Melricflash/CW_MedAbstractsAlt huggingface dataset:
Video display terminals and the risk of spontaneous abortion. BACKGROUND. The relation between spontaneous abortion and the use of video display terminals (VDTs) is of great public health concern. Previous investigators of this issue have reported inconsistent findings. METHODS. To determine whether electromagnetic fields emitted by VDTs are associated with an increased risk of spontaneous abortion, a cohort of female telephone operators who used VDTs at work was compared with a cohort of operators who did not use VDTs. To obtain reliable estimates of exposure, we determined the number of hours of VDT use per week from company records and measured electromagnetic fields at VDT workstations and, for purposes of comparison, at workstations without VDTs. Operators who used VDTs had higher abdominal exposure to very-low-frequency (15 kHz) electromagnetic fields (workstations without VDTs did not emit very-low-frequency energy). Abdominal exposure to extremely-low-frequency fields (45 to 60 Hz) was similar for both operators who used VDTs and those who did not. Among 2430 women interviewed, there were 882 pregnancies that met our criteria for inclusion in the study. RESULTS. We found no excess risk of spontaneous abortion among women who used VDTs during the first trimester of pregnancy (odds ratio = 0.93; 95 percent confidence interval, 0.63 to 1.38), and no dose-response relation was apparent when we examined the women's hours of VDT use per week (odds ratio for 1 to 25 hours per week = 1.04; 95 percent confidence interval, 0.61 to 1.79; odds ratio for greater than 25 hours per week = 1.00; 95 percent confidence interval, 0.61 to 1.64). There continued to be no risk associated with the use of VDTs when we accounted for multiple pregnancies, conducted separate analyses of early abortion, late abortion, and all fetal losses, or limited our analyses to spontaneous abortions for which a physician was consulted. CONCLUSIONS. The use of VDTs and exposure to the accompanying electromagnetic fields were not associated with an increased risk of spontaneous abortion in this study. 

Category: general pathological conditions
Prophylaxis of deep venous thrombosis after acute abdominal operation. Two hundred and forty-five patients who underwent acute extensive abdominal operations were randomized into three regimens to achieve optimal prophylaxis of postoperative thromboembolic complications. All of the patients were screened by the 125I-fibrinogen uptake test for seven days and if the phlebographic findings were positive. Of 81 patients receiving low dose heparin, 12 had thromboembolism. Of 79 receiving a combination of low dose heparin and graded compression stockings, two had thromboembolism, and of 85 receiving a combination of dextran and graded compression stockings, 13 had this complication. This difference is significant in favor of the second treatment (p = 0.013). It is concluded that the combination of low dose heparin and graded compression stockings is an effective way to prevent thromboembolism after acute abdominal operations. 

Category: cardiovascular diseases
Vaginosonographic measurement of endometrial thickness in the evaluation of amenorrhea. The progestin-induced withdrawal bleeding test has often been used in patients with amenorrhea to assess endogenous estrogen (E) production. The endometrial thickness measured by vaginal ultrasonography with a 5 MHz transducer is also dependent on E stimulation of the endometrium. In this study, 70 consecutive patients were evaluated with both the progestin-induced withdrawal bleeding test and a measurement of the endometrial thickness by vaginosonography. An endometrial thickness of 1.5 mm or less was selected to predict absence of bleeding after a progesterone (P) challenge test. This resulted in a sensitivity of 94% with a 95% confidence interval (CI) of 0.70 to 1.00 and a specificity of 93% with a 95% CI of 0.82 and 0.98. The positive and negative predictive values were 79% and 98%, respectively. This study shows that the endometrial thickness measured by vaginosonography can predict the results of the P challenge test in patients with amenorrhea. 

Category: general pathological conditions
Risk factors for carotid artery stenosis: an epidemiological study of men aged 69 years. Four hundred and seventy-eight men born in 1914 and residing in the city of Malmo, Sweden, underwent ultrasonic Doppler examination of the carotid arteries in 1982/83. The known risk factors for vascular disease--blood pressure, lipids, glucose, hematocrit, alcohol consumption and Body Mass Index were also measured. A moderate stenosis (diameter reduction 30-59%) of the internal carotid artery was found in 95 men (20%); 15 men (3%) had a greater than or equal to 60% stenosis of the internal carotid artery, while 7 (1.5%) had complete unilateral occlusion. Smoking was found to be significantly related to severe carotid artery disease. There was also a significant correlation between maximum flow velocity in the internal carotid artery and triglycerides. Those quitting smoking before the age of 50 had the same incidence of internal carotid artery disease as non-smokers, while those quitting later in life had a slightly higher incidence than life-long smokers. 

