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inflammatory abdominal aortic aneurysm masquerading occlusion inferior vena cava inflammatory aneurysms uncommon disorder represent 5 10 abdominal aortic aneurysms presentation often variable may include pain obstruction adjacent anatomic structures report describes 68yearold man sought treatment insidious onset progressive bilateral lower extremity edema 6month period noninvasive studies suggestive bilateral iliac vein occlusion venogram showed nearly obstructed vena cava external compression ct scan showed thickwalled infrarenal abdominal aneurysm exploration inflammatory abdominal aortic aneurysm found presence dense inflammatory changes surrounding aneurysm extending pelvis surgical procedure choice aortobifemoral bypass graft done dacron aneurysmal wall debrided vena cava postoperative course uneventful edema resolved followup noninvasive studies normal postoperative venography showed resolution extrinsic compression vena cava
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catabolic effects highdose corticosteroids persist despite therapeutic benefit rheumatoid arthritis although corticosteroids cs cause nitrogen wasting healthy humans known whether salutary antiinflammatory appetitestimulating effects cs inflammatory diseases mitigate effect measured nitrogen balance 3 highdose methylprednisolone therapy nine patients flareups rheumatoid arthritis evidence preexisting somatic protein fat depletion seven nine subjects patients allowed eat freely metabolic ward nitrogen balances 089 138 gd means sem cs therapy 577 130 gd therapy p less 0001 354 138 gd therapy p less 001 despite increased energy nitrogen intake clinical resolution inflammation pulse therapy conclude patients rheumatoid arthritis often cachectic highdose cs cause nitrogen wasting patients despite antiinflammatory appetitestimulatory benefit
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dna analysis neoplasia introduction family physician pathologic evaluation neoplastic process traditionally consisted microscopic examination stained section tissue although method generally reliable performed experienced pathologist morphologic features lesion may consistently predict biologic behavior dna content tumors studied flow cytometer help determine prognosis risk tumor recurrence dna analysis neoplasm may provide clinician important prognostic information future date may help direct chemotherapy treatment protocols
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detection duodenal gastrinomas operative endoscopic transillumination prospective study ability operative endoscopic transillumination bowel wall detect duodenal gastrinoma evaluated prospectively 26 patients zollingerellison syndrome results assessed exploratory laparotomy compared results localization techniques twelve duodenal gastrinomas resected 10 patients operative endoscopic transillumination detected 10 12 gastrinomas sensitivity 83 significantly greater p less 005 either preoperative imaging 25 intraoperative ultrasonography palpation 42 sensitivity operative endoscopic transillumination result ability detect focal areas transilluminate serosal side duodenum mucosal appearances seen endoscope helpful operative endoscopic transillumination detected gastrinomas less 1 cm diameter throughout duodenum patients study 39 duodenal gastrinomas greater frequency previously reported results indicate operative endoscopic transillumination sensitive technique yet described detecting duodenal gastrinomas performed routinely patients zollingerellison syndrome undergo exploratory laparotomy cure
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7th nerve palsy extradural blood patch describe patient developed 7th cranial nerve palsy following extradural blood patch full recovery followed likely aetiology discussed
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percutaneous thecoperitoneal shunt syringomyelia report three cases january april 1990 three consecutive cases syringomyelia treated percutaneous placement thecoperitoneal shunts two patients undergone craniovertebral decompression earlier centers third treated primarily thecoperitoneal shunt case syrinx associated chiari malformation although clinical presentation due myelopathy three patients obtained unequivocal benefit simple procedure postoperative magnetic resonance images showed considerable shrinkage cysts corresponding clinical improvement
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correlation hyperthermoradiosensitivity clinical effect carcinoma esophagus correlation hyperthermoradiosensitivity evaluated vitro succinate dehydrogenase inhibition sdi test histopathologic effects hyperthermochemoradiotherapy hcr therapy investigated 43 patients carcinoma esophagus succinate dehydrogenase sd activity tissue fragments taken biopsy assayed exposure heat 43 degrees c radiation 6 grays done sensitivity radiation plus heat treatment estimated percentage sd activity treated cells compared control cells 43 patients divided three groups according degree sd activity exposure radiation plus heat treatment sd activity less 50 per cent group 1 highly sensitive 50 70 per cent group 2 moderately sensitive 70 per cent group 3 less sensitive eighteen 20 group 1 11 17 group 2 two six group 3 classified histopathologically effective hcr therapy two year survival rate groups 1 2 3 555 349 zero per cent respectively statistical differences regard prognostic factors data suggest vitro activities sd correlate well clinical effectiveness hcr therapy therefore recommended sd inhibition test included among guidelines clinical management
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prolonged anginal perceptual threshold diabetes effects exercise capacity myocardial ischemia anginal perceptual threshold time onset 01 mv st segment depression onset angina treadmill exercise prolonged diabetic patients coronary artery disease present study functional significance perceptual abnormality evaluated analysis effect exercise capacity severity myocardial ischemia treadmill exercise 32 diabetic patients 36 nondiabetic control patients showed close linear correlation time onset electrical ischemia st segment depression exercise capacity groups r 08 09 respectively p less 0001 however slope relation flatter diabetic group prolongation anginal perceptual threshold permitted continued exercise ischemia intensified anginal perceptual threshold showed close linear correlation exercise capacity diabetic group r 08 p less 0001 although nondiabetic group variables unrelated permissive effect prolonged anginal perceptual threshold exercise capacity undesirable reflected correlation ischemia peak exercise r 06 p less 0001 longer threshold greater exercise capacity severe ischemia indeed inverse relation severity ischemia peak exercise exercise capacity nondiabetic group r 04 p less 002 completely lost diabetic group thus diabetic patients coronary artery disease anginal perceptual threshold major determinant exercise capacity
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use gastroepiploic artery graft increase surgical risk seventy patients gastroepiploic artery used coronary artery bypass grafting compared 70 patients gastroepiploic artery used mean age 568 years group artery used 618 years group p less 0001 preoperative characteristics including number women extent coronary artery disease previous myocardial infarction unstable angina preoperative left ventricular function significantly different two groups internal mammary artery graft concomitantly used 68 patients 97 group gastroepiploic artery graft 61 patients 87 without graft mean number distal anastomoses 33 34 aortic crossclamp time 653 199 minutes 540 201 minutes cardiopulmonary bypass time 1148 236 minutes 1129 250 minutes respectively groups without gastroepiploic artery graft aortic crossclamp time significantly p less 005 longer group gastroepiploic artery graft two 29 early deaths two 29 new qwave infarctions groups intraaortic balloon pumping required five patients 71 group gastroepiploic artery graft three patients 43 without graft postoperative complications similar rare groups intraoperative endoscopic laser doppler study demonstrated significant change gastric mucosal blood flow division gastroepiploic artery concluded additional risk use gastroepiploic artery coronary bypass grafting favorable outcome expected
