Melricflash/CW_MedAbstractsAlt huggingface dataset:
Health effects of radon exposure. Report of the Council on Scientific Affairs, American Medical Association. The consensus of scientists is that exposure to radon is hazardous, but disagreement exists about the effects of lower radon concentrations. Studies of underground miners have indicated that the risk of lung cancer increases in proportion to the intensity and duration of exposure to radon, and a recent authoritative report (BEIR IV) has concluded that estimates based on those studies are appropriate for estimating risks for occupants of homes. The BEIR IV report concluded that smoking cigarettes increases the risk of lung cancer associated with radon. Average radon levels in US homes range from 0.055 to 0.148 Bq/L (1.5 to 4 pCi/L), depending on the circumstances of measurement. Few studies have investigated health outcomes in occupants of homes with high radon levels. In advising patients about reducing the risks associated with radon, physicians should consider the costs, as well as the benefits, of remedial actions, and they should emphasize that, by far, the best way to avoid lung cancer is to stop smoking. 

Category: neoplasms
Traumatic popliteal artery pseudoaneurysms: case report and review of the literature. Traumatic pseudoaneurysms of the popliteal artery are an uncommon late complication of arterial injury. Although reviewed extensively in wartime, they occur less frequently in civilian trauma and have accordingly been less frequently studied. A case report of a traumatic popliteal artery pseudoaneurysm and review of the literature are presented. 

Category: cardiovascular diseases
Genetic determination of cytomegalovirus-induced and age-related cardiopathy in inbred mice. Characterization of infiltrating cells. Carditis developed 7 days after the administration of murine cytomegalovirus to neonatal, young adult or aged mice of varying sensitivity to lethal infection with this virus. The inflammation persisted for up to 80 days, but infected myocardial cells were rare and were not seen after day 10. The inflammatory cells comprised macrophages (up to 30%) and T cells (up to 80%), with a high ratio of Lyt2+ to L3T4+ cells throughout. Although the H-2 genotype affects murine cytomegalovirus replication at the level of individual cells, and hence resistance to lethal infection, it did not determine resistance to cardiopathy per se. However BALB/c, BALB.B, and BALB.K mice developed persistent myocarditis regardless of age at infection, and age-related cardiopathy was frequent and severe in infected and uninfected mice. B10 and B10.BR mice also developed myocarditis after neonatal infection, but inflammation resolved rapidly after adult infection and age-related cardiopathy was correspondingly mild. C3H mice exhibited minimal carditis after neonatal or adult infection. However neonatal infection appears to accelerate age-related cardiopathy, which is severe in retired breeders of this strain. 

Category: cardiovascular diseases
Intraoperative ultrasonic imaging of the ascending aorta in ischemic heart disease. In an attempt to locate any atherosclerotic lesion in the ascending aorta and to prevent embolization, intraoperative B-mode ultrasonography was performed in 100 patients with ischemic heart disease (31 women and 69 men). Ultrasonography was carried out with a 10-MHz probe placed directly on the ascending aorta. Ultrasonic imaging demonstrated an atherosclerotic lesion in the lower half of the aorta in 76 patients (76%), a lesion in the upper half of the aorta in 89 patients (89%), and a lesion at the orifice of the innominate artery in 99 patients (99%). Prospective palpation identified an atherosclerotic lesion in 12 (25%) of 48 patients. Thoracic computed tomography in 79 patients showed calcification in the lower half of the aorta in 6 patients (7.6%) and in the upper half of the aorta in 11 (13.9%). Palpation and thoracic computed tomography underestimated the frequency of atherosclerotic lesions. Intraoperative ultrasonography accurately identified atherosclerotic disease. This technique allows the surgeon to modify cannulation, aortic clamping, and operative technique to reduce the risk of perioperative stroke due to embolization of atherosclerotic debris from the ascending aorta. 

