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endoscopic transpapillary therapy disrupted pancreatic duct peripancreatic fluid collections eighteen patients active pancreatic ductal disruptions including 14 definable fluid collections treated transpapillary pancreatic duct drains stents twelve patients undergone previous percutaneous surgical pancreatic drainage procedure 8 longterm drainage tubes chronic fistulous tracts transpapillary catheters could placed across ductal disruption directly fluid collection case 16 18 patients resolution disrupted pancreatic duct twelve 14 fluid collections resolved complications limited mild exacerbation pancreatitis symptoms 2 patients 2 patients developed subsequent stent occlusion leading recurrent pancreatitis 1 patient recurrent duct blowout pseudocyst 1 patient nine patients variably significant ductal changes attributable pancreatic duct stents median followup 16 months 7 patients ultimately required surgery ongoing pancreatic pain residualrecurrent fluid collection transpapillary treatment ongoing pancreatic ductal disruption without fluid collection potential obviate surgery patients change urgent surgical procedure elective one even assist surgeon performance intraoperative pancreatography study technique appears warranted must placed perspective current therapies
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inflammatory myofibroblastic tumor plasma cell granuloma clinicopathologic study 20 cases immunohistochemical ultrastructural observations twenty cases inflammatory myofibroblastic tumor imt studied 19 involved lung 1 esophagus patients ages ranged 3 72 years 9 males 11 females involvement bronchus seen one case mediastinal structures four chest pain dyspnea common symptoms eight patients asymptomatic seven patients underwent lobectomy 12 local excision 1 biopsy alone lesions nonencapsulated ranged 12 15 cm various proportions plasma cells histiocytes spindle cells observed latter corresponded ultrastructurally fibroblasts myofibroblasts immunoreactive vimentin actin focally desmin negative epithelial markers plasma cells polyclonal light chains one patient two recurrences one case large pleural imt found eight years excision similar lesion lung patients followup ten well long ten years diagnosis average 37 years
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localization calcitonin generelated peptide human esophageal langerhans cells previously undescribed calcitonin generelated peptideimmunoreactive intraepithelial cells seen specimens esophageal mucosa obtained biopsy surgical resection 14 individuals calcitonin generelated peptideimmunoreactive cells sparsely seen normal mucosa increased markedly esophagitis inaccessible routine histological stains osmication showed dendritic forms resembling langerhans cells skin cytological identity determined immunocytochemical tests human antigenic markers ia hladr okt6 langerhans cells leum5 leum3 intraepithelial macrophages cd3 tcr1 tlymphocytes leu14 blymphocytes s100 merkel cells chromogranin amine precursor uptake decarboxylation cells double localization showed calcitonin generelated peptide immunoreactivity colocalized ia hladr okt6 markers studies show intraepithelial langerhans cells esophageal mucosa contain calcitonin generelated peptide may serve immunomodulator
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medical necessity evaluation treatment portwine stains new lasers improved laser delivery systems allowed safe effective treatment portwine stains patients ages satisfactory results obtained laser treatment increased number patients seeking consultation regarding birthmarks imperative physicians recognize various medical syndromes problems associated portwine stains review 415 patients facial portwine stains revealed hypertrophy andor nodularity 65 patients fifth decade life increases significantly morbidity lesions believed laser treatment minimize medical psychologic complications result natural evolution portwine stains
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neuropsychological assessment cognitive functioning children epilepsy variety cognitive dysfunctions related learning disabilities children epilepsy studied linking electroencephalogram eeg computerized neuropsychological testing showed subclinical discharges impaired performance 61 patients simple choice reaction time test although discharges lasted 1 neuropsychological investigation subclinical eeg discharges may help determine adverse effect learning
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cytologic patterns juice human pancreatic transplants correlation histologic findings graft 19 patients undergone pancreatic transplantation temporary exteriorization pancreatic juice graft tissue became available histologic examination patients cytologic patterns pancreatic juice compared histologic findings graft specimens five samples diagnosis cytologic studies rejection acute rejection confirmed histologic specimens eight cytologic samples graft pancreatitis suspected increased amounts neutrophils degenerating cells epithelial cells monocytes macrophages without necrotic tissue fragments eight histologic specimens showed findings characteristic pancreatitis three cytologic samples bacteria fungi observed histologic examination patients showed graft pancreatitis four patients cytologic findings normal graft histologic factors normal two instances one grafts graft pancreatitis one graft chronic vascular rejection seen study shows two different pathologic events occurring pancreatic graft ie acute rejection pancreatitis reflected characteristic changes pancreatic juice cytology
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homocystinuria presenting central retinal artery occlusion longstanding thromboembolic disease case central retinal artery occlusion patient 10year history unexplained thromboembolic disease due secondary hypercoagulable state presented ophthalmological examination led final diagnosis
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perianal abscess fistulainano children authors present retrospective review 40 pediatric patients perianal abscess andor fistulainano total patient population could divided clinically 2 broad groups first group consisted 22 infants younger 2 years age males 10 presented recurrences previous incision drainage 14 infants presenting abscess 12 857 percent fistulainano discovered surgery contrast group 18 children older 2 years age 7 females 11 males fistulas identified 7 13 patients 548 percent presented abscesses surgical treatment consisted examination anesthesia diligent search fistulous tract abscesses primarily saucerized fistulotomy cryptotomy confluent crypt performed fistulous tract identified recurrences form treatment occurred two immunocompromised patients
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comparison dna content gastric cancer cells primary lesions lymph node metastases cytophotomtric dna contents tumor cells primary lesions corresponding metastatic lymph nodes compared 61 cases gastric cancer determine whether dna content remains stable lymph node metastasis dna distribution patterns grouped three types according proportion aneuploid cell population changes dna patterns primary metastatic lesions evident 36 61 patients 590 remaining 25 410 dna distribution patterns noted lesions 33 36 dna pattern primary carcinoma transformed narrowly scattered one metastatic lesion lymph node mean modal values frequency cells tetraploid 4c hexaploid 6c significantly higher primary lesion compared findings metastatic lesions reduction dna content metastatic lesions frequent occurrence differentiated 18 23 undifferentiated adenocarcinoma 15 35 p less 001 therefore primary lesions widely scattered dna ploidy tumor cells smaller dna ploidy frequently metastasized lymph nodes particularly cases differentiated carcinoma observations may pertinent future designing treatment protocols
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glucosephosphate isomerase csf marker leptomeningeal metastasis glucosephosphate isomerase gpi also known phosphohexoisomerase glycolytic enzyme whose activity elevated serum csf patients primary metastatic cns tumors improve diagnostic accuracy leptomeningeal metastasis lm measured gpi levels csf 66 patients cns systemic malignancies suspected lm determined gpi kinetically using coupled enzyme reaction assay 31 males 35 females aged 1 seventysix thirtyone primary brain tumors 35 systemic cancer suspected cns metastasis analyzed 95 samples gpi values ranged 085 3290 ul normal less 20 ul compared positive csf cytology myelography gpi sensitivity 535 specificity 921 group whole highly significant association elevated csf gpi greater 20 ul lm results similar primary cns systemic malignancies although sensitive elevated csf gpi strongly suggests lm may aid early diagnosis serious complication cancer
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liver pathology morbidly obese patients without diabetes contribution obesity andor diabetes liver pathology morbidly obese patient controversial studied liver biopsies 100 consecutive patients undergoing gastric bypass surgery morbid obesity multiple morphologic parameters analyzed graded independently without knowledge clinical history liver function tests oral glucose tolerance results patients six percent entire group demonstrated fat 42 mild fat 20 moderate fat 24 severe fatty metamorphosis liver twentythree percent patients central vein fibrosis 23 sinusoidal fibrosis 19 bridging fibrosis 4 cirrhosis thirtysix percent patients degree steatohepatitis 66 possessed socalled glycogen nuclei hepatocytes 6 paspositive thickening blood vessels portal tracts 1 lipogranulomas degree fatty metamorphosis fibrosis analyzed three separate groups categorized glycemic status patient 46 patients normal glucose tolerance ngt 23 patients impaired glucose tolerance igt 31 patients noninsulindependent diabetes mellitus niddm increasing severity fatty metamorphosis normoglycemic obese diabetic obese patients found statistically significant chi 2 analysis four six patients showing fatty metamorphosis normoglycemic glycogen nuclei paspositive blood vessels significantly prevalent diabetic obese normal obese conclusion distribution significant liver histopathology morbidly obese patient correlates severity degree impaired glycemic status
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alterations left ventricular diastolic twist mechanics acute human cardiac allograft rejection background contraction obliquely oriented left ventricular lv fibers results twisting motion left ventricle purpose study assess effects acute human cardiac allograft rejection lv twist pattern twistvolume relation methods results tantalum markers implanted lv midwall 15 transplant recipients measure timevarying threedimensional chamber twist using computerassisted analysis biplane cinefluoroscopic images twist defined mean longitudinal gradient circumferential rotation lv long axis plotted normalized percent ejection fraction ef resulting twistnormalized ef relation could divided three phases systole lv twist linearly related ejection blood contrast diastolic untwist characterized early rapid recoil little change lv volume followed gradual untwisting bulk diastolic filling occurred 10 acute rejection episodes 10 patients maximum twist peak systolic twist rate slope systolic twistnormalized ef relation change contrast slope early first 15 filling diastolic twistnormalized ef relation mearlydia decreased significantly 0194 0062 prerejection versus 0103 0054 radcm rejection p 00003 resulting prolonged tau 12 time required untwist 50 20 5 versus 28 5 diastole p 00003 decrease percent untwisting 15 diastolic lv filling 62 11 versus 36 13 p 00003 therefore greater proportion lv untwisting occurred later diastole rejection reflected increase slope mmiddia middle late 15 90 filling diastolic twistnormalized ef relation 0018 0009 versus 0030 0010 radcm p 00015 peak rate untwist affected resolution rejection mearlydia percent untwist early diastole returned baseline levels p ns versus baseline also trend mmiddia return toward prerejection values p ns versus baseline change reach statistical significance compared rejection values conclusion acute cardiac allograft rejection associated altered diastolic twist mechanics absence demonstratable systolic abnormalities rejection myocardial edema factors may result intrinsic changes elastic properties myocardium thereby leading modification recoil forces responsible early rapid unwinding deformed ventricle
