Melricflash/CW_MedAbstractsAlt huggingface dataset:
Effects of brief coronary occlusion and reperfusion on porcine coronary artery reactivity. The loss of coronary vasodilator reserve after ischemia-reperfusion may be due to endothelial injury, and this vascular dysfunction may contribute to functional alterations observed after ischemia. To determine whether endothelial dysfunction occurs after relatively brief periods of moderate low-flow ischemia in vivo, open-chest swine were subjected to 15 minutes of critical, subtotal left anterior descending coronary artery occlusion (80%) followed by 60 minutes of reperfusion. Serial measurements of regional coronary flow were made with the radiolabeled microsphere technique. After 60 minutes of reperfusion, the left anterior descending coronary artery was excised together with a section of the normally perfused left circumflex coronary artery to examine in vitro the relaxations to the endothelium-dependent dilators ADP and bradykinin and to the endothelial-independent dilators sodium nitroprusside and adenosine. Contractions to serotonin in quiescent rings were also examined. Endocardial and transmural blood flows recovered to preocclusion levels within 60 minutes of reperfusion, as did the epicardial-to-endocardial ratio. Vascular responses in isolated, reperfused left anterior descending coronary artery rings were significantly different from responses in control left circumflex coronary artery rings. Endothelium-dependent relaxations to adenosine diphosphate and bradykinin were significantly depressed in the left anterior descending coronary artery rings compared with left circumflex coronary artery rings (p less than 0.05). Serotonin-induced contractions were significantly greater in occluded-reperfused left anterior descending than in left circumflex coronary arteries (p less than 0.05). Relaxations to adenosine and sodium nitroprusside were not significantly different between the two groups. 

Category: cardiovascular diseases
Brain magnetic resonance imaging and neuropsychologic evaluation of patients with idiopathic dilated cardiomyopathy. We compared brain magnetic resonance imaging and neuropsychologic performance in 20 neurologically asymptomatic patients suffering from idiopathic dilated cardiomyopathy (mean age 41 [range 18-49] years) and 20 age-matched controls (mean age 38 [range 28-49] years). Patients exhibited a significantly higher rate of cerebral infarcts (20% versus 0%, p less than 0.05) and cortical (50% versus 5%, p less than 0.01) and ventricular (55% versus 15%, p less than 0.02) atrophy than controls. Accordingly, semiquantitative volumetric measurements yielded a significantly increased ventricular-to-intracranial cavity ratio in the patients (6.2 +/- 2.9% versus 4.1 +/- 1.3%, p less than 0.01). This ratio and the cortical atrophy ratings correlated positively with disease duration (r = 0.63 and 0.54, p less than 0.05). Cognitive test performance was significantly worse in patients than in controls and was most impaired in those patients with morphologic cerebral abnormalities. 

Category: cardiovascular diseases
Donor leukocyte transfusions for treatment of recurrent chronic myelogenous leukemia in marrow transplant patients. Three patients with hematologic relapse after bone marrow transplantation for chronic myelogenous leukemia were treated with interferon alpha and transfusion of viable donor buffy coat. All had complete hematologic and cytogenetic remission, which persisted 32 to 91 weeks after treatment. In two patients graft-versus-host disease developed and was treated by immunosuppression. These results are an example of adoptive immunotherapy without cytoreductive chemotherapy or radiotherapy in human chimeras. 

Category: neoplasms
Maternal feeding behavior and child acceptance of food during diarrhea, convalescence, and health in the central Sierra of Peru. Feeding patterns by mothers and child acceptance of food were measured in a Peruvian village to determine changes on days when children had diarrhea as compared to days of convalescence and health. Morbidity surveillance identified 40 children, aged 4-36 months, with diarrhea. Children were followed using twelve-hour in-home structured observations during two to four days each of diarrhea, convalescence, and health. Using scales of maternal encouragement to eat and child acceptance of food and cumulative logistic regression analyses, maternal encouragement to eat decreased significantly during convalescence compared to diarrheal days (OR: 0.54, 90% CI: 0.35, 0.82) and health compared to diarrhea (OR: 0.65, 90% CI: 0.46, 0.93). In contrast, child acceptance of food increased during health compared to diarrhea (OR: 1.55, 90% CI: 1.02, 2.35). Results illustrate the importance of carefully examining the behavioral aspects of nutritional intake. Decreases in intake during diarrhea are due to anorexia and not withdrawal of food by mothers. In response to reductions in child appetite during illness, mothers are more likely to encourage children to eat, while they tend to become more passive feeders after the diarrhea has stopped. Program efforts should focus on messages to feed children more actively especially after diarrhea episodes, when appetite levels increase. 