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femur fracture limb shortening causing occlusion polytetrafluoroethylene femoral popliteal graft traumatic occlusion lower extremity polytetrafluoroethylene arterial grafts exceedingly rare report patient suffered supracondylar femur fracture resulting shortening right lower extremity kinking thrombosis aboveknee polytetrafluoroethylene arterial graft first report english language prosthetic graft occlusion result traumatic limb shortening graft thrombus successfully lysed use intraarterial urokinase kink repaired graft resection reanastomosis mechanism injury treatment discussed
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trichothiodystrophy chronic neutropenia mild mental retardation trichothiodystrophy feature several diseases consist characteristic hair shaft abnormalities wide spectrum developmental defects detection sulfurdeficient hairs identifies disorder separates similar ectodermal dysplasias normal sulfur content detection low sulfur hair syndrome also important genetic counseling disease appears autosomal recessive trait report patient chronic neutropenia mild mental retardation low sulfur content hair case expands spectrum disorders associated trichothiodystrophy
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notes munchausens syndrome case report change acute abdominal neurological type rare case munchausens syndrome beginning early childhood described diagnosis munchausens syndrome made age 29 years symptoms changed acute abdominal neurological complaints feigned loss consciousness first ascribed encephalitis insight psychopathology patient given biography assessment psychotherapist treated years observed profile psychological tests
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protracted mononucleosislike illness associated acquired cytomegalovirus infection previously healthy child transient cellular immune defects chronic hepatopathy ordinarily severe disease due acquired cytomegalovirus cmv infection occur immunocompetent children describe previously healthy boy acquired primary cmv infection approximately 2 years age experienced 2yearlong debilitating multisystem illness ultimately recovered clinical features illness included fatigue poor weight gain pallor unexplained fever musculoskeletal complaints drenching night sweats lymphadenopathy massive hepatosplenomegaly laboratory abnormalities included elevated erythrocyte sedimentation rate lymphocytosis elevated immune complex levels cellular immune function impaired illness demonstrably normal convalescence evidence known immunodeficiency state immunoblot analysis showed enhanced antibody response 66kd infected cell protein symptomatic recovery despite consistently normal indices hepatic function liver enlargement persisted symptoms resolved liver biopsy demonstrated mononuclear cell portal tract infiltrate fibrosis cmv could demonstrated directly tissue primary cmv infection reported previously cause persistent symptoms seen child
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cemented total knee arthroplasty gonarthrosis patients 55 years old younger results 68 cemented total knee arthroplasties tkas 50 patients gonarthrosis 55 years old younger time surgery reviewed patients operated 1979 1987 followed average 62 years average age patients 50 years patients evaluated hospital special surgery knee score average preoperative score 53 average followup score 90 overall 55 tkas rated excellent 13 good using knee rating score advocated knee society average postoperative score 92 pain 84 function four successful reoperations patellar component loosening metalbacked patellae femoral tibial components patients intact followup period two knees rated excellent two good detailed roentgenographic evaluation demonstrated 20 tibial components radiolucencies least one zone anteroposterior roentgenogram 11 lateral roentgenogram femoral radiolucencies occurred 2 knees patellar radiolucencies one zones occurred 20 knees patellar revision complete progressive radiolucencies bonecement interface noted component components considered roentgenographically loose cemented tkas achieve excellent longterm results patients younger 55 years old gonarthrosis knee results compare obtained published reports older age groups
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persistent recurrent hyperparathyroidism assessment gadopentetate dimeglumineenhanced mr imaging effect gadopentetate dimeglumine signal intensity abnormal parathyroid glands assessed 14 patients persistent recurrent hyperparathyroidism noncontrast materialenhanced t1 t2weighted spinecho images compared t1weighted images obtained 1 minute 10 minutes administration gadopentetate dimeglumine percentage contrast abnormal gland surrounding tissue determined use skeletal muscle subcutaneous fat thyroid gland reference tissues 11 abnormal parathyroid glands showed low intermediate signal intensity t1weighted images high signal intensity t2weighted images gadopentetate dimeglumine significantly increased signal intensity enhancement ratio abnormal parathyroid glands causing increased percentage contrast relative thyroid gland skeletal muscle t1weighted images however percentage contrast relative tissues even greater nonenhanced t2weighted images thus gadopentetate dimeglumine substantially enhance signal intensity abnormal parathyroid glands improve differential contrast neighboring tissues t1weighted images improve contrast surrounding tissue beyond achieved t2weighted images
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thyroid carcinoma mixed tallcell columnarcell features tallcell columnarcell carcinomas regarded aggressive variants papillary thyroid carcinoma present case report authors describe composite tumor forms differentiation coexisted transitional changes occurring within single follicular structures finding indicates two variants closely related local recurrences one feature appeared separate lesions lung metastases developed patient died 5 12 years diagnosis primary treatment
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cardiorespiratory effects endoscopic esophageal variceal sclerotherapy endoscopic variceal sclerotherapy evs effective means controlling variceal hemorrhage develops consequence portal hypertension esophageal perforation ulceration strictures mediastinitis potential complications associated procedure clear whether isolated pleuropulmonary events pleuritis pneumonitis adult respiratory distress syndrome causally related evs endoscopy sedation attendant risk aspiration particularly background hepatic encephalopathy may account events recent controlled studies respiratory function demonstrate evs results minor changes gas exchange lung volumes pulmonary systemic hemodynamics pulmonary complications reported use sodium morrhuate sclerosant comparative studies among different sclerosants necessary evaluate relative safety finally rare reports myocardial ischemia pericarditis reported association evs transient nature chest symptoms roentgenographic pleuropulmonary changes pulmonary hemodynamics cardiac perturbations transient preclude offering evs patients variceal hemorrhage
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spinal accessory nerve palsy unusual complication coronary artery bypass neurologic complications coronary artery bypass surgery well documented reported incidence 61 one large study injuries peripheral nervous system involve brachial plexus report first case spinal accessory nerve lesion coronary bypass surgery patient presented progressive right shoulder weakness electrodiagnostic studies revealed partial lesion right spinal accessory nerve physical therapy including strengthening range motion electric stimulation right shoulder prescribed assist recovery strength function repeat electrodiagnostic studies confirmed nerve regeneration prompt recognition spinal accessory nerve damage coronary bypass surgery essential early rehabilitation improve chances better functional outcome