Category: cardiovascular diseases
Power of oesophageal peristalsis can be controlled voluntarily. The hypothesis that oesophageal peristalsis can be modified voluntarily was explored. Six healthy male volunteers and eight female patients with angina like chest pain underwent oesophageal manometry. Each was asked to take a series of swallows, and to vary their size, in random order, by taking either a big gulp or a little swallow. None of the subjects experienced difficulty in doing so. In both groups the amplitude of oesophageal contractions were significantly greater after big gulps than little swallows (p less than 0.01) and this was true for wet (82.0 v 68.9 mmHg) and dry swallows (52.3 v 43.3 mmHg). For the patients' wet swallows the mean values were 73.0 and 56.0 mmHg. Thus, the amplitude of oesophageal peristalsis can be controlled voluntarily. This effect may account for some of the within subject variation in the amplitude of oesophageal contractions. During oesophageal manometry subjects should be encouraged to standardise the size of their swallows whenever possible. Patients with symptoms related to abnormal oesophageal peristalsis such as dysphagia, heartburn, and chest pain may benefit from biofeedback training. 

Category: cardiovascular diseases
Long-term effect of mexiletine on left ventricular function and relation to suppression of ventricular arrhythmia. The effects of oral mexiletine on left ventricular (LV) ejection fraction (EF) and ventricular arrhythmias--and a possible relation between these effects--were evaluated during 3 months of therapy in 29 patients with chronic ventricular premature complexes (VPCs) and a moderately reduced to normal LVEF by 24-hour Holter monitoring and by radionuclide ventriculography at rest and during maximum tolerable exercise testing. After an average titration period of 13 days, a mean daily mexiletine dose of 739 mg was maintained throughout the treatment. At the end of titration and after 3 months of treatment, patients with a baseline LVEF less than or equal to 40% (group 2) responded with a median reduction of the hourly VPC rate by 90 and 81%, respectively, compared with 79 and 72% in those with a baseline LVEF greater than 40% (group 1). Couplets and runs of ventricular tachycardia were almost completely suppressed in nearly all patients. A single patient had a proarrhythmic increase in VPCs during treatment. Compared with baseline, there were no significant changes in resting or exercise LVEF after 1 or 3 months of treatment in either of the 2 groups of patients. No correlation was found between treatment-induced changes in arrhythmia frequency and in resting EF. No symptoms of congestive heart failure developed. The study confirms that long-term use of mexiletine is efficacious and relatively free of cardiac depressant effects even in patients with diminished LV function. 

Category: cardiovascular diseases
Carcinoma of the vulva. Clinicopathologic factors involved in inguinal and pelvic lymph node metastasis. Eighty-five women with vulvar squamous cell carcinoma were subjected to radical vulvectomy with bilateral inguinal and femoral node dissection or to radical vulvectomy with bilateral inguinofemoral and deep pelvic node dissection. The association between lymph node status (metastatic or not) and several parameters was analyzed: tumor location, size and clinical stage; tumor thickness, histologic grade and mitotic index; blood vessel, lymphatic and perineural infiltration; and lymphocytic and plasma cell infiltrates. There were no metastases to the pelvic lymph nodes without previous inguinal lymph node involvement. Unilateral vulvar carcinomas did not have contralateral metastatic nodes when there was no ipsilateral nodal involvement. Lymphatic vessel infiltration showed a statistically significant correlation with inguinal node metastases (P less than .05). No correlation was found between lymph node metastasis and tumor size, clitoral invasion, tumor thickness, histologic grade, blood vessel and perineural infiltration, lymphocytic and plasma cell infiltrates, and mitotic index. 

Category: neoplasms
Continuing care for cancer pain relief with oral morphine solution. One-year experience in a regional cancer center. This report is a prospective study of 223 patients with intractable cancer pain who were offered continuing care during the year 1988 at the Pain Relief Unit, Kidwai Memorial Institute of Oncology, Bangalore, India, with a minimum follow-up of 4 months and a maximum follow-up of 16 months. A high percentage of pain relief was attained within a mean duration of 4 days, which on follow-up was maintained at a steady level in most patients (91.1%). Oral morphine could not be continued in three patients because of vomiting. The main side effects noticed were nausea and vomiting, itching, and constipation. At any time during the first 140 days, only 30% of patients had side effects and appropriate medication successfully managed these side effects. During the rest of the study period, the side effects were minimal. Oral morphine used with proper adjuncts offers the best pain palliation in most patients, with minimal side effects. 

