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8221263

Toxicity and immediate allergenicity of latex gloves.

Surgical latex gloves and a natural rubber latex (NRL) catheter were evaluated for biocompatibility by cell culture methods and Type I allergic reactions in operating room personnel using latex gloves. The prevalence of relevant immediate allergy to NRL was 5.2% when using eluates made from different latex gloves as allergens and the skin-prick test methodology. The reliability of a questionnaire in detecting the sensitized persons was limited. Weak positive skin test reactions to surgical latex glove eluates were found to be unreliable as compared with challenging with the corresponding glove. Latex gloves exhibited more toxicity in cell culture than non latex gloves, but, inversely, the toxic catheter gave weak positive skin-prick test reaction in only one sensitized person, confirming that the allergenicity and toxicity of natural rubber products do not refer to the same properties of the products. Catheters exhibiting toxicity in cell culture have earlier been found to cause significant clinical symptoms in operated patients, but in the case of surgical gloves this relationship is not clear. One glove brand with a low content of known sensitizing rubber chemicals caused clear toxicity in cell culture but was well tolerated by the hospital personnel.

Allergens,Asthma,Cell Division,DNA Replication,Dermatitis, Atopic,Female,Gloves, Surgical,Hand Dermatoses,Humans,Hypersensitivity, Immediate,Latex,Male,Rhinitis,Rubber,Surveys and Questionnaires,Tumor Cells, Cultured

518831,1285566,1395564,1430699,1500627,1546814,1696439,1755135,1802906,1809696,1853515,1898540,1979406,2312994,2469016,2766703,2932282,2940070,2941222,2954760,2963724,2968213,2972512,2976652,3142599,3219830,3565720,3780800,3798614,3971110,6119570

8221266

Priorities for understanding and managing occupational allergy: a Delphi consensus.

Limiting factors in the understanding, clinical management, and prevention of occupationally related allergic disease should be identified, since these dictate the tasks that need to be undertaken and/or important research questions that warrant an answer. Through an adaptation of the Delphi technique, a working group of the Special Interest Group on Occupational Allergy of the British Society of Allergy and Clinical Immunology addressed these issues. The consensus categorized and ranked the limiting factors and tasks needed in relation to epidemiology and natural history, mechanisms, clinical diagnosis, statute and education, and the workplace environment. This report should help focus the debate regarding which issues are perceived to be most relevant and timely for research and good practice in the field of occupational allergy.

Delphi Technique,Humans,Hypersensitivity,Occupational Diseases,Societies, Medical,United Kingdom

591704,1472437,1809529,1831103,2039741,2042880,2508944,2689481,2758358,3049276,3258196,3354797,3711550

8221267

Standardization of pollen allergens of Parthenium hysterophorus and selection of an in-house reference extract.

A standardized in-house reference extract from the pollen of Parthenium hysterophorus, which is responsible for the high incidence of allergic rhinitis in India, was generated and examined by skin test, radio-allergosorbent test inhibition and isoelectric focusing. Parthenium reference allergen discs and positive reference serum were also generated. These reference reagents could not only be used for the quantitation of Parthenium-specific IgE in the sera of rhinitis patients but also for the evaluation of allergenic activity (relative potency and lot-to-lot variation) of different batches of Parthenium pollen.

Adult,Allergens,Electrophoresis, Polyacrylamide Gel,Female,Humans,Immunoglobulin E,Isoelectric Focusing,Male,Middle Aged,Plant Extracts,Pollen,Radioallergosorbent Test,Reference Standards,Rhinitis,Skin Tests

388439,1053442,1149930,2021879,2464016,2578495,3170981,3338856,3372043,3605795,3653998,3679564,3719935,3944372,4008796,4053335,4536625,4543977,4801121,4819732,5432063,6660488,6725791,6992630,7196716,7309259

8221268

Venom-specific IgG antibodies in bee and wasp allergy: lack of correlation with protection from stings.

This paper investigates the relationship between venom IgG levels and protection from stings. Venom-specific IgG antibody levels have been measured by radioimmunoassay in untreated wasp-(n = 38) and bee-allergic (n = 16) patients presenting with systemic reactions to stings and in a sub-group of these (wasp = 15; bee = 9), before and after the initial course of venom immunotherapy (VIT). A history was taken of all reactions, the last systemic reaction being graded on a scale of 1-8 and of the number and timing of stings. In untreated patients venom IgG levels were much higher in bee-allergic patients (mean +/- s.e. = 68.2 +/- 7.1% positive pool) than in the wasp group (27.1 +/- 4.2%) (P < 0.05 Mann-Whitney U-test). There was a marked rise in venom IgG after the initial course of VIT in the wasp group (geometric mean and 95% confidence intervals = 40.5%, 28.8-54.3) but a much smaller rise in the bee group (15.3%, 6.6-24.1), with no overlap in the 95% confidence intervals. Bee patients, who were mainly beekeepers or their relatives, had been more heavily immunized with venom than wasp patients. They had received: (i) more stings (mean number of stings: bee, 26; wasp, 4; P < 0.001) and (ii) more stings per year. Wasp patients received their smaller number of stings over a much longer period, up to 40 yr. There was no correlation between the severity of the last systemic reaction and the venom IgG levels alone or venom IgG and IgE levels in combined analysis in either bee or wasp patients. This study shows that the pattern of IgG response differs in bee and wasp-allergic subjects, and that most bee-allergic subjects with systemic reactions have high levels of venom IgG. The degree of immunization with venom seems to be an important determinant of the venom IgG level. Our findings suggest that venom-specific IgG levels do not predict systemic reactions to stings and are not useful for monitoring VIT. If protection from stings is IgG-mediated, our observations suggest that the relevant immune response is more complex, possibly involving IgG sub-classes, IgG antibodies to individual venom antigens or antibody affinity, and not adequately reflected by measurement of the concentration of venom-specific IgG.

Adolescent,Adult,Aged,Animals,Bee Venoms,Bees,Desensitization, Immunologic,Female,Humans,Hypersensitivity,Immunoglobulin E,Immunoglobulin G,Immunotherapy,Insect Bites and Stings,Male,Middle Aged,Wasp Venoms,Wasps

75280,78446,447951,1527321,1699985,2005323,2707888,2778238,2802114,3583409,3584749,3621550,3722631,3742787,3989140,4008813,6619452,6638413,6699314,7076990,7215389,7229226

8221269

Lymphocyte transformation test with house dust mite (Dermatophagoides pteronyssinus) in normal children, asthmatic children and asthmatic children receiving hyposensitization.

In the first part of this study the proliferative response of lymphocytes (lymphocyte transformation test) to house dust mite (HDM) stimulation in cultures was studied in normal children (n = 16), asthmatic children who never received hyposensitization (HS) (n = 50) and asthmatic children receiving HS with HDM for at least 6 months (n = 20). The results are expressed as disintegrations per minute (d.p.m.) and as stimulation index (SI = d.p.m. in the presence of the allergen/d.p.m. in the control culture). A positive SI (> 2) was found in 54% of the asthmatic children who never received HS, in 30% of the asthmatics receiving HS and in none of the normal children. Furthermore, between asthmatics with and without HS, the SI was not statistically different, although asthmatics without HS tended to have a higher SI (median value: 2.13 vs 1.38) (P = 0.10). In a second series of experiments the effect of adding interleukin-2 (IL-2) to the lymphocyte cell culture was studied in asthmatic children with and without HS. Interleukin-2 induced an additional stimulatory effect on the lymphoproliferative response to HDM and to phytohaemagglutinin in patients who never received HS, but had no effect in patients receiving HS. We conclude that HS treatment seems to have an inhibiting effect upon this proliferative response, not only inhibiting the degree of the allergen-induced lymphocyte proliferation, but also inhibiting the sensitivity of proliferating lymphocytes for IL-2. These inhibiting effects upon lymphocytic activation could be responsible for the anti-inflammatory effects (i.e. suppression of the late asthmatic reaction) of HS.

Allergens,Animals,Antigens, Dermatophagoides,Asthma,Cells, Cultured,Child,Desensitization, Immunologic,Glycoproteins,Humans,Immunoglobulin E,Immunoglobulin G,Interleukin-2,Lymphocyte Activation,Mites,Phytohemagglutinins

578360,646942,1345897,1346489,1349902,1572445,1583244,1744364,2122966,2179364,2357617,2379943,2469641,2474592,2649212,2788180,2951427,3111315,3134389,3259080,3485579,3866538,3874894,3876426,4131252,4151329,4632865,5786760,6126624,6135080,6154241,6609976,7021642,7059196,7432312,7440857

8221270

Increased immune reactivity to house dust mites in adults with chronic rhinosinusitis.

Sixty-three adults with symptomatic chronic rhinosinusitis had computerized tomographic (CT) scans of the paranasal sinuses, which were used to quantify disease severity. These patients were divided into three closely age- and sex-matched groups: a CT scan-negative group (chronic rhinitis only), a mild sinusitis group and a severe sinusitis group. Serum dust mite-specific IgG levels were found to be significantly elevated in the sinusitis patients compared with a matched group of asymptomatic normal individuals. Levels were highest in the more severe sinusitis group, in which the mean titre was 559 U/ml and the incidence of titres greater than 400 U/ml was 48%, as compared with a mean titre of 139 U/ml and only a 10% incidence of titres greater than 400 U/ml in the normal subjects (P < 0.005 and < 0.01). In contrast, although the frequency of immediate hypersensitivity to dust mite, as assessed by intradermal skin tests, tended to be higher in patients with sinusitis, it was not significantly different from normal individuals. The association between mite IgG and disease was most striking in the patient sub-group with negative mite skin tests. In this group, mite IgG levels were significantly higher than normal, even in those patients with only chronic rhinitis. These findings demonstrate that increased serum levels of IgG against dust mites are strongly associated with chronic rhinosinusitis, especially in the sub-group of patients who are not allergic to mites.

Adolescent,Adult,Aged,Allergens,Animals,Antigens, Dermatophagoides,Chronic Disease,Female,Glycoproteins,Humans,Hypersensitivity, Immediate,Immunoglobulin G,Male,Middle Aged,Mites,Nasal Polyps,Rhinitis,Sinusitis,Skin Tests

448124,1937889,2229810,2262640,2794295,2926137,3192869,3286721,3286729,3320157,3777694,3819230,4470574,6824285,7410747

8221271

The determinants of airway hyperresponsiveness to hypertonic saline in atopic asthma in vivo. Relationship with sub-populations of peripheral blood leucocytes.

In patients with asthma there is only a weak relationship between airway responsiveness to hypertonic saline and methacholine. We tested the hypothesis that airway responsiveness to hypertonic saline in asthma is related to the presence and activity of inflammatory cells in the peripheral blood. Nineteen atopic asthmatic adults (19-28 yr; PC20 0.06-12.4 mg/ml), not receiving steroid treatment, entered a metacholine and hypertonic saline period in random order. Dose-response curves to doubling doses of inhaled methacholine (0.03-256 mg/ml) or hypertonic saline (0.9-14.4% NaCl) were obtained twice in each period, 7 days apart. The response was measured by FEV1. Methacholine responsiveness was measured by PC20 METH of FEV1 and responsiveness to hypertonic saline was expressed as the percentage fall in FEV1 after 14.4% NaCl (HYP14.4%). Peripheral blood was collected before the second challenge test of each period. Apart from leucocyte counts and serum eosinophilic cationic protein (ECP) level, sub-sets of lymphocytes (CD4+/CD3+, CD8+/CD3+, CD25+/CD4+ and VLA-1+/CD4+) were determined using flow cytometry. HYP14.4% was positively correlated to basophil, eosinophil and monocyte counts (r = 0.64, 0.54 and 0.44, respectively; P < 0.05). The basophil count remained positively related to HYP14.4% when PC20METH or FEV1%pred were entered in multiple linear regression analyses (r = 0.66 and 0.75, respectively; P < 0.05). There were no significant relationships between HYP14.4% or PC20METH on one side and ECP level or T-lymphocyte subsets on the other (P > 0.05). We conclude that airway responsiveness to hypertonic saline is positively related to the number of peripheral blood basophils, eosinophils and monocytes. Basophil count is an independent correlate of responsiveness to hypertonic saline, after correction for methacholine responsiveness and baseline lung function. This fits in with active involvement of basophils in airway narrowing to hypertonic saline in vivo.