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lack transmission live attenuated varicella vaccine virus immunocompromised children immunization siblings safety administering live attenuated okamerck varicella vaccine well siblings children malignancy evaluated strategy reducing risk household exposure varicella among immunocompromised children susceptible well children eligible vaccination child malignancy leukemia lymphoma solid tumor remission 3 months longer evidence vaccine virus transmission found among 30 children malignancy whose 37 healthy susceptible siblings immunized varicella vaccine varicellazoster virus isolated oropharyngeal secretions taken 17 vaccinees 14 immunocompromised siblings none 30 immunocompromised children vaccinerelated rashes showed immunologic evidence subclinical varicellazoster virus infection based testing varicellazoster virus igg antibodies tlymphocyte proliferation varicellazoster virus four healthy vaccinees eventually mild breakthrough cases varicella transmission highrisk sibling 3 cases however even families immunocompromised children protected household exposure varicella least 20 months early course immunosuppressive treatment
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colonic volvulus complication celiac sprue colonic volvulus rarely reported complication celiac sprue describe two patients longstanding celiac sprue one recurrent sigmoid volvulus developed cecal volvulus following surgery asymptomatic glutenfree diet association celiac sprue colonic volvulus first reported 1953 isolated cases documented surprisingly two major predisposing conditions colonic volvulus often seen patients celiac sprue colonic bacterial fermentation malabsorbed carbohydrate celiac sprue leads excess gas production flaccid bowel loops sigmoid redundancy long mesentery cecal hypermobility uncommon motility disorder celiac sprue also proposed thus factors together would suggest likelihood development colonic volvulus celiac sprue would relatively great possibility underlying celiac sprue considered patients colonic volvulus background history recurrent abdominal distention malabsorptive symptoms
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atherosclerotic cardiovascular disease sudden deaths among young adults wayne county based postmortem records wayne county medical examiners office 1982 1986 autopsy results indicated deaths 129 persons aged 2034 resulted heart disease 51 deaths attributed atherosclerotic cardiovascular disease ascvd 29 hypertensive cardiovascular disease 28 cardiomyopathy 21 cardiac causes majority deaths due ascvd occurred among men black white followed black women incidence increased age deaths due ascvd sudden accounted deaths due ischemic heart disease age group among wayne county residents diabetes mellitus left ventricular hypertrophy history seizures recent ingestion alcohol found associated sudden death ascvd group obesity seem significant factor data suggest ascvd rare cause death young adults risk factors identified older subjects also operate age group
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touch surgical division anterior quadrant spinal cord investigation carried determine whether tactile sensibility affected anterolateral cordotomy 65 patients cordotomies painful forms cancer thirty eight necropsy examination histological investigation spinal cord form mechanoreception removed 65 patients majority forms tactile sensibility altered division pathways anterolateral anterior columns case graphaesthesia affected knowledge joint position movement awareness vibration normal 62 65 patients information carried anterolateral pathways reach neural levels consciousness total lesions posterior columns previously reported touch pressure still felt itch removed division anterolateral pathways although posterior columns essential discrimination mechanoreception discrimination may disturbed lesions anterolateral pathways notably twopoint discrimination evidence pathways essential conveying impulses giving rise tickle inconclusive
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daytime reduction gastrooesophageal reflux healing oesophagitis value indicator favourable response maintenance treatment order investigate response gastrooesophageal reflux medically induced healing oesophagitis relation occurrence relapse prophylactic treatment 20 patients erosiveulcerative oesophagitis underwent 24 hour oesophageal ph monitoring healing achieved 12 24 week treatment ranitidine 150 300 mg twice daily compared pretreatment values macroscopic healing significant reduction daytime median percentage reflux time 100 v 65 p less 005 median number reflux episodes lasting 5 minutes 55 v 10 p less 005 observed whereas night time reflux frequency severity change maintenance treatment ranitidine 150 300 mg nocte five six patients shown improvement gastrooesophageal reflux acute healing relapsed results suggest contrast previous work decrease gastrooesophageal reflux patients reflux oesophagitis achieved macroscopic healing occurrence reduction acute healing predictive good response longterm treatment
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continuous postoperative regional analgesia nerve sheath block amputation surgerya pilot study pilot study continuous postoperative regional analgesia nerve sheath block lower limb amputation presented time exposure sciatic posterior tibial nerve trunks belowknee amputations 11 patients asa physical status iii iv catheter introduced directly transected nerve sheath continuous infusion 025 bupivacaine rate 10 mlh 72 h effective amputation stump analgesia obtained significantly reducing need ondemand narcotic analgesics time mean dose equivalent 14 mg morphine compared retrospective control group received equivalent mean dose 184 mg morphine p less 00001 complications related technique observed followup group receiving continuous postoperative regional analgesia 12 mo showed total absence phantom pain despite presence preoperative limb pain
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parosteal osteosarcoma treatment wide resection prosthetic replacement reviewed 20 cases parosteal osteosarcoma treated wide local resection prosthetic replacement followed six 17 years limb function excellent 85 one patient grade iii histological disease developed pulmonary metastases four patients local recurrences related repeated preliminary biopsies inappropriate siting biopsy vascular encroachment tumour mode treatment outcome related medullary invasion tumour
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strategies underlying control disordered movement purpose article fourfold first theory motor controlthe dualstrategy hypothesisis outlined second methodologies theoretical framework used develop theory examined third motor dysfunction discussed context theory particular syndrome parkinsons disease cardiovascular accidents spasticity discussed finally potential applications theory physical therapy considered
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comparison hybrid uncemented total hip replacement retrospective matchedpair study efficacy type uncemented total hip replacement compared hybrid total hip replacement uncemented acetabular cemented femoral component used twentyfive patients hybrid total hip replacement matched age weight sex diagnosis twentyfive patients uncemented total hip replacement operations done one surgeon used operative approach regimen postoperative rehabilitation patients followed least two years mean postoperative hip score 96 points hybrid group 84 points cementless group p less 002 twentyfour 96 per cent patients hybrid prosthesis reported slight pain postoperatively uncemented group six patients 24 per cent reported mild severe pain five pain thigh limp occurred frequently five femoral components migrated four hips needed reoperation results hybrid replacement cemented femoral component superior uncemented femoral component relatively brief period patients followed
