Melricflash/CW_MedAbstractsAlt huggingface dataset:
Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group. We compared 211 consecutive patients who had acute ischemic hemispheric stroke and atrial fibrillation with 837 consecutive patients who had stroke without atrial fibrillation. The atrial fibrillation group included a higher frequency of women, older subjects, and those with a severe neurologic deficit, abnormal computed tomogram, and elevated heart rate. The 1-month case-fatality rate in the atrial fibrillation group was 27% while that in the group without atrial fibrillation was 14%. The 6-month case-fatality rates in the two groups were 40% and 20%, respectively. The risk of death attributable to atrial fibrillation, adjusted for the effect of other prognostic factors, was significant at 1 month (relative risk = 1.55) and at 6 months (relative risk = 1.74). The causes of death were equally distributed in the two groups during both the acute and subacute phases. We conclude that atrial fibrillation is a negative prognostic factor in patients hospitalized for acute stroke. Nevertheless, cerebral embolism alone does not completely explain the increase in mortality for stroke patients with atrial fibrillation. Other associated pathogenetic mechanisms must also be taken into account. 

Category: cardiovascular diseases
The role of neutrophils and platelets in a rabbit model of thromboembolic stroke. Cerebral ischemia is accompanied by many of the cardinal features of acute inflammation such as neutrophil and platelet activation and accumulation. We sought to determine whether circulating neutrophils or platelets contribute to brain injury in a rabbit model of thromboembolic stroke that includes a fixed duration of superimposed systemic hypotension. We randomized 18 rabbits to receive either antineutrophil antiserum (n = 6), antiplatelet antiserum (n = 5), or nonimmune serum (n = 7). We assessed brain ischemia by measuring cerebral blood flow, intracranial pressure, and infarct size. Following the intracarotid administration of an autologous clot, cerebral blood flow in all groups fell to less than 5 ml/100 g/min during induced hypotension. After restoration of baseline blood pressure, mean cerebral blood flow in neutropenic animals recovered to 20-30 ml/100 g/min while that in control and thrombocytopenic rabbits remained at less than 10 ml/100 g/min. Intracranial pressure in control animals rose steadily to a final value of 241% of baseline, while a much smaller increase (148% of baseline) was noted in the thrombocytopenic group; no change from baseline was evident in the neutropenic group. Infarct size was significantly (p less than 0.05) reduced in the neutropenic group but not in the thrombocytopenic group. These results suggest that neutrophils may be important contributors to ischemia-induced brain injury whereas the role of platelets is more subtle. 

Category: cardiovascular diseases
Systemic and renal production of thromboxane A2 and prostacyclin in decompensated liver disease and hepatorenal syndrome. To assess the role of altered renal and systemic production of thromboxane A2 and prostacyclin in the hepatorenal syndrome, urinary excretion of their major renal and extrarenal metabolites was measured in patients with compensated and decompensated liver disease, chronic renal failure, and hepatorenal syndrome. Urinary excretion rates of all prostanoids (renal and extrarenal) were increased in subjects with liver disease compared with normal controls. Moreover, they were considerably higher in subjects with severe hepatic decompensation but good renal function compared with those with hepatorenal syndrome. In contrast, the excretion rate of all metabolites was reduced in patients with chronic renal failure. The excretion rate of all metabolites was markedly elevated during the early stages of hepatorenal syndrome and decreased in parallel with creatinine clearance. When corrected for creatinine clearance, there was a strong correlation between prostanoid excretion and serum bilirubin in subjects with liver disease; there was no difference, however, in the excretion of renal and extrarenal prostanoids between hepatorenal syndrome and severe hepatic decompensation. It is concluded that hepatic decompensation is associated with a progressive increase in prostanoid excretion but that changes in production of prostacyclin or thromboxane A2 are unlikely to be major factors in the pathogenesis of the hepatorenal syndrome. 