Category: cardiovascular diseases
Nifedipine protects the heart from the acute deleterious effects of cocaine if administered before but not after cocaine. BACKGROUND. We tested the hypothesis that nifedipine, a calcium channel blocker, could ameliorate the toxic effects of cocaine on the myocardium. METHODS AND RESULTS. In an initial protocol, anesthetized dogs were pretreated with nifedipine or saline and then administered cocaine (10 mg/kg, i.v. bolus). Coronary blood flow, heart rate, mean arterial pressure, and the first derivation of left ventricular pressure (dP/dt) were measured at baseline, 2 minutes, and 15 minutes after cocaine administration. Nifedipine pretreatment prevented the early cocaine-induced decrease in coronary blood flow and improved left ventricular dP/dt compared with untreated control animals. After cocaine, ejection fraction fell in the saline group to 37 +/- 3% but increased in the nifedipine group to 59 +/- 4% (p less than 0.05). In a second protocol, vehicle or intravenous nifedipine was administered after an infusion of cocaine (10 mg/kg). In contrast to pretreatment, there was no significant improvement in left ventricular function or coronary blood flow in nifedipine-treated versus control animals. Data from the study also suggested that cocaine acts directly on the myocardium. Within seconds of cocaine bolus administration, coronary blood flow in control animals increased to a peak level 59 +/- 14% higher than before cocaine and left ventricular dP/dt decreased by 23 +/- 5%, providing evidence that cocaine causes direct depression of myocardial function independent of a decrease in myocardial blood flow. CONCLUSIONS. We conclude that nifedipine administered as a pretreatment protects against the depression of myocardial function and decrease in coronary blood flow caused by acute cocaine administration. However, when nifedipine is given after cocaine, no improvement is seen. Cocaine has a direct negative inotropic effect on the heart that is independent of a decrease in coronary blood flow. 

Category: cardiovascular diseases
The hyperlipidemia of the nephrotic syndrome. Lipid abnormalities in patients with the nephrotic syndrome have long been recognized. However, the significance of these lipid abnormalities, the mechanisms producing them, and their potential treatment have all been a cause of debate. Recent data have helped clarify each of these areas of controversy. Studies of the lipoprotein abnormalities of patients with the uncomplicated nephrotic syndrome have shown that many will have elevated levels of total and low-density lipoprotein cholesterol, whereas only a few will have elevated levels of high-density lipoprotein cholesterol. If these lipid abnormalities have the same significance in this population as in other populations studied, then some patients with unremitting nephrotic syndrome will be at high risk for cardiovascular disease. The elevated cholesterol levels noted in the nephrotic syndrome are caused primarily by enhanced hepatic synthesis, with lesser contributions by decreased clearance and altered enzyme activities. The signal for enhanced hepatic lipogenesis may relate to changes in plasma albumin concentration, plasma oncotic pressure, a local effect of viscosity at the hepatic sinusoidal level, or a loss of urinary proteins or other liporegulatory substances. Recently, a number of short-term studies in nephrotic patients have documented the safety and efficacy of lipid-lowering drugs such as the bile acid-binding resins, probucol, and the HMGCoA (hydroxymethylglutaryl coenzyme A) reductase inhibitors. 

Category: cardiovascular diseases
Jejunal-rectal fistula as a complication of postoperative radiotherapy. We present the case of a patient with an unusual, complex enteric fistula with multiple tracts and associated abscesses. The fistula was a late complication of radiotherapy, administered three years earlier, after resection for carcinoma of the sigmoid colon. Most of the small bowel was involved in the radiation-induced disease. A wide resection was performed successfully. This report reviews current literature on intra-abdominal postradiotherapy injuries, particularly intestinal fistulae. 