Category: digestive system diseases
Effects of mental stress on myocardial perfusion in patients with ischemic heart disease. The purpose of the present study was to determine whether and to what extent mental stress can reproduce the perfusion defects that are known to be induced by exercise. Twenty-four patients with recent myocardial infarction (New York Heart Association functional class I) and evidence of ischemic response were evaluated by means of SESTAMIBI scintigraphy performed once after exercise and then again within 2 days after mental arithmetic. Baseline, exercise, and mental stress planar scintigrams were divided into 15 segments, and each segment was reviewed and scored on a scale of 0 to 3 by experienced observers using circumferential profile analysis. Conflicting scores were resolved by consensus. Electrocardiographic abnormalities were found in 15 of 24 patients during exercise and in none during mental arithmetic. Chest pain was experienced by five patients during exercise and by none during mental stress. Twenty patients showed reversible perfusion defects during mental stress. Of the 360 pooled scintigram segments, 99 evidenced uptake defects during exercise, and 48 of these showed the same defects during mental stress. Twenty of the remaining 51 of 99 segments were adjacent to segments showing reversible hypoperfusion, suggesting milder hypoperfusion in these segments during mental arithmetic than during exercise. Furthermore, 10 segments showed reversible defects only during mental stress such that seven of these occurred in areas adjacent to those that had shown exercise-induced reversible perfusion defects, two occurred in areas that had shown fixed SESTAMIBI defects during exercise, and one occurred in a segment that had shown completely normal uptake during exercise. 

Category: cardiovascular diseases
Proximal placement of the acetabular component in total hip arthroplasty. A long-term follow-up study. A retrospective review was undertaken of thirty-seven hips (thirty-four patients) that had had a complex cemented total hip arthroplasty. In these hips, circumstances had necessitated that the center of the hip be placed farther proximally, as measured from the interteardrop line, than the anatomical position that is normally used. The mean duration of clinical and roentgenographic follow-up was eleven years (range, seven to seventeen years), and the mean age of the patients was fifty-one years (range, sixteen to seventy-three years). Most of these hips had a major deficiency or defect of the acetabular bone stock, or both. Of the six acetabular components (16 per cent) that became loose and were followed for ten years, only one needed revision. Because this study was aimed specifically at assessment of the acetabular component, if the femoral component alone needed revision, the final clinical rating that was used was the one obtained after the femoral revision. Thirty-one hips (84 per cent) were rated as having a good or excellent result; they had an average Harris hip-rating score of 43 points preoperatively and 93 points postoperatively. Thirty-three of the thirty-seven acetabular components were not substantially displaced laterally as compared with the anatomical location that is normally used. Our findings suggest that, when circumstances dictate, proximal positioning of the acetabular component without lateral displacement can give an acceptable result in cemented total hip-replacement procedures. 

Category: general pathological conditions
Sex differences in control of cutaneous blood flow. Women are far more likely than men to suffer from Raynaud's disease. The purpose of this study was to determine whether there are gender differences in local or central control of cutaneous blood flow that could account for the increased incidence of Raynaud's disease in women. To assess cutaneous blood flow, hand blood flow (HBF), finger blood flow (FBF), or skin perfusion (SP) was measured by fluid plethysmography, mercury strain-gauge plethysmography, or laser Doppler spectroscopy, respectively, in 47 volunteers. Basal HBF in men exceeded that of women (12.1 +/- 2.0 versus 6.2 +/- 1.5 ml/100 ml/min). Likewise, FBF in men surpassed that of women (19.5 +/- 4.1 versus 7.7 +/- 1.8 ml/100 ml/min). Similarly, SP in men was greater than that of women (270 +/- 42 versus 81 +/- 16 perfusion units). However, after total body warming (to induce a thermal sympatholysis), HBF in women exceeded that of men, suggesting that the lower basal HBF in women was due to increased sympathetic outflow to the extremities. Mental stress and deep inspiration reduced HBF and SP in men. Paradoxically, both of these maneuvers increased HBF and SP in women. To determine whether these paradoxical responses in women were due to the women's elevated basal sympathetic tone, these experiments were repeated after total body cooling in men to increase sympathetic tone and after total body warming in women to reduce sympathetic tone. Total body cooling reduced HBF and SP in men. Under these conditions, mental stress and deep inspiration induced vasodilation. In women, total body warming for 10 minutes increased HBF. 