Category: general pathological conditions
Coronary vascular remodeling and myocardial fibrosis in the rat with renovascular hypertension. Response to captopril. Progressive myocardial fibrosis, including the accumulation of collagen within the adventitia of intramyocardial coronary arteries, is seen in the hypertrophied rat myocardium secondary to renovascular hypertension (RHT) and has been held responsible for alterations in myocardial diastolic stiffness. This study was undertaken to test the hypothesis that this presumptive angiotensin-aldosterone mediated fibrosis and its functional consequences could be favorably altered by an antihypertensive oral dose (50 mg/kg/day) of the angiotensin converting enzyme (ACE) inhibitor captopril. Three groups were studied: control; untreated RHT for 8 weeks; treated RHT, with captopril started 48 h before banding and continued for 8 weeks. Interstitial collagen volume fraction and perivascular collagen area (morphometry), the fibrillar nature of collagen (picrosirius polarization), and the end diastolic stress-strain relation of the intact left ventricle were examined in each group. In comparison to untreated animals with RHT, we found that captopril, begun prior to banding, attenuated interstitial and perivascular fibrosis and prevented hypertrophy and the rise in diastolic stiffness 8 weeks later. Thus, an adverse accumulation of collagen in the interstitium and around intramyocardial coronary arteries, and its functional consequences in the rat with RHT, can be prevented by captopril. Other ACE inhibitors may have similar salutary effects, but remain to be evaluated. The pathogenetic origin of myocardial fibrosis in RHT requires further investigation, but appears to be related to the angiotensin-aldosterone system. 

Category: cardiovascular diseases
Management of spinal cord compression secondary to metastatic prostatic carcinoma. Spinal cord or cauda equina compression from prostatic cancer is an oncologic emergency necessitating prompt evaluation and treatment. The strong correlation between pretreatment motor status and treatment outcome underscores the importance of immediate treatment before further neurologic deterioration and before the damage to the spinal cord becomes permanent. Patients with known osseous metastases should be alerted by their clinicians to seek medical help within hours should they develop weakness in an extremity. Prompt MRI of the entire spine should be done prior to treatment. Myelography should be reserved for those patients who cannot undergo a technically adequate or expeditious MRI study. The convenience of MRI relative to myelography allows clinicians to diagnose actual or impending spinal cord compression earlier. High-dose steroids (dexamethasone) should be instituted immediately, and endocrine therapy should be started if not already in use. Ambulatory and moderately paraparetic patients seem best treated initially with radiation alone. Immediate surgical decompression should be used in patients with an expected lifespan of at least 6 months who deteriorate during radiation, who have had previous radiation to the involved site, or who have a potentially correctable unstable spine. In addition, paraplegic patients or severely paraparetic patients with recent neurologic deterioration should be treated with immediate surgical decompression if they are judged reasonably able to tolerate the surgery. These patients should then receive postoperative radiation treatment. 

Category: neoplasms
Continuous papaveretum infusion for the control of pain in painful sickling crisis. We describe our experience of using continuous papaveretum infusions to control pain in 24 children admitted on 45 occasions with painful sickling crisis. The children were aged from 1.7 to 14.3 years. Infusion duration ranged from one to nine days (median three days), total dose from 0.3 to 21 mg/kg (median 2.4 mg/kg), with a pronounced tendency for dosage to increase with increasing age. No respiratory depression was observed. One infusion was discontinued because of cerebral toxicity. 

Category: nervous system diseases
Bilateral homonymous visual field defects as initial manifestation of multiple sclerosis. Symptomatic suprageniculate lesions in multiple sclerosis expressed as a visual field defect are infrequent. The present case developed a bilateral homonymous defect as the initial and unique symptom of the disease. It was confirmed by nuclear magnetic resonance imaging, which disclosed extensive demyelinating areas in both optic nerve radiations. The mode of onset, perimetric findings, and unusual presentation of this condition are briefly discussed. 

Category: nervous system diseases
Pancreatic involvement in human immunodeficiency virus infection. Involvement of the pancreas by human immunodeficiency virus (HIV) infection has not been adequately addressed and is the object of this review. I analyzed the English language literature, including single case reports of pancreatic involvement and larger series reporting detailed pathological findings of patients with HIV infection. Nonspecific pathological changes in the pancreas are frequently seen at autopsy of HIV-infected patients, but are not more common than in controls. Several types of infections (mainly cytomegalovirus, Cryptococcus neoformans, and Mycobacteria) and neoplasms (lymphoma and Kaposi's sarcoma) can involve the pancreas because they are usually disseminated. Although the serum amylase may be elevated, the patient remains asymptomatic. Occasional instances of severe and even fatal pancreatitis have been reported with HIV infections and attendant drug toxicity. Pentamidine has a predictable incidence of hypoglycemic episodes and 2',3'-dideoxyinosine provokes pancreatitis in a minority of treated patients. Such drug toxicity seems to deserve greater clinical concern than opportunistic infections or neoplasms. 