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longterm followup cemented total hip arthroplasty rheumatoid arthritis seventyfive primary cemented total hip arthroplasties thas performed 53 patients rheumatoid arthritis juvenile rheumatoid arthritis patients followed average 74 years unless prosthetic hips failed time clinical evaluation based 10point maximum rating scale ratings pain walking function activity improved preoperative values recent followup examination revision tha performed aseptic acetabular loosening four hips femoral loosening one hip sepsis occurred another four hips complications wound healing occurred 14 hips roentgenographic evidence loosening seen six acetabular components three femoral components femoral acetabular component one hip none hips yet required revision tha kaplanmeier survivorship analysis revealed 93 survival probability seven years fell 77 12 years patients trend younger larger patients increased failure component loosening rates cemented primary tha satisfactory operation rheumatoid patient relatively high rate wound healing problems sepsis may due systemic immune nature rheumatoid arthritis however 25 prosthetic hips either failed risk future failure thus improved techniques still necessary increase longterm success tha rheumatoid patient
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polypectomy sufficient treatment colorectal cancer polyp eightyseven patients carcinoma polyp reviewed 12year period ten histologic criteria analyzed association presence residual carcinoma four factors identified prognostic value size greater 15 cm sessility cancer least 50 adenoma volume invasive carcinoma polypectomy alone adequate treatment unless carcinoma invades deeper muscularis mucosa associated one characteristics
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disproportionate septal hypertrophy associated erythroblastosis fetalis retrospectively reviewed clinical echocardiographic data 10 newborns erythroblastosis fetalis admitted nurseries 1984 1988 required doublevolume exchange transfusion neonatal intensive care echocardiograms performed first 48 hours life 5 patients disproportionate septal hypertrophy demonstrated 1 additional patient biventricular hypertrophy thickened septum disproportionate septal hypertrophy mean septal left ventricular freewall ratio group n 10 137 correlation apparent occurrence disproportionate septal hypertrophy newborn glucose bilirubin hematocrit values analyzed separately 4 patients receive intrauterine blood transfusions ratio 173 021 mean sem significantly greater ratio 6 patients transfused utero 113 024 patients underwent transfusions correlation number transfusions septalleft ventricular ratio study reports significant previously unrecognized cardiac hypertrophy disproportionate septal hypertrophy patients erythroblastosis fetalis data suggest sparing effect intrauterine fetal transfusions mechanism transfusions may affect hypertrophic development myocardium remains determined
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dna aneuploidy follicular thyroid neoplasia potential value dna aneuploidy distinguishing benign malignant follicular thyroid neoplasms studied nuclear dna content 65 follicular thyroid neoplasms 52 adenomas 13 carcinomas determined flow cytometric analysis paraffin embedded material 58 cases preparations technically satisfactory 22 follicular neoplasms dna analysis also performed fresh material obtained fine needle aspiration surgical specimens cell cycle analysis performed fresh fixed specimens aneuploid dna profile found analysis fixed tissue eight 45 18 per cent follicular adenomas four 13 31 per cent follicular carcinomas dna aneuploidy also found six 22 27 per cent fresh preparations follicular adenomas frequency dna aneuploidy apparently benign malignant follicular neoplasms similar follicular thyroid neoplasia best regarded single entity low incidence local distant spread follicular neoplasia therefore best excised
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thrombus natural left ventricle left ventricular assist another thromboembolic risk factor systemic thromboembolism one serious complications use left ventricular assist system lvas authors original lvas excellent antithrombogenicity reduce risk thrombus formation natural left ventricle lv another risk factor systemic embolization used lvas 22 patients lv wall motion studied 15 smokelike echo disclosed thrombus lv eight lvas sufficiently supported systemic circulation lv wall motion irregular upon closure aortic valve upon recovery lv function decrease lvas flow smokelike echo diminished lv thrombus decreased one lv thrombus remained unchanged increased seven systemic administration antithrombotic agents unclear effect seven eight patients lv thrombus echo died lvas seven high incidence lv thrombus 71 systemic embolism brain 29 kidney 86 revealed necropsy subsequently used local heparinization prevent lv thrombus formation one patient smokelike echo evidence lv thrombus systemic embolism lv assist careful management lvas intralv heparinization considered reduce risk thrombus formation natural lv
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clinical course residual carotid arterial disease 5year period 642 patients underwent 686 carotid endarterectomies patch closure intraoperative surveillance continuouswave doppler perioperative stroke rate 15 patients screened duplex scans immediately operation presence residual carotid lesions followed every 3 6 months either development true recurrent lesion change residual one five hundred thirtynine arteries 84 postoperative abnormalities incidence recurrent carotid lesions groups 15 34 52 1 2 3 years respectively incidence symptoms group 02 07 14 1 2 3 years respectively earliest recurrence symptom occurred 8 months operation one hundred fortyseven arteries residual lesions common either temporary shunt used operation carried hypoglossal nerve omohyoid muscle sixtyone patients plaque proximal arteriotomy without significant stenosis followed average 21 months changes plaque morphology proven symptoms related residual lesion fiftysix patients plaque significant hemodynamic abnormalities carotid bulb followed average 18 months seven patients 125 either significant deterioration lesion symptom event occurred within 6 months operation thirty patients significant flow abnormalities visible plaque none lesions deteriorated although common residual carotid lesions benign unless lesion characterized plaque within artery hemodynamically significant stenosis lesions investigated treated discovered
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clues electrocardiographic diagnosis subtle wolffparkinsonwhite syndrome children electrocardiographic diagnosis wolffparkinsonwhite syndrome wpw may missed delta waves subtle children examined 66 electrocardiograms patients proven wpw 24 questionable wpw subtle wpw 369 consecutive electrocardiograms control patients identify additional clues wpw might present three features notable wpw q wave left chest leads 88 pr interval less 100 milliseconds 80 left axis deviation 33 subtle wpw findings similar 79 67 46 respectively comparison 5 control subjects q wave 16 pr interval less 100 milliseconds 4 left axis deviation p less 0001 coexistence two features common 74 wpw subtle wpw 63 rare 2 control subjects p less 0001 pr interval less 100 milliseconds less specific 1 year age 89 patients wpw qrs duration greater 80 milliseconds versus 2 control subjects p less 0001 obvious wpw disappeared later 11 patients however left axis deviation lack q wave persisted eight p less 001 conclude diagnosis wpw children even subtle suggested presence four changes preexcitation may persist patients overt delta waves longer present
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role endogenous angiotensin ii control vasopressin secretion hypovolemia hypotension conscious rabbits order investigate physiological role angiotensin ii ang ii control vasopressin vp secretion vp responses hypotension induced hemorrhage 20 mlkg n 10 nitroprusside infusion 110 microgramskgmin n 9 studied without blockade ang ii formation converting enzyme inhibitor captopril conscious rabbits administration captopril 5 mgkg iv caused small decrease mean arterial pressure enhance hypotensive response subsequent hemorrhage nitroprusside infusion renin response stimuli enhanced captopril whereas increase plasma ang ii concentration attenuated plasma vp pavp concentration increased hemorrhage 20 021136 477 pgml p less 001 nitroprusside infusion 21 0351 10 pgml p less 001 captopril change basal plasma pavp attenuate vp responses hemorrhage nitroprusside indeed captopril tended enhance vp responses hemorrhage 23 031471 659 pgml nitroprusside infusion 19 02154 60 pgml relationship log pavp mean arterial pressure hemorrhage nitroprusside infusion presence captopril different absence captopril results indicate conscious rabbits reninangiotensin system contribute increase vp secretion hypotension induced hemorrhage nitroprusside infusion
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endocrine function morphological findings patients disorders hypothalamopituitary area study magnetic resonance evaluation sellar area performed magnetic resonance imaging 101 patients age range 0827 years hypopituitarism isolated diabetes insipidus hypogonadotrophic hypogonadism central precocious puberty hypopituitary patients n 70 included multiple pituitary deficiency n 23 pituitary deficiency diabetes insipidus n 5 isolated growth hormone deficiency n 42 patients multiple pituitary deficiency showed pathological morphological findings cases stalk posterior lobe always involved group associated diabetes insipidus abnormal stalk four five cases posterior lobe visible cases five 42 12 patients isolated growth hormone deficiency abnormalities sellar area two four patients isolated diabetes insipidus posterior lobe seen patients hypogonadotrophic hypogonadism three kallmanns syndrome one praderwilli syndrome two idiopathic hypogonadism appeared normal precocious puberty n 21 three patients onset symptoms age 2 years exhibited hypothalamic hamartoma whereas others onset puberty age 2 7 magnetic resonance image normal 17 18 patients probability finding pathological magnetic resonance image considerably high patients multiple pituitary deficiency isolated diabetes insipidus precocious puberty early onset symptoms contrary purely functional abnormality suggested patients isolated growth hormone deficiency hypogonadotrophic hypogonadism precocious puberty later onset symptoms
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surgical treatment low rectovaginal fistulas forty women low rectovaginal fistulas operated upon 9year period etiology fistula majority obstetric nine women prior attempts repair fistula 40 women managed endorectal advancement flap addition sphincteroplasty perineal body reconstruction 15 patients rectocele repair six patients postoperative complications included urinary difficulties two patients wound complications three patients two recurrences women treated sphincteroplasty perineal body reconstruction continent seven women complained varying degrees incontinence postoperatively none undergone sphincter perineal body reconstruction endorectal advancement flap safe effective operation women rectovaginal fistulas concomitant sphincteroplasty perineal body reconstruction performed women historical physical manometric evidence incontinence
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laparoscopic cholecystectomy initial report sixty consecutive patients underwent elective attempt laparoscopic cholecystectomy march 15 july 31 1990 mount sinai hospital new york fiftytwo patients successful completion laparoscopic cholecystectomy 87 reasons conversion open cholecystectomy acute cholecystitis four patients inability define cystic ductcommon duct junction three patients one patient unexpected choledochal cyst variant forty patients 77 discharged first postoperative day remaining 12 patients second postoperative day thirtythree patients 63 required oral pain medication 11 patients 21 needed pain medication postoperatively fiftyone patients 98 resumed normal activities seventh postoperative day cholecystectomy remains treatment choice biliary colic laparoscopic cholecystectomy minimizes length stay hospital lessens postoperative pain allows quicker return normal activities superior cosmetic result