Category: cardiovascular diseases
Comparison of clinical and electrophysiologic features of preexcitation syndromes in patients presenting initially after age 50 years with those presenting at younger ages. Although patients may develop arrhythmias due to preexcitation syndromes at any time from the prenatal period to late adulthood, presentation in late adulthood is considered uncommon and has not been well studied. From June 1981 to June 1989, 73 patients were documented to have preexcitation syndromes on the basis of electrophysiologic studies. Those whose initial arrhythmias appeared at an age greater than 50 years (group 1, n = 13) were compared with the remaining 60 patients (group 2). All group 1 patients presented in the setting of acute medical or surgical diseases (n = 7), or chronic cardiac disease (n = 6) commonly associated with middle age and often with atrial arrhythmias; only 13 group 2 patients had underlying illnesses (p = 0.0001). Almost two-thirds of group 2 patients were evaluated because of narrow complex orthodromic tachycardia or palpitations and electrocardiographic evidence of preexcitation. Wide complex tachycardia was more often a reason for referral of older patients (7 of 13 vs 11 of 60, p less than 0.05), among whom atrial fibrillation/flutter also tended to be more frequent (4 of 13 vs 11 of 60, difference not significant). The PR and QRS intervals of group 1 patients were within the normal range and differed significantly from those of group 2 patients (PR, 0.15 +/- 0.04 vs 0.11 +/- 0.03 second, p less than 0.001; QRS, 0.09 +/- 0.01 vs 0.12 +/- 0.03 second, p less than 0.001), making electrocardiographic identification of preexcitation more difficult in group 1. Several factors likely contributed. 

Category: general pathological conditions
Myelopathic neurosarcoidosis: diagnostic value of enhanced MRI. Neurosarcoidosis is an underdiagnosed variant of the systemic disease. We report a case of myelopathic neurosarcoidosis, noting the contribution made by MRI in establishing the diagnosis, and we discuss the possibility that the disease is differentially responsive to various steroid formulations. 

Category: nervous system diseases
Safety and efficacy of urokinase during elective coronary angioplasty. Eighty-nine of 462 patients were treated with adjunctive urokinase during elective percutaneous transluminal coronary angioplasty (PTCA), 26% for unstable angina, 34% for intracoronary thrombus, 27% for intimal dissection, 10% for abrupt closure, and 3% for saphenous vein graft embolism. The 80 patients treated before abrupt closure (group A) were compared with 167 patients with similar profiles who did not receive urokinase (group B). Procedural success rates were similar. Adverse cardiac events (abrupt closure, myocardial infarction, emergency coronary artery bypass, or death) in group A versus group B occurred in: 1 of 30 (3%) versus 5 of 27 (18.5%) (p = 0.07) with intracoronary thrombus, 5 of 45 (9%) versus 18 of 110 (16.3%) with unstable angina, 1 of 12 (8%) versus 4 of 13 (31%) with unstable angina with intracoronary thrombus, 4 of 33 (12%) versus 14 of 97 (14.4%) with unstable angina without intracoronary thrombus, and 5 of 24 (20.8%) versus 6 of 66 (9%) with intimal dissection. Hemorrhagic complications occurred in 11% of patients who were treated with urokinase versus 9% of patients who were not (p = NS). No difference in blood transfusions existed. Thus urokinase was found to be safe during elective PTCA. In patients with intracoronary thrombus, urokinase appears to decrease the incidence of new adverse cardiac events, whereas in patients with intimal dissection it might have an adverse effect. 