Category: digestive system diseases
Colonic lipoma as a source of massive hemorrhage. Report of a case. Colonic lipomas are a rare source of massive lower gastrointestinal bleeding requiring operative intervention. A case of massive hemorrhage from cecal lipomatosis is presented. The methods of preoperative diagnosis and treatment are discussed. 

Category: neoplasms
Effects of nitroprusside on transmitral flow velocity patterns in extreme heart failure: a combined hemodynamic and Doppler echocardiographic study of varying loading conditions. To explore the mechanisms of change of left ventricular diastolic filling associated with preload and afterload reduction, the influence of nitroprusside on the transmitral flow velocity pattern, pulmonary capillary wedge pressure and left ventricular pressure interaction was studied in 11 patients with end-stage heart failure. Pulsed Doppler echocardiographic recordings of mitral inflow were obtained with simultaneous high fidelity left ventricular and phase-corrected pulmonary capillary wedge pressure recordings before and during levels of nitroprusside infusion. With nitroprusside, left ventricular systolic and end-diastolic pressures decreased by 14% and 41% (p less than 0.05, p less than 0.05), respectively, and cardiac output increased by 67% (p less than 0.05). The pulmonary capillary wedge-left ventricular crossover pressure decreased by 41% (p less than 0.05), but the time constant of isovolumetric left ventricular pressure decrease T was insignificantly changed. Isovolumetric relaxation time and acceleration and deceleration times of the early diastolic filling wave were significantly prolonged with nitroprusside infusion (p less than 0.05, p less than 0.05 and p less than 0.05, respectively). Peak early diastolic filling velocity was maintained (65 +/- 11 to 62 +/- 13 cm/s, p = NS) in spite of the decreased absolute crossover pressure. Changes in peak early diastolic filling velocity correlated weakly with changes in the crossover pressure (r = 0.48, p less than 0.05) and correlated better with the crossover to left ventricular minimal pressure difference (r = 0.78, p less than 0.05). Peak early diastolic filling velocity appears to be most affected by the early diastolic pulmonary capillary wedge to left ventricular pressure difference rather than the absolute pulmonary capillary wedge pressure. The lack of peak flow velocity change during nitroprusside infusion could be explained by either the associated decrease in left ventricular minimal pressure or downward shift of left ventricular diastolic pressure by the same amount as the decrease in pulmonary capillary wedge pressure. This may reflect a reduction of external constraint to ventricular distensibility produced by a reduction in filling volume in patients with a markedly dilated ventricle. Thus, a prolonged early diastolic filling period and preserved peak early diastolic filling velocity in spite of decreased left ventricular filling pressure and constant relaxation rate are associated with the beneficial effects of nitroprusside on left ventricular function in patients with severe congestive heart failure. 