Category: digestive system diseases
Acute limb ischaemia: the place of intravenous streptokinase. Intravenous streptokinase infusions (100,000 units/h) have been used to treat 48 patients, with 50 episodes of acute limb ischaemia who were unlikely to benefit from a surgical approach. These included 17 acute thromboses, 14 late or distal emboli and 19 bypass graft occlusions. Overall, 17 (34 per cent) instances had complete lysis with reappearance of distal pulses and a further 28 per cent had clinical improvement without change in pulse status. Final outcome after 30 days was limb salvage in 60 per cent, amputation in 24 per cent and death in 16 per cent, but this was achieved after eight patients without lysis had vascular reconstructive surgery. Serious complications were infrequent, but included a fatal stroke, a haematemesis and two episodes of distal embolization. The outcome was not related to the duration of ischaemia or the site of occlusion. Lysis was more frequent with emboli (50 per cent) and graft occlusions (47 per cent) than arterial thromboses (6 per cent). Limb salvage was more likely in patients with no neurological deficit in the limb (70 per cent) than if a deficit was present (37 per cent). In conclusion, intravenous streptokinase produced a moderate benefit with low morbidity and has a role in acute limb ischaemia if surgery is inappropriate and intra-arterial lysis unavailable. In particular, selected patients with emboli or graft occlusions without a neurological deficit may be most suitable. 

Category: cardiovascular diseases
Identification and characterization of a regulated promoter element in the epidermal growth factor receptor gene. We have identified a 36-base-pair proximal element (-112 to -77 relative to the AUG translation initiation codon) in the epidermal growth factor receptor 5' region that functions as a promoter; mediates inductive responses to epidermal growth factor, phorbol 12-myristate 13-acetate, and cyclic AMP; and acts in an orientation-independent manner. This region functions as an enhancer when transferred to a heterologous promoter containing a TATA box. Mutations within the 36-base-pair region alter function as assayed by reporter gene expression in recipient cells. A protein has been identified that demonstrates appropriate binding specificity to mutant DNA sequences that correlates with promoter activity observed in vivo. On the basis of DNA binding characteristics and size, the identified protein appears distinct from several previously identified transcription factors known to bind to G+C-rich regions. 

Category: general pathological conditions
Implications of a dynamical systems approach to understanding infant kicking behavior. Implications of the dynamical systems approach to understanding movement dysfunction in infants are discussed. Traditional theories of motor development attribute changes in movement to the hierarchical maturation of the central nervous system. The dynamical systems approach emphasizes that movement self-organizes as the result of the interaction of the participating subsystems in developmental and real time. In this article, I discuss, from the theoretical perspective of the dynamical systems approach, the organization of leg movements in low- and high-risk preterm and full-term infants, developmental changes in movement in low-risk preterm infants from 34 weeks' gestational age to 40 weeks' postgestational age, and differences in movement between low-risk preterm infants at 40 weeks' postgestational age and full-term infants. Preliminary data on high-risk preterm infants are presented. Based on these data, the necessity to review and reinterpret traditional concepts of motor development is explored. Suggestions are offered and questions posed on how the dynamical systems perspective may influence the practice of physical therapy in the evaluation, and treatment of infants at risk for movement dysfunction. 

Category: nervous system diseases
Hybridization protection assay: a rapid, sensitive, and specific method for detection of Philadelphia chromosome-positive leukemias. The Philadelphia (Ph1) chromosome is present in greater than 90% of patients with chronic myelogenous leukemia (CML) and in 2% to 20% of those with acute leukemias, for which it is an important prognostic marker too. The chimeric BCR-ABL mRNAs resulting from the translocation encode either a 210-Kd or a 190-Kd protein. The techniques used to detect Ph1 chromosome include karyotyping, Southern analysis to demonstrate bcr rearrangement, and polymerase chain reaction to amplify the BCR-ABL transcripts. However, the routine performance of these methods by clinical laboratories is cumbersome, time consuming, and exposes laboratory personnel to radioisotopes. We describe here the clinical application of a new method, the hybridization protection assay (HPA), which uses chemiluminescent acridinium-ester-labeled probes in conjunction with PCR for detection of the amplified BCR-ABL sequences. The method is sensitive, specific, and can reliably distinguish between the transcripts for P190BCR-ABL and P210BCR-ABL. In contrast to the 2 days or longer required for conventional hybridization, HPA analysis can be completed in less than 30 minutes. We have successfully used this method to analyze 60 leukemia samples (34 from Ph1-negative acute leukemias; 6 from Ph1-positive acute leukemias; and 20 from CML) with complete correlation (of BCR-ABL positivity or negativity) with the results of karyotype or Southern Blot analysis of genomic DNA for bcr rearrangement. Therefore, the HPA, in conjunction with PCR, appears to provide a rapid and reliable test for the diagnosis of Ph1-positivity. 