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throughknee amputation highrisk patients vascular disease indications complications rehabilitation 10year period 104 patients mean age 72 years 106 throughknee amputations indications surgery limb gangrene 67 64 per cent ischaemic ulceration 22 21 per cent rest pain 9 knee contractures 6 thirty patients previous unsuccessful vascular reconstructive surgery five failed femoral embolectomy throughknee disarticulation used lateral skin flaps mortality 21 20 per cent 83 survivors 59 71 per cent underwent uncomplicated primary wound healing 36 43 per cent survivors unsuitable rehabilitation prosthesis remaining 47 57 per cent walking discharge 30130 days mean 68 days amputation throughknee amputation rapid relatively bloodless amputation useful debridement procedure many surgical functional advantages conjunction recent reports better rehabilitation compared aboveknee grittistokes amputation suggests throughknee amputation deserves greater consideration
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subtle cerebellar phenotype mice homozygous targeted deletion en2 homeobox two mouse genes en1 en2 homologs drosophila segmentation gene engrailed show overlapping spatially restricted patterns expression neural tube embryogenesis suggestive role regional specification mice homozygous targeted mutation deletes homeobox viable showed obvious defects embryonic development may due functional redundancy en2 related en1 gene product embryogenesis consistent hypothesis mutant mice showed abnormal foliation adult cerebellum en2 en1 normally expressed
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levels mrna putative kainate receptor affected seizures situ hybridization rna blothybridization techniques used examine regional distribution mrna putative kainate receptor adult rat brain ii test possibility seizures affect expression receptor gene highest densities hybridization distributed within hippocampal pyramidal granule cells medial habenula purkinje cells molecular layer cerebellum olfactory bulb recurrent limbic seizures caused massive delayed reversible reduction levels kainate receptor mrna dentate gyrus lesser decreases found pyramidal cell fields hippocampus superficial cortex findings provide evidence unusual patterns physiological activity alter genomic expression subclass glutamate receptors brain
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aspirin primary prevention angina pectoris randomized trial united states physicians purpose objective study examine effect lowdose aspirin 325 mg alternate days primary prevention angina pectoris united states physicians health study despite postulated role platelets atherogenesis myocardial ischemia effect chronic platelet inhibition development clinical angina pectoris unknown subjects methods physicians health study randomized doubleblind placebocontrolled trial among 22071 male physicians aged 40 84 years free previous myocardial infarction stroke transient cerebral ischemia entry followed average 602 months 21738 physicians also free angina pectoris baseline constituted study population present analyses results 106652 personyears followup 331 patients confirmed angina pectoris diagnosed 194 underwent coronary revascularization procedure coronary artery bypass graft surgery coronary angioplasty compared participants assigned placebo relative risk confirmed angina pectoris aspirin group 110 95 confidence interval ci 088 138 coronary revascularization relative risk 119 95 ci 088 159 simultaneous control coronary risk factors proportionalhazards model relative risks remained near unity 107 95 ci 084 136 111 95 ci 081 152 respectively risks angina pectoris examined according year randomization trial pattern increasing benefit longer duration treatment conclusion randomized trial data indicate chronic platelet inhibition lowdose aspirin average duration 602 months reduce incidence angina pectoris
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lesions side branches arteries undergone percutaneous transluminal coronary angioplasty histopathologic study percutaneous transluminal coronary angioplasty ptca may cause occlusion side branches histologic studies however made side branches arteries ptca performed histologic study therefore made explain effect ptca side branches histologic specimens prepared serial step sectioning 15 side branches 10 autopsied cases undergone ptca results examination light microscope follows 1 stenoses due ptca seen seven branches 467 2 stenoses classified three types stenosis due blocking orifice side branch disrupted portion intima main artery one branch b stenosis due medial dissection main artery dissection occurring even side branches three branches c stenosis due fragmentation internal elastic lamina main artery accompanied proliferation smooth muscle cells even side branch three branches clear stenosis caused side branches long ptca extra care required major side branches exist portion procedure performed
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ampullary hamartoma endoscopic diagnosis treatment study shows patient presented intermittent biliary tract obstruction caused ampullary hamartoma endoscopic retrograde cholangiopancreatography showed large ulcerated papilla dilated biliary ducts tissue diagnosis established large particle biopsy obtained snare patient underwent successful endoscopic sphincterotomy remained symptom free 4 years
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cauda equina syndrome continuous spinal anesthesia four cases cauda equina syndrome occurring continuous spinal anesthesia reported four cases evidence focal sensory block achieve adequate analgesia dose local anesthetic given greater usually administered singleinjection technique postulate combination maldistribution relatively high dose local anesthetic resulted neurotoxic injury suggestions may reduce potential neurotoxicity discussed use lower concentration ceiling maximum dose local anesthetic establish block considered maldistribution local anesthetic suspected indicated focal sensory block use maneuvers increase spread local anesthetic recommended maneuvers prove unsuccessful technique abandoned
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cardiac disease alcoholic patient ethanol acute low doses believed relatively nontoxic normal myocardium despite data indicating lowlevel contractility impairment patients myocardial disease serum ethanol concentration increased high levels angina myocardial infarction arrhythmia may potentiated chronic ethanol use moderate doses may protective coronary artery disease despite increased rates hypertension alcohol consumption high doses may result dilated cardiomyopathy dismal prognosis alcohol abuse associated increased mortality
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prospective randomized comparison protracted infusional 5fluorouracil without weekly bolus cisplatin metastatic colorectal carcinoma midatlantic oncology program study one hundred eightyfour patients advanced measurable colorectal cancer previously treated chemotherapy entered prospective randomized clinical trial midatlantic oncology program maop assess value weekly cisplatin 20 mgm2 added protracted schedule 5fluorouracil 5fu infusion pif 300 mgm2d 10 weeks every 12 weeks liver primary indicator lesion approximately 75 study group tumor measurements required radiographic confirmation response rate pif alone arm 35 29 83 95 confidence interval ci 25 46 compared 33 28 85 95 ci 23 44 arm weekly cisplatin added pif median survival times 118 112 months two groups weekly cisplatin appear add effectiveness pif colorectal carcinoma
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new concepts treatment stage d1 adenocarcinoma prostate stage d1 disease encountered 20 per cent patients treat prostate cancer marked heterogeneity among cancers discovered stage 5year diseasefree survival rates ranging 0 95 per cent generally prostate cancer escaped confines gland metastasis occurs widespread systemic disease prevails significant chance longterm cure depend systemic therapy maturing data retrospective reviews preliminary data prospective trials recent wellconducted animal studies chemotherapy hormonal deprivation appear effective tumor volumes smallest evidence supports removal cancer possible early institution systemic treatment caution must exercised extrapolating aforementioned evidence include cases extensive prostate cancer ie patients bulky pelvic retroperitoneal disease distant metastasis significant elevation serum markers doubtful debulking removal prostate lymph nodes provide justifiable advantages patients whether removal prostate affords local palliative benefit issue debate certainly primary tumor left untreated progress locally cause symptoms necessitating procedures half patients whereas incidence local recurrence adverse effects recurrences patients d1 disease radical prostatectomy adjuvant therapy less 10 per cent surgical refinements coupled acceptably low morbidity associated radical prostatectomy led authors endorse palliative benefits removing primary tumor selected patients purpose article endorse disparage aggressive treatment patients stage d1 prostate cancer evidence suggests longterm survival endpoint used compare treatment groups date treatment option offers significant advantages contrary progression rates diseasefree survival compared cytoreductive surgery early systemic adjuvant treatment testosterone deprivation chemotherapy provides significant advantages selected patients stage d1 disease although ploidy analysis receptor mapping oncogene assays promising today practical way identify patients benefit multimodality treatment approachesabstract truncated 400 words
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large loop excision transformation zone lletz compared carbon dioxide laser treatment cin superior mode treatment series 199 patients histologically confirmed cervical intraepithelial neoplasia cin grade ii iii allocated hospital number receive outpatient treatment carbon dioxide laser vaporization large loop excision transformation zone lletz patients received local anaesthesia women lletz group experienced less post operative haemorrhage less discomfort operative time greatly reduced histological material available confirmation diagnosis significant difference recurrence cin treatment two groups 6 month followup recurrence rates 82 cin ii 75 cin iii observed lasergroup 5 cin ii 53 cin iii lletz group advantages lletz reduced capital expenditure hazard eyesight surgeon laser treatment preferable patients widespread vaginal involvement
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platelet activation emotional stress patients coronary artery disease studied effects experimentally induced emotional stress mental arithmetic different hemodynamic parameters catecholamine levels serum platelet function tests 25 postinfarction patients 10 apparently healthy agematched control subjects mental stress 10 minutes induced significant increments heart rate systolic blood pressure diastolic blood pressure double product cardiac output indicating sympathoadrenal stimulation confirmed significant increase serum epinephrine norepinephrine levels effects disappeared minute 10 recovery concomitantly test produced significant increase platelet aggregation induced 3 microm adp 1 microgramml collagen formation circulating platelet aggregates increase thromboxane b2 levels plasma serum effects also rapidly reversible similar activation hemodynamic parameters similar less evident increase platelet function emotional stress observed control subjects possible artifact due factitious platelet activation catheter sampling excluded experiments 40minute rest introduced baseline period mental stress platelet activation occur baseline rest periods emotional stress furthermore antiplatelet drug dipyridamole reduced stressinduced formation platelet aggregates postinfarction patients results demonstrate existence direct link emotional stress platelet function offer explanation one mechanisms mental stress may involved development coronary artery disease
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early diastolic clicks fontan procedure double inlet left ventricle anatomical physiological correlates mode echocardiograms simultaneous phonocardiograms recorded four patients early diastolic clicks auscultation double inlet left ventricle undergone fontan procedure closure right atrioventricular valve orifice artificial patch phonocardiogram confirmed high frequency sound occurring 6090 ms aortic valve closure coinciding time maximal excursion atrioventricular valve patch towards ventricular mass one patient coexisting congenital complete heart block mode echocardiogram showed reversed motion patch towards right atrium atrial contraction doppler flow studies showed coincident motion forward flow pulmonary artery augmentation atrial contraction coincided ventricular systole early diastolic click patients explained abrupt cessation motion atrioventricular valve patch towards ventricular mass early diastole one patient atrial contraction led reversal motion associated forward flow pulmonary artery