Category: neoplasms
Aortobronchial fistula after an aortic operation. A 71-year-old man with a postoperative aortobronchial fistula was successfully treated. The fistula occurred between the left lower lobe and the descending thoracic aorta, to which a distal anastomosis of a temporary bypass graft had been placed during thoracic aortic aneurysmectomy 3 years before. For saving patients with this complication, early surgical treatment during episodes of intermittent hemoptysis is important. The use of an omentum pedicle flap for the isolation of the suture line is a important adjunct. 

Category: cardiovascular diseases
Myocardial metabolic and hemodynamic effects of a sustained intravenous infusion of nifedipine with and without metoprolol in patients with unstable angina. We tested the usefulness of a sustained intravenous infusion of nifedipine and a combination of nifedipine and metoprolol in the early management of 14 patients with unstable angina pectoris. After a 24-hour run-in period, nifedipine was titrated in a stepwise fashion (mean dose 27 +/- 7 micrograms/min). After nifedipine treatment coronary blood flow increased from 150 +/- 66 to 183 +/- 74 ml/min (p less than 0.05), whereas double product, myocardial oxygen consumption, and both arterial and coronary sinus (nor)epinephrine levels were unchanged. Myocardial lactate uptake increased from 3.4 +/- 26.1 to 31.3 +/- 26.6 mumol/min (p less than 0.005) and free fatty acid uptake from 7.2 +/- 22.1 to 34.5 +/- 33.7 mumol/min (p less than 0.05). A small nonsignificant improvement in amino acid metabolism was observed. Metoprolol was added in seven patients and led to a decrease in double product (-2.2 +/- 1.6 x 10(3); p less than 0.01) and myocardial oxygen consumption (-3.2 +/- 3.8 ml/min; p less than 0.05). The lactate uptake/oxygen uptake ratio increased by 18% after metoprolol (p = NS). The number of episodes of chest pain decreased from 2.4 +/- 1.1/24 hours to 0.1 +/- 0.2 in the nifedipine group and from 2.9 +/- 1.1/24 hours to 0.3 +/- 0.5 in the nifedipine plus metoprolol group (both p less than 0.01). We conclude that in the acute phase of unstable angina, intravenous nifedipine can be carefully titrated to improve coronary blood flow and oxidative metabolism. The addition of metoprolol is also associated with a reduction in myocardial oxygen demand. This treatment results in significant hemodynamic stability. 

Category: cardiovascular diseases
Cerebellar voice tremor: an acoustic analysis. Patients with cerebellar disease may exhibit tremulous phonation as part of their dysarthria. The results of an acoustic analysis of cerebellar voice tremor in a patient with hereditary ataxia and presenting with a purely cerebellar syndrome are reported. Analysis included computation of speech intensity contours, fundamental frequency contours, and spectral parameters from sustained productions of vowels and voiceless fricatives. Fundamental frequency contours during sustained phonation of vowels showed rhythmic oscillations at a rate of about 3 Hz. No concomitant periodicity could be detected for the parameters characterising voiceless fricative production. The results indicate an impairment of phonatory control in relation to the maintenance of a constant isometric activity of the internal laryngeal muscles. Cerebellar voice tremor may therefore be classified as a form of postural tremor. 

Category: general pathological conditions
Cytologic diagnosis of aspergillosis in cardiac transplantation. Fine-needle aspiration of the lung is now widely utilized to diagnose pulmonary neoplasms, but often serologic techniques or open-lung biopsy is relied on for the diagnosis of infectious pulmonary processes. We report a series of four patients in whom the fine-needle aspiration technique was used to make the rapid cytologic diagnosis of pulmonary aspergillosis. Culture confirmation was also obtained on the aspirated material. A discussion of the available techniques for the laboratory diagnosis of pulmonary aspergillosis is presented and the advantages of fine-needle aspiration cytology are stressed. Our favorable results support expanded use of fine-needle aspiration cytology in the evaluation of lung nodules appearing in immunosuppressed populations. 