Adult,Asthma,Bronchial Hyperreactivity,Bronchial Provocation Tests,Dose-Response Relationship, Immunologic,Female,Humans,Leukocyte Count,Leukocytes,Male,Methacholine Chloride,Saline Solution, Hypertonic,T-Lymphocyte Subsets

603764,1053434,1124105,1626792,1672334,1691604,1693378,1708690,1717532,1744364,1756847,1826367,1834578,1847158,1918731,1955630,1970229,1971165,2026843,2064141,2064143,2112128,2178963,2215562,2424960,2659385,2681332,2707402,2868172,3046775,3438883,3532884,3660304,4053332,6165738,6715730,7214688,24576915,24576917

8221272

Cough variant asthma is associated with a higher wheezing threshold than classic asthma.

Cough variant asthma is an occult form of asthma in which the only sign or symptom is chronic cough. It is a common problem amongst all ages that frequently goes unrecognized, leading to underdiagnosis and undertreatment. To characterize the pathophysiological abnormalities in these patients, we performed bronchial provocation tests with methacholine using the stepwise doubling concentration technique, and measured the concentration of methacholine and the severity of airway obstruction when wheezing was first detected. Airway hyperresponsiveness, defined as PC20 in the cough variant asthma group was not significantly different from that of classic asthma. There was a good correlation between the PCW (the concentration of methacholine causing wheezing) and the PC20 with the PCW values higher than PC20 values in both groups. However, in the cough variant asthma group, the PCW:PC20 ratio was greater than that of the classic asthma group. Furthermore, the mean % fall in FEV1 at which wheezing was first detected in the former group was significantly larger than that of the latter group. The results indicated that the mechanism for the manifestation of cough without wheeze in the cough variant asthma may be a higher wheezing threshold, i.e. wheezing becomes audible at the greater degree of airway obstruction than classic asthma. They suggested that patients with cough variant asthma may represent a subset of asthmatic subjects whose airways are less able to produce a wheeze.

Adolescent,Asthma,Bronchial Hyperreactivity,Bronchial Provocation Tests,Bronchoconstriction,Child,Cough,Female,Forced Expiratory Volume,Humans,Male,Methacholine Chloride,Respiratory Sounds,Sensory Thresholds

58147,763286,908121,1110670,1176724,1267261,1672866,1897812,1901691,1929491,2011424,2026843,2039256,2096171,2266070,2371436,2681641,2874335,3046444,3101841,3280772,3304810,4015154,4028846,5044498,6404414,6469819,6679232,7053462,7243436,7294009

8221273

Allergen extracts. Standardization of preparations for bronchial provocation tests. A position paper. (EAACI Sub-committee on Bronchial Provocation Tests).

Standardization of allergen provocation tests of the airways requires standardization of each of the steps involved, including standardization of the extracts used. The value of international standards is emphasized and so is the determination of a clinically relevant potency. The allergen extracts used for bronchial provocation tests must be compared with qualitatively and quantitatively clinically relevant standards using complementary immunochemical and biological methods. Ideally the same extracts should be used for diagnosis (skin test, specific IgE determinations, provocations) and treatment (immunotherapy). The importance of the biological compared with the non-biological methods is that the biological methods are established in allergenic patients in order to select a clinically relevant potency of the allergen in question, and this potency ought to be confirmed in clinical trials. Once established the biological potency of an in-house preparation can be reproduced by supplementary in vitro methods. Very few commercial allergen preparations are available which fulfil the above-mentioned criteria.

Allergens,Bronchial Provocation Tests,Humans,Indicators and Reagents,Reference Standards,Reproducibility of Results,Sensitivity and Specificity

81622,236308,362426,447944,701667,947977,1571815,1863894,1998791,2018203,2252164,2568881,2572192,3058033,3069238,3252626,3542164,3608140,3745723,3800152,3949913,4205187,5019945,5806584,6528954,6625575,6625585,6839441,7130550,8454793

8221281

Access and isolation problem solving in endodontics: posterior teeth.

Through the pictorial presentation of case studies, this paper explores the versatility of alternative methods of retention as a means of improving overall access to the endodontically-involved tooth. Successful endodontics is the result of precise biomechanical instrumentation and involves procedural manipulations that depend on a complete and unobstructed approach to the working field. This paper is aimed principally at those practitioners who would ordinarily reject rubber dam isolation in cases where the clinical pretreatment conditions are anything but ideal.

Humans,Molar,Root Canal Therapy,Rubber Dams

8221282

Down's syndrome and Alzheimer's disease.

Individuals with Down's syndrome (DS) who live to be 40 years of age will demonstrate neuropathological changes that are consistent with Alzheimer's disease (AD). Due to modern medical intervention, we are now observing an aging DS population. Middle-aged Down's syndrome adults are actually considered to be "very old," and it is not uncommon to observe a progressive loss of cognitive function and a decline in the ability to perform daily tasks consistent with that seen in Alzheimer's disease. At this stage, the DS individual will not be able to perform daily preventive dental care and may be unable to cooperate for professional dental care. Clinicians who care for DS adults must be aware of this problem when preparing their dental treatment plans, which must emphasize preventive care prior to the onset of dementia and the maintenance of that program during their patients' cognitive decline. In the latter stages of AD, it may be necessary to extract all the remaining teeth due to the inability of the individual or care giver to provide adequate oral hygiene to prevent dental caries or periodontal disease.

Adult,Alzheimer Disease,Dental Care for Disabled,Down Syndrome,Humans,Middle Aged,Oral Hygiene

8221283

Oral health and the quality of life among older adults: the oral health impact profile.

A number of studies are beginning to show that oral disorders can have a significant impact on the functional, social and psychological well-being of older adults. The Oral Health Impact Profile (OHIP) was developed to collect information on the nature and extent of this impact, and to facilitate the use of such data in oral health surveys, the evaluation of dental procedures and the clinical evaluation of patients. This paper describes OHIP and the results of two studies undertaken in Ontario to assess its measurement properties and to provide preliminary data on the way in which oral conditions compromise the quality of life of older adults. The measure proved to be reliable and valid, while data collected using this measure indicated that oral conditions have a negative impact on the daily lives of substantial proportions of older people. This impact was particularly marked among both edentulous and dentulous individuals who did not make regular visits for dental care.

Aged,Chi-Square Distribution,Dental Care,Dental Health Surveys,Female,Health Status Indicators,Humans,Interviews as Topic,Male,Mastication,Middle Aged,Mouth, Edentulous,Ontario,Oral Health,Quality of Life,Social Desirability,Surveys and Questionnaires,Toothache

8221284

[A case of swallowing a lower partial denture].

This paper reports on the case of an elderly person who accidentally swallowed his partial denture. The ingestion did not result in any signs or symptoms and the denture was found totally by chance. A major surgical procedure was required to remove the prosthesis.

Aged,Aged, 80 and over,Denture, Partial, Removable,Esophagus,Foreign Bodies,Humans,Male

8221285

Successful mandibular anesthesia following numerous unsuccessful attempts: a case report.

The management of a very anxious patient who had undergone uneventful dental treatment in the past, but posed a problem when clinicians attempted to secure profound mandibular anesthesia, is discussed. This case report also examines the advantages and disadvantages of the Gow-Gates mandibular block technique, and describes the patient's subsequent management.

Anesthesia, Dental,Female,Humans,Mandibular Nerve,Middle Aged,Nerve Block,Neuroleptanalgesia

8221287

Endothelium-derived contracting factors.

In the past decade, the importance of endothelium in modulating vascular tone has become apparent. Endothelium can produce different vasodilators, such as prostacyclin, endothelium-derived relaxing factor (most likely nitric oxide), and endothelium-derived hyperpolarizing factor. Endothelium can also produce endothelium-derived contracting factors (EDCF) which can induce constriction of the underlying vascular smooth muscle. Constriction may be mediated by a variety of products released by the endothelium. Thus, by responding to various stimuli and releasing either relaxing or contracting factors, the endothelium can set and modulate vascular tone.

Animals,Calcium,Endothelins,Endothelium, Vascular,Humans,Hypoxia,Nitric Oxide,Superoxides,Vasoconstriction

8221288

The antimicrobial activity of imipenem/cilastatin and its treatment in critical ill patients with polymicrobial and mixed infection.

The antimicrobial activity of imipenem/cilastatin (IPM/CS) was determined for a broad spectrum of 7,157 organisms isolated from the Clinical Microbiology Laboratory of Chang Gung Memorial Hospital, Linkou Medical Center, between April 1 and June 30, 1988. Ninety eight point one percent of 4,389 gram negative aerobes, 95.8% of 2391 gram positive rods, and 95.9% of 507 anaerobes, were shown to be sensitive to IPM/CS. Ninety nine point two percent of 837 Pseudomonas aeruginosa isolates were sensitive to this antibiotic. This study also disclosed that this agent was much more active against Pseudomonas aeruginosa than any other tested aminoglycosides (gentamicin, amikacin, netilmicin) or third generation cephalosporins (cefotaxime, latamoxef, ceftazidime). Twelve critically ill patients with polymicrobial and mixed infection were recruited into this trial. All patients received IPM/CS 500 mg intravenously every six hours except one patient with poor renal function had 250 mg every six hours. The average duration of therapy was 12.5 days. All patients were evaluated according to the selection criteria. IPM/CS achieved favorable clinical response in 83.7 percent. The antibiotic was well tolerated. One patient discontinued treatment because of jaundice. One patient had superinfection of fungemia. The results suggested that IPM/CS is very useful in the treatment of patients with mixed infections due to gram positive, gram negative, and anaerobic bacteriae, even when empirical therapy with other antibiotics fails.

Adult,Aged,Anti-Bacterial Agents,Bacterial Infections,Cilastatin,Cilastatin, Imipenem Drug Combination,Drug Combinations,Female,Humans,Imipenem,Male,Microbial Sensitivity Tests,Middle Aged

8221289

Electrodiagnostic studies in myasthenia gravis.

Forty-three patients with myasthenia gravis (MG) were studied to compare the sensitivity of repetitive nerve stimulation (RNS) test with single fiber electromyography (SFEMG) in the diagnosis of MG. SFEMG was abnormal in 81% (35 of 43 cases), while RNS test was abnormal in 53% (23 of 43 cases). In ocular MG, SFEMG showed a much higher positive rate (70%, 16 of 23 cases) than RNS test (22%, 5 of 23 cases). Both studies had similar abnormal rates in the generalized group. In patients studied with SFEMG in the EDC muscle, the clinical severity was closely correlated with jitter abnormality. We conclude that SFEMG is more sensitive than RNS test in the diagnosis of MG, especially in the ocular group.

Adolescent,Adult,Child,Electric Stimulation,Electromyography,Female,Humans,Male,Middle Aged,Myasthenia Gravis

8221290

Features of spinal cord injury in Taiwan (1977-1989).

In order to establish an etiological and statistical base for spinal cord injuries, 1,617 spinal cord injured patients admitted to the Chang Gung Memorial Hospital in Taiwan during the period of 1977 to 1989 were reviewed. The most common causes of injury were pedestrian (29.31%) and motorcycle (28.88%) accidents. The greatest incidence of injury was in the 26-35 year age group. The complete tetraplegic patients had the highest mortality rate (26.5%). Additional features studied were the time of occurrence and pattern of injury. Information gathered from this study suggest the need to establish a Spinal Cord Injury Prevention Program, to develop a Prehospital Care System and set up comprehensive Spinal Cord Injury Units in Taiwan. We expect this study to be adaptable to other similar developing countries.

Adolescent,Adult,Female,Humans,Length of Stay,Male,Middle Aged,Spinal Cord Injuries,Taiwan,Time Factors

8221291

Planned replacement of daily wear Acuvue disposable contact lenses.

A study of Acuvue disposable contact lenses was performed on 30 patients. The lenses were worn daily and renewed every 2 weeks for 6 months. During collection of these patients, another 16 were excluded due to an improper lens fit. Of the 30 patients included in the study, 98 to 100% had good vision and felt comfortable when wearing Acuvue lens during the whole study course. Twelve (40%) patients felt the lens were floppy and had some difficulty handling them at first. Nineteen (2.4%) of the 780 lenses used had prominent defect and 4 (0.5%) were lost during daily manipulation or wearing. Four (6.6%) eyes suffered mild punctate superficial keratitis. So, patients should be selected carefully because Acuvue lens only have one size and base curve. Acuvue lens can provide good vision and comfort of lens wearing but handling may be difficult at first. Caution should be exercised in checking and manipulating lens to prevent lens and ocular damage.