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expressional potency mrnas encoding receptors voltageactivated channels postmortem rat brain stability integrity mrnas encoding neurotransmitter receptors voltageactivated channels postmortem rat brain investigated isolating polya mrna injecting xenopus oocytes examining expression functional neurotransmitter receptors voltageactivated channels oocyte membrane electrophysiological recording approach also used assess stability mrnas brains incubated oxygenated mammalian ringers solution various lengths time brains freshly frozen thawed room temperature oocytes injected mrna 21hr postmortem brains gave large agonist voltageactivated responses indicating mrnas encoding neurotransmitter receptors voltageactivated channels relatively stable postmortem brain tissue contrast oocytes injected mrna brains incubated ringers solution exhibited smaller responses oocytes injected mrna tissue frozen thawed displayed small undetectable responses northern blot analysis using nucleic acid probe rat brain nachannel mrna indicated size na currents injected oocytes reflected levels mrna na channels different mrna preparations thus expressional potency mrnas encoding neurotransmitter receptors voltageactivated channels quite stable postmortem brains situ reduced brains kept oxygenated saline freezing thawing tissue results rapid degeneration mrna
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giant chest wall tumor resulting tissue reaction foreign bodies three patients reported chest wall tumors developed 19 28 years thoracoplasty increased size time tumors could removed operatively good results tumors composed hematoma necrotic material cases revealed foreign bodies microscopically diagnosis possible etiological factors discussed
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tangled web coronary risk factors although epidemiologic genetic pathophysiologic studies shown lowdensity lipoproteins ldls involved development coronary artery disease standard measurement ldl cholesterol comprises number separate components may contribute different ways disease process components appear particular pathologic importance intermediatedensity lipoproteins idls lipoprotein highly atherogenic species normally account 10 15 total ldl cholesterol may disproportionately elevated pathologic states may therefore contribute disproportionately coronary disease risk certain patients recently another subclass ldl characterized relatively small particle size increased density also found associated relatively increased risk coronary disease furthermore levels subclass designated ldliii linked number interrelated hormonal metabolic factors also associated risk coronary artery disease include male gender postmenopause abdominal adiposity elevated triglyceride levels increased levels apolipoprotein b reductions highdensity lipoproteins hdls particularly hdl2 subclass studies demonstrated many factors also commonly associated relative insulin resistance hyperinsulinemia thus lipoprotein profile characterized relative increase ldliii reduction hdl2 indicative constellation metabolic features defines highrisk state makes extremely difficult single one factors directly involved disease process combinations genetic environmental factors acting tangled web risk factors may account much variation coronary disease susceptibility found general population
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influence age vs peak serum concentration lifethreatening events chronic theophylline intoxication identify risk factors development seizures cardiac arrhythmias chronic unintentional theophylline intoxication monitored clinical course 72 consecutive patients referred regional poison center chronic theophylline intoxication serum theophylline concentration greater equal 167 mumoll protracted use median age sample 475 years range 4 days 91 years median peak theophylline concentration 239 mumoll range 167 722 mumoll lifethreatening event lte occurred 28 patients 39 included seizures eight major cardiac arrhythmia 22 median peak theophylline patients lte vs 2358 vs 2387 mumoll however median age patients lte compared without lte significantly greater 705 vs 180 years stratification data chronologic age revealed stepwise increase frequency lte advancing years patients 75 years old 167fold greater risk lte patients less 25 years old 95 confidence interval 356 775 despite comparable intergroup median serum theophylline data suggest primary determinant ltes chronic theophylline intoxication chronologic age elderly patients inordinately greater risk lte younger patients peak serum theophylline concentration cannot predict patients chronic theophylline intoxication lte finally data indicate theophylline used cautiously frequent monitoring serum theophylline concentrations elderly patients
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recurrent tension headache adolescents treated selfhelp relaxation training muscle relaxant drug fortyeight adolescents suffering recurrent tension headache participated controlled trial conducted high school setting first treatment phase selfhelp relaxation training compared waitinglist group following phase pharmacological regimen consisting muscle relaxant chlormezanone placebo superimposed relaxation therapy doubleblind crossover design treatment phase encompassed 5week period addition evaluation headache complaints psychological distress among students measured respect experience somatic complaints depressive anxiety stress symptoms although selfhelp relaxation training significantly decreased severity annoyance adolescents headache besides somatic complaints clinical improvement headache modest addition chlormezanone help nonresponders selfhelp relaxation training finally set pretreatment variables consisting baseline headache severity annoyance experience anxiety daily life stress among adolescents could predict outcome selfhelp relaxation therapy
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metastatic tumors unknown origin clinical appearance metastatic lesions without obvious primary source tumor common event tumor registry figures epidemiologic data grossly understate actual frequency unknown primaries primary sites often assigned patients bestguess basis without positive proof tumors origin majority patients whose primary tumors continued elude detection extensive use diagnostic imaging studies fails produce information alters patients clinical course rare exceptions cited exceptions prove general rule imaging studies therefore targeted selected patients disseminated malignancies identification primary tumors could benefit quality life length survival
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coronary artery aneurysm without stenosis association oslerweberrendu diseasea case report fiftythreeyearold woman presented coronary artery aneurysm association oslerweberrendu disease hereditary hemorrhagic telangiectasia manifested also large pulmonary arteriovenous fistulas arterial dye dilution curves unusually distorted owing righttoleft shunts coronary artery aneurysm located multiple sites accompanied stenotic lesions coronary artery aneurysm without stenosis rare pathologic state previously reported association hereditary telangiectasia
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central adenoid cystic carcinoma mandible patient adenoid cystic carcinoma arising centrally within mandible rare location malignant salivary gland tumor described current concepts regarding etiology diagnosis histology treatment central intramandibular salivary gland tumors discussed literature reviewed
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urinary retention due sacral myeloradiculitis clinical neurophysiological study report 5 cases sacral myeloradiculitis presenting transient urinary retention neurophysiological testing including bulbocavernosus reflex pudendal evoked response external anal sphincter electromyography performed parasympathetic pelvic nerves pudendal nerves well spinal cord seem involved various degrees infrequent disorder