Category: neoplasms
Arterial blood pressure. Correlation with erythrocyte count, hematocrit, and hemoglobin concentration. The relationship between arterial blood pressure and red blood cell variables was investigated in 1013 unselected persons with a blood pressure range of 90 to 225 mm Hg systolic and 50 to 145 mm Hg diastolic. Statistically significant correlations were demonstrated between mean (as well as systolic and diastolic) arterial blood pressure and red blood cell count (r = 0.27; P less than .0001), hematocrit (r = 0.28; P less than .0001), and hemoglobin concentration (r = 0.29; P less than .0001). Average arterial blood pressure was higher in men than in women (133 +/- 16/83 +/- 10 v 124 +/- 16/79 +/- 9 mm Hg, P less than .0001) and this was associated with higher values for erythrocyte count, hemoglobin concentration, and hematocrit in men as compared to women. The significant correlation of blood pressure and hematocrit, which represents one important determinant of blood viscosity, points to a role for rheological factors in the long-term control of blood pressure. Moreover, it might be speculated that the sex difference in blood pressure as observed in the present study may be due, at least in part, to stimulated erythropoiesis in men as compared to women. 

Category: cardiovascular diseases
Regional variation in brain lactate in Leigh syndrome by localized 1H magnetic resonance spectroscopy. Localized water-suppressed 1H magnetic resonance spectroscopy was performed in an 11-month-old infant with Leigh syndrome. Spectra obtained from the basal ganglia, occipital cortex, and brainstem showed elevations in lactate, which were most pronounced in regions where abnormalities were seen with routine T2-weighted magnetic resonance imaging. This approach has allowed us to examine metabolism in brain tissue directly and noninvasively, and may provide a sensitive means for evaluating metabolic disease and the response to therapy in the brain. 

Category: nervous system diseases
Left ventricular pseudoaneurysm with hemoptysis. A 53-year-old man who had previously undergone resection of a left ventricular aneurysm was admitted because of hemoptysis. Preoperative evaluation with computed tomographic scan and cardiac catheterization demonstrated a pseudoaneurysm of the inferior ventricular wall measuring 16 cm in diameter with protrusion into the left hemithorax. The neck of the pseudoaneurysm was a defect in the ventricular wall extending from the base of the mitral valve annulus to the insertion of the posterior papillary muscle. Operative repair was performed using an albumin-coated, low-porosity Dacron patch. 

Category: general pathological conditions
The effect of ursodiol on the efficacy and safety of extracorporeal shock-wave lithotripsy of gallstones. The Dornier National Biliary Lithotripsy Study BACKGROUND. In the treatment of gallstones with extracorporeal shock-wave lithotripsy, the bile acid ursodiol is administered to dissolve the gallstone fragments. We designed our study to determine the value of administering this agent. METHODS. At 10 centers, 600 symptomatic patients with three or fewer radiolucent gallstones 5 to 30 mm in diameter, as visualized by oral cholecystography, were randomly assigned to receive ursodiol or placebo for six months, starting one week before lithotripsy. RESULTS. The stones were fragmented in 97 percent of all patients, and the fragments were less than or equal to 5 mm in diameter in 46.8 percent. On the basis of an intention-to-treat analysis of all 600 patients, 21 percent receiving ursodiol and 9 percent receiving placebo (P less than 0.0001) had gallbladders that were free of stones after six months. Among those with completely radiolucent solitary stones less than 20 mm in diameter, 35 percent of the patients receiving ursodiol and 18 percent of those receiving placebo (P less than 0.001) were free of stones after six months. Biliary pain, usually mild, occurred in 73 percent of all patients but in only 13 percent of those who were free of stones after three and six months (P less than 0.01). There were few adverse events. Only diarrhea occurred with a significantly different frequency in the two groups: 32.6 percent were affected in the ursodiol group, as compared with 24.7 percent in the placebo group (P less than 0.04). Severe biliary pain occurred in 1.5 percent of all patients, acute cholecystitis in 1.0 percent, and acute pancreatitis in 1.5 percent; endoscopic sphincterotomy was performed in 0.5 percent, and cholecystectomy in 2.5 percent. CONCLUSIONS. Extracorporeal shock-wave lithotripsy with ursodiol was more effective than lithotripsy alone for the treatment of symptomatic gallstones, and equally safe. Treatment was more effective for solitary than multiple stones, radiolucent than slightly calcified stones, and smaller than larger stones. 