Adolescent,Adult,Contact Lenses,Disposable Equipment,Female,Humans,Keratitis,Time Factors

8221292

[Acute upper gastrointestinal bleeding in Chang Gung Memorial Hospital: comparison between 1980 and 1989].

Upper gastrointestinal (UGI) bleeding remains a great medical problem despite the improvement in both diagnostic and therapeutic management. We retrospectively analyzed 560 cases (male 429 cases, female 131 cases, mean age 45.8 +/- 23.1 years) of acute UGI bleeding within one year from January to December 1980, and 1872 cases (male 1395 cases, female 477 cases, mean age 48.7 +/- 27.5 years) within one year from January to December 1989, in order to define the changing pattern of etiology in the past 10 years. The major cause of bleeding was duodenal ulcer bleeding, which occurred at the age of 20-40 years. The incidence significantly decreased (57.8% in 1980 VS. 46.3% in 1989, P < 0.001). The second common cause was gastric ulcer (11.1% VS. 13.5%), which occurred mainly at the age of 50-70 years. The third was esophageal varices bleeding with a significantly increased incidence (6.6% VS. 11.4%, P < 0.001), which occurred mainly at the age of 40-60 years. The other less common causes included gastric cancer (5.9% VS. 5.8%), which occurred mainly at the age of 50-70 years, gastric erosion (5.2% VS. 6.1%), Mallory Weiss tear (2.1% VS. 3.1%), esophagitis (1.9% VS. 2.9%), Dieulafoy's ulcer (1.6% VS. 2.7%), vascular lesion (1.6% VS. 2.6%), and non-diagnostic cases (6.2% VS. 5.6%). The ratio of male to female for each etiology of UGI bleeding was about 3 to 1 in both 1980 and 1989.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult,Age Factors,Aged,Female,Gastrointestinal Hemorrhage,Humans,Male,Middle Aged,Retrospective Studies,Seasons,Time Factors

8221294

Type I familial amyloid polyneuropathy--report of a family in Taiwan.

We report three cases of histologically verified systemic amyloidosis with polyneuropathy. Common to them were early onset progressive peripheral sensorimotor disturbance starting in the legs and prominent autonomic dysfunctions such as postural hypotension, anhidrosis, and loss of pupillary light reflexes. Other characteristic features included vomiting, alternating diarrhea and constipation, opacities of the vitreous bodies, and congestive heart failure. All these clinical manifestations resemble type I familial amyloid polyneuropathy described by Andrade in 1952 from Portugal. Sural nerve biopsy stained with Congo red showed typical green birefringence under polarized light microscope. Histologically verified familial cases of this form of amyloid polyneuropathy have not been reported from Taiwan before.

Adolescent,Adult,Amyloid Neuropathies,Female,Humans,Male,Middle Aged,Pedigree

8221293

[Pheochromocytoma nuclear pattern analysis by flow cytometry].

Flow cytometric nuclear DNA analyses were performed on paraffin-embedded tissue samples taken from 39 patients with pheochromocytoma treated between 1981 and 1992. The Hedley technique was used for measurement of nuclear DNA contents. Only 30 cases out of the 39 tumors were available for the determination of DNA ploidy analyses. Ten cases (33.3%) showed a diploidy pattern, 8-cases (27%) showed an aneuploidy pattern and 12 cases (40%) revealed a tetraploidy pattern. Four cases of malignant pheochromocytoma with regional or distal metastasis had been noted during a mean follow-up period of 4.75 years. All these four cases showed tetraploidy nuclear pattern with vascular invasion on pathological examination, which was statistically significant (p < 0.001) in differentiation between benign and malignant pheochromocytoma. About one third of patients with tetraploidy appeared to have malignant tendencies and this was statistically significant (p < 0.05). None of the patients with either diploidy or aneuploidy pattern had disease progression. The location of the tumor (adrenal vs. extra-adrenal) and 24 hours urine total vanillylmandelic acid (VMA) amounts were not significantly different from the diploid, aneuploid or tetraploid groups. These results suggested that nuclear DNA ploidy pattern is an important independent, and useful prognostic factor for patients with pheochromocytoma.

Adrenal Gland Neoplasms,Adult,DNA, Neoplasm,Female,Flow Cytometry,Humans,Male,Middle Aged,Pheochromocytoma,Ploidies

8221295

Deep vein thrombosis during pregnancy.

Antepartum deep vein thrombosis is quite rare in Chinese women during pregnancy. An adequate diagnosis and early treatment are extremely important as the deep vein thrombosis can embolize, in particular, to the pulmonary vasculature. We present a case of pregnancy at 36 weeks gestation complicated by deep vein thrombosis. The objective diagnosis of deep vein thrombosis for obstetric patients is the noninvasive Doppler ultrasound and plethysmography. An early diagnosis is important to reduce maternal and fetal risks related to embolization. Continuous therapy of low dose intravenous heparin is safe and effective during pregnancy.

Adult,Female,Humans,Pregnancy,Pregnancy Complications, Cardiovascular,Thrombophlebitis

8221296

[Squamous cell carcinoma originating from ovarian dermoid cyst--report of three cases].

We report three cases of squamous cell carcinoma originating from ovarian dermoid cysts. All patients were postmenopausal with the chief complaints of lower abdominal pain and palpable masses found by themselves. Two of them had diabetes mellitus. The tumor sizes were all more than 10 cm. The diagnoses were made by histological examination of tissues removed at surgery. Two cases were categorized into the FIGO stage IIIc and one in stage Ia. Sonographic findings were characterized by a large adnexal mass with mixed components. An elevated serum squamous cell carcinoma antigen was found in the two cases of advanced stage and one of them also had an elevated serum CA-125 level. All reported cases were unilaterally involved without ascites at laparotomy, while omental lymph nodes metastases were noted in the two cases of advanced stage. One of the patients in the advanced stage died six months after surgery and radiation therapy due to recurrence. The other patient in the advanced stage refused further treatment even though recurrence was found five months after surgery and chemotherapy. There was no evidence of recurrence in the early stage case during the two years of follow-up.

Carcinoma, Squamous Cell,Dermoid Cyst,Female,Humans,Middle Aged,Ovarian Neoplasms

8221297

[A phoniatric treatment report for a dysphonia case with unilateral false cord bulging].

This case report was a 43-year-old male with phonation problem described as hoarseness, reduced loudness and with effort. Patient was examined by a laryngologist and a voice-speech pathologist. The laryngeal finding showed left false cord bulging under indirect laryngoscope and fiberscope. Patient's dysphonia was analyzed from perceptual and acoustic parameters. Patient was diagnosed as dysphonia with left cord bulging and under a phoniatric treatment. The goal of treatment was to eliminate vocal abuse and misuse behaviors, stimulate true cords function by Boone's "inhalation phonation" method then reduce compensatory behaviors of false cord involvement and balance life between work and after work. The results after the phoniatric treatment and underlying phonation mechanism were presented and discussed.

Adult,Humans,Male,Phonation,Vocal Cords,Voice Disorders

8221299

[Treatment of chronic osteomyelitis of leg with free latissimus dorsi musculocutaneous flap anastomosed to contralateral leg vessels].

A free latissimus dorsi musculocutaneous flap was first anastomosed to dorsal vessels of the contralateral leg. It was then used to cover a large defect of the leg as a result of chronic osteomyelitis. The use of such a cross-leg flap was not affected by the poor circulatory condition of the diseased leg. It was done in 20 patients with satisfactory results. All of them could take part in the physical work.

Adolescent,Adult,Anastomosis, Surgical,Chronic Disease,Female,Humans,Leg,Leg Ulcer,Male,Microsurgery,Osteomyelitis,Surgical Flaps

8221301

[Septicemia in early stage of severe burns].

Among 108 cases of severely burned patients, 11 were complicated with septicemia in early stage. This analysis showed that pathogenic bacteria might mainly come from the intestinal tract, and shock played a critical role in the occurrence of septicemia, and at the same time septicemia aggravated shock and also induced complications of internal organs. Attention should be paid to severely burned patients who were hospitalized late or with severe shock, and early administration of broad-spectrum antibiotic against intestinal flora might improve the therapeutic effect.

Adult,Aged,Amikacin,Bacteremia,Burns,Escherichia coli Infections,Female,Humans,Male,Middle Aged,Penicillins,Shock,Staphylococcal Infections,Time Factors

8221303

[Comparative study on tissue morphology and vascular changes of skin xenografts, allografts and autografts after transplantation].

In this study, the tissue morphology and the vascular changes of skin xenografts from the rats to the rabbits were compared with that of skin allografts and autografts simultaneously transplanted to the same recipient by the use of histological examination and dye injection. The results suggested that the xenografts were incapable of becoming vascularized, and exhibited necrosis on the third day, while early vascularization was demonstrated in the allografts and autografts. The xenografts underwent a course of "white graft rejection", which probably contributed to rejection.

Animals,Female,Graft Rejection,Male,Rabbits,Rats,Skin,Skin Transplantation,Transplantation, Autologous,Transplantation, Heterologous,Transplantation, Homologous

8221304

[Comparison of topical therapeutic effect between silver norfloxacin (Ag-NFL) and silver sulfadiazine (Ag-SD) in treatment of pyocyaneous sepsis in burn rats].

The purpose of the study was to carry out a further investigation of the efficacy of topical antimicrobial treatment of Ag-NFL in comparison with that of the most commonly used topical agent Ag-SD. An experimental model of rats with 20% TBSA full thickness burns seeded with 109 CFU of Pseudomonas aeruginosa ATCC-27853 was used. At 24, 48 and 72h after the seeding bacteriologic examination showed that the subeschar bacterial counts exceeded 10(6) CFU per gram of tissue. Subeschar bacterial counts were zero in the group in which Ag-NFL was used, while those in the group using Ag-SD were almost the same as the control. The amount of silver accumulated in the eschar of Ag-NFL, treated rats was significantly higher than that of Ag-SD treated rats. In conclusion, Ag-NFL was proved valuable in the treatment of burn wound infection caused by invading organisms, particularly by the Ag-SD resistant strain of Pseudomonas.

Administration, Topical,Animals,Anti-Infective Agents,Burns,Female,Fluoroquinolones,Male,Norfloxacin,Pseudomonas Infections,Rats,Rats, Sprague-Dawley,Silver Sulfadiazine,Wound Infection

8221305

[An experimental observation of effect of tetrandrine on pulmonary dysfunction in rabbit model of smoke inhalation injury].

A rabbit model with severe smoke inhalation injury was adopted to observe the effect of tetrandrine, a calcium antagonist, on pulmonary dysfunction after smoke inhalation during 24 hours post injury. It was found that tetrandrine could decrease the permeability of pulmonary and tracheal vascular permeability (p < 0.01), reduce lung edema and improve the function of respiration. These results imply that tetrandrine might be used in the treatment of inhalation injury.

Alkaloids,Animals,Benzylisoquinolines,Burns, Inhalation,Calcium Channel Blockers,Capillary Permeability,Male,Pulmonary Edema,Rabbits,Respiratory Insufficiency

8221310

[V-Y advancement of volar skin flap in the repair of fingertip defect and cicatricial contracture].

The traditional Kutler and Atasoy V-Y advancement flaps have minimal range of advancement, so it is not satisfactory to repair large skin defect in fingers, hence limited indications. The sensory function of the repaired fingers is impaired because of injury to sensory nerves and scar formation. Since 1985 to 1991, the V-Y advancement flap with bilateral digital arteries and nerves as the pedicle has been used for the reconstruction of 33 fingertip defects and 5 digital volar cicatricial contracture. Satisfactory results were obtained in all these cases. In this paper, the anatomical characteristics and principles of device were recommended, the advantages and key points to success were discussed.

Adolescent,Adult,Cicatrix,Contracture,Female,Finger Injuries,Humans,Male,Surgical Flaps

8221311

[Early repair of burned cranium].