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renal vein thrombosis initial manifestation goodpastures syndrome report patient presented renal vein thrombosis nephrosis progressed alveolar hemorrhage renal failure renal biopsy immunofluorescence serum antiglomerular basement membrane antibody titer studies confirmed diagnosis goodpastures syndrome knowledge first report renal vein thrombosis initial presentation goodpastures syndrome
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prognostic significance multimodality evoked response testing highrisk newborns exposure hypoxicischemic events fetal neonatal life may lead permanent brain damage subsequent neurodevelopmental deficits clinical diagnostic tools somewhat helpful identifying atrisk group particularly patients sustaining significant neurologic sequelae prospective study prognostic significance multimodality evoked responses highrisk newborns examined group 44 highrisk newborns well 14 healthy newborns tested newborn period auditory brainstem responses somatosensory evoked responses tests repeated 2 6 months corrected age neonatal neurologic examination einstein neonatal neurobehavioral assessment scale also conducted 1 year corrected age groups assessed blind fashion pediatric neurologist psychologist determine neurodevelopmental outcome results indicated somatosensory evoked response abnormalities particular predict abnormal neurologic status 1 year age abnormalities persisted worsened correlated severe neurologic impairment whereas abnormal somatosensory evoked response improved normalized infancy associated mild moderate neurologic sequelae increased brainstem conduction auditory brainstem responses also associated neurologic sequelae normal findings auditory brainstem responses somatosensory evoked responses predicted normal developmental scores areas well normal neurologic outcome 1 year negative predictive powers ranging 85100 evoked response testing appears important adjunct neurologic investigation highrisk newborns
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utility upright tilttable testing evaluation management syncope unknown origin purpose vasovagally mediated hypotension bradycardia believed common difficult diagnose causes syncope upright tilttable testing proposed possible way test vasovagal episodes study investigated clinical utility technique evaluation management patients syncope unknown origin patients methods twentyfive patients recurrent unexplained syncope six control subjects evaluated use upright tilttable test 30 minutes without infusion isoproterenol 1 3 microgramsminute given intravenously attempt provoke bradycardia hypotension 25 patients 14 males 11 females mean age 50 16 years six control patients history syncope also studied tiltpositive patients received therapy either betablockers disopyramide transdermal scopolamine hydroflurocortisone efficacy evaluated another tilttable test results syncope occurred six patients 24 baseline tilt nine patients 36 isoproterenol infusion total positives 60 none controls syncope test patients positive test results eventually became tilttablenegative therapy mean followup period 16 2 months episodes occurred conclusion study conclude upright tilttable testing combined isoproterenol infusion clinically useful diagnosis vasovagal syncope evaluation pharmacologic therapy
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alternating hepatic intraarterial floxuridine fluorouracil less toxic regimen treatment liver metastases colorectal cancer hepatic intraarterial hia infusion floxuridine fudr via implanted pump shown promise treatment colorectal cancer metastasized liver however potential benefit therapy may offset high incidence treatmentlimiting biliary toxicity although weekly hia bolus fluorouracil 5fu effective metastatic colorectal cancer liver biliary toxicity limited systemic side effects december 1986 began phase ii trial alternating hia fudr 5fu via implanted pump attempt extend duration treatment obviating limiting biliary fudr systemic 5fu drug toxic effects patients received continuous hia fudr 01 mgkg body weight per day days 1 8 followed hia bolus 5fu 15 mgkg given via pump sideport days 15 22 29 cycle repeated every 35 days sixtyeight patients enrolled trial 64 fully evaluable 64 patients 30 47 previously received chemotherapy major response complete response plus partial response observed 32 50 64 patients median survival pump implantation patients 224 months contrast experience singleagent hia fudr regimen patient treatment terminated drug toxicity alternating hia fudr 5fu efficacy similar hia fudr given alone closely monitored adjusted appropriately associated toxic effects requiring treatment termination
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hemodialysisassociated febrile episodes surveillance major alteration water treatment system surveillance bacteremic pyrogenic episodes associated hemodialysis undertaken reconstruction water treatment system university medical center new water system included holding tank iodination treatment water delivered individual dialysis stations occasional positive bacterial cultures 3 21 samples completion construction 2 16 samples afterwards intermittent detection endotoxin 6 21 samples completion construction 9 16 samples afterwards monthly sampling among 51 individual dialysis treatments 25 patients reconstruction 56 treatments 29 patients 2 3 febrile events identified respectively associated underlying infectious illness hemodialysis procedure overall conclude pyrogenic episodes associated directly hemodialysis treatment infrequent addition water storage tank iodination treatment appear increase risk bacteremia pyrogenic episodes
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ndyaglaser microsurgery frontobasal meningiomas fortythree patients big frontobasal meningiomas underwent microsurgical removal tumor 132 microns ndyaglaser proved useful prospective series particularly contactless shrinkage tumors necrotization dural bony attachments tumor shrinkage achieved radiating tumor surface ndyaglaser technique facilitated microsurgical dissection reduced blood loss half ndyaglaser necrotization dural bony attachments reduced recurrence rate following grade two resections 20 zero postoperative quality life excellent complete rehabilitation 76 patients use 132 microns ndyaglaser improved significantly results microsurgery frontobasal meningioma
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induction arthritis rats aqueous suspensions mycobacteria without use oil report first time induction arthritis aqueous rather oil suspension killed tubercle bacilli accomplished highly susceptible dark agouti strain rats intraperitoneal injection healing phase chemically induced peritonitis procedure injection induction peritonitis augmented incidence arthritis produced bovine type ii collagen freunds complete adjuvant enhanced delivery antigen peritoneal cavity regional lymph nodes postinflammatory state responsible increase induction arthritis
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role infections rheumatic diseases molecular mimicry bacterial human stress proteins infections cause exacerbate rheumatic diseases several ways including immune crossreactivity bacterial heat shock proteins similar proteins normal human tissues may lead autoimmunity rheumatoid arthritis systemic lupus addition increased activation gene regulating synthesis heat shock protein found scleroderma fibroblasts infectioninduced model rheumatic diseases rheumatic fever rf wellestablished link prior group streptococcal infection revisited lessons learned rf rheumatic diseases directly linked infection applied ankylosing spondylitis rheumatoid arthritis sjogrens syndrome polymyositis mounting body circumstantial evidence suggests probable infectious cause interplay genetic susceptibility infection particular organisms implications new information present future therapy rheumatic diseases also presented
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role elective lymph node dissection management patients thick cutaneous melanoma retrospective search patients seen duke melanoma clinic 1970 1986 identified 308 clinically stage patients 40 100 mm cutaneous melanomas fiveyear tenyear survival 56 43 respectively elective lymph node dissection elnd done 116 patients 377 difference diseasefree interval dfi survival patients versus patients treated wide excision p 09 thirtytwo patients 276 pathologically positive nodes elnd patients shorter dfi p 005 survival p 003 compared patients negative node dissections divided breslows thickness difference persisted patients 40 60 mm lesions p 001 however thicker lesions greater 60 mm difference survival nodenegative nodepositive groups p 09 mean followup 71 years elective lymph node dissection done 192 patients 78 recurred first regional nodes 78 patients compared 32 patients pathologically positive nodes elnd see patient survival improved early removal nodal disease difference dfi p 05 survival p 03 two groups concluded elnd may provide prognostic information patients thick cutaneous melanomas however change dfi ultimate survival patients followed nodes removed clinically positive authors recommend elnd patients thick melanomas risk distant metastases outweighs benefit regional node dissection
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sudden death young competitive athletes clinicopathologic correlations 22 cases purpose investigate pathologic substrates sudden death young competitive athletes patients methods twentytwo cases sudden death young competitive athletes occurring veneto region northern italy period january 1979 december 1989 studied postmortem examination athletes included 19 males three females ranging age 11 35 years mean 23 years results 18 cases sudden death occurred 16 cases immediately two cases competitive sport activity 10 subjects sudden death apparently first sign disease postmortem examination disclosed fatality due arrhythmic cardiac arrest 17 cases among right ventricular cardiomyopathy also known right ventricular dysplasia frequently encountered cardiovascular disease six cases followed atherosclerotic coronary artery disease four cases conduction system pathology three cases anomalous origin right coronary artery wrong aortic sinus two cases mitral valve prolapse two cases two athletes abrupt lethal complication mechanical consisted pulmonary embolism rupture aorta three athletes death due cerebral cause athletes right ventricular cardiomyopathy died effort history palpitations andor syncope whenever available electrocardiographic ecg tracings showed inverted waves precordial leads andor left bundle branch block ventricular arrhythmias conclusions clinicopathologic correlations indicate veneto region italy right ventricular cardiomyopathy rare among cardiovascular diseases associated risk arrhythmic cardiac arrest seems account majority cases sudden death young athletes disorder suspected life basis prodromal symptoms ecg signs
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proliferating trichilemmal tumor report case review literature authors report case proliferating trichilemmal tumor review related literature although considered biologically benign malignant proliferating trichilemmal tumor reported authors emphasize importance recognizing tumors occur individuals 20s 30s tumors excised margin normal tissue routine followup recommended
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association elevated plasma homocysteine progression symptomatic peripheral arterial disease plasma homocysteine sum free bound homocysteine homocystine mixed disulfide homocysteinecysteine expressed homocysteine levels determined high performance liquid chromatography 214 patients symptomatic claudication rest pain gangrene amputation lower extremity arterial occlusive disease andor symptomatic stroke cerebral transient ischemic attacks cerebral vascular disease 103 control persons mean plasma homocysteine significantly higher patients controls 1437 689 nmolml vs 1010 216 p less 005 thirtynine percent patients 83 214 plasma homocysteine values greater control mean 2 standard deviations plasma homocysteine values contrasted age male sex diabetes hypertension smoking renal failure plasma cholesterol difference found incidence andor level risk factors patients normal plasma homocysteine compared elevated plasma homocysteine univariate multivariate analysis patients elevated plasma homocysteine likely demonstrate clinical progression lower extremity disease coronary artery disease cerebral vascular disease patients normal plasma homocysteine rate progression rapid p 0002 progression lower extremity disease assessed vascular laboratory also common patients elevated plasma homocysteine p 001 conclude elevated plasma homocysteine independent risk factor symptomatic lower extremity disease cerebral vascular disease symptomatic patients lower extremity disease elevated plasma homocysteine also appear rapid progression disease