Category: general pathological conditions
Expression of blood group antigens by normal bronchopulmonary tissues and common forms of pulmonary carcinomas. The expression of ABH and Lewis antigens has been studied in a series of pulmonary carcinomas, in areas of squamous metaplasia, and in normal adjacent bronchopulmonary tissues by means of a panel of lectins and monoclonal antibodies. All respiratory epithelial cells can express antigens, with the exception of glandular serous cells. The expression of AB antigens is rather homogeneous, while Lewis antigens are expressed in a more irregular pattern, alternating positively stained cells with negatively stained cells in the same microscopic field. The expression of blood group antigens allows the identification of residual pneumocytes inside the tumor and the proper classification of some neoplasms. Metaplastic areas show a variation in the staining profile when compared with normal tissues and pulmonary carcinomas. The most significant findings are the deletion of A antigen and the strong expression of Le antigen. Pulmonary carcinomas are composed by a heterogeneous population and tend to express antigens in the more differentiated cases or areas. The most important findings are the deletion of AB antigens and the strong expression of Le(y) antigen. 

Category: neoplasms
Survey of the use of thrombolysis for acute limb ischaemia in the UK and Ireland. A total of 156 vascular surgeons from the UK and Ireland responded to a postal questionnaire on the use of thrombolysis in acute limb ischaemia. Almost half had used thrombolysis in the previous 12 months. Low dose intra-arterial streptokinase (89 per cent) was the regimen most frequently used, but 33 per cent had used intravenous streptokinase. Detailed results for 103 patients (limb salvage rate 60 per cent, amputation rate 35 per cent, mortality rate 5 per cent) were similar to those of previously published reports. Complications in most series were infrequent, but in the entire survey there were six bleeding-related deaths and one death from anaphylaxis. A total of 67 per cent of surgeons with working experience indicated that selected patients with acute arterial thromboses were most suitable for thrombolysis, particularly if there was no neurological deficit and no run-off for surgical bypass. Distal or late emboli and graft occlusions were regarded as appropriate by some surgeons. This study demonstrated that many vascular surgeons currently use thrombolysis, although sparingly and in selected cases. Patients with acute limb ischaemia should be managed by experienced vascular surgeons who are aware of the new therapeutic alternatives, an ideal supported by almost three-quarters of respondents to this survey. 

Category: cardiovascular diseases
Deficiency of complex III of the mitochondrial respiratory chain in a patient with facioscapulohumeral disease. Facioscapulohumeral disease (FSHD), an inherited neuromuscular disorder, is characterized by progressive wasting of specific muscle groups, particularly the proximal musculature of the upper limbs; the primary defect in this disorder is unknown. We studied a patient with FSHD to determine whether the mitochondrial respiratory chain was functionally abnormal. Muscle biopsy revealed fiber atrophy with patchy staining for oxidative enzymes. Electron microscopy of a liver section showed many enlarged mitochondria with paracrystalline inclusions. Decreased oxidation of the respiratory substrates-alanine and succinate-in skin fibroblasts suggested a deficiency of complex III of the electron-transport chain; cytochrome c oxidase activity (complex IV) was in the normal range. Biochemical analysis of liver supported the fibroblast data, since succinate oxidase activity (electron-transport activity through complexes II-IV) was reduced, whereas complex IV activity was normal. Furthermore, analysis of the cytochrome spectrum in liver revealed typical peaks for cytochromes cc1 and aa3, whereas cytochrome b (a component of complex III) was undetectable. Southern blot analysis of fibroblast mtDNA revealed no major deletions or rearrangements. Our study provides the first documentation of a specific enzyme-complex deficiency associated with FSHD. 

Category: nervous system diseases
Benign parotid tumour enucleation--a reliable operation in selected cases. The method of surgical treatment for benign tumours of the parotid gland had not yet been rationalized, but many authors recommend parotidectomy as the most appropriate procedure. A series of 289 operations for parotid swelling is reported; the majority of mixed and Warthin's tumours underwent enucleation without either complications or recurrence. The rationale of parotidectomy versus enucleation is discussed but in fast growing, deeply infiltrating and recurrent tumours, parotidectomy appears to be the best choice. In the other group of more commonly occurring tumours, enucleation represents a reliable time saving option. 