Early repair was done on 10 patients, of whom there was necrosis of either the outer or both outer and inner tables of the skull as a result of deep burn injuries. Multiple drill holes were made through the necrotic cranial bones until bleeding occurred on 7 PBD. The wounds were immediately covered with skin flaps. A continuous drip of lidocaine, chloramphenicol and normal saline was instituted underneath the flaps. The results after one to five years follow-up were satisfactory.

Adolescent,Adult,Burns,Child,Child, Preschool,Female,Follow-Up Studies,Humans,Infant,Male,Necrosis,Skull,Surgical Flaps

8221312

[Correction of naso-labial disfigurement subsequent to bilateral cleft lip repair with combined upper lip flap and Abbe flap].

Anomalies of the nose and lip after repair of bilateral cleft lip and palate is a psychological injury to the patients affecting their social intercourse. The author has designed an operative method using a flap of the fore-lip combined with Abbe flap of the lower lip to repair the anomaly with successful result. In two patients, free Abbe lip flap was used, with one complete success and partial necrosis of the other.

Adolescent,Adult,Cleft Lip,Cleft Palate,Female,Humans,Lip,Male,Nose Deformities, Acquired,Postoperative Complications,Surgical Flaps

8221313

[Repair of lower nasal defect with compound skin flap from forehead with trochlear artery and subcutaneous tissue pedicle].

This article reports the repair of lower nasal defect with forehead compound skin flap consisting of the trochlear artery and subcutaneous tissue pedicle in one stage in 11 patients. The repaired area ranged from 2 x 2 to 4 x 3 cm and the frontal bone area 1.5 x 1 cm. This operation had achieved good results, and the frontal bones were not absorbed, except 1 case, after 1 year follow-up. The methods of this flap design and operation were described. The merits, demerits and points for attention were discussed.

Adolescent,Adult,Female,Forehead,Humans,Male,Middle Aged,Nose Deformities, Acquired,Surgical Flaps

8221316

[Suction lipectomy for male gynecomastia].

This paper reports the application of the suction lipectomy to treat gynecomastia in 10 cases with excellent results. A 2-2. 5 cm incision was made on the lower areolar border at 5 to 7 o'clock. The suction power was adjusted to 67-93 kPa. The suction cannula was moved to and fro in radial direction rapidly. The diameter of the sucked area should be larger than desired size of the breast by 2 cm to avoid a saucer deformity. If gynecomastia is entirely due to fat accumulation, suction lipectomy only is enough. But, when gynecomastia is due partly to parenchymal hypertrophy, an additional excision of the parenchymatous tissue is required. After the operation, elastic garment must be worn at all time for 4 to 6 weeks to avoid hematoma and to achieve a flat appearance.

Adult,Gynecomastia,Humans,Lipectomy,Male

8221318

[A new scapular free flap with ascending and descending branches of the circumflex scapular artery as the main axial arteries].

Free scapular skin flap was transplanted for repair of burn scars on the face and neck successfully in 8 patients. The ascending and descending branches of the circumflex scapular artery are utilized as the main axial vessel. This method expands the range of use of skin flap in the scapular region.

Adolescent,Adult,Burns,Child,Cicatrix,Face,Female,Humans,Male,Neck,Surgical Flaps

8221319

[Oro-pharyngeal flora in severely burned patients].

Throat cultures were taken in thirty-seven cases of burned patients, and also, at the same time, from twenty-three healthy persons. The results showed that the essential oro-pharyngeal flora in healthy persons were Neisseria (65.7%) and Streptococcus viridans (14.3%), and Staphylococcus aureus was obtained occasionally. In twenty-five out of thirty-seven patients dominant growth of invaders was observed. The prominent aerobic bacteria in patients included Serratia (9.33%), Pseudomonas aeruginosa (8.44%) and Proteus (7.11%). The positive rate of fungi was as high as 75.1%, of which Candida was the most commonly found organism. In 7 patients the number of bacteria in the throat was in excess of 108/cm2. Of these 7 patients, 4 died. Quantitative bacterial count of lungs were taken in 3 non-survivors, and the bacterial count was over 10(5)/g. The bacteria in the lungs were as same as the predominantly colonized bacteria in the throat, and in a part of cases were the same as the systemically disseminated bacteria. The study of the throat flora is simple, its result might help the prediction of pulmonary infection.

Adolescent,Adult,Aged,Burns,Candida,Female,Humans,Male,Middle Aged,Oropharynx,Pseudomonas aeruginosa,Serratia

8221320

[Comparison of irradiated porcine skin with exposure or occlusive method in the care of second degree burn wounds].

This article compared irradiated porcine skin with exposure and occlusive method in the care of second degree burn wounds. In 30 patients in whom irradiated porcine skin (IPS) was used, no wound infection occurred. The rate of wound infection, in patients on whom herb medicine and exposure method were used, was 19% (7/37), and that of occlusive dressing plus drug group was 22% (2/9). The rate of wound infection of IPS was significantly lower than the other two groups (P < 0.05). The time of wound healing in IPS group was 13.5 + 5.03 days; it was significantly shorter than the other two groups.

Adolescent,Adult,Biological Dressings,Burns,Female,Humans,Male,Middle Aged,Wound Infection

8221321

[Therapeutic effect of calcium preparation in phosphorus poisoning following phosphorus burns].

All of 20 patients with phosphorus burn, admitted from 1987 to 1991, have been cured by intravenous drip of calcium gluconate combined with other therapies. The wounds were washed with tap water, followed by eschar formation in 12 days. The clinical data showed that phosphorus poisoning did not occur if calcium was given very early postburn. Calcium also could abolish or ameliorate clinical manifestations of existing phosphorus poisoning, accelerate the elimination of phosphorus and recovery of damaged organs.

Adult,Burns, Chemical,Calcium Gluconate,Humans,Male,Phosphorus,Poisoning

8221323

[An evaluation of problems arising from the use of soft tissue expander].

From November 1987 to July 1992, expanded skin was examined with both light and electron microscopes in 15 patients. Using these results, several problems arising from clinical use of skin expander were evaluated.

Adolescent,Adult,Burns,Child,Cicatrix,Female,Humans,Male,Microscopy, Electron,Skin,Tissue Expansion

8221325

[A clinical research of three dimensional computerized imaging in the aid of operative design for reconstructive surgery of the face].

This article reports the utilization of three dimensional imaging technique of computer in reconstructive surgery of the face. In 312 cases, the technique has been proved that it can make the preoperative analysis computerized, quantitated and picturized. The measurement and analysis through computer are quick and exact, rendering operative designs feasible. The use of the evaluation system can also help enhance the communication and understanding between the surgeon and his patient. The surgical simulation system can replace the traditional preoperative manual work such as paper molds, plaster casts, and wax mold, and it is therefore much valuable for practical use.

Computer-Aided Design,Evaluation Studies as Topic,Face,Humans,Rhinoplasty,Surgery, Plastic

8221326

[Experimental study on the skin by laser-assisted anastomosis].

Incisions in 35 rats were performed on the back bilaterally. Both incisions were sutured by hand with threads at equal interval. One of the incisions immediately welded by laser after suture, the others as follow. When 24 hours after suture, the stitches of the laser welded incisions were removed. The maximal strength force and histology of the bilateral incisions were measured and examined respectively at 1, 3, 7 and 14 days after the operation. The results showed: there was obviously significant differences of the strength force within 3 days between the two incisions. There was slightly inflammatory reactions, no scar and ideal healing in laser welded incisions.

Animals,Dermatologic Surgical Procedures,Female,Laser Therapy,Male,Rats,Rats, Wistar,Surgery, Plastic,Suture Techniques,Wound Healing

8221327

[Angiotensin converting enzyme (ACE) in scalded rats and protective effect of chloroquine (CQ) in lung injury].

Wistar rats were scalded and then divided at random into control group and scalded+CQ group. They were sacrificed in lots at 6, 24 and 48 hours after the scald and blood was drawn for the determination of ACE, PLAa, Pa02. Pathological examination was also done. The results revealed that, 1. after scald, the rat's serum ACE was reduced below normal value, and it occurred before changes in blood gas, suggesting that ACE might be used as a valuable supplementary diagnostic criterion for pulmonary failure; 2. CQ provided certain amount of protection in pulmonary failure of scalded rat.

Animals,Burns,Chloroquine,Lung,Peptidyl-Dipeptidase A,Pulmonary Edema,Random Allocation,Rats,Rats, Wistar

8221330

[Effect of burn injury, blast injury and combined burn-blast injury on immune reactions of thymocytes and splenocytes in rats].

Rats were inflicted with burn (15% TBSA full-thickness) by flash thermal radiation, blast injury in shock tube (over pressure 429.3 +/- 11.5 kPa) and both of them, respectively. The dynamic changes of several cellular immune reactions of thymocytes and splenocytes were observed. One hour after injuries, the immune reactions were significantly enhanced in combined injury group as well as in blast injury group, but somewhat depressed in burn group. 12 hours after injuries, the immune reactions in all three groups were obviously depressed. It was found that the degree of depression showed an order as follows: Combined injury > Blast injury > Burn. The combined effects were more serious than that of the sum of two single injuries, and the combined injury recovered more slowly than the other two. Therefore, an aggravated effect was observed in combined injury in this experiment.

Animals,B-Lymphocytes,Blast Injuries,Burns,Leukocyte Count,Male,Multiple Trauma,Rats,Rats, Wistar,Spleen,T-Lymphocyte Subsets,T-Lymphocytes,Thymus Gland

8221331

[Early coverage of deep partial-thickness burn wound with porcine dermal collagen membrane. An experimental study].

Collagen was extracted by pepsin digestion from porcine skin and collagen membrane was prepared by salt precipitation. Collagen membrane as a wound dressing was evaluated in a deep partial-thickness burn wounds in a rat model. Burn wound, 4 x 4 cm, were inflicted by exposing skin to 75 degrees C for 15 seconds followed by de-epithelization. Wound healing was assessed by plenimetry of epithelization on day 10 postwounding. Open wounds exhibited a re-epithelialization of 24% of wound area. Collagen membrane dressing significantly improved the healing rate to approximately 70% of wound area.

Animals,Biological Dressings,Burns,Collagen,Female,Rats,Rats, Sprague-Dawley,Wound Healing

8221332

[Technetium-99m bone imaging and mechanical strength test on heterogenous inorganic bone implantation].

Two kinds of heterogenous inorganic bone (HAB), lower temperature treated HAB (LHAB) and higher temperature treated HAB (HHAB), were implanted and observed by technetium-99m bone imaging and mechanical strength test. The results confirmed that the LHAB possessed biocompatibility and osteoinductivity. Half a year after implantation, LHAB induced bone formation and bridged large osseous defect.

Animals,Bone Transplantation,Bone and Bones,Female,Male,Rabbits,Radionuclide Imaging,Technetium Tc 99m Medronate,Temperature,Tensile Strength,Transplantation, Heterologous

8221341

Coronary thrombolysis: mortality trials.

There is unequivocal evidence for the reduction of early mortality (up to about 35 days) by SK, APSAC and rt-PA, each compared with placebo, for patients treated intravenously within the first few hours of onset of acute MI. An overview of early trials demonstrating mortality reduction with SK, has been confirmed by three level I trials of SK, one level I trial of APSAC and one level I trial of rt-PA. The early benefits observed in the large trials of SK, APSAC and rt-PA have persisted at the one-year follow-up. The initial two large trials which directly compared mortalities of therapy with SK, rt-PA and APSAC detected no significant differences. However, the recently presented GUSTO trial has demonstrated greater mortality reduction with accelerated rt-PA plus heparin, compared with regimens of combined rt-PA/SK plus heparin, SK plus iv heparin, and SK plus sc heparin.

Fibrinolytic Agents,Heparin,Humans,Plasminogen Activators,Randomized Controlled Trials as Topic,Streptokinase,Thrombolytic Therapy

8221348

Coronary thrombolysis: prehospital use.

Strong evidence supports the concept that earlier application of fibrinolytic treatment can maximize the benefits derived. The results of two level I trials have shown that prehospital thrombolysis is feasible and safe. Although the trials have not proven that prehospital thrombolysis improves prognosis, they have shown that early identification of eligible patients can greatly accelerate the process of drug administration.

Clinical Trials as Topic,Fibrinolytic Agents,Humans,Mobile Health Units,Myocardial Infarction,Prognosis,Thrombolytic Therapy,Time Factors

8221343

Coronary thrombolysis: nonmortality measures of efficacy.