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comparison supraannular subannular pledgeted sutures mitral valve replacement ten fresh canine hearts used compare peak left ventricular pressure required disrupt prosthetic mitral valves sutured place horizontal mattress sutures either subannular supraannular pledgets group consisted 5 animals 29mm medtronic mitral valve secured mitral position ten pledgeted sutures aorta cannulated normal saline solution infused left ventricle valvar disruption occurred peak pressure location mechanism disruption noted peak left ventricular pressure required valvar disruption individual sutures broken instead specimens subannular myocardial rupture occurred posterior portion mitral annulus along extent atrioventricular groove addition posterior wall left atrium dissected upward subsequently significantly greater pressures required group subannular suture placement compared supraannular group 354 37 versus 236 33 mm hg p less 00007 data suggest placement horizontal mattress sutures pledgets subannular position superior currently recommended method supraannular suture placement mechanical valves
| 3 |
14,249 |
interleukin2 therapy patients metastatic malignant melanoma phase ii study fortyseven patients metastatic malignant melanoma treated two 5day cycles 100000 ukg recombinant interleukin2 il2 intravenously iv every 4 hours separated 1 week dose schedule il2 identical used previous combined il2 lymphokineactivated killer lak cell phase ii clinical trial il2lak working group patient eligibility criteria clinical management guidelines similar used previous trial fortysix patients assessable response objective responses observed 10 46 patients two complete responses crs eight partial responses prs 22 responses occurring lung liver well lymph nodes subcutaneous sites median response duration 8 months toxicity significant three patients developed myocardial infarction one patient died therapy overall toxicity response rate singleagent il2 similar observed il2 administered combination lak cells previous trial results suggest singleagent therapy il2 administered schedule significant antimelanoma activity humans lak cells generated peripheral blood add little antimelanoma activity dose schedule il2
| 4 |
14,250 |
cognitive deficits children adaptive behavior treatment techniques impaired cognitive functioning impedes development ageappropriate adaptive behavior thus adding burdens many children epilepsy detailed neuropsychological assessment identify underlying abilityrelated impairments contribute adaptive behavior deficiencies evidenced particularly home school settings information serve basis multidisciplinary treatment plan tailored individual needs ideally need treatment plan perceived early childhood developed applied preventively remedial principles also apply older children set detail
| 4 |
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obstructive jaundice use expandable metal endoprosthesis biliary drainage work progress expandable metal endoprostheses implanted transhepatically 61 patients obstructive jaundice fiftythree patients malignant eight benign obstructions small diameter compressed stent 7 f primary implantation stent without previous catheter drainage preferred postprocedural complications occurred three patients 5 biliary pleuritis peritonitis hepatic artery aneurysm 30day mortality rate 82 reocclusions observed six patients malignant obstructions 11 observation period 110 months mean 45 months two patients benign stenoses 25 observation period 321 months mean 9 months higher reocclusion rate benign obstructions must interpreted care small number patients preliminary experience authors conclude expandable metal endoprostheses offer patency rates equal plastic stents implantation trauma reduced due small 7f introducing catheter system
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adjuvant chemotherapy breast cancer many women cured breast cancer even best early detection surgical techniques micrometastases present diagnosis adjuvant therapy extended diseasefree interval patients lengthens overall survival many combination chemotherapy become standard form adjuvant treatment premenopausal women breast cancer positive lymph nodes primary therapy minimal toxicity diseasefree overall survival improved results less impressive less clearcut postmenopausal women woman negative lymph nodes longterm toxicities adjuvant chemotherapy may include second malignancies cardiac dysfunction although complications probably rare must considered seriously weighing chemotherapy patients benefits may slight innovations likely become standard adjuvant therapy decision making include risk assessment new prognostic indicators growth fraction oncogene expression investigation dose intensification using bone marrow growth factors autologous stemcell support
| 0 |
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primary adenocarcinoma bladder favorable prognostic significance deoxyribonucleic acid diploidy measured flow cytometry flow cytometric nuclear deoxyribonucleic acid ploidy analysis done successfully 38 specimens primary bladder adenocarcinoma treated 1954 1985 specimens 10 26 deoxyribonucleic acid diploid 8 21 tetraploid 20 53 aneuploid distribution ploidy patterns 14 histological low grade 24 high grade tumors similar 38 tumors 35 92 showed muscle invasion one tumor arose previously exstrophied bladder 10 urachal origin 27 arose anatomically normal bladder urachal origin tumors 80 deoxyribonucleic acid aneuploid 5 10 years diagnosis 80 70 respectively patients diploid tumors free disease contrast 5 10 years treatment 20 12 respectively patients nondiploid tumors disease progression p less 0001 logrank test none 6 patients diploid high grade high stage muscle invasive tumors subsequent progression contrast 16 17 patients 94 high grade high stage nondiploid tumors either local distant tumor recurrence p less 00005 nuclear deoxyribonucleic acid ploidy pattern appears significant prognostic information currently available stratify expected prognosis patients muscle invasive adenocarcinoma bladder test probably standard tool clinical management patients rare bladder malignancy
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epidemiology acute respiratory tract infection young children comparison findings several developing countries coordinated data group bostid researchers investigators 10 countries studied epidemiology acute respiratory tract infection ari among children 059 months old data incidence rates age gender season pathogenic agents casefatality rates selected risk factor findings presented incidence rates six communitybased studies ranged 127 168 new episodes ari per 100 childweeks risk rates lower respiratory tract infection lri ranged 02 34 new episodes per 100 childweeks risk children spend 217 401 observed weeks ari 1 144 observed weeks lri incidence rates ari highest younger children viruses especially respiratory syncytial virus isolated frequently bacteria children episodes lri risk factors exhibited different patterns association ari different studies interventions could great impact highrisk levels common study populations studies provide interesting useful data epidemiologic dynamics ari
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antigen specific serum antibody response chlamydia trachomatis patients acute pelvic inflammatory disease sera 35 patients acute pelvic inflammatory disease pid without chlamydia trachomatis confirmed culture sera 19 control patients neither evidence pelvic infection c trachomatis infection studied presence serum igg iga igm antibodies c trachomatis using enzyme immunoassay eia immunoblotting techniques correlation antibody concentrations eia spread chlamydial infection determined cervical endometrial laparoscopic sampling chlamydia immunoblot analysis showed antibodies major outer membrane protein momp c trachomatis elementary bodies patients c trachomatis isolated reactivity also frequently observed 68 62 60 45 31 kilodalton antigens 20 antigenic polypeptides identified differences antibody prevalence specific chlamydial antigens however related site chlamydial isolation serum antibody concentrations observed eia results indicate patients pid without upper genital tract infection c trachomatis cannot differentiated reactivity sera specific chlamydial polypeptide antigens determination specific serum iga antibody response eia effective single test discriminate patients without acute chlamydial infection
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uterine rupture uterine rupture sudden unforeseeable event carries high rate maternal perinatal mortality diagnosis uterine rupture suspected prompt surgical intervention experienced pelvic surgeon blood product replacement considered time uterine rupture patient evaluated possible repair hysterectomy appears based aforementioned information repair reasonable consideration patients undergone repair early delivery elective cesarean assessment fetal lung maturity around 36 weeks gestation would appear prudent patients prior cesarean continuous electronic fetal monitoring detect intrapartum fetal distress would appear prudent patients fetal distress common sign symptom uterine rupture frequently precedes clinical manifestations complication
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clinical experience palmazschatz coronary stent initial results multicenter study stenting native coronary arteries balloonexpandable stent attempted 226 patients elective angioplasty delivery device successful 213 94 patients 39 received aspirin dipyridamole group 1 174 received aspirin dipyridamole warfarin 13 months group 2 abrupt closure less equal 1 day perioperative death either group inhospital perioperative complications group 1 compared group 2 follows subacute closure 114 days seven 18 patients versus one 06 patient respectively p less 00001 myocardial infarction five 13 patients versus one 06 patient respectively condition requiring urgent bypass surgery one 25 patient versus patients respectively thus incidence major complications death myocardial infarction condition requiring urgent bypass surgery 15 group 1 06 group 2 clinical followup revealed 92 patients asymptomatic 3 months stenting compared 6 stenting p less 00001 13 patients symptomatic nine underwent cardiac catheterization ultimately successful elective coronary angioplasty bypass surgery conclude high delivery success rate expected device clinical thrombosis less frequent anticoagulated patients nonanticoagulated patients furthermore selected patient population coronary stenting results low incidence inhospital perioperative complications clinical success defined absence symptoms appears sustained 3 months
| 4 |
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cancer relatives survivors childhood sarcoma relatives 88 longterm survivors childhood sarcoma examined familial cancer syndrome sarcoma breast cancer neoplasms lifraumeni syndrome twentysix 402 close relatives developed cancer expected 238 including breast cancer four mothers expected 31 two sarcoma probands developed second malignant tumors multiple relatives cancer might inherited predisposition increased cancer risk exceptional requirement disease screening appear confined firstdegree relatives small fraction children sarcoma notably probands second cancers
| 0 |
14,259 |
valve great vessel stenosis assessment mr jet velocity mapping measurement poststenotic jet velocities magnetic resonance mr imaging authors reduced echo time te field evenecho rephasing feer velocity mapping sequence 140 36 msec minimizing problem mr signal loss turbulent fluid vitro use rotating disk stenotic flow phantoms confirmed 36msec te sequence enables accurate measurement jet velocities 60 msec r 996 peak jet velocity measurements made mr imaging 36 patients stenosis native heart valves n 9 conduits n 19 fontan connections n 2 aortic coarctation n 6 peak velocity measurements made mr imaging agreed well measurements made doppler ultrasound us available 18 cases standard deviation 02 msec velocity mapping fastecho mr imaging likely considerable importance noninvasive means locating evaluating stenoses particularly sites inaccessible us care must taken prevent errors caused malalignment signal loss phase wrap partialvolume effects