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preventive therapy first gastrointestinal bleeding patients cirrhosis results controlled trial comparing propranolol endoscopic sclerotherapy placebo propranolol endoscopic sclerosis esophageal varices two approaches currently used prophylaxis first gastrointestinal hemorrhage cirrhotic patient one hundred twentysix cirrhotic patients esophageal varices histories bleeding included trial regardless gravity cirrhosis size esophageal varices patients hepatocarcinomas cancers clearly impossible followup previous treatment portal hypertension contraindication betablockers excluded randomization 43 patients received propranolol twice daily dose reducing heart rate 25 42 patients treated intravariceal extravariceal injections polidocanol 41 control patients received vitamin k orally placebo patients seen 3mo intervals 2 yr entry trial three groups comparable terms clinical biological parameters including size esophageal varices grade 51 grade ii 54 grade iii 17 childpugh classification 29 b 61 c 32 origin cirrhosis alcoholic 79 cases twentyfour patients bled two bled propranolol group nine bled endoscopic sclerosis esophageal varices group 13 bled placebo group actuarial estimates kaplanmeier time onset first bleeding showed differences significant propranolol placebo p less 0004 propranolol sclerotherapy p less 003 sclerotherapy placebo
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treatment patients isolated axillary nodal metastases occult primary carcinoma consistent breast origin records 42 patients axillary metastases compatible clinically occult breast primary reviewed forty patients mammography performed part evaluations mastectomy yielded primary tumor one 13 patients biopsy yielded positive results one five among 29 patients undergo mastectomy 16 received breast irradiation 13 simply observed signs primary tumor patients undergo mastectomy 5year actuarial risk appearance primary 17 irradiated group versus 57 nonirradiated group p 006 patterns failure correlated stage local systemic therapy results affirm belief patients axillary metastases histologically consistent breast tumor treated identically patients similar nodal stages proven breast primaries
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caffeine ventricular arrhythmias electrophysiological approach little information known regarding caffeines effect substrate supporting sustained ventricular arrhythmias prospective study evaluated effect coffee 275 mg caffeine substrate programmed ventricular stimulation 22 patients history symptomatic nonsustained ventricular tachycardia ventricular tachycardia ventricular fibrillation patients underwent electrophysiological testing 1 hour coffee ingestion mean sem plasma caffeine level achieved coffee consumption 62 05 mgl mean plasma catecholamine potassium values altered significantly 1 hour following caffeine ingestion number extrastimuli required induce arrhythmia unchanged 10 patients 46 increased six 27 decreased six 27 rhythm severity unchanged 17 patients 77 severe two 9 less severe three 14 patients clinical ventricular arrhythmias caffeine significantly alter inducibility severity arrhythmias suggesting little effect substrate supporting ventricular arrhythmias
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evaluation results oesophagectomy oesophageal cancer longterm results standard techniques oesophagectomy examined 127 patients squamous cell carcinoma oesophagus neartotal oesophagectomy cervical anastomosis performed 93 patients oesophagogastrectomy intrathoracic anastomosis carried 34 patients one hundred eight patients curative oesophagectomy 19 patients palliative resection eight patients received radiotherapy tumour bed 15 deaths hospital overall 5year survival rate including perioperative deaths 132 per cent survival adversely affected incomplete excision macroscopic tumour p less 0001 positive regional lymph nodes p less 005 distant lymphatic metastases p less 002 5year survival rate patients tumour invasion beyond oesophageal wall t3 negative nodes 20 per cent postoperative irradiation effect survival patients gross residual tumour complete clearance microscopic tumour achieved 50 per cent patients t3 tumours group benefit adjuvant radiotherapy survival patients undergoing curative oesophagectomy residual microscopic tumour however significantly improved irradiation tumour bed p less 001 results suggest survival patients increased significantly excision gross tumour identification benefit local radiotherapy
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assessment care planning strategy nursing home residents dementia dementia extremely common among nursing home patients takes many forms accurate assessment staff crucial providing appropriate care patients equally important ability establish care priorities current staging models general however usefulness limited thus paper proposes strategy using basic assessment data categorizes dementia residents according four key determinants care needs activities daily living status behavioral problems communication abilities physical transition
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nonrandom chromosomal abnormalities primary uveal melanoma report 14 cases clonal chromosomal anomalies patients primary uveal melanoma increased dosage chromosome 8 parts long arm chromosome 8 8q detected eight patients 57 smallest multiplied area 8q appeared region 8q21qter monosomy chromosome 3 seen six patients 43 five associated anomalies chromosome 8 increased dosage parts chromosome 8q loss heterozygosity chromosome 3 combination seemed nonrandom uveal melanoma may distinguish genetically cutaneous malignant melanoma anomalies chromosome 6 mostly resulting additional material 6p deletion 6q found six patients 43 anomalies seem common features cutaneous malignant melanoma considered secondary rather primary changes uveal melanoma since present subclones cases loss chromosome restricted tumor cells detected four male patients loss one x chromosome detected female patient
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physiologic pathologic alterations associated ultrasonically generated shock waves kidneys 25 dogs treated ultrasonic shock waves examined physiologic pathologic changes number pulses ranged 2000 8000 rate shock waves varied one 20 pulses per second difference pulse rate affect changes seen either acutely delayed examination kidneys repair process physiologic pathologic changes occurred involved renal tubule greater degree glomerulus alterations resolving one week following exposure shock waves
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evolution fundic argyrophil cell hyperplasia nonantral atrophic gastritis fundic argyrophil cells studied mean period 687 months range 11170 18 patients fundic atrophic gastritis achlorhydria initially 12 patients hyperplasia argyrophil cells severity assessed using semiquantitative classification based number argyrophil clusters per square millimeter end study degree hyperplasia unchanged 9 patients decreased 2 increased 1 significant increase number argyrophil clusters precarcinoid changes carcinoid tumors observed high level gastrinemia mean 48 range 1981 times upper limit normal change significantly 6 patients hyperplasia outset study 4 continued without hyperplasia 2 presented lowgrade hyperplasia 20th 130th month gastrinemia increased significantly last patient stayed normal 5 study argues favor stable appearance fundic argyrophil cells patients atrophic gastritis stable gastrinemia