Early reperfusion during AMI results in myocardial salvage, recovery of function and reduced mortality (level I). This can be achieved with all of the currently available thrombolytic agents (level I). Benefits from late reperfusion are not proven but there are data which suggest that delayed reperfusion is better than persistent occlusion (level II). There is now clear evidence that accelerated dose rt-PA (plus heparin) is more effective in reducing mortality than is SK (plus heparin) or a combined regimen of rt-PA/SK (plus heparin) (level I). Soon-to-be published data will refine the extent to which different subgroups benefit and will provide a basis from which to select the most appropriate agent in individual patients. The overall benefit was the reduction of one death per 100 patients treated with rt-PA compared with SK, while the absolute benefit varied considerably among patient subgroups.

Evaluation Studies as Topic,Fibrinolytic Agents,Heparin,Humans,Myocardial Infarction,Stroke Volume,Thrombolytic Therapy,Treatment Outcome,Vascular Patency,Ventricular Function, Left

8221359

Neuroendocrine response to cardiac transplantation.

The neuroendocrine response to heart transplantation was characterized in 11 patients with special reference to long term effects on plasma hormone concentration.

Aldosterone,Atrial Natriuretic Factor,Catecholamines,Central Venous Pressure,Female,Graft Rejection,Heart Transplantation,Humans,Male,Middle Aged,Pulmonary Wedge Pressure,Renin,Stroke Volume

8221360

Reversal of diastolic dysfunction by intravenous magnesium chloride.

To treat diastolic dysfunction in patients with coronary artery disease (CAD).

Aged,Coronary Angiography,Coronary Disease,Diastole,Female,Humans,Magnesium Chloride,Male,Middle Aged,Ventricular Function, Left

8221361

Coronary artery bypass grafting in Alberta from 1984 to 1989.

To examine the geographic and temporal trends in the performance of coronary artery bypass grafting (CABG) in the province of Alberta. This examination was designed to improve understanding of the geographic distribution and temporal changes in the incidence of the procedure.

Aged,Alberta,Coronary Artery Bypass,Female,Humans,Insurance, Health,Male,Middle Aged

8221362

Overview of clinical trials in congestive heart failure.

Heart failure is the only cardiovascular disorder which is increasingly prevalent in North America. Several large clinical trials have emerged within the past 10 years. The results from some of these trials have had a significant impact on the way congestive heart failure is recognized and treated. The objective of this review is not to review exhaustively all recent clinical trials in heart failure but to present the most important ones selected because of their impact on how one understands and treats congestive heart failure in 1993. The results, as well as some important pathophysiological considerations related to these trials, will be addressed.

Clinical Trials as Topic,Heart Failure,Humans,Ventricular Function, Left

8221363

Role of endothelin in heart function in health and disease.

A comprehensive review of the literature has revealed that endothelins belong to a family of vasoactive peptides which are formed and released from the endothelium. By producing constriction of the coronary arteries and peripheral blood vessels, endothelins are known both to reduce coronary bloodflow and increase blood pressure and thus can be seen to affect heart function adversely. On the other hand, endothelins are capable of producing positive inotropic and chronotropic effects by directly affecting both the myocardium and nodal tissues. Prolonged actions of high concentrations of endothelins can be seen to induce relative hypoxia in the myocardium which will eventually result in heart dysfunction. The mechanisms of actions of endothelin on smooth muscle cells and cardiomyocytes include interaction with endothelin receptors on the cell surface, activation of phospholipase C through G-proteins, and increase in the intracellular concentration of Ca2+ through the increase in phosphoinositol turnover. Endothelins were found to exert no effects on sarcolemmal Na+,K(+)-ATPase, Na(+)-Ca2+ exchange and Ca2+ pump systems nor on the sarcoplasmic reticular Ca2+ pump system and myofibrillar ATPase activities in the rat heart. Marked elevation in the levels of plasma endothelins and down-regulation of endothelin receptors in ischemia-reperfusion injury, hypertension and chronic diabetes indicate a significant role of endothelins in the genesis of heart dysfunction under different pathological conditions.

Animals,Endothelins,Heart,Heart Failure,Heart Rate,Humans,Receptors, Endothelin

8221364

Repeated plaque rupture in the same bypass graft.

A 51-year-old man experienced a plaque rupture at the site of a shallow plaque in his anterior descending bypass graft and went on to suffer a myocardial infarct. Angiography, five months later, showed excellent recanalization; however, one month after that angiogram, the patient presented with unstable angina and evidence of plaque rupture at the same site. The presence of plaque in a graft indicates risk for future plaque rupture, but there appear to be no definite indicators to identify the specific plaque that is at highest likelihood of rupture.

Angioplasty, Balloon, Coronary,Coronary Angiography,Coronary Artery Bypass,Coronary Thrombosis,Humans,Male,Middle Aged,Myocardial Infarction,Postoperative Complications,Recurrence,Reoperation,Rupture, Spontaneous

8221365

Patterns of recurrence and survival in AMI patients in Canada.

To describe the patterns of recurrence and survival of patients following their first acute myocardial infarction (AMI).

Adult,Age Factors,Aged,Female,Humans,Male,Middle Aged,Myocardial Infarction,Nova Scotia,Recurrence,Retrospective Studies,Saskatchewan,Sex Factors,Survival Rate,Time Factors

8221366

Comparison of the oculokinetic perimetry glaucoma screener with two types of visual field analyser.

We compared the accuracy and testing time of a new 26-point central visual field glaucoma screening device, the oculokinetic perimetry (OKP) screener, with the results obtained with the Friedmann field analyser standard program (phase 1) and the Humphrey field analyser 40-point screening program (phase 2). Seventy-three eyes of 73 subjects were tested in phase 1, and 142 eyes of 75 subjects in phase 2. The study population comprised patients with eyes that were ocularly normal and patients with eyes showing early cataract, posterior vitreous detachment, established chronic open-angle glaucoma or ocular hypertension. The OKP glaucoma screener demonstrated a sector concordance rate of 95% in phase 1 and 93% in phase 2. The OKP screener was three to four times more rapid in execution than the standard device. We feel that the OKP glaucoma screener is ideally suited for use by physicians in a family practice setting.

Adolescent,Adult,Aged,Aged, 80 and over,Chronic Disease,Female,Glaucoma,Humans,Male,Middle Aged,Ocular Hypertension,Reproducibility of Results,Time Factors,Vision Screening,Visual Field Tests,Visual Fields

1138849,2226985,2226995,2630329,3211553,3378021,4084485,5009107,6733069,6733070,6837687,7466593

8221367

Recession of the superior oblique tendon for inferior oblique palsy and Brown's syndrome.

Superior oblique tendon recession of 12 to 14 mm was performed in five patients with inferior oblique muscle palsy and three patients with Brown's syndrome. The angle of deviation was decreased by an average of 18 prism dioptres in the worst field of gaze for the former group and by 17.3 delta for the latter group. As a secondary benefit of the procedure for the patients with inferior oblique palsy, any associated preoperative A-pattern was collapsed an average of 10 delta postoperatively. The procedure eliminated all abnormal head postures and improved versions and ductions for both groups. Symptoms of diplopia and torsion were resolved, and full fusional ability was maintained at preoperative levels in all fields of gaze for all patients. After an average follow-up period of 18 months none of the patients had manifested superior oblique palsy or other notable postoperative surgical complications. Theoretical advantages of superior oblique tendon recession include the potential for reversibility and reoperation if required, the possibility of asymmetric surgery and the potential to perform the procedure with an adjustable suture. The technique is an advantageous approach in the surgical treatment of these complicated cases.

Child,Child, Preschool,Eye Diseases,Follow-Up Studies,Humans,Middle Aged,Oculomotor Muscles,Ophthalmoplegia,Orbit,Prognosis,Strabismus,Syndrome,Tendons,Tissue Adhesions,Visual Acuity

345531,901268,1191613,1258952,1867560,2264661,2694414,3192088,3658365,3717840,3969472,5053253,5492457,5505476,6040010,6871788,7073569,7099550,7155517,7386560,20273126,24877301

8221368

Brown's syndrome with contralateral inferior oblique overaction: a possible mechanism.

The simultaneous occurrence of Brown's syndrome in one eye and inferior oblique overaction in the other eye is an infrequently reported association. Review of our series of 38 cases of Brown's syndrome disclosed six patients with overaction of the contralateral inferior oblique, of whom four stepped out to contralateral superior oblique palsy. We propose that these patients initially have bilateral Brown's syndrome in infancy, and spontaneous resolution occurs in one eye only. While Brown's syndrome is present the antagonist inferior oblique muscle undergoes isometric contracture. With spontaneous resolution of Brown's syndrome a relative imbalance of forces occurs, with the superior oblique muscle now being relatively paretic compared with the contracted and fibrotic inferior oblique. Up-shoot in adduction then becomes apparent.

Child,Child, Preschool,Eye Diseases,Female,Follow-Up Studies,Humans,Infant,Isometric Contraction,Male,Oculomotor Muscles,Strabismus,Syndrome,Tissue Adhesions

5053253,6871788,7386560

8221369

Unexpected stereoacuity following surgical correction of long-standing horizontal strabismus.

Eight patients with long-standing large-angle constant tropias unexpectedly achieved stereoacuity (40 seconds of arc in six patients and 60 seconds of arc in two patients) following strabismus surgery. There are few reports in the literature documenting this finding. The authors found that if excellent postoperative alignment can be achieved in patients with good bilateral visual acuity, some of these patients will demonstrate high-grade stereoacuity even if the preoperative findings suggest this outcome to be unlikely.

Adult,Child,Depth Perception,Esotropia,Exotropia,Female,Follow-Up Studies,Humans,Male,Middle Aged,Oculomotor Muscles,Treatment Outcome,Visual Acuity

1269367,3192089,6489098,6864410,7172109,14061739

8221370

Presumed photic retinopathy after cataract surgery: an angiographic study.

To ascertain the prevalence rate of presumed photic retinopathy after cataract surgery, 276 fluorescein angiograms of 147 patients were reviewed. The diagnosis was based on strict angiographic criteria. Lesions consistent with healed photic retinopathy were noted in four patients (prevalence rate of 3%). This finding is discussed and comparisons with the literature are made.

Cataract Extraction,Fluorescein Angiography,Flurbiprofen,Follow-Up Studies,Fundus Oculi,Humans,Indomethacin,Infant, Newborn,Light,Macular Edema,Prevalence,Radiation Injuries,Retina,Retinal Diseases

443337,869422,1985488,3068607,3355405,3355421,3826232,3839567,3991126,6195575,6634079,7247168

8221371

Pars plana vitrectomy in the management of vitreous touch syndrome.

The management of three patients with aphakic bullous keratopathy by means of pars plana vitrectomy is described. The patients had previously undergone uneventful intracapsular cataract extraction with intact vitreous face. Eventual herniation of the vitreous into the anterior chamber with resultant corneal endothelial touch caused the corneal edema in all three cases. Pars plana vitrectomy resulted in resolution of photophobia and irritation. The visual acuity improved from 20/200, 20/200 and 20/70 to 20/70, 20/60 and 20/40 respectively. The central cornea was cleared of edema in all three cases. The final vision was limited in two of the patients by the persistence of preoperative cystoid macular edema. Pars plana vitrectomy may be used in the management of selected cases of aphakic bullous keratopathy from vitreous touch.

Aged,Aphakia, Postcataract,Cataract Extraction,Corneal Edema,Endothelium, Corneal,Eye Diseases,Hernia,Herniorrhaphy,Humans,Male,Visual Acuity,Vitrectomy,Vitreous Body

1140910,14902189,18146131

8221377

Sequence analysis of the lysin gene region of the prolate lactococcal bacteriophage c2.

Approximately 80% of the genome of the prolate-headed lactococcal bacteriophage c2 was cloned into shuttle vectors pSA3 and pFX3 in Escherichia coli and transferred to Lactococcus lactis. A 1.67-kilobase EcoRV fragment containing the gene for the phage lysin was identified and the position and orientation of the phage lysin gene in the physical map of the phage were determined. The phage lysin was expressed in E. coli and its sequence was determined and compared with the sequences of other bacteriophage lytic genes. The sequence was similar, but not identical, to that of the related lactococcal phage m13, having a number of silent substitutions and an apparent deletion that altered the carboxy terminus of the protein. Possible alternative translation initiation codons for the lysin gene and two possible alternative mechanisms for access of the lysin enzyme to the cell wall are discussed. An open reading frame upstream of the putative lysin gene was found to be 177 base pairs longer than that reported for phage m13. A codon usage table for the lysin genes of several phages as well as for reported gene sequences from L. lactis and lactococcal bacteriophages is presented.