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severe gastrointestinal hemorrhage crohns disease twentyone fifteen hundred twentysix patients crohns disease cd treated mount sinai hospital 1960 1986 developed severe gastrointestinal hemorrhage 26 separate episodes severe hemorrhage 17 patients bled three bled twice one bled three times frequency bleeding significantly higher among patients colonic involvement 17 929 19 among small bowel disease alone 4 597 07 p less 0001 twelve patients required surgery 13 occasions involved colon resection one case eleven patients underwent surgery first hemorrhagic episodes 1 11 second operation recurrent bleeding 12th patient whose first hemorrhage treated medically surgery repeated episode hemorrhage precise bleeding points could located 2 26 bleeding episodes ileocecal area three patients died two undergone surgery bled weeks earlier primary bleeding episodes subsided without surgery 10 21 cases 3 10 patients 30 rebled massively contrast primary excisional surgery followed recurrent hemorrhage 1 11 cases 9 differences mortality recurrent bleeding rates although statistically significant seem favor removal diseased bowel time first episode massive hemorrhage
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gynecologic cancer patients subacute cerebellar degeneration predicted antipurkinje cell antibodies limited metastatic volume 1982 1989 19 patients gynecologic carcinoma paraneoplastic cerebellar degeneration seropositivity antipurkinje cell cytoplasmic antibodies identified institution seven patients clinical computed tomographic magnetic resonance imaging evidence cancer undergone laparotomy solely antipurkinje cell antibodies found serum highgrade adenocarcinoma cerebellar symptoms preceded coincided initial cancer diagnosis 15 patients preceded diagnosis recurrent cancer 4 patients cancers 14 ovarian 2 fallopian tube 2 surface papillary 1 poorly differentiated metastatic adenocarcinoma periaortic lymph node two remarkable surgical observations patients highgrade ovarian tubal cancers conspicuous lack peritoneal implants small metastatic volume comparison 8 patients primary stage iii cancer 24 matched control patients without paraneoplastic cerebellar degeneration revealed difference primary tumor volume significantly smaller volume metastatic tumor seropositive group p 005 antipurkinje cell antibodies detected 111 neurologically normal patients advanced ovarian cancer small metastatic volume face highgrade advanced stage malignancy seropositive patients paraneoplastic cerebellar degeneration suggests immune response tumor presumably crossreactive cerebellar cells may impair metastatic process earlier diagnosis treatment cancer based prompt serologic testing may offer improved neurologic oncologic prognosis
| 2 |
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role continued drinking loss portal perfusion distal splenorenal shunt fifty percent patients alcoholic cirrhosis undergo distal splenorenal shunting variceal bleeding lose portal perfusion within 1 year although previously considered loss portal flow irrevocable present study shows resolution alcoholic hepatitis portal perfusion restored 34yearold patient alcoholic liver disease distal splenorenal shunt lost portal perfusion 1 year operation continued drink alcohol high sinusoidal pressure following forced abstinence next 2 years sinusoidal pressure fell liver volume decreased results liver biopsy improved portal perfusion restored shunt patency documented collaterals portal vein shunt could still visualized seen portal flow absent restoration portal perfusion attributed decreased intrahepatic resistance secondary abstinence alcohol return drinking next 9 months led alcoholic hepatitis loss portal perfusion study places emphasis increased intrahepatic resistance rather development portaltoshunt collaterals important loss portal flow patients
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14,263 |
complement activation use cell saver cardiopulmonary bypass complement activation evaluated ten patients undergoing cardiopulmonary bypass cpb intraoperative blood salvage cell saver cs assess inflammatory response related cs washed red blood cell concentrate reinfused protamine injection plasma c3a measured radioimmunoassay preoperatively 5 min cpb 5 60 90 min cpb 5 min protamine infusion end surgery 24 hr addition clinical score based renal pulmonary neurologic myocardial postoperative evolution given 08 every patient results compared c3a changes clinical scores obtained 26 routine cs cardiac surgical patients results showed maximal c3a generation protamine activation cases cs concentrate reinfusion ranged 400 ml 2000 ml difference clinical score observed cs 1 1 control 085 06 groups authors conclude cs enhance complement activation resulting extracorporeal circulation safely used blood saving strategy cardiac surgery
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14,264 |
infective dermatitis jamaican children marker htlvi infection jamaican children infective dermatitis chronic eczema associated refractory nonvirulent staphylococcus aureus betahaemolytic streptococcus infection skin nasal vestibule 14 children ages 2 17 years typical infective dermatitis attending dermatology clinic university hospital west indies jamaica tested antibody human tlymphotropic virus type 1 htlv1 seropositive whereas 11 children similar age atopic eczema negative 2 2 cases infective dermatitis biological mother htlv1 seropositive none 14 patients showed signs adult tcell leukaemialymphoma though experience previous cases infective dermatitis indicates possibility progression
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central neurogenic hyperventilation pharmacologic intervention morphine sulfate correlative analysis respiratory sleep ocular motor dysfunction central neurogenic hyperventilation cnh effective therapy eventually result respiratory fatigue death report describes patient cnh due brainstem anaplastic astrocytoma also exhibited disturbances sleep ocular motor function cnh responded clinically morphine sulfate methadone analysis ventilatory response co2 morphine demonstrated depression ventilatory response 49 53 baseline occlusion pressure response 35 50 baseline co2 requirement high doses naloxone 10 mg iv reverse effect polysomnography revealed sustained hyperventilation elevated o2 saturation low endtidal co2 throughout stages nonrapid eye movement nrem sleep absence rapid eye movement rem sleep ocular motor evaluation disclosed absence horizontal reflexive saccades compensatory head thrusts correlation clinical physiologic data mri abnormalities suggested lesion responsible cnh patient might reside medial tegmental parapontine reticular formation since recurrent episodes hyperventilation responded sustained fashion iv oral opiates treatment may warrant consideration patients cnh
| 0 |
14,266 |
optimum results surgical treatment carotid territory ischemia continuing controversy role carotid endarterectomy stroke prevention based largely reports high perioperative morbidity mortality rates obviate possible longterm benefit procedure purpose review examine optimal results carotid surgery order describe potential procedure stroke prevention optimal surgical results compared optimal medical results therapy symptomatic patients optimal nonsurgical results therapy asymptomatic patients factors common series excellent results patient selection operative technique examined problems recurrent carotid stenosis coexisting coronary disease continue plague even best surgical series discussed
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14,267 |
tumorassociated neurological dysfunction prevented lazaroids rats efficacy u74006f u78517f treatment bloodtumor barrier permeability tumorassociated neurological dysfunction evaluated braintumor model rats u74006f 21aminosteroid u78517f 2methylamino chroman rats stereotactically implanted walker 256 tumors treated methylprednisolone u74006f u78517f vehicle 005 n hcl days 6 10 following implantation neurological function vascular permeability assessed day 10 methylprednisolone u74006f equally effective preventing neurological dysfunction compared control group p less 001 u78517f slightly less effective u74006f methylprednisolone significantly better vehicle preventing neurological dysfunction delivery methylprednisolone resulted significant decrease tumor vascular permeability p less 0006 u74006f u78517f effect permeability suggests u74006f u78517f prevented tumorassociated neurological dysfunction mechanism decreasing permeability tumor capillaries u74006f u78517f could prove useful treatment brain tumors
| 2 |
14,268 |
treatment severe colitis behcets syndrome thalidomide cg217 35yearold male patient known department since 1979 account severe complete behcets syndrome treated thalidomide cg217 final pharmacological measure avoid colectomy severe attack behcet colitis prior administration thalidomide patient treated 7 weeks full parenteral nutrition high doses steroids intravenously without satisfactory effect colitis treatment sulphasalazin unsuccessful decreasing number platelets drug days thalidomide 300 mg given daily bedtime patients stools normalized without reaction blood oral ulcers pleural effusion disappeared steroid doses could reduced gradually put oral nutrition rectal mucosa became normalized dose thalidomide reduced 200 mg 100 mg daily patient discharged hospital less 3 weeks institution drug treatment 5 months outpatient condition still satisfactory without symptoms former disease thalidomide previously reported value treatment behcets syndrome knowledge never dramatic effect severe colitis reported case
| 1 |
14,269 |
limb salvage pediatric surgery use expandable prosthesis limb sparing growing children proved effective oncologic perspective good longterm acceptance patients adult performed experienced surgeons limb sparing neither compromises survival rate significantly increases local recurrence rate compared crossbone amputation discussions include patient evaluation surgical options materials methods results
| 0 |
14,270 |
systemic local administration cyclosporine treatment psoriasis since 1984 cyclosporine used increasingly indications prophylaxis transplant rejection current awareness psoriasis least part cellmediated condition led initiation several studies cyclosporines role treatment disease remarkable efficacy systemically administered cyclosporine even severely refractory cases psoriasis provided us new therapeutic option also helped understanding pathophysiology psoriasis although hailed breakthrough systemic cyclosporine usage associated undesirable sequelae principally hypertension decreased renal function effects limit widespread use review assesses current knowledge capabilities prospects systemic cyclosporine treatment psoriasis well status topical preparations
| 4 |
14,271 |
surgical resection intrinsic brain stem lesions overview major limitation effective treatment intrinsic mass lesions brain stem inability clearly define pathological anatomy radiographically improved soft tissue resolution offered magnetic resonance imaging compared axial computed tomography makes possible accurately distinguish anatomical relationships also predict pathological nature lesion accordingly encouraged pursue aggressive approach intrinsic lesions brain stem appear well circumscribed magnetic resonance imaging scan object paper report successful treatment four intrinsic lesions brain stem present overview relevant published experience
| 3 |
14,272 |
bacterial endocarditis presenting acute myocardial infarction cautionary note era reperfusion coronary embolism known complication bacterial endocarditis sometimes causes acute myocardial infarction necessity rapidly restoring coronary artery perfusion time constraints governing clinical decisions may prevent endocarditis diagnosed pharmacologic mechanical thrombolysis report describes first documented cases coronary angioplasty two patients acute myocardial infarction caused bacterial endocarditis reviews literature coronary artery complications bacterial endocarditis first patient developed coronary artery mycotic aneurysm dilatation site second experienced small intracerebral hemorrhage following reperfusion course unwise generalize two cases believe patients likely endocarditis cause acute myocardial infarction impulse follow conventional strategies coronary reperfusion tempered thoughts possible consequences