Category: cardiovascular diseases
Percutaneous fine-needle aspiration cytologic study of main pancreatic duct stenosis under pancreatographic guidance. When pancreatography shows a stenosis of the main pancreatic duct in patients with normal or inconclusive ultrasound and computed tomography, the exact nature of such stenosis is sometimes difficult to precise before surgical exploration. In such cases, the authors systematically performed a percutaneous fine-needle aspiration cytologic study of the stenosis under pancreatographic guidance. Fifteen patients were referred because of suspected pancreatic malignancy. The tumor markers, carcinoembryonic antigen (CEA) and CA 19-9 were normal in 11 patients and elevated in one patient, whereas only CA 19-9 was elevated in three others. In 14 cases, both the ultrasound and computed tomography did not show any obvious pancreatic mass. The pancreatography was done through endoscopic retrograde cholangiopancreatography (ERCP) (12 patients) or percutaneously in case of failure at ERCP3 and showed a main pancreatic duct stenosis that underwent aspiration by percutaneous fine needle precisely positioned using biplane fluoroscopy. The aspirated material was then smeared on glass slides, air-dried, and stained by Giemsa. In nine of the 15 patients, cytologic study revealed adenocarcinoma. This was confirmed by surgery in five and by progressive deterioration followed by death in four. In six patients, cytologic study gave a nonmalignant result. Chronic pancreatitis was found in five of them, confirmed at surgery in three and based on uneventful follow-up of at least 12 months in two others. In one case, a pancreatic adenocarcinoma not detected by cytologic study was found at surgery. Thus, the sensitivity and specificity of this diagnostic approach were 90% and 100%, respectively. No serious complication was noticed. The authors conclude that when ultrasound and computed tomography are inconclusive, percutaneous fine-needle aspiration cytologic study of main pancreatic duct stenosis under pancreatographic guidance is a safe, simple, and helpful procedure in the investigation of patients with suspected pancreatic malignancy. 

Category: general pathological conditions
Chylothorax as presenting manifestation of adenocarcinoma with probable gastric primary. Chylothorax is an unusual complication of various malignant neoplasms, generally lymphomas. The few reported cases of chylothorax with gastric and other abdominal malignancies have involved large abdominal masses with prominent adenopathy and chylous ascites. We describe a patient in whom chylothorax was the presenting manifestation of an adenocarcinoma with probable gastric primary, developing prior to any clinical or radiologic evidence of tumor. 

Category: general pathological conditions
Nuclear shape as a prognostic discriminant in colorectal carcinoma. In search for a more reliable prognostic discriminant, a retrospective analysis of 100 cases of colorectal carcinoma having undergone curative resection and followed for at least 5 years were assessed by nuclear morphometry. Each case was staged according to the Dukes' classification as well as graded histologically. For all patients in this series, the perimeter, area, and nuclear shape factor of 50 interphase nuclei were determined for each carcinoma. The information was obtained through the use of an image analysis system by tracing the nuclear profiles (magnification 1000x) as digitized on a video screen. The nuclear shape factor was defined as the degree of circularity of the nucleus, a perfect circle recorded as 1.0. A nuclear shape factor greater than 0.84 was associated with poor outcome. Multiple regression models showed that the single nuclear parameter of the shape factor was the most highly significant predictor of survival (P less than 0.0001). This variable remained highly significant even when corrected for sex, age, histologic grade, and Dukes' classification. These findings indicate that a nuclear shape factor greater than or equal to 0.84 as determined by nuclear morphometry is an independent morphometric nuclear variable of great importance in the prognosis of large bowel carcinoma. 

Category: neoplasms
Impairment of the myocardial ultrastructure and changes of the cytoskeleton in dilated cardiomyopathy. This study was designed to determine the morphological correlate of chronic heart failure. Myocardial tissue from eight patients undergoing transplantation surgery because of end-stage dilated cardiomyopathy was investigated by electron microscopy and immunocytochemistry using monoclonal antibodies against elements of the cytoskeleton: desmin, tubulin, vinculin, and vimentin. The tissue showed hypertrophy, atrophy of myocytes, and an increased amount of fibrosis. Ultrastructural changes consisted of enlargement and varying shape of nuclei, numerous very small mitochondria, proliferation of T tubules, and accumulation of lipid droplets and glycogen. The most obvious ultrastructural alteration was the decrease of myofilaments, ranging from rarefication to complete absence of sarcomeres in cells filled with unspecified cytoplasm. Immunocytochemistry showed that desmin was localized at the Z lines. In diseased myocardium, the amount of desmin was increased, but it was disorderly arranged. Tubulin formed a fine network throughout the myocytes and was significantly increased in cardiomyopathic hearts. Vinculin, a protein closely associated with the cytoskeleton, occurred not only at the sarcolemma and the intercalated disc but also within the myocardial cells. Ultrastructural changes and alterations of the cytoskeleton were severe in about one third of all cells. About one third of all cells showed moderately severe changes, and the remaining cells were normal. Vimentin was present in the interstitial cells and was increased in relation to the increase of fibrosis. We conclude that the increase of fibrosis, the degeneration of hypertrophied myocardial cells, and the alterations of the cytoskeleton are the morphological correlates of reduced myocardial function in chronic heart failure. 