Amino Acid Sequence,Bacteriophages,Base Sequence,Cloning, Molecular,Codon,DNA, Viral,Escherichia coli,Genes, Viral,Genetic Vectors,Lactococcus lactis,Molecular Sequence Data,Open Reading Frames,Sequence Alignment,Sequence Homology,Viral Proteins,Viral Structural Proteins

416755,1400210,1406491,1900800,1901837,2183202,2183205,2506424,2985470,3095188,3883896,6269067,6269464,6324674,6546423,16350018

8221378

Digestion of cell-wall monosaccharides of ryegrass and alfalfa hays by the ruminal bacteria Fibrobacter succinogenes and Butyrivibrio fibrisolvens.

The ruminal bacteria Fibrobacter succinogenes strains S85 and BL2 were grown in monocultures or in coculture with strain D1 of Butyrivibrio fibrisolvens, and the solubilization of ryegrass and alfalfa cell walls (CW) and digestion of CW monosaccharides were measured. Fibrobacter succinogenes monocultures and cocultures with B. fibrisolvens D1 degraded 58-69% of ryegrass CW, solubilizing 67-78% of CW glucose, 65-71% of CW xylose, 69-75% of hemicellulose, and 68-77% of total CW monosaccharides. When grown on alfalfa CW, those cultures degraded 28-39% of alfalfa CW, solubilizing 42-58% of CW glucose, 30-36% of CW xylose, and 37-45% of hemicellulose. With respect to both substrates, F. succinogenes strains solubilized CW carbohydrates better than did B. fibrisolvens D1. Complementary interaction between B. fibrisolvens D1 and the F. succinogenes strains was identified with respect to the utilization of some solubilized carbohydrates, but not with respect to the extent of CW solubilization, which was determined mainly by the F. succinogenes strains. For both substrates, utilization of cellulose by F. succinogenes monocultures was high (96-98%), whereas that of hemicellulose was lower (24-26% in ryegrass and 49-50% in alfalfa). Under scanning electron microscopy, F. succinogenes bacterial cells attached to and colonized on CW particles were characterized by the appearance of protuberant surface structures that we have identified as "polycellulosome complexes."

Animals,Bacteroides,Cell Wall,Gram-Negative Anaerobic Bacteria,Lolium,Medicago sativa,Microscopy, Electron, Scanning,Monosaccharides,Rumen

1539970,1667013,2030098,2283039,2619305,3124741,4269305,7016031,16348005

8221379

Activity of microbial peptidases, oxidases, and esterases in lake waters of varying trophic status.

The range and activities of microbial enzymes present in lake water were assessed directly in cells concentrated by tangential flow filtration. A total of 108 enzymes were assayed in this study, which included tests for 60 peptidases, 20 oxidases, and 10 esterases, and 18 miscellaneous tests. In general, no trends in the range of enzymes were associated with trophic status of the lakes. However, one lake that was hypereutrophic had a greater range of enzymes than the other lakes tested. An increase in total enzyme activity (activity/mL) was recorded with an increase in trophic status of the water. The relationship between the physical and chemical attributes of each lake and microbial enzyme activities was investigated by principal component analysis. Quantitative changes between lakes in 11 of the 21 variables were shown to be closely related to changes in the enzyme activities of the lakes; total organic carbon, particulate carbon, particulate nitrogen, pH, and chlorophyll a showed the closest relationships.

Bacterial Proteins,Carbon,Cations,Ecology,Esterases,Nitrogen,Oxidoreductases,Peptide Hydrolases,Water,Water Microbiology

54353,2330053,2409920,2430518,16345636,16345934,16346181,16348342,16348543,24221149

8221380

Physiology of basal ganglia disorders: an overview.

The pathophysiology of the movement disorders arising from basal ganglia disorders has been uncertain, in part because of a lack of a good theory of how the basal ganglia contribute to normal voluntary movement. An hypothesis for basal ganglia function is proposed here based on recent advances in anatomy and physiology. Briefly, the model proposes that the purpose of the basal ganglia circuits is to select and inhibit specific motor synergies to carry out a desired action. The direct pathway is to select and the indirect pathway is to inhibit these synergies. The clinical and physiological features of Parkinson's disease, L-DOPA dyskinesias. Huntington's disease, dystonia and tic are reviewed. An explanation of these features is put forward based upon the model.

Basal Ganglia Diseases,Humans,Models, Biological

1375883,1471865,1510355,1518510,1695401,1695403,1695404,1736169,1898264,1988764,1992365,2011256,2217661,2330111,2471629,2597995,2665687,2731027,2789701,2797458,2811890,2909917,2927683,2967729,3364889,3386815,3443961,4031930,4041776,5566110,6234055,6539874,6573576,6660125,6737302,6838141,6946193,7200209,7397480

8221381

Pathogenesis of mesial temporal sclerosis.

A relationship between epilepsy and damage to mesial temporal structures has long been recognized. Recent advances have clarified somewhat the issue of whether the pathological changes seen in mesial temporal sclerosis represent the cause or the effect of seizures. This paper reviews mesial temporal sclerosis from an historical perspective and summarizes recent developments in the fields of excitotoxicity, selective vulnerability, and synaptic reorganization as they pertain to the pathogenesis of mesial temporal sclerosis.

Animals,Epilepsy, Temporal Lobe,Humans,Sclerosis,Temporal Lobe

16986,487185,492534,625338,737525,856951,899824,1000285,1279853,1688284,1688934,1697342,1726760,1829904,2181500,2282474,2327736,2381513,2411586,2449733,2452481,2461436,2469166,2508534,2542848,2549634,2569920,2647252,2776009,2862970,2884013,2913203,2924151,2925892,3018587,3037433,3061362,3317757,3345425,3357023,3362871,3559710,3559711,3574769,3607518,3670595,3674798,3719320,3827212,3841294,3981241,4043015,4152936,4197956,4434186,4523024,4582499,4629379,4630226,4981856,5157537,5528533,5543199,5677186,5922048,6089046,6119136,6130475,6139418,6143283,6172187,6189867,6249441,6315469,6316143,6433403,6510380,6510381,6633867,6639740,6777154,6829333,6843775,6871737,7031398,7059802,7108779,7131310,7143035,7279294,7322276,7350980,7378761,7378766,12996130,12998590,13212417,13385382,14106768

8221382

Nuclear magnetic resonance study of cerebrospinal fluid from patients with multiple sclerosis.

Proton nuclear magnetic resonance (NMR) spectroscopy was used to examine cerebrospinal fluid (CSF) from patients (n = 30) with actively progressive multiple sclerosis (MS). Metabolite concentrations obtained from the spectra were compared to those determined from the spectra of CSF from control patients (n = 27) with benign spinal disorders. No significant difference was found between the 2 groups for most constituents, including lactate, glutamine, citrate, creatine and creatinine, and glucose. Acetate levels were significantly higher in MS patients, while formate levels were significantly lower, than the controls. There were no significant differences in metabolite concentrations in CSF from early and longstanding MS patients. A peak due to an unidentified compound was found at 2.82 ppm in the spectra of CSF from patients with actively progressive MS, but not in the spectra of CSF from the controls. The peak was not found in spectra of CSF from patients with AIDS dementia complex (n = 9) or Parkinson's disease (n = 5), but it did appear in spectra of CSF from 1 patient with Jakob-Creutzfeldt disease (out of 3 examined) and from 1 patient (out of 7) with Guillain-Barré disease. The unidentified compound is volatile and, from the chemical shift of the observed NMR peak, is probably an N-methyl compound. As such, it may be an intermediate in the cholinoglycine cycle, in which an abnormality has been proposed to exist in MS patients.

Adult,Female,Humans,Magnetic Resonance Spectroscopy,Male,Middle Aged,Multiple Sclerosis,Nervous System Diseases

762561,886334,1151432,1556919,1637131,2420146,2450176,2718204,2809622,3034477,3243898,3340277,3746301,4737686,5422549,5927765,7121719,7453944

8221383

Severe permanent encephalopathy in acute lymphoblastic leukemia.

As survival rates for childhood acute lymphoblastic leukemia have increased, concerns over improved quality-of-life have also increased. Although 3-10% of children may experience acute transient neurotoxicity during induction chemotherapy, they are felt to be at low risk for late sequelae. We report three previously healthy boys with newly-diagnosed acute lymphoblastic leukemia who presented with obtundation and severe seizures during late induction with a standard four drug chemotherapy regimen. While all three are disease-free survivors, they unexpectedly have persistent and medically intractable partial complex seizures, broad-based neuropsychological impairment and striking neuroimaging abnormalities. These findings suggest that children with leukemia who develop an acute encephalopathy during induction chemotherapy are at risk for long-term neurological and neuropsychological sequelae, despite the cessation of further potentially neurotoxic therapy.

Antineoplastic Combined Chemotherapy Protocols,Attention,Brain Diseases,Child,Child, Preschool,Humans,Intelligence Tests,Language,Male,Memory,Memory, Short-Term,Neuropsychological Tests,Precursor Cell Lymphoblastic Leukemia-Lymphoma,Seizures,Tomography, X-Ray Computed

803160,1003126,1182497,1878094,1930413,1985164,2304789,2505541,2653080,2758890,2969762,3309198,3422180,3615782,3722348,3860796,3875694,3891922,3892694,4019053,4045379,4516522,6199470,6465469,6933231

8221384

Serum lipoprotein fatty acid profile in hereditary ataxias.

We investigated the serum fatty acid profiles of cholesterol esters, phospholipids and triglycerides in 24 patients with Friedreich's disease and 16 patients with other forms of spinocerebellar degeneration. In 8 patients with Friedreich's disease we also analyzed the fatty acid profile of the lipoprotein fractions. We found no major differences in fatty acid profiles between ataxic patients and sex and age-matched controls; in particular there was no decrease of linoleic acid in Friedreich's disease. The level of linoleic acid in serum cholesterol esters decreased with increasing disability of patients.

Adolescent,Adult,Aged,Cerebellar Ataxia,Child,Cholesterol,Fatty Acids,Female,Friedreich Ataxia,Humans,Lipoproteins,Male,Middle Aged,Phospholipids,Spinocerebellar Degenerations,Triglycerides

185334,226259,2277267,2392212,2899844,4690906,6133167,6452193,6509419,7359148,13876261,14213469

8221385

The usefulness of CT scanning in diagnosing dementia of the Alzheimer type.

In order to determine the usefulness of Computerized Tomography (CT) scanning in making a diagnosis of dementia of the Alzheimer type, a group of patients diagnosed by NINCDS-ADRDA criteria (n = 22) were compared to a group of normal subjects (n = 49) using certain defined linear CT scan measurements. These measurements included specific measurements of the temporal lobes (temporal horns). Subjects were classified correctly 91.5% of the time with a high degree of probability. A diagnostic equation is presented which will allow testing of these methods in a prospective fashion.

Aged,Aged, 80 and over,Alzheimer Disease,Cerebral Ventriculography,Female,Humans,Male,Middle Aged,Psychiatric Status Rating Scales,Temporal Lobe,Tomography, X-Ray Computed

848276,870622,993813,1079610,1202204,2070294,2144615,2404055,2863031,2940453,3143242,3258902,3347338,3434201,3489017,3491651,3491665,3513888,3532737,3591276,3785670,3789663,3873896,5505685,5707082,6191001,6402073,6446279,6462433,6474172,6497729,6610841,6618185,6622694,6625982,6971454,7100467,7175555,7202160,7204897,7316681,7388228,7425886,7455102

8221386

The use of antiepileptic drug levels in children: a survey of Canadian pediatric neurologists.

There are 60 pediatric neurologists in Canada. Replies were received from 56 in response to a survey regarding the use and perceived value of antiepileptic drug (AED) levels. AED levels are frequently ordered and influence clinical care. There were, however, discrepancies among pediatric neurologists regarding the upper and lower limits of the "therapeutic ranges" and the clinical application of levels. We suggest that both the value and use of AED levels needs further study.