| 3 |
14,273 |
cumulative aids incidence altered mortality bacterial infections determine whether populations high cumulative incidence acquired immunodeficiency syndrome aids experienced increased deaths sepsis central nervous system abscess endocarditis new jersey aids patients grouped according age sex race residencespecific cumulative incidence aids since onset aids epidemic 1980 1986 among 2544 year olds highest cumulative incidence group aids sepsis mortality increased 33 152 deaths100000year increase 119 deaths100000year 95 confidence interval 69 170 deaths100000year mortality central nervous system abscesses increased zero 17 01 32 deaths100000year mortality endocarditis increased 08 deaths100000year 24 deaths100000year increase 16 05 37 deaths100000year agematched new jersey patient populations low cumulative incidence aids sustain similar increase hiv diseaseassociated increase sepsis mortality among young populations represents new component substantial increase us sepsis mortality occurred last two decades previously limited older populations
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oral manifestations crohns disease analysis 79 cases report four new cases oral manifestation crohns disease cd evaluate 75 reported cases morphology site oral intestinal manifestations cd clinical manifestation treatment oral cd presenting symptom 43 72 60 patients relapsed 34 60 57 median age presentation 22 range 657 years males affected often 1851 malefemale ratio total 228 oral lesions 79 patients lips 57 lesions gingiva 40 lesions vestibular sulci 31 lesions buccal mucosa 25 lesions sites frequently affected edema 62 lesions ulcers 57 lesions polypoid papulous hyperplastic mucosa 45 lesions common type lesions rate granuloma detection high oral 6777 intestinal lesions 4571 total 66 courses drug therapy 51 patients analyzed complete remission oral symptoms achieved systemic steroids andor azathioprine 13 26 50 patients whereas strictly topical treatment steroids resulted complete remission oral symptoms 7 12 58 conclude oral cd exhibits characteristic morphologic appearance often preceding intestinal symptoms adolescents young adults thus patients orofacial granulomatosis cd vigorously searched complete gastrointestinal endoscopic investigation oral cd may cause disabling pain facial distortion results treatment remain unrewarding absence data controlled therapeutic trials systemic steroids andor azathioprine recommended topical treatment failed control symptoms
| 1 |
14,275 |
clinical doppler echocardiographic evaluation bioprosthetic valve failure 10 years four hundred thirteen consecutive patients underwent valve replacement bioprosthesis 1976 1982 aortic valve replacement performed 240 patients mitral valve replacement 132 patients multiple valve replacement 41 carpentieredwards porcine n 336 angellshiley porcine n 23 hancock porcine n 11 ionescushiley pericardial valves n 43 inserted followup 5 12 years postoperatively 98 complete freedom structural valve deterioration 72 7 59 9 59 9 respectively aortic mitral double valve replacement risk structural valve deterioration reoperation valverelated complications significantly increased ionescushiley pericardial prosthesis risk reoperation inversely related patient age postoperative doppler echocardiographic studies 87 available patients revealed subgroup asymptomatic patients evidence structural valve deterioration patients n 61 significantly reduced prosthetic valve areas aortic less 1 cm2 mitral less 17 cm2 elevated resting transvalvular gradients aortic greater 40 mm hg moderatetosevere regurgitation summary postoperative doppler echocardiographic examination identified asymptomatic patients structural valve dysfunction patients must followed carefully determine optimal timing reoperation
| 4 |
14,276 |
granulocytic sarcoma presenting epidural mass acute paraparesis aleukemic patient granulocytic sarcomas rare tumors composed granulocytic precursor cells commonly encountered patients acute myelogenous leukemias myeloproliferative disorders blast crisis rarely patients presenting granulocytic sarcoma show evidence acute leukemia authors report aleukemic patient acute paraparesis epidural granulocytic sarcoma five cases reported previously immunoperoxidase stain lysozyme chloroacetate esterase stain used prove myeloid origin tumor cells
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14,277 |
venous stasis vein lumen changes surgery mechanisms underlying development postoperative deep vein thrombosis remain fully elucidated previous studies suggested peroperative venous distension may factor associated venous thromboembolism study obtained high resolution ultrasound images gastrocnemius posterior tibial veins 62 patients undergoing range general surgical procedures determined changes vein diameter occurring operative procedures response induction anaesthesia completion surgery veins showed evidence dilatation response induction anaesthesia end operative procedure showed distension 2228 per cent distension prominent gastrocnemius veins lesser distension observed posterior tibial veins series patients received infusion 1 litre saline addition basal requirements distension 57 per cent compared 22 per cent corresponding control group intraoperative venous distension associated factors lead deep vein thrombosis may involved mechanisms result commencement deep vein thrombosis
| 3 |
14,278 |
intramuscular hemangioma oral region report three cases occurrence intramuscular hemangioma intraoral perioral localization rare thorough knowledge tumors necessary adequate diagnosis treatment three cases presented discussion histopathology differential diagnosis discussed adequate primary excision necessary avoid recurrence
| 0 |
14,279 |
posttraumatic epilepsy cellular mechanisms implications treatment epilepsy complicates severe head trauma development persistent seizures appears correlate extent trauma although early reports suggested prophylactic administration antiepileptic drugs would prevent epileptogenesis controlled studies failed corroborate assumption head trauma initiates sequence responses includes altered blood flow vasoregulation disruption bloodbrain barrier increases intracranial pressure focal diffuse ischemia hemorrhage inflammation necrosis disruption fiber tracts presence intracranial hematoma robust association development posttraumatic epilepsy extravasation blood followed hemolysis deposition hemecontaining compounds neuropil initiating sequence univalent redox reactions generating various free radical species including superoxides hydroxyl radicals peroxides perferryl ions free radicals initiate peroxidation reactions hydrogen abstraction methylene groups adjacent double bonds fatty acids lipids within cellular membranes intrinsic enzymatic mechanisms control free radical reactions include activation catalase peroxidase superoxide dismutase steroids proteins tocopherol also terminate peroxidative reactions tocopherol selenium effective preventing tissue injury initiated ferrous chloride heme compounds treatment strategies prevention prophylaxis posttraumatic epilepsy must await absolute knowledge mechanisms antioxidants chelators may useful given speculation peroxidative reactions may important component brain injury responses however potential treatment strategies involving gammaaminobutyric acid gaba agonists nmda receptor antagonists barbiturates need scientific assessment
| 2 |
14,280 |
multifactorial analysis mortality morbidity perforated peptic ulcer disease perforated peptic ulcer disease remains source considerable morbidity mortality suggested methods surgical therapy diverse reviewed course 113 patients treated surgically identified 14 factors influenced morbidity mortality rates multiple regression analysis showed number coexisting medical conditions lower mean blood pressure level duration acute perforation independent risk factors death age use bronchodilator lower mean blood pressure level number coexisting medical conditions correlated positively complications duodenal site independently favorable respect complications type operation performed either simple closure vagotomy drainage resection influence morbidity mortality severely ill patients also benefit particular type operation short term long term results improved definitive operation measured visick classification need reoperations definitive operations recommended virtually patients perforated peptic ulcer
| 4 |
14,281 |
spontaneous rupture stomach adult reported case spontaneous rupture stomach adult immediate onset severe upper abdominal pain overindulgence food drink along radiographic evidence pneumoperitoneum clinical findings massive abdominal distention epigastric tenderness shock occasionally subcutaneous emphysema suggest possibility gastric rupture treatment simple mortality high surgical intervention rapid
| 1 |
14,282 |
efficacy safety low highdose sotalol versus propranolol prevention supraventricular tachyarrhythmias early coronary artery bypass operations supraventricular tachyarrhythmias reported 40 patients early coronary artery bypass graft operations randomized study compared efficacy safety class iii antiarrhythmic betablocking drug sotalol versus propranolol low high doses prevention supraventricular tachyarrhythmias 429 consecutive patients coronary artery bypass graft operations patients severely depressed left ventricular function contraindications betablockers excluded fourth hour sixth day coronary artery bypass 74 patients received lowdose sotalol 40 mg every 8 hours 66 patients lowdose propranolol 10 mg every 6 hours 133 patients highdose sotalol 80 mg every 8 hours 156 patients highdose propranolol 20 mg every 6 hours baseline characteristics comparable groups supraventricular tachyarrhythmia observed 10 72 139 received lowdose sotalol 12 64 188 received lowdose propranolol 13 119 109 received highdose sotalol 19 139 137 received highdose propranolol significant drugrelated adverse effects necessitating discontinuation drug occurred four receiving low doses 29 31 receiving high doses 107 p less 002 conclusion medication found superior although supraventricular tachyarrhythmias tended less prevalent patients treated sotalol treated propranolol moreover significantly fewer adverse effects noted lowdose groups therefore lowdose betablocking treatment especially lowdose sotalol seems preferable
| 3 |
14,283 |
return work persons traumatic brain injury supported employment approach supported employment used place 41 persons competitive employment 30 months individuals experienced severe head injuries almost 70 injuries due motor vehicle accidents mean seven years passed since injury referred clients unconscious mean 53 days 36 referred clients achieved competitive postinjury employment compared 91 group competitively employed injury job retention rate 71 reported jobs warehouse clerical servicerelated occupations mean 291 hours job coaching required place maintain clients supported employment
| 2 |
14,284 |
modulatory action adenosine gastric function ethanolinduced mucosal damage rats study examines gastric effects adenosine antagonist theophylline secretory function mucosal blood flow ethanolinduced glandular mucosal damage rats fasted 24 hr experimentation animals anesthetized sodium pentobarbitone 50 mgkg intraperitoneal tracheae cannulated ex vivo stomach chamber prepared luminal bathing solution collected every 15 min concentrations h na determined ph autotitrator ionmeter respectively glandular mucosal blood flow measured laser doppler flowmeter severity lesions determined measuring hemorrhagic areas adenosine administration 25 75 mgkg subcutaneous markedly lowered h na output increased secretory volume mucosal blood flow dosedependent manner doses nucleoside also prevented ethanolinduced mucosal damage effects prevented pretreatment theophylline 30 60 mgkg subcutaneous ethanol given alone significantly depressed h na secretion effects modified adenosine treatment however depressive action ethanol mucosal blood flow prevented adenosine findings indicate adenosine modulates physiological function stomach also directly activates defensive mechanism stomach partially mediated improvement gastric mucosal blood flow increase nonacid component gastric secretion
| 1 |
14,285 |
