contrast, type III was associated with delayed ulcer healing and reactivation (75%; six of eight patients). 

Category: digestive system diseases
High dietary fiber and low saturated fat intake among oligomenorrheic undergraduates. Numerous functional risk factors are associated with the occurrence of secondary amenorrhea in young women. Less is known regarding factors associated with the more prevalent problem of oligomenorrhea. We have evaluated nutrient intake, body composition, perceived psychological stress, 24-hour urinary cortisol, and urinary C peptide (UCP) in 35 eumenorrheic, 11 mildly oligomenorrheic, and 10 oligomenorrheic nonathletic undergraduate women. Nutrient intake was evaluated by a validated food frequency questionnaire. Oligomenorrheic women were found to consume significantly more dietary fiber, crude fiber, and polyunsaturated fat, and significantly less saturated fat than their eumenorrheic classmates. Oligomenorrheic women had significantly lower 24-hour UCP excretion than mildly oligomenorrheic women. The groups did not differ in any aspect of body composition, body weight, age of menarche, perceived psychological stress, or urinary cortisol excretion. The data suggest that higher intake of fiber and lower intake of saturated fat may be associated with oligomenorrhea among otherwise healthy undergraduate nonathletic women. 

Category: general pathological conditions
Spinal coning after lumbar puncture in prostate cancer with asymptomatic vertebral metastasis: a case report. A 60-year-old man was admitted to our hospital for complete urinary retention. Prostate cancer was diagnosed and anti-cancer chemotherapy was administered. Regression of prostatic enlargement was appreciated and difficult urination improved. At 6 months after the initial treatment vertebral metastasis of T10-11 was noted on a bone scintigram but there were no symptoms induced by bone metastasis. Orchiectomy was performed with the patient under lumbar anesthesia. Complete paralysis of both lower extremities occurred postoperatively. Computerized tomography and myelographic findings demonstrated complete subarachnoid block with an extramedullary spinal cord tumor. It was concluded that traction on the spinal cord producing neurological deterioration (spinal coning) occurred after removal of the cerebrospinal fluid by lumbar puncture. 

Category: neoplasms
Rapid admixture blood warming: technical advances. The technique of rapid admixture blood warming of cold erythrocyte units is designed to warm erythrocyte units rapidly (less than 30 sec) while simultaneously providing saline for dilution. However, questions have been raised about the recommended use of a standard 250-ml bolus of 70 degrees C admixture saline, the uniformity and speed of blood unit warming, the difficulties inherent in keeping saline bags at 70 degrees C, and the safety of the methodology. To answer these questions, a series of tests were performed and modifications of the technique were introduced. The mean weight of 1000 successive units of erythrocytes for adult infusion was 305 g (range 220 to 410). The maximum temperature was 44 degrees C, using an internal temperature probe (1-cm temperature gradations; 2-sec recording intervals) when the smallest unit was admixed with a 250 ml 70 degrees C saline bolus; the largest unit had a minimum temperature of 30 degrees C. Plasma Hgb, osmotic fragility, and K of the minimum size erythrocyte unit showed no significant deviation from its control. Both thermographic photographs and the internal temperature recordings of the erythrocyte units demonstrated that solely due to fluid turbulence, uniform mixing occurs within approximately 30 sec of beginning the admixture process. Inverting the blood units caused a thermal layering of fluids and an unacceptable maximum blood temperature of 50 degrees C. There was no difference between the mixing time or efficacy in the presence of standard or large-bore iv tubing or additional in-line filters. Volumes of the 250-ml saline bags for admixture decreased markedly with deviations in electrolyte composition after greater than 2 wk at 70 degrees C. 

Category: general pathological conditions
Syringomatous squamous tumors of the breast. Four cases are reported of syringomatous squamous tumors of the breast occurring in women aged 37 to 70 years. The lesions were characterized histologically by relatively well-circumscribed tumor-like nodules composed of a proliferation of teardrop or comma-shaped islands of squamous epithelium. The squamous epithelial islands contained central lumens lined by eosinophilic cuticles and were surrounded by a densely cellular fibrous matrix, thus closely resembling the growth pattern of dermal eccrine syringomas. The lesions appeared to arise de novo from breast parenchyma without evidence of transitions with the surrounding normal or hyperplastic mammary epithelium and were not associated with the overlying skin or nipple epidermis. In all cases, the surrounding breast tissue showed fibrocystic and benign proliferative changes, and in one case, the lesion was found in the vicinity of a large cyst surrounded by microcalcifications. All patients were treated by local surgical excision and have shown no evidence of recurrence over a follow-up period of 1 to 6 years. The histologic differential diagnosis and the possible pathogenesis of these lesions are discussed. 