Adolescent,Anticonvulsants,Attitude of Health Personnel,Carbamazepine,Child,Epilepsy,Ethosuximide,Female,Humans,Male,Phenobarbital,Valproic Acid

376307,386704,626839,731240,2182266,2863509,2911851,3137017,3142761,3280304,3923777,4212949,5106302,5556637,6440825,6804224,13805571

8221387

Contact thermography in the diagnosis of childhood migraine.

The objective of our prospective study was to assess the role of contact thermography in children with migraine. Contact thermograms were done in 54 children aged 4.2-16.5 years (median 10.5 years), who were seen for headache and on 10 age-matched controls, between July and December 1991. Thermograms were interpreted as definitely normal, equivocally normal, equivocally abnormal, and definitely abnormal by a radiologist who was blinded to clinical information. Forty-eight children had the test between headaches; of these, four out of 26 patients (15%) who had migraine without aura and 3 out of 14 children (21%) who had migraine with aura had definitely abnormal thermograms. Nine out of 10 normal controls had definitely normal thermograms. The sensitivity of contact thermography in the diagnosis of childhood migraine, when done between headaches, was low in our study.

Adolescent,Child,Child, Preschool,Female,Humans,Male,Migraine Disorders,Prospective Studies,Thermography

669947,1312684,1399546,1815545,2179765,2380727,2583993,3781821,3781827,3972567,5545970,6498929,6541301

8221388

Inflammatory myopathy and Walker-Warburg syndrome: etiologic implications.

Walker-Warburg syndrome is a well delineated clinical entity with characteristic brain and eye anomalies. Recent diagnostic surveys have revealed that muscular dystrophy is an obligatory feature of this syndrome. We report a patient with an inflammatory myopathy that preceded dystrophic changes. While reports of parental consanguinity and multiple affected sibships strongly suggest an autosomal recessive genetic basis for this syndrome, previous pathological analyses of the CNS have suggested an inflammatory process. Our case supports both the notion of an aberrant inflammatory process that is likely under genetic control or etiologic heterogeneity (phenocopies) underlying this syndrome.

Brain,Eye Abnormalities,Humans,Infant, Newborn,Male,Muscles,Myositis,Syndrome,Tomography, X-Ray Computed

413438,581135,803883,1646253,1671808,2192302,2494887,2986525,3049189,3088278,3100980,3103478,3105522,3278673,3454442,3931474,6339705,6403688,6405616,6441438,6504323,6714263,6766714,6820333,6984134,7277429

8221389

Dural cavernous hemangioma: an under-recognized lesion mimicking meningioma.

We report a 77-year-old woman who presented with partial seizures and was found to have an enhancing dural-based parietal convexity mass. The lesion enlarged on serial examination by computed tomography (CT) over a one year period. The clinical features and radiologic appearance were compatible with a pre-operative diagnosis of meningioma; however, pathologic findings were typical of a dural cavernous hemangioma. Accumulating evidence suggests that these lesions are an uncommon but distinct type of vascular malformation most often arising from the cavernous sinus, tentorium, or cerebello-pontine angle. With CT, magnetic resonance imaging and angiography, these lesions can closely resemble meningioma in terms of signal characteristics, enhancement pattern, and location. This is of importance both in the practical management of meningiomas where the diagnosis is often based on radiologic studies alone, and in clinical trials where incorrect entry diagnosis should be avoided.

Aged,Brain Neoplasms,Diagnosis, Differential,Dura Mater,Female,Hemangioma, Cavernous,Humans,Meningeal Neoplasms,Meningioma,Parietal Lobe,Tomography, X-Ray Computed

758370,1537199,1885977,1895122,1919691,1944845,2002367,2021438,2033444,2046894,2198485,2366075,2385350,2398393,2406985,2585088,2797405,2809720,3064554,3185904,3351594,3681431,3960293,6836497,7057243,7384454,7403545

8221390

Failure to recognize status epilepticus in a paralysed patient.

Paralysis induced by neuromuscular blocking agents facilitates ventilation of seriously ill patients but may preclude clinical recognition of seizures. We describe the occurrence of severe cognitive impairment in a 14-year-old girl in whom status epilepticus was recognized only when pancuronium was withdrawn after 14 hours of paralysis. This patient emphasizes a potential danger of paralysis from drugs in patients with acute cerebral dysfunction.

Adolescent,Diazepam,Electroencephalography,Female,Humans,Neuromuscular Blocking Agents,Nitrazepam,Paralysis,Phenytoin,Respiration, Artificial,Status Epilepticus,Tomography, X-Ray Computed

237981,3072003,4050421,4199751,4521092,4525503,5270550,6403176,6780106,7062216

8221391

Tremorgenic encephalopathy: a role of mycotoxins in the production of CNS disease in humans?

We describe a young man who, shortly after exposure to moldy silage, developed a neurological syndrome consisting of dementia and a remarkable tremor which was precipitated by movement. All symptoms resolved within one week. Despite investigation, no definitive diagnosis was reached. We propose that this patient's illness may have resulted from inhalation exposure to a tremorgenic mycotoxin.

Adolescent,Agricultural Workers' Diseases,Brain Diseases,Electroencephalography,Humans,Male,Mycotoxins,Silage,Tremor

726205,2563012,3555338,3757822,3808308,4337445,4341967,4386440,5122678,6108984,14107473

8221392

Syrinx extending from conus medullaris to basal ganglia: a clinical, radiological, and pathological correlation.

A 41-year-old woman with a history of birth injury to the brachial plexus suffered several delayed episodes of neurological deterioration. Magnetic resonance imaging studies revealed a syrinx extending from the conus medullaris into the brainstem and rostrally into both internal capsules. She died of an acute exacerbation of chronic respiratory failure. Autopsy demonstrated syringomyelia and syringobulbia with cavity extension bilaterally along the corticospinal tracts into the internal capsules. Islands of glial tissue in the subarachnoid space around the medulla caused obstruction of the subarachnoid space at the foramen magnum. These were probably the result of birth injury to the cerebellum. A detailed clinico-pathological correlation is provided to explain her neurological deficits. The pathogenesis of syrinx formation is discussed in terms of a late manifestation of birth trauma.

Adult,Basal Ganglia,Birth Injuries,Female,Fistula,Humans,Magnetic Resonance Imaging,Medulla Oblongata,Neuropsychological Tests,Radiography,Spinal Cord,Syringomyelia

1123112,1557985,1870887,1919705,1941120,2795182,3048069,3124575,3495974,4472909,4688255,4739774,5815001,5910900,6625993,7071616,7299420,13439399,14130048,14416159,14493140

8221393

Concerning mind.

The nature of the human mind is addressed from a neurological viewpoint. First from reported observations on subjects born blind with congenital cataract, who acquired vision after surgery, the concept of the primacy of somatosensation is developed. Therefrom some principles of the organization of higher sensory functions in the dominant parietal, occipital and temporal lobes are deduced. Sentience is traced to somatosensation. Some characteristics of the mind and of thinking are described. The non-existence of the unconscious is inferred. The question of free will is approached. Using neurological experience it is demonstrated that a good case for operation of a free will is difficult to establish. Positing the absence of a free will may be beneficial in the analysis and management of behavior. Finally the opportunity to study the nature and mechanism of the emotions in clinical neurology is outlined.

Blindness,Brain,Humans,Neurology,Sensation,Volition

917278,1948051,5777307,5828502,6697163,13342275,13937583,17741054

8221397

The influence of intermittent positive-pressure ventilation on the cardiorespiratory dynamics of diaphragmatic rupture with gastric herniation.

To determine the effect of intermittent positive-pressure ventilation (IPPV) on gastric herniation in diaphragmatic rupture, 16 piglets underwent laceration of the left hemidiaphragm. Arterial blood gas levels, pulmonary artery wedge pressure, cardiac output and arterial blood pressure were measured. The stomach was then placed above the diaphragm. The initial measurements were repeated, and displacement of the stomach above the diaphragm (S/D) was measured. The animals were divided into two groups: group 1, eight animals breathing 80% oxygen spontaneously and group 2, eight animals receiving IPPV. Initially in group 2 there was only a small decrease in mean (+/- SD) arterial oxygen tension from 484 +/- 34 mm Hg to 424 +/- 20 mm Hg (other parameters were unchanged). In group 1, gastric herniation produced a further fall in arterial oxygen tension to 308 +/- 10 mm Hg at 1 hour, a rise in arterial carbon dioxide tension to 49 +/- 4 mm Hg and a decrease in pH to 7.32 +/- 0.04. In group 2 similar changes in arterial blood gas levels occurred with gastric herniation, but there was a return to baseline values of 490 +/- 28 mm Hg for arterial oxygen tension, 37 +/- 4 mm Hg for carbon dioxide tension and 7.38 +/- 0.05 for pH after IPPV. Similar changes were seen in blood pressure, cardiac output and pulmonary artery wedge pressure. S/D remained at 6.3 +/- 0.2 cm in group 1 but decreased from 6.0 +/- 0.2 cm to 1.1 +/- 0.5 cm after 1 hour in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals,Blood Pressure,Carbon Dioxide,Cardiac Output,Diaphragm,Hemodynamics,Hernia,Hydrogen-Ion Concentration,Intermittent Positive-Pressure Ventilation,Oxygen,Pulmonary Wedge Pressure,Respiration,Rupture,Stomach,Stomach Diseases,Swine,Wounds and Injuries

1455883,1507287,1898570,3411640,3519567,3970412,7392109

8221398

Effect of cardiac stabbing on ventricular function: evaluation by radionuclide angiography.

To determine whether cardiac stab wounds cause early ventricular dysfunction.

Adult,Arrhythmias, Cardiac,Female,Heart Injuries,Heart Ventricles,Humans,Male,Middle Aged,Postoperative Complications,Radionuclide Angiography,Reproducibility of Results,Retrospective Studies,Ventricular Function,Ventricular Function, Left,Ventricular Function, Right,Wounds, Stab

455621,642547,839281,1174374,2310096,2916389,3012633,3369631,3400568,3753117,3954485,3964358,4755444,4850883,6314797

8221399

Recycling of cardiopulmonary bypass cannulae: a risk-benefit analysis.

To determine whether recycling of arterial and venous cannulae for cardiopulmonary bypass is associated with an increased risk of infectious complications after open heart surgery.

Cardiopulmonary Bypass,Costs and Cost Analysis,Endocarditis, Bacterial,Equipment Reuse,Evaluation Studies as Topic,Heart Arrest, Induced,Humans,Infections,Mediastinitis,Postoperative Complications,Prospective Studies,Risk Factors,Sepsis,Surgical Wound Infection

1911809,1989546,2113784,2299863,2306138,2306142,2310253,2310254,2796369,3092753,3173456,3530161,3619541,3828905,4016637,6812466

8221400

Myocardial and circulatory performance during the ischemic phase of superior mesenteric artery occlusion.

To investigate myocardial and circulatory parameters during the acute ischemic phase of mesenteric artery occlusion.

Animals,Blood Pressure,Dogs,Heart,Hemodynamics,Intestines,Ischemia,Mesenteric Artery, Superior,Mesenteric Vascular Occlusion,Prospective Studies,Pulmonary Artery,Random Allocation,Stroke Volume,Vascular Resistance,Ventricular Function

288535,380836,419430,655196,848686,3400026,3511560,3764695,4719688,5020665,5560183,5647587,5780594,5933801,6036337,6701789,6831886,14338323,14416956

8221401

Reconstruction of composite facial defects: the combined application of multiple reconstructive modalities.

To describe the combined use of craniofacial skeletal reconstruction, tissue expansion and microvascular free tissue transfer in the repair of major composite facial defects.

Adolescent,Adult,Face,Facial Bones,Facial Injuries,Female,Humans,Male,Mandibulofacial Dysostosis,Middle Aged,Surgery, Plastic,Surgical Flaps,Tissue Expansion,Wounds, Gunshot

2928404,3317205,3725956,3886258,4269200,4551236,4578998,4652235,4752569,4942075,6194539,6614754,6721392,13242607

8221402

Iodine replacement in fibrocystic disease of the breast.

To determine the response of patients with fibrocystic breast disease to iodine replacement therapy.