Category: general pathological conditions
Bilateral Norrie's disease in identical twins. A case of Norrie's disease in an identical twins is reported. No positive family history was obtained. The couple had no other children. The older of the twins died at the age of 9 months of uncertain cause. To the best of my knowledge this is the first case of Norrie's disease reported in Malaysia. And its occurrence in an identical twins is very rare. 

Category: general pathological conditions
Prevalence of carcinoma in situ and other histopathological abnormalities in testes from 399 men who died suddenly and unexpectedly. To determine the prevalence of carcinoma in situ of the testis and other testicular histopathological abnormalities in the general male population, we examined gonads from 399 men 18 to 50 years old who died suddenly and unexpectedly. No sign of malignancy was found in any of these gonads. However, 3 of the 399 men had been previously treated for testicular tumor or carcinoma in situ. Thus, the over-all prevalence of testicular neoplasia in the population studied was 0.8% (95% confidence limits 0.2 to 2.2%). This frequency is of the same magnitude as the lifetime risk of testicular cancer in the Danish male population. The median weights of the left and right testes were 19.3 and 19.7 gm., respectively. This difference was statistically significant (p = 0.00003). Thus, our study confirmed that on average the left testis is smaller than the right testis. The median weight of the gonads collected in our study was 0.9 gm. lower than the weight of testes examined 40 years earlier at the same department of forensic medicine. However, this difference was not statistically significant (p = 0.17). Microscopic examination of the gonadal specimens revealed that 83% of the men exhibited complete spermatogenesis, including late spermatids in all tubules. In the age group studied we found no age-related changes in testicular weight or in the proportion of tubules with degenerative changes, such as spermatogenic arrest, the Sertoli-cell-only syndrome or hyalinization. 

Category: neoplasms
Elevated pulmonary artery pressure. An independent predictor of mortality. Analyses in this study were based on hemodynamic and angiographic data obtained in a cohort of 1,371 predominantly black patients during right and left heart catheterization. All patients were followed up prospectively for a mean of 117 weeks, and 103 fatal events were recorded. In Cox survival analysis, three variables were found to be independently related to survival: pulmonary artery mean pressure (PAMP), number of stenosed vessels, and left ventricular (LV) ejection fraction (p less than 0.01); in multivariate stepwise analysis, PAMP entered the model first with the largest chi 2 value of the three prognostic variables (chi 2 = 33.4; p less than 0.0001). The PAMP was 32 percent higher in decedents compared with survivors (25 + 11 mm Hg vs 19 + 8 mm Hg, p less than 0.01 [mean, SD]) and a 10 mm Hg increase in PAMP was associated with a more than fourfold increase in the relative risk of dying; this finding was independent of pulmonary vascular resistance and therefore could not be attributed to primary pulmonary vascular or parenchymal disease. In both the subgroup of 1,118 patients with a normal LV ejection fraction (greater than 50 percent) and the 253 patients with a reduced ejection fraction (less than 50 percent), PAMP emerged as an independent predictor of mortality (p less than 0.0001 and 0.01, respectively), and is therefore a marker of cardiac disease beyond impairment of systolic contractile function. Among patients without obstructive coronary artery disease, PAMP alone provided prognostic information in the multivariate survival analysis. 

Category: cardiovascular diseases