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early diagnosis surgical intervention acute aortic dissection transesophageal color flow mapping determine whether transesophageal color doppler echocardiography tee useful early diagnosis surgical intervention acute aortic dissection 57 serial patients acute aortic dissection examined patients evaluated tee either singleplane probe 39 patients biplanar probe 18 patients admission intimal flap detected patients 18 patients type dissection 39 patients type b dissection entry visualized 83 type dissection cases 90 type b dissection cases two 18 patients examined biplanar probe technique entry detected longitudinal view emergency operations performed 18 patients type dissection 10 patients ruptured type b dissection twentynine 39 patients type b dissection treated conservatively operative mortality rate patients type dissection 22 patients ruptured type b dissection 60 major advantage tee ease application bedside operating room allows immediate accurate diagnosis acute aortic dissection emergency surgical intervention biplanar tee provides additional acoustic windows ease spatial orientation accurate visualization entry tee useful powerful diagnostic tool acute aortic dissection using method one may achieve rapid aggressive surgical approach patients acute aortic dissection
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strategy reduce infant mortality using maternal mortality reviews historic model fetal infant mortality reviews proposed reduce infant mortality united states national program three elements 1 guidelines direction national multidisciplinary steering panel staff 2 technical advisory capacity translate guidelines work local regional review committees 3 local review committees special emphasis lacking limited efforts previous infant mortality reviews would given fetal mortality plan proposes broad classification potential contributing causes mortality related strictly medical care health system individual patient factors allow different effective targeted responses factors identified locally critical impetus gained american college obstetricians gynecologists leading effort private medical sector partnership national state local public health agencies national medical societies
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giardia lamblia infestation reveals underlying whipples disease patient longstanding constipation whipples disease uncommon disorder generally associated gastrointestinal symptoms diarrhea common feature report case whipples disease associated chronic constipation diagnosed giardia lamblia infestation caused diarrhea best knowledge association previously reported clinical laboratory endoscopic manometric aspects described discussed
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preventive therapy first gastrointestinal bleeding patients cirrhosis results controlled trial comparing propranolol endoscopic sclerotherapy placebo propranolol endoscopic sclerosis esophageal varices two approaches currently used prophylaxis first gastrointestinal hemorrhage cirrhotic patient one hundred twentysix cirrhotic patients esophageal varices histories bleeding included trial regardless gravity cirrhosis size esophageal varices patients hepatocarcinomas cancers clearly impossible followup previous treatment portal hypertension contraindication betablockers excluded randomization 43 patients received propranolol twice daily dose reducing heart rate 25 42 patients treated intravariceal extravariceal injections polidocanol 41 control patients received vitamin k orally placebo patients seen 3mo intervals 2 yr entry trial three groups comparable terms clinical biological parameters including size esophageal varices grade 51 grade ii 54 grade iii 17 childpugh classification 29 b 61 c 32 origin cirrhosis alcoholic 79 cases twentyfour patients bled two bled propranolol group nine bled endoscopic sclerosis esophageal varices group 13 bled placebo group actuarial estimates kaplanmeier time onset first bleeding showed differences significant propranolol placebo p less 0004 propranolol sclerotherapy p less 003 sclerotherapy placebo
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prevention hypertension vascular changes captopril treatment treatment female spontaneously hypertensive rats shr control wistarkyoto wky rats captopril carried addition drug drinking water throughout pregnancy lactation weaning 28 weeks age average systolic blood pressure treated shr 113 3 mm hg control shr 188 3 mm hg wky rats 124 3 mm hg body weight heart rate shr affected treatment tissue level catecholamines increased captopril treatment superior cervical ganglia remained unchanged plasma heart mesenteric arteries adrenal glands shr wky rats left ventricular weight wall thickness internal diameter left ventricle shr reduced treatment morphometric measurements mesenteric arteries showed vascular alterations present control shr prevented treatment superior mesenteric artery large mesenteric artery smaller lumen size maximal relaxation found control shr normalized level wky rats hypertrophy medial wall superior mesenteric large small mesenteric arteries increase number smooth muscle cell layers large mesenteric artery shr prevented treatment perfusion study mesenteric vascular bed showed reactivity vessels norepinephrine reduced sensitivity norepinephrine determined effective dose causes 50 maximal response increased shr captopril treatment sensitivity tail artery response norepinephrine altered treatment conclude longterm treatment captopril shr birth prevented development hypertension structural functional alterations mesenteric arteries cardiac hypertrophy
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degenerative aortic stenosis one effect graying america degenerative calcific aortic stenosis evolving common geriatric problem symptoms develop highly lethal disease respond well medical therapy aortic balloon valvuloplasty may offer palliation unlikely alter overall course disease aortic valve replacement therapy choice high perioperative morbidity mortality rates expected elderly presence appreciable cardiac disorders may contribute occurrence postoperative complications patients asymptomatic aortic stenosis normal left ventricular function treated medically followed serial aortic valve area determinations using doppler echocardiography
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detection antiepsteinbarr virus transactivator zebra antibodies sera patients human immunodeficiency virus patients aids aidsrelated complex often show symptoms epsteinbarr virus ebv reactivation several ebvencoded transacting factors activate ebv lytic cycle one zebra bamhi z ebv replication activator also called eb1 switches ebv latent productive cycle indirect immunofluorescence studies done using human cells transfected recombinant dnaharboring cdna sequence spanning bzlf1 bamhi z left frame 1 inserted downstream adenovirus major late promoter igg antizebra antibodies detected high proportion asymptomatic hiv carriers aids patients absent healthy control individuals presence antizebra antibodies sera hivpositive patients favors hypothesis ebv reactivates subjects finding may practical importance prognostication aids development
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psychosocial correlates temporomandibular joint pain dysfunction study examines psychological differences temporomandibular joint pain dysfunction tmjpd patients pain controls healthy controls two hundred two patients classified according diagnostic criteria eversole machado either myogenic facial pain n 42 internal derangement type n 69 internal derangement type ii n 85 internal derangement type iii n 6 patients completed basic personality inventory illness behavior questionnaire multidimensional health locus control perceived stress scale ways coping checklist subjects also answered question pertaining tmjpd symptomatology including chronicity severity conservative treatment simple jaw exercise ultrasound patients contacted 5 months complete followup questionnaires similar previously completed comparison groups comprised 79 patients attending outpatient physiotherapy clinics painrelated injuries involving temporomandibular joint 71 painfree healthy students data analyzed using multivariate statistics results indicate significant relationship pain intensity extent chronicity diverse measures personality among pain controls among tmjpd patients calls question validity assuming individual pain disorders subsets larger homogenous pain disorder population tmjpd patients pain controls score higher hypochondriasis anxiety painfree controls elevations clinically significant elevations decrease normal levels response positive treatment outcome differences tmjpd patients pain controls measures results suggests tmjpd patients appear significantly different pain patients healthy controls personality type response illness attitudes towards health care ways coping stress