Category: general pathological conditions
Infarct of the conus medullaris simulating a spinal cord tumor: case report. A 71-year-old woman had the sudden onset of a neurogenic bladder and a stepwise increase in paraparesis that left her unable to stand or walk. Magnetic resonance imaging showed what appeared to be a tumor in the conus medullaris. After laminectomy, the lesion was localized by ultrasound examination, and a biopsy was performed. The deficits remained unchanged postoperatively. Microscopic examination of the biopsy specimen showed necrosis and pathologic changes consistent with infarction of the conus medullaris. An anomalous arterial supply of the conus medullaris is the most likely cause of this unusual problem. The patient gradually regained her ability to walk, but the neurogenic bladder persists. 

Category: general pathological conditions
Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations. Selected literature review of the clinical course of patients with ventricular shunts for hydrocephalus shows that the effects of cerebrospinal fluid overdrainage are subdural hematoma, craniosynostosis, slit ventricle syndrome, and low intracranial pressure syndrome. These occur sequentially at different age groups, but approximate averages of incidence and time of occurrence after first shunt reveal an overall incidence of 10%-12% for at least one of these appearing at 6.5 years after shunting. The basic etiology, diagnosis, and variety of treatment modalities available are reviewed, including the need for shunt closing intracranial pressure control. Included is a hydrocephalus program designed to minimize the need for long-term extracranial shunts and to maximize therapeutic intracranial procedures for hydrocephalus. 

Category: general pathological conditions
Acute pulmonary embolism triggered by the act of defecation. Pulmonary embolism associated with the act of defecation has not been previously well described. Recently, we reported our experience with four patients who presented to us over a 12-month period with syncope, near syncope, or sudden death following the act of defecation. In all four cases, acute pulmonary embolism was shown to be the etiology of the defecation-associated events. A retrospective chart review of all patients with the diagnosis of pulmonary embolism at our institution over a three-year period yielded five additional patients with the diagnosis of defecation-associated pulmonary embolism. These nine patients accounted for 6.8 percent of all patients with a discharge diagnosis of pulmonary embolism seen at our institution during the three-year study period. Six of the nine patients died from their defecation-associated pulmonary embolism. These six deaths accounted for 25 percent of all deaths from pulmonary embolism seen at our institution during the study period. Based on our experience, we suggest that the act of defecation may trigger the development of acute pulmonary embolism in some patients with deep vein thrombosis. 

Category: general pathological conditions
Myocardial infarction in Mexican-Americans and non-Hispanic whites. The San Antonio Heart Study. Mexican-American men experience reduced cardiovascular mortality compared with non-Hispanic white men. There is no corresponding ethnic difference in cardiovascular mortality in women. The difference in men could result either from a lower incidence of cardiovascular disease or a lower case fatality rate among Mexican-Americans. Although the incidence of cardiovascular disease in Mexican-Americans is unknown, we have collected data on prevalence of myocardial infarction in 5,148 individuals examined in the San Antonio Heart Study, a population-based survey of cardiovascular disease conducted between 1979 and 1988 in Mexican-Americans and non-Hispanic whites aged 25-64 years. Myocardial infarction was assessed by Minnesota-coded electrocardiograms and by a self-reported history of a physician-diagnosed heart attack. For both end points, the age-adjusted prevalence of myocardial infarction was lower in Mexican-American men than in non-Hispanic white men. After adjustment for age and diabetes status (present/absent), the odds of a myocardial infarction, as defined by either criterion, was approximately one third lower in Mexican-American men than in non-Hispanic white men (p = 0.06). In women, the prevalence of both myocardial infarction end points was slightly higher in Mexican-Americans than in non-Hispanic whites, although neither of these differences was significant. Although the ethnic differences in prevalence in this study were not statistically significant, their pattern parallels the pattern in the mortality due to cardiovascular diseases. Therefore, the results support the hypothesis that the reduced cardiovascular mortality rate observed in Mexican-American men reflects a lower incidence of myocardial infarction rather than a reduced case fatality rate because the latter would result in a higher prevalence. 

Category: cardiovascular diseases