early postoperative balloon coronary angioplasty failed coronary artery bypass grafting small number patients coronary artery bypass grafting cabg fails relieve anginal symptoms usefulness coronary angioplasty treatment early less equal 90 days recurrent ischemia cabg examined fortyfive patients treated 2 90 days cabg including 8 patients studied emergently prolonged ischemic symptoms one 2 3vessel native disease found 4 10 31 patients respectively time postoperative angiography major anatomic mechanism recurrent ischemia complete vein graft occlusion 12 patients 27 internal mammary artery occlusion 3 7 vein graft stenoses 13 29 internal mammary artery stenoses 10 22 unbypassed disease 4 8 disease distal graft insertion site 3 7 angioplasty successful 91 98 sites 93 including 95 41 lesions native arteries 89 46 lesions vein grafts 100 11 internal mammary artery lesions attempted complete revascularization achieved 84 patients 2 inhospital deaths 2 myocardial infarctions two additional patients underwent repeat cabg discharge uncomplicated unsuccessful angioplasty late followup 43 survivors mean 44 months 4 deaths 2 noncardiac repeat cabg required 3 patients repeat angioplasty performed 10 angina absent minimal 35 patients 17 patients employed full time thus percutaneous transluminal coronary angioplasty relieve myocardial ischemia unsuccessful cabg majority patients
| 3 |
14,286 |
primary adenocarcinoma urinary bladder clinicopathologic analysis 72 cases adenocarcinomas account approximately 2 primary epithelial malignancies urinary bladder clinicopathologic features 72 cases treated one institution reported 22 cases evaluated immunohistochemically twentyfour tumors urachal 48 nonurachal cases analyzed according stage presentation histologic type mucin staining tested immunohistochemically determine reaction carcinoembryonic antigen leum1 prostatespecific antigen prostatic acid phosphatase tumor stage highly significant predictor outcome p 0001 nonurachal tumors tended worse outcome urachal difference statistically significant p 007 histologic type significant predictor outcome p 010 adenocarcinoma urinary bladder stage significant predictive factor separating urachal nonurachal tumors important mucin histochemistry immunohistochemistry help distinction occasion tumors may react polyclonal antibodies prostatespecific antigen thus results must interpreted caution instances possibility using highly sensitive specific monoclonal antibodies one employed study considered
| 0 |
14,287 |
singlestage laryngotracheal reconstruction mainstay repairing subglottic tracheal stenosis rib graft prolonged stenting refinement treatment use anterior cricoid decompression split present singlestage reconstruction airway additional refinement laryngotracheoplasty article describes experience two institutions singlestage reconstruction offers observations principles technique
| 4 |
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respiratory muscle strength control ventilation patients neuromuscular disease assess relationship respiratory mechanics muscle strength control ventilation patients neuromuscular disease nmd compared pimax pemax rv frc tlc total respiratory elastance ers vt ti tt vtti titt p01 p01vtti effective impedance 21 patients nmd 21 healthy control c subjects seated position breathing room air ers nmd patients 79 percent higher c subjects ti tt vt nmd approximately half corresponding c values p01 66 percent greater c subjects p less 0001 nmd pimax pemax ranged 37 52 percent corresponding c values respectively despite significant respiratory muscle weakness 7 16 patients demonstrated paco2 greater 45 mm hg ventilatory output nmd modulated respiratory mechanics indicated increased p01 spite muscle weakness central drive patients nmd decreased fact often increased accurate measure central drive abnormal intrinsic respiratory mechanics effects conscious responses reflexes
| 2 |
14,289 |
clinical efficacy ptca identification restenosis evaluation serial body surface potential mapping used serial body surface potential mapping bspm departure map technique evaluate clinical efficacy percutaneous transluminal coronary angioplasty ptca various pathophysiologic stages coronary artery disease detect restenosis bspm performed prior 1 week 1 month ptca followup coronary angiography performed 3 6 months ptca bspm also performed time results bspm compared thallium201 singlephoton emission computed tomography tl201 spect radionuclide ventriculography ptca bspm showed significant reduction departure area tl201 spect also showed significant reduction extent severity scores left ventricular ejection fraction improved significantly cases restenosis departure area decreased size ptca showed increase size successful reptca size departure area became smaller concluded bspm simple noninvasive inexpensive method useful evaluation clinical efficacy ptca detection restenosis successful ptca
| 4 |
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secondary femoraldistal bypass thirtynine secondary femoraldistal femorotibial femoroperoneal bypasses reviewed compared 89 primary femoraldistal bypasses done time period investigate efficacy secondary femoraldistal bypass graft patency 2 years life table analysis similar groups 38 primary group vs 36 secondary group however limb salvage significantly less secondary group 52 vs 68 2 years p less 005 decrease primarily due poorer limb salvage using composite grafts prostheticvein compared vein grafts patients underwent secondary femoraldistal bypasses 37 vs 76 2 years p less 005 postoperative wound infections mortality similar groups thus femoraldistal bypass failure previous infrainguinal reconstruction offers good longterm limb salvage acceptable surgical risk autologous vein available use arterial conduit
| 4 |
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aetiology pancreatic cancer curative surgery possible small minority patients pancreatic cancer date responses chemotherapy radiotherapy disappointing make impact incidence disease clearer understanding aetiology required review explores present knowledge aetiology epidemiology pancreatic cancer
| 1 |
14,292 |
influence hypoxia adrenergic modulation triggered activity isolated adult canine myocytes although findings several reports suggest nonreentrant focal mechanisms contribute genesis arrhythmias early ischemia contribution triggered activity arising early delayed afterdepolarizations resolved previously demonstrated beta alphaadrenergic stimulation induces afterdepolarizations triggered activity isolated normoxic myocytes present study influence extent cellular derangements well increases ko alpha betaadrenergicmediated afterdepolarizations triggered activity evaluated adult canine myocytes exposed one following experimental conditions simultaneous intracellular transmembrane action potential recordings 1 low po2 less 10 mm hg obtained using specially designed hypoxic chamber low 68 ph 2 low po2 low ph high extracellular potassium ko 10 mm 3 severe metabolic inhibition cyanide 106 cells group superfused either alphaagonist phenylephrine 105 107 105 nadolol betaagonist isoproterenol 106 moderate changes action potentials observed conditions 1 2 moderate hypoxia whereas marked reversible changes observed cyanide severe metabolic inhibition moderate hypoxia normal ko delayed afterdepolarizations triggered activity elicited alpha 12 13 cells betaadrenergic five five cells stimulation increasing ko moderate hypoxia completely abolished afterdepolarizations induced alphaadrenergic stimulation prevented occurrence triggered activity contrast influence betaadrenergic stimulation attenuated increase ko exposure cyanide completely prevented induction afterdepolarizations triggered activity alpha betaadrenergic stimulation findings indicate moderate hypoxia normal ko associated development adrenergicmediated afterdepolarizations triggered activity contrast accumulation ko severe impairment cellular metabolism accompanied inhibition adrenergicmediated afterdepolarizations triggered activity
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vagal schwannoma associated syncopal attacks postural hypotension case report case vagal schwannoma cerebellomedullary angle reported preoperatively patient paroxysmal episodes postural hypotension syncope total removal vagal tumor systemic blood pressure returned normal
| 3 |
14,294 |
improved access lesions central skull base mobilization zygoma experience 54 cases improved access lesions medial end sphenoid wing interpeduncular cistern mobilization zygoma subject growing interest recent years study describes operative technique adopted records experience 55 operations 54 patients underwent procedure past 3 years seven patients vascular lesions 44 tumors 3 miscellaneous lesions majority tumors medial meningiomas particular note made arising cavernous sinus respect resectability sixteen tumors encountered total excision possible 11 cases access infratemporal fossa facilitated 2 cases able excise completely trigeminal neuromas extended extra maneuver adds little overall operating time complications relating uncommon mild degree usually selflimiting conclude operation extremely valuable appropriate circumstances
| 0 |
14,295 |
cortical atrophy cognitive performance infantile nephropathic cystinosis group children adolescents infantile nephropathic cystinosis underwent cognitive testing examined cortical atrophy using magnetic resonance imaging computed tomography ten 11 patients demonstrated cortical atrophy consistent pattern lower cognitive performance found patients greater atrophy however relationship atrophy shortterm memory approached statistical significance addition evidence greater impairment visual memory cognitive functions observed latter observation appear related degree atrophy
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melanosis esophagus endoscopic histochemical ultrastructural study endoscopic histological ultrastructural features 21 cases esophageal melanosis described cases detected 1000 consecutive routine upper gastrointestinal endoscopies staining characteristics ultrastructure pigment contained endoscopically visible lesions found similar true melanin
| 1 |
14,297 |
increasing yield ventricular tachycardia induction prospective randomized comparative study standard ventricular stimulation protocol shorttolong protocol new twosite protocol programmed ventricular stimulation standard protocol used three extrastimuli compared prospectively shorttolong protocol twosite protocol 77 consecutive patients undergoing electrophysiologic study attempt increase yield ventricular tachycardia vt induction shorttolong protocol uses train eight stimuli short cycle length two extrastimuli twosite protocol similar standard protocol delivers last extrastimulus via second spatially separated right ventricular catheter patients divided two groups based indications study group 1 included 45 patients syncope nonsustained vt group 2 included 32 patients history sustained vt sudden cardiac death yield vt induction shorttolong protocol less standard protocol none patients group 1 standard protocol results negative shorttolong protocol produce sustained vt two patients group 2 sustained arrhythmias induced shorttolong protocol standard protocol results negative one sustained vt induced one long qt syndrome ventricular fibrillation vf induced shorttolong protocol however shorttolong protocol failed induce sustained vt seven patients standard protocol produced sustained vt seven patients required three extrastimuli standard protocol induction vt
| 4 |
14,298 |
immunopathological response loose cementless acetabular components membranes surrounding seven loose cementless acetabular implants shown contain polyethylene particles birefringent polarised light three implants made titanium alloy membranes around contained titanium particles well metallosis around four implants made chromiumcobaltsteel alloy titanium polyethylene particles caused migration adherence phagocytosis cd11bpositive peroxidasenegative macrophages histological signs activation specific immune response neither interleukin2 receptorpositive activated cells pca1 plasmablastsplasma cells present tissues cases simple loosening resident mesenchymal fibroblastlike cells active aggressive granulomatosis many macrophages multinucleated giant cells little fibroblast reaction clinical relevance findings use cementless prostheses guarantee adverse tissue reactions
| 4 |
14,299 |
hemolysis due branch pulmonary stenosis arterial switch procedure infant dtransposition great arteries underwent arterial switch operation using modified jatene technique severe bilateral branch pulmonary artery stenosis mechanical hemolysis subsequently developed hemolysis resolved surgical repair stenotic arteries probable causes discussed
| 4 |
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