Category: general pathological conditions
Insulin resistance and blood pressure in young black men. Insulin resistance, independent of obesity or non-insulin-dependent diabetes mellitus, has been demonstrated to be associated with high blood pressure. To determine if insulin resistance could be an antecedent to hypertension in a high-risk population, we studied normotensive (112 +/- 12/70 +/- 10 mm Hg) and borderline hypertensive (135 +/- 8/85 +/- 5 mm Hg) lean young black men (22-26 years old) with the euglycemic hyperinsulinemic clamp technique. All subjects had clinically normal oral glucose tolerance. Body mass index and percent adipose mass were the same in both groups. Fasting plasma insulin concentration was significantly higher in the borderline hypertensive group (p less than 0.01). Insulin-directed exogenous glucose metabolism at the same degree of steady-state hyperinsulinemia was significantly lower in the borderline hypertensive group (5.98 +/- 2.22 versus 8.22 +/- 1.96 mg/kg/min; p less than 0.01). For the total population, a significant inverse correlation existed between the glucose infusion rate and systolic blood pressure (p less than 0.01). These data indicate that there is a relation between insulin-mediated glucose uptake and blood pressure. Furthermore, in this high-risk population insulin resistance may precede the onset of established essential hypertension. 

Category: cardiovascular diseases
The encased ureter: bullet and bodkin pattern, a reliable radiographic sign. Among the causes of constricted ureter is benign or malignant encasement. The diagnosis of ureteric encasement is frequently overlooked, even by well informed clinicians and radiologists. The most common benign cause is retroperitoneal fibrosis and the most frequent malignant causes are extension from an adjacent primary tumour, true metastases to the ureter and lymphoma. Lack of recognition of the process may lead to mistaken diagnosis of an inflammatory stricture or infiltrating transitional cell tumour, with resultant inappropriate management. A sign which appears to be almost specific for encasement, the bullet and bodkin configuration, is described here. Newer imaging modalities such as computed tomography and ultrasound, while helpful, are probably less sensitive and less specific than the retrograde ureterogram because a detectable mass is not always present. 

Category: general pathological conditions
Clinical implications of screening for cervical cancer under Medicare. The natural history of cervical cancer in the elderly: what do we know? What do we need to know? Despite the recent passage of coverage for Papanicolaou test screening under Medicare, several aspects of the natural history of cervical cancer in the elderly remain uncertain. This article reviews what we know about cervical cancer in elderly women to provide clinicians with the background necessary for assessments of screening recommendations, integration of new data into practice, and development of consensus approaches to screening in the elderly. Two central questions that affect a screening program for the elderly are how long the neoplastic process takes from preinvasive disease to the development of invasive cancer, and how likely is it that a given neoplastic state observed in an elderly woman will, in fact, progress to a more severe state. The ultimate success of the new Medicare benefit will also be affected by the use of Papanicolaou testing, the technique of obtaining the smear, and the adequacy of reporting and follow-up. The expansion of Medicare benefits to include early cervical cancer detection has the potential to improve the quality and the duration of older women's lives. 

Category: neoplasms
Anorectal sensory and motor function in neurogenic fecal incontinence. Comparison between multiple sclerosis and diabetes mellitus. We measured anorectal sensory and motor function in 11 patients with multiple sclerosis and fecal incontinence, 11 continent patients with multiple sclerosis, 10 diabetics with fecal incontinence, and 12 healthy control subjects. The threshold volume at which patients with multiple sclerosis and fecal incontinence experienced rectal sensation was higher than that in healthy controls (42.7 +/- 6.2 mL vs. 13.3 +/- 2.8 mL; P less than 0.01) and was similar to that in incontinent diabetics (36.5 +/- 5.7 mL). Patients with multiple sclerosis and incontinent diabetics also showed increased thresholds of phasic external sphincter contraction compared with controls (P less than 0.05). Diabetics with incontinence had reduced resting and maximal voluntary anal sphincter pressures compared with controls (P less than 0.05), whereas patients with multiple sclerosis and incontinence showed only decreased maximal voluntary anal sphincter pressures (P less than 0.01 vs. controls and diabetics). Incontinent patients with multiple sclerosis also required smaller volumes of rectal distention to inhibit internal sphincter tone compared with diabetics and controls (P less than 0.01). Decreased maximal voluntary squeeze pressures were less severe in continent patients with multiple sclerosis than in incontinent patients with multiple sclerosis. We conclude that impaired function of the external anal sphincter and decreased volumes of rectal distention to inhibit the internal anal sphincter or both may contribute to fecal incontinence in multiple sclerosis. In addition, increased thresholds of conscious rectal sensation in some incontinent patients with multiple sclerosis and diabetes mellitus may contribute to fecal incontinence by impairing the recognition of impending defecation. 