Adolescent,Adult,Aged,Aged, 80 and over,Child,Double-Blind Method,Female,Fibrocystic Breast Disease,Humans,Iodine,Middle Aged,Prospective Studies,Sodium Iodide

31120,100215,222001,414366,679211,684613,717798,1346172,2373302,3159597,3942926,3978372,3981766,4345607,6474353,6626922,6632051,6821763,7110289,13285446

8221403

[Patellectomy: results of a long-term follow-up].

The authors are in disagreement with the literature on the results of patellectomy after comminuted fracture of the patella. They assessed retrospectively 17 patients who underwent unilateral total patellectomy between 1955 and 1980. Subjective and objective (clinical examination, radiologic examination and Cibex II studies) assessment was carried out for each patient using the contralateral healthy knee as a control. The results demonstrated 88% patient satisfaction, no ligamentous instability and no early arthrosis but a decrease in extensor muscle strength to 75% of normal. The authors conclude that total patellectomy is better tolerated and causes less morbidity than suggested in the literature.

Evaluation Studies as Topic,Female,Fractures, Open,Humans,Male,Middle Aged,Patella,Patient Satisfaction,Postoperative Complications,Retrospective Studies

961401,1270472,2229101,4072666,5084247,5453899,5651060,6390605,6826602

8221404

Intramedullary nailing of femoral shaft fractures: reoperation and return to work.

To define the functional outcome and residual disability in adults treated for isolated femoral shaft fractures.

Adult,Femoral Fractures,Follow-Up Studies,Fracture Fixation, Intramedullary,Fracture Healing,Fractures, Ununited,Humans,Pain,Reoperation,Retrospective Studies

1541494,1733998,1748704,3198668,3198669,3997923,6707031

8221405

Anterior and posterior spinal fusion: comparison of one-stage and two-stage procedures.

To compare postoperative morbidity and length of hospital stay after combined anterior and posterior spinal fusion for patients treated by a one-stage procedure and those treated in two stages, 1 to 2 weeks apart.

Adolescent,Adult,Child,Costs and Cost Analysis,Female,Humans,Length of Stay,Male,Neurofibromatoses,Neuromuscular Diseases,Outcome Assessment, Health Care,Postoperative Complications,Retrospective Studies,Spinal Dysraphism,Spinal Fusion,Spine

479255,489641,2259986,2772727,3388111,3589820,3992341

8221406

Bochdalek hernia with hemorrhage in an adult.

Life-threatening herniation of intra-abdominal viscera through a patent Bochdalek foramen is well recognized in neonates. Persistent foramina, leading to clinical problems in adult life, are very rare. In the case of the 17-year-old girl described in this paper, two-thirds of the stomach had inverted and passed into the left side of the chest as had the splenic flexure of the colon and most of the greater omentum. There was 500 mL of blood free in the peritoneal cavity and 1200 mL in the left pleural cavity, with no hernial sac. The defect measured 5 cm in diameter. It was repaired primarily after reduction of the viscera. Prompt operative intervention is recommended in such cases to prevent strangulation and bleeding from engorged viscera.

Adolescent,Female,Hemoperitoneum,Hemothorax,Hernia, Diaphragmatic,Hernias, Diaphragmatic, Congenital,Humans

1670242,2041234,3285266,3574217,3677819,6498658,14409345

8221407

Aorto-esophageal fistula secondary to benign Barrett's ulcer: a rare cause of massive gastrointestinal hemorrhage.

Aorto-intestinal fistula is a rare cause of massive upper gastrointestinal bleeding. The authors report on an 82-year-old man who had an aorto-esophageal fistula due to a benign Barrett's ulcer. The patient presented with a sentinel hemorrhage followed by fatal exsanguination despite vigorous attempts at resuscitation. Management of the entity requires awareness, appropriate radiologic and endoscopic investigation and early surgery. Even with appropriate management, the mortality remains high.

Aged,Aged, 80 and over,Aortic Diseases,Barrett Esophagus,Esophageal Fistula,Fatal Outcome,Fistula,Gastrointestinal Hemorrhage,Humans,Male

677387,2799449,3107831,3418835,3611690,4037554,6971377,6978112,7089636,7302210,13543631,13955712,14360987,14401132

8221408

The anatomical basis for laparoscopic splenectomy.

The anatomy of the splenic blood supply is extremely variable. Two principal patterns, the distributed and the magistral types, include the majority of variations. These two types differ with respect to the length of the splenic trunk, the number of arterial branches and the proportion of the medial surface of the spleen occupied by the branches as they enter the organ. The suspensory ligaments of the spleen, including the sustentaculum lienis, are usually avascular except for the gastrocolic and lienorenal ligaments on the medial side. The tail of the pancreas touches the spleen in 30% of cases and lies within 1 cm of the spleen in 73%. Knowledge of these basic anatomic facts and the variations should contribute to the safety of laparoscopic splenectomy.

Humans,Laparoscopy,Ligaments,Spleen,Splenectomy,Splenic Artery

14835182,17863663

8221424

Interactions between physicians and the pharmaceutical industry: what does the literature say?

To determine the effect of three types of interaction between physicians and the pharmaceutical industry--company-funded clinical trials, company-sponsored continuing medical education (CME) and information for physicians supplied by pharmaceutical detailers--on orientation and quality of clinical trials, content of CME courses and physicians' prescribing behaviour.

Attitude of Health Personnel,Australia,Canada,Clinical Trials as Topic,Conflict of Interest,Drug Industry,Drug Utilization,Education, Medical, Continuing,Ethics, Medical,Humans,Interprofessional Relations,New Zealand,Physicians,Research Support as Topic,Training Support,United Kingdom,United States

717966,1544041,1611368,1620175,1623766,1817480,2218627,2282231,2341925,2374278,2398609,2677732,2905075,3179887,3574417,3585265,3609550,3680674,3704702,3772583,5550114,5900395,6463670,7077617,7091173,7381888,7387011,7417103,7452646,7471001,8094123,8257470,10259426,10280368,10294441,11652162,13826366

8221425

Periodic health examination, 1993 update: 3. Periodontal diseases: classification, diagnosis, risk factors and prevention. Canadian Task Force on the Periodic Health Examination.

To review the 1979 Canadian Task Force on the Periodic Health Examination recommendations on the diagnosis and prevention of periodontal disease.

Adult,Child,Dental Deposits,Gingivitis,Humans,Periodontitis,Practice Guidelines as Topic,Risk Factors

275282,282430,284036,290784,321483,767366,1067277,1094035,1709619,1765937,1819278,1870068,1913306,1986529,2005225,2027069,2027103,2045513,2060449,2061415,2061418,2076500,2125313,2142729,2164535,2179511,2185919,2209317,2212083,2212086,2254831,2262579,2262585,2319439,2335645,2347946,2355443,2388141,2391627,2391631,2398135,2401776,2403939,2407756,2557049,2600746,2689627,2705941,2709366,2723103,2768535,2768537,2778601,2778606,2782060,2784086,2786959,2795417,2844215,2911074,2911075,2961865,2963112,2989346,3053794,3060580,3110317,3163966,3164778,3198851,3201112,3263399,3271730,3308968,3455939,3455945,3458724,3465959,3466765,3467892,3468166,3477575,3487557,3489010,3497960,3519689,3534210,3856578,3857145,3872765,3902908,4237480,4396693,4514570,4514571,4528700,4866974,5284178,5285683,6231362,6386896,6572120,6575080,6575980,6582072,6583037,6584447,6936116,6936406,6947990,6973623,6975365,7042797,14296927

8221426

Effects of acetaminophen on adverse effects of influenza vaccination in health care workers.

To evaluate the effects of acetaminophen on the incidence of adverse effects to, and the immunogenicity of, whole-virus influenza vaccine in health care workers.

Acetaminophen,Dose-Response Relationship, Drug,Double-Blind Method,Female,Humans,Influenza Vaccines,Male,Manitoba,Nausea,Pain,Personnel, Hospital,Prospective Studies,Time Factors

342619,342623,342626,852336,2070311,2295029,2774292,3313232,3998514,6467117,7059061,13620783

8221427

Case-control study of prenatal ultrasonography exposure in children with delayed speech.

To determine whether there is an association between prenatal ultrasound exposure and delayed speech in children.

Bias,Case-Control Studies,Child,Child, Preschool,Female,Humans,Language Development Disorders,Male,Odds Ratio,Pregnancy,Retrospective Studies,Ultrasonography, Prenatal

447779,474647,686067,1100136,1131547,1345870,2648634,2900977,3277240,3551588,3920278,4192094,5053945,6198611,6347551,6378349,6805497,7168190,10302061

8221428

Sudden unexpected death in the emergency department: caring for the survivors.

To determine whether emergency department staff met the needs of the next of kin and close friends ("survivors") of patients dying in an emergency department and to assess the effectiveness of a program to improve care of survivors.

Bereavement,Death, Sudden,Emergency Service, Hospital,Family,Hospital Bed Capacity, 300 to 499,Hospitals, Teaching,Humans,Ontario,Professional-Family Relations,Program Evaluation,Social Support

456007,1607632,2001665,2301788,2383706,2406490,2549479,3320445,3354947,3578974,3592335,3607678,3607679,3942358,7409661,10239061

8221447

A rational approach to the cause, prevention and treatment of postdural puncture headache.

To review the current research and formulate a rational approach to the cause, prevention and treatment of postdural puncture headache (PDPH).

Adult,Aged,Anesthesia, Spinal,Blood Patch, Epidural,Female,Headache,Humans,Male,Needles,Pregnancy,Risk Factors,Spinal Puncture

125053,1767932,1768536,1837469,2042781,2138488,2143882,2148264,2190594,2193757,2240540,2240541,2248412,2248852,2268025,2278356,2297108,2310024,2316881,2331074,2400077,2639667,2655500,2662802,2672869,2742103,2782645,2929939,3232788,3278726,3414352,3421454,3619101,3688397,3767026,3826597,3954102,3994890,4073430,4735287,5045552,5058136,6118577,7396157,13318967,15402031

8221448

A measurement process for evaluating clinical teachers in internal medicine.

With input from faculty members and residents in the internal medicine residency training program at McMaster University, Hamilton, Ont., the authors developed a form to evaluate attending physicians in clinical teaching units according to 14 domains of performance. Although brief, the form included all main areas of teacher performance, allowed specification of attending physician behaviour and differentiated areas of strengths and weaknesses between and within attending physicians. The authors describe the new evaluation process and the results for 41 attending physicians.

Canada,Education, Medical, Graduate,Faculty, Medical,Humans,Internal Medicine,Professional Competence

712768,1152022,2233177,2923638,3772621,3870777,3955484,3972947,6571650,6614032,7054507,7205919,17829813

8221449

Can Haemophilus influenzae type b-tetanus toxoid conjugate vaccine be combined with diphtheria toxoid-pertussis vaccine-tetanus toxoid?

To assess the side effects and immune responses after three serial doses of PRP-T vaccine (a Haemophilus influenzae type b [Hib]-tetanus toxoid conjugate vaccine) given concurrently or mixed with adsorbed DPT vaccine (diphtheria toxoid-pertussis vaccine-tetanus toxoid).

Antibodies, Bacterial,Diphtheria-Tetanus-Pertussis Vaccine,Drug Incompatibility,Enzyme-Linked Immunosorbent Assay,Female,Haemophilus Vaccines,Humans,Infant,Male,Tetanus Toxoid

370354,1517908,1731134,1735812,1891954,1903846,1945578,1945579,1993943,2062620,2062621,2190140,2771530,3050001,3313232,3317732,7031583

8221450

Outcome of rationing access to open-heart surgery: effect of the wait for elective surgery on patient outcome.

To assess the effect of the waiting period before elective open-heart surgery on patient outcomes.

Analysis of Variance,Cardiac Care Facilities,Cardiac Surgical Procedures,Elective Surgical Procedures,Female,Health Care Rationing,Humans,Male,Middle Aged,Outcome Assessment, Health Care,Postoperative Complications,Prognosis,Quebec,Retrospective Studies,Risk Factors,Waiting Lists

313148,503167,1541137,1544079,1901921,1970377,1993774,2215598,2268793,2395442,2491412,2492637,2963851,2968469,3050522,3492614,3510394,6413862,6600574,6824988,6834594,6834619,6981065