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radiotherapy palliation locally advanced prostatic carcinoma patients present distressing symptoms due locally advanced prostatic carcinoma may refractory hormonal manipulation andor surgical treatment 8year period 26 patients received local palliative radiotherapy recurrent bleeding lower urinary outflow tract obstruction treated conventional external beam radiotherapy 2 obtained useful palliation symptoms especially recurrent bleeding also found radiotherapy could given majority patients outpatient basis 2 3 fractions well tolerated side effects
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microvascular sequestration parasitized erythrocytes human falciparum malaria pathological study thirtynine falciparum malaria autopsy cases hospital tropical diseases mahidol university bangkok thailand divided two groups either cerebral malaria cm noncerebral malaria ncm studied significant pathological differences groups order investigate correlation parasitized erythrocyte prbc sequestration small blood vessels brain heart lungs small intestines found percentage prbc sequestration organs studied higher cm patients ncm patients difference prbc sequestration among organs two groups significant p less 005 cm group average percentage prbc sequestration brain significantly higher heart lungs small intestines p less 005 statistically significant difference found prbc sequestration brains hearts lungs small intestines ncm group p greater 005 study indicates severity malaria cm patients depends prbc sequestration especially brain combination functional disturbances organs addition cerebral pathology may augment severity disease
| 2 |
14,354 |
longterm results surgical resection locally advanced colorectal carcinoma study undertaken review longterm results multivisceral resection locally advanced colorectal carcinoma 1964 1980 1042 patients underwent exploratory surgery colorectal cancer 58 patients 55 underwent curative multivisceral resection suspected contiguous invasion primary tumor followup complete patients primary tumors located rectum 38 patients sigmoid 9 patients left colon 6 patients right colon 5 patients en bloc resection viscera included uterus adnexa bladder vagina small intestine abdominal wall liver stomach kidney ureter operative morbidity mortality rates 31 17 respectively resection margins free tumor 54 patients four patients tumorpositive resection margins recurrence disease evident 8 22 weeks surgery mean survival time 82 months carcinomatous invasion resected contiguous organ confirmed 49 patients 84 mean survival time patients without lymph node metastases 1007 months 162 months p less 001 patients lymph node metastases actuarial 5year diseasefree survival rate patients without lymph node metastases 76 36 47 patients none patients 0 11 lymph node metastases survived 5 years three 36 5year survivors experienced recurrence disease seventh postoperative year cancerrelated deaths occurred 7 25 years data suggest survival locally advanced colorectal carcinoma dependent lymph node status extent local invasion effective disease control associated survival long term achieved multivisceral resection
| 0 |
14,355 |
detecting lower motor neuron dysfunction pharynx larynx electromyography study assessed utility clinical electromyography emg detecting lower motor neuron lmn upper motor neuron umn dysfunction affecting intrinsic muscles larynx pharynx twentynine subjects examined clinical diagnoses included perioperative nerve injury cerebral infarction lateral medullary infarction resting activity motor unit action potential muap morphology muap recruitment evaluated every case medical records excluding emg data analyzed clinical evidence lmn umn dysfunction intrinsic muscles larynx pharynx diagnosis lmn dysfunction rested clinical data consistent cranial nerve injury poliomyelitis wallenberg syndrome unilateral bulbar palsy criteria umn dysfunction included previous cerebral brainstem infarction mass lesion presence hemiparesis electromyographic abnormalities significantly associated lmn dysfunction p less 05 significantly associated umn dysfunction parameters tested muap recruitment sensitive 82 specific 92
| 2 |
14,356 |
persistent rectal ulcer associated human papillomavirus type 33 patient aids successful treatment isotretinoin rectal dysplasia carcinoma associated human papillomavirus infection increasing prevalence among homosexual men particularly infected human immunodeficiency virus report case involving 39yearold homosexual man aids developed persistent rectal ulcer biopsy ulcer revealed severe squamous dysplasia human papillomavirus type 33 detected rectal tissue use situ dna hybridization genotype virus previously associated anal rectal dysplasia homosexual men including infected human immunodeficiency virus rectal ulcer resolved 2 months oral therapy 60 mgd isotretinoin retinoid
| 4 |
14,357 |
sinus nodal dysfunction young patients long qt syndrome although sinus bradycardia low heart rate exercise found patients long qt syndrome systematic evaluation including intracardiac electrophysiologic eps tests sinus node function reported records reviewed 14 children adolescents age 3 16 years long qt syndrome mean qtc 051 second underwent noninvasive testing intracardiac eps syncope cardiac arrest resting electrocardiographic ecg sinus heart rate low age 1 13 patients lowest holtermonitored sinus heart rate abnormal 4 12 maximum exercise heart rate abnormally low 6 12 underwent exercise testing eps tests corrected sinus node recovery time csnrt long 8 14 sinoatrial conduction time sact long six nine calculable noninvasive eps indices considered 13 14 patients type sinus node dysfunction
| 3 |
14,358 |
ileosigmoid knot ileosigmoid knot isk rare cause intestinal obstruction unfamiliarity condition could disastrous consequence surgery past 20 years encountered seven cases analyzing data gathered reviewing literature found possible arrive preoperative diagnosis two patients four patients women two developed obstruction postpartum period one males found inflamed meckels diverticulum included knotting symptoms clinical findings nonspecific characteristic xray findings double closed loop obstruction seen three patients resection gangrenous bowel anastomoses feasible four unlike series primary anastomosis large gut undertaken two deaths early series guidelines management suggested
| 4 |
14,359 |
intraabdominal desmoid tumors familial polyposis coli case report tumor regression prednisolone therapy case intraabdominal desmoid tumors familial polyposis coli fpc regressed disappeared prednisolone treatment reported 37yearold japanese man abdominal lumps admitted hospital proctocolectomy two years fpc rectal cancer laparotomy tumors present abdominal wall mesentery retroperitoneum small part tumors resected diagnosed microscopically desmoid tumors prednisolone administration 20 5 mgday subjective symptoms ameliorated desmoid tumors slowly regressed bilateral hydronephrosis continued resulted retroperitoneal fibrosis knowledge case first welldocumented case retroperitoneal fibrosis patient fpc characteristics desmoid tumor familial polyposis coli gardners syndrome methods management discussed
| 0 |
14,360 |
righttoleft shunt across patent foramen ovale caused cardiac tamponade diagnosis transesophageal echocardiography cardiac tamponade manifest profound hypoxemia intracardiac shunting across patent foramen ovale consequence pulmonary embolus erroneously diagnosed demonstrated case described herein transesophageal echocardiography useful determining correct diagnosis especially transthoracic echocardiography technically limited patient findings transesophageal echocardiography also helped determine appropriate treatment relative inaccessibility pericardial effusion needle drainage prompted open surgical drainage