Category: cardiovascular diseases
Neurinoma in the cavernous sinus: report of two cases. Two cases of trigeminal neurinoma located solely in the cavernous sinus are reported. Preoperatively, magnetic resonance imaging provided the accurate localization of the lesions, allowing precise planning of the surgical approach, that is, a subtemporal lateral approach and a pterional superior approach, respectively. The neurinomas inside the cavernous sinus were removed successfully, and the patients developed no new neurological deficits except for anesthesia in the 1st division of the trigeminal nerve. The characteristic magnetic resonance imaging findings of trigeminal neurinoma in the cavernous sinus are presented, and the different surgical approaches are discussed. 

Category: neoplasms
Effects of the calcium antagonist nilvadipine on focal cerebral ischemia in spontaneously hypertensive rats. We studied the efficacy of preischemic and postischemic systemic treatment with a new calcium antagonist nilvadipine in a permanent focal cerebral ischemia model of spontaneously hypertensive rats. Rats that underwent microsurgical middle cerebral artery occlusion were blindly assigned to a single intraperitoneal injection of nilvadipine (0.32 mg/kg) or the same amount of polyethylene glycol either 15 minutes before, immediately after, 1 hour after, or 3 hours after occlusion of the left middle cerebral artery. Neurologic conditions of rats were closely examined, and rats were killed 24 hours later. Removed brains were sliced coronally, stained with triphenyltetrazolium chloride, and the size of infarct was determined. Although no neurologic improvements were observed in the treated rats, the area of infarcts was significantly reduced in the groups treated before, immediately after, and 1 hour after occlusion of the middle cerebral artery. Treatment started 3 hours after occlusion was ineffective. 

Category: nervous system diseases
Early afterdepolarizations and triggered activity in rabbit cardiac Purkinje fibers recovering from ischemic-like conditions. Role of acidosis. BACKGROUND. The mechanisms underlying repetitive activity during reperfusion of ischemic myocardium are thought to include triggered responses elicited at short pacing cycle lengths. The potential to generate repetitive responses at longer pacing cycle lengths under similar conditions, however, has not been explored. Thus, the present study examined the role of cycle length on the cellular electrical changes produced during recovery from ischemic-like conditions and identified the major component precipitating nondriven, repetitive activity. METHODS AND RESULTS. Transmembrane potentials were recorded in vitro from isolated rabbit Purkinje fibers exposed to hypoxia (defined as PO2 less than 30 mm Hg, high [K+]o, and zero glucose) plus lactic acidosis (pH 6.7) for 45 minutes and during recovery in normal Tyrode's solution (pH 7.4). Compared with control, action potential duration (90% repolarization) during recovery increased transiently by 40.9 +/- 11.8 and 241.0 +/- 51.1 msec at respective basic cycle lengths of 1,000 and 3,000 msec (both p less than 0.005). In 81% of preparations, action potential prolongation was accompanied by early afterdepolarizations and triggered activity generated from low (positive to -40 mV) or high (negative to -40 mV) membrane potentials. In 62% of experiments, brief periods of abnormal automaticity also occurred. Triggered responses were 1) unaffected by 1 microM ryanodine, 2) abolished by pacing at short basic cycle lengths or by exposing tissues to 2.5 micrograms/ml lidocaine, and 3) more easily induced at long basic cycle lengths or by superfusing 2.5 micrograms/ml quinidine. When tissues were conditioned with hypoxia alone (pH 7.4), action potential prolongation on recovery was comparatively small, and nondriven responses did not develop. Conversely, addition of 10-20 microM amiloride to the hypoxic, acidic test solution augmented recovery-induced action potential prolongation. CONCLUSIONS. We conclude that acidosis, as a component of ischemia, plus slow pacing frequencies may mediate the genesis of early afterdepolarizations and triggered activity in Purkinje fibers on recovery, long after extracellular pH has been restored to normal. These data may have clinical relevance to the mechanisms of reperfusion arrhythmias in the intact human heart. 

Category: cardiovascular diseases