Category: neoplasms
Alarm reaction and serum K+ in hypertensive patients. The effect of serum K+ of the alarm reaction induced by the participation to an experimental noninvasive study was evaluated in 35 subjects with borderline hypertension and in 18 essential hypertensives. A group of 44 inpatients undergoing routine blood sampling served as a control. Serum K+, blood pressure and heart rate were measured before (casual) and after (baseline) 20 min of rest in the recumbent position. Baseline serum K+ values were significantly higher than casual values in patients participating to the experimental protocol while no change was observed in inpatients undergoing routine blood sampling. The increase in serum K+ induced by relaxation was significantly related to heart rate decrease (r = 0.73). After relaxation 75% of patients had an increase in serum K+ with a change greater than 10% in about 35% of patients. In a subgroup of patients who repeated the same test three times, the alarm reaction was still evident and not reproducible within each patient. These data suggest that when potassium levels are measured in outpatients undergoing diagnostic or experimental procedures falsely reduced levels can be found in a large proportion of subjects. 

Category: cardiovascular diseases
Multiagent chemotherapy in relapsed acute lymphoblastic leukemia in children. Twenty-seven evaluable children with early first bone marrow relapse of acute lymphoblastic leukemia were treated with an intensive induction/consolidation and ongoing maintenance therapy. Induction therapy consisted of a 35-day course of daunomycin, vincristine, and prednisone, immediately followed by teniposide, cytosine arabinoside (Ara-C), and L-asparaginase. Intrathecal methotrexate, hydrocortisone, and Ara-C were given through the induction/consolidation phase. Twenty-three of 27 patients achieved remission by the end of induction/consolidation. Maintenance with the same drugs in a modified dosage schedule continued for approximately 2 years. A small subgroup of patients who were M3 at day 35 but M1 at day 56 (end of induction/consolidation) and had a cumulative event-free survival (EFS) of only 0.40 at 6 months, all had relapsed by 15 months. However, the EFS for M1 patients by day 35 and maintained on chemotherapy was 0.64 at 12 months and 0.32 at 30, 36, and 48 months, respectively. Although good reinduction and remission duration rates at 12 to 24 months were achieved and an apparent plateau in survival occurs at 30 months, fall-off in survival would not be unexpected with probably less than 20% alive after 5 years. 

Category: neoplasms
Protective and curative effects of rifampicin in Acanthamoeba meningitis of the mouse. BALB/c mice inoculated nasally with Acanthamoeba culbertsoni, resulting in amebic encephalitis and death 3-7 days, were treated with rifampicin prophylactically (daily for 2 days with 75 and 100 mg/kg) and after infection (daily for 5 days with doses of 10-100 mg/kg). Prophylactic treatment resulted in full protection against infection, as assessed by absence of symptoms of central nervous system malfunction and negative brain culture 10 days after inoculation. Curative treatment was effective at the same doses; however, at doses of 10, 25, and 50 mg/kg, only two of six animals were free of symptoms and infection. 

Category: nervous system diseases
Familial trigeminal anesthesia. Familial congenital trigeminal anesthesia as an isolated abnormality is an unusual disorder. To our knowledge, only one family has previously been reported. We report here a family with three affected members demonstrating facial anesthesia, bilateral corneal changes, and nasal septal damage secondary to self-traumatization. Magnetic resonance imaging demonstrated hypoplasia of gasserian ganglia and trigeminal nerves in the affected father of two affected sons. The pathogenesis of this disorder appears to be congenital hypoplasia of the trigeminal nerves and gasserian ganglia that is inherited in a dominant fashion. 

Category: nervous system diseases
The neglected medical history and therapeutic choices for abdominal pain. A nationwide study of 799 physicians and nurses. A random national sample of 501 physicians and 298 nurse practitioners was presented a case vignette describing a patient with epigastric pain and endoscopy showing diffuse gastritis. Respondents were encouraged to request further information and then were asked for recommendations. History available if requested included substantial use of aspirin, coffee, cigarettes, and alcohol, and severe psychosocial stress. More than one third of the physicians chose to initiate therapy without seeking a relevant history. Nearly half of all physicians indicated that a prescription would be the single most effective therapy; 65% recommended a histamine antagonist. By contrast, only 19% of nurse practitioners opted to treat without taking further history; the nurse sample asked an average of 2.6 questions vs 1.6 for physicians; only 20% of the nurses recommended a prescription medication. These findings raise concerns about the adequacy of basic history taking in this setting and the underuse of nonpharmacologic approaches in favor of excessive reliance on prescription drugs, even when not indicated by clinical circumstances. 

Category: digestive system diseases
Deficiency of calcitonin gene-related peptide in Raynaud's phenomenon. Skin biopsy samples from the fingers of nine patients with primary Raynaud's phenomenon, nine with the disorder associated with systemic sclerosis, and eleven healthy controls were examined by immunocytochemistry. There were no differences between the groups in the distribution of PGP 9.5 (a pan-neuronal marker) immunoreactivity, but there was a significant reduction in the number of calcitonin gene-related peptide (CGRP) immunoreactive neurons in the skin of patients with primary Raynaud's phenomenon and those with systemic sclerosis. These findings implicate dysfunction of the CGRP neurovascular axis in the pathophysiology of Raynaud's phenomenon. 

Category: cardiovascular diseases