Category: digestive system diseases
Echocardiographic assessment of doxazosin on left ventricular mass in patients with essential hypertension. A single daily dose of doxazosin taken during a 12-week period produced a significant reduction in blood pressure and left ventricular mass index in patients with mild or moderate hypertension. The systolic shortening coefficient was also increased and a trend in the improvement of ejection fraction, rate of circumferential fiber shortening, systolic contraction time, and preejective/ejective ratio was observed. No change in heart rate was recorded and no patients had side effects. The serum lipid profile was modified favorably, particularly with regard to the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. By producing a reduction in blood pressure and left ventricular mass while favorably modifying the serum lipid profile, doxazosin produced a beneficial change in the overall coronary heart disease risk profile. 

Category: cardiovascular diseases
Captopril-induced cholestatic jaundice. I have reported a case of captopril-induced cholestatic jaundice. This drug is being used with increasing frequency, so it is important that physicians recognize this adverse effect. Captopril-induced jaundice resolves after cessation of captopril therapy. 

Category: general pathological conditions
Effect of the topical anesthetic EMLA on the efficacy of pulsed dye laser treatment of port-wine stains. EMLA cream (Eutectic Mixture of Local Anesthetics) is a new topical anesthetic composed of 25 mg lidocaine and 25 mg prilocaine in an oil-in-water emulsion cream. It has been found to be very effective for local anesthesia prior to venepuncture, minor surgical procedures, and pulsed dye laser (PDL) therapy for port-wine stains (PWS) in children. However, since EMLA may cause vasoconstriction of cutaneous vessels, we tried to determine whether pretreatment with EMLA decreases the efficacy of subsequent PDL treatment. We report eight patients between the ages of 4 and 32 years with PWS who received two test site treatments prior to PDL treatment. One site was pretreated with EMLA cream under occlusion for 60 minutes and then left unoccluded for 15 minutes prior to PDL test treatment. The other site, in the same area of the PWS and patient's body, was not pretreated with EMLA. The test sites were compared 6-8 weeks later to determine whether EMLA decreased the degree of lightening of the PWS compared to the non-EMLA-treated site. We conclude that EMLA is an effective topical anesthetic for PDL treatment of PWS and does not adversely affect the efficacy of the treatment. 

Category: neoplasms
Basal cell carcinoma recurring after radiotherapy: a unique, difficult treatment subclass of recurrent basal cell carcinoma. Twenty-seven basal cell carcinomas (BCCs) recurring following radiation therapy alone or in addition to other treatment modalities were treated with Mohs micrographic surgery (MMS) from 1983 to 1989. Mean tumor size was 2.1 cm. Of the tumors, 70.4% arose in the mid-face region, 55.6% had undergone multiple previous treatment modalities. The present recurrence rate is 7.4% (mean follow-up: 25 months). Basal cell carcinoma recurring following radiotherapy deserves special subclassification among recurrent BCC. It is very difficult to eradicate, with high recurrence rates following standard surgical excision or further radiotherapy. Tumors are usually large, aggressive, and invasive. Most arise in the cosmetically crucial mid-face region, where extension into subcutaneous tissue planes is common. Mohs surgery, with its inherent abilities to examine all margins, map tumor extension, and conserve tissue, is uniquely suited to treatment of these difficult tumors. 

Category: neoplasms