| 4 |
14,361 |
oxygen uptake heart rate responses hypoxic exercise children adults control ventilation heart rate exercise appears undergo maturation aerobic metabolism vo2 may since previously found hypoxia exercise produced different ventilatory responses children c compared adults hypothesized vo2 heart rate kinetics exercise would show similar maturational responses hypoxia test hypothesis examined responses progressive ramp constant work rate tests children adults breathing either room air hypoxic gas fio2 015 corrected body weight children adults similar values lactic acidosis threshold lat c 291 50 mlmin1kg1 279 43 vo2max c 407 86 mlmin1kg1 452 67 normoxia hypoxia significantly lowered lat c 275 54 mlmin1kg1 232 38 p less 005 vo2max c 377 83 mlmin1kg1 401 53 p less 005 children adults metabolic efficiency delta vo2delta work rate vo2heart rate relationship delta vo2delta hrkg similar two groups unaffected hypoxia constant work rate exercise vo2 kinetics time constant phase 2 response pi 1 o2 deficit similar children adults significantly slowed hypoxia consistent current understanding control oxidative metabolism finally heart rate increased rest exercise hypoxia time reach 75 endexercise response delayed significantly groups
| 4 |
14,362 |
cholangiocarcinoma association multiple biliary microhamartomas rarity cholangiocarcinoma occurring von meyenburg complexes well appreciated describe case 35yearold man found cholangiocarcinoma association multiple biliary microhamartomas liver areas ductal proliferation atypia within bile duct hamartomas suggest malignant transformation cholangiocarcinoma
| 0 |
14,363 |
localregional breast cancer recurrence following mastectomy localregional recurrence patterns investigated 1392 patients breast cancer primary treatment patients included mastectomy nine hundred seventeen patients negative nodes receive systemic therapy four hundred seventyfive patients node metastases randomized receive different combinations chemoendocrine therapy followup ranged 5 16 years two hundred thirty 258 nodenegative patients recurrences initial recurrence localregional 92 two hundred fortytwo 509 nodepositive patients recurrences initial recurrence localregional 171 larger tumors extensive node involvement associated first localregional recurrences relative percent first localregional recurrence among patients cancer recurred similar nodenegative nodepositive patients 354 335 respectively 636 patients cancer recurred first localregional recurrence distant larger tumors extensive node involvement shorter diseasefree interval mastectomy associated rapid appearance distant recurrence among patients
| 0 |
14,364 |
chromogranin posttranslational modifications secretory granules primary structure chromogranin indicates multiple domains might subject posttranslational modification explored chromogranin proteolytic cleavage glycosylation possible intermolecular disulfide links using biochemical cell biological approaches antichromogranin regionspecific immunoblots chromaffin granules suggested bidirectional endoproteolytic cleavage chromogranin control experiments ruled artifactual cleavage granule isolation lysis isolation chromogranin aderived peptides gel filtration chromatography sodium dodecyl sulfatepolyacrylamide gel electrophoresis sdspage followed nterminal amino acid sequencing established several cleavage sites including least two dibasic sites secretion chromogranin bovine chromaffin cells initiate cleavage prolonged exposure secreted chromogranins secretory cells chromogranin cleavage pattern qualitatively similar neuroendocrine tissues though cleavage complete adrenal medullary anterior pituitary hormone storage vesicles nterminal fragments 45 55 kilodaltons prominent hypothalamus similar cleavage pattern seen human pheochromocytoma granules judged chromogranin regionspecific immunoblots fragment isolation sdspage microsequencing presence fulllength chromogranin core protein chromaffin granule soluble proteoglycan suggested bovine human chromaffin granules glycoprotein staining chondroitinase abc digestion chemical deglycosylation regionspecific immunoblotting human bovine chromogranin displayed intermolecular disulfide crosslinks sdspage gels immunoblotting results document diverse structural paths chromogranin molecule may take endocrine secretory cells translation
| 0 |
14,365 |
study preneoplastic changes liver cells immunohistochemical molecular hybridization techniques status hepatitis b virus dna investigated situ hybridization multifocal areas noncancerous hepatitis b virusassociated cirrhosis liver exhibited marked degree dysplasia adenomatous hyperplasia results studies correlated histopathology immunohistochemical stains hepatitis b core surface antigens clear evidence marked reduction absence hepatitis b viral dna situ hybridization absence hbc hbsag foci liver cell dysplasia adenomatous hyperplasia results support hypothesis liver cell dysplasia adenomatous hyperplasia preneoplastic nature
| 0 |
14,366 |
ocular motor abnormalities head trauma head injuries cause hospitalization 200300 persons per 100000 population per year ophthalmologists provide diagnostic therapeutic care trauma victims damage globe optic nerve orbit ocular motor system eye movements affected damage level central nervous system peripheral motor unit comprehensive ocular motor assessment trauma patient substantially contribute understanding patients injury recovery rehabilitation review examines aspects head face trauma lead ocular motility disturbances
| 2 |
14,367 |
staging followup breast cancer patients staging systems breast cancer unlike neoplasms distant recessed sites allowed early development clinical staging evaluation established clinical assessment breast lesion often wrong compared pathologic examination benign vs malignant clinical measurement tumor centimeters often larger histologic size clinical assessment axillary nodes clear metastatic incorrect 30 cases although clinical pathologic staging provide effective discriminants prognosis treated patients prognosis accurately determined pathologic stage single important prognostic indicator axillary nodal status positive number positive nodes american joint committee cancer union international contra cancer agreed tnm staging breast carcinoma preferable staging system followup treated patients value detecting local recurrence chest wall mastectomy irradiated breast lumpectomy also early detection contralateral breast cancer physical examination periodic mammography useful tendency overinvestigate asymptomatic patients bone scans blood tests etc correctly criticized recent years
| 0 |
14,368 |
opioids cerebrospinal fluid hypotensive newborn pigs study designed determine opioids detectable cerebrospinal fluid csf concentrations altered hemorrhagic hypotension study designed determine effects topically administered opioids pial arteriolar diameter normotension hypotension closed cranial windows used determine pial arteriolar diameter periarachnoid cortical cisterna magna csf collected piglets normotension hypotension systemic arterial pressure decreased 63 1 33 1 mm hg opioid profiles assessed qualitatively radioreceptor assay individual opioids measured quantitatively radioimmunoassay periarachnoid cortical cisterna magna csf methionine enkephalin leucine enkephalin dynorphin betaendorphinlike receptor active values increased hypotension quantified radioimmunoassay periarachnoid cortical csf values methionine enkephalinlike immunoreactivity 1167 58 2975 139 pgml normotension hypotension respectively periarachnoid cortical csf radioimmunoassay values dynorphinlike immunoreactivity 15 2 28 2 pgml normotension hypotension respectively applied topically cortical surface synthetic methionine enkephalin increased pial arteriolar diameter 134 4 158 4 163 4 microns control 574 pgml 1010 5740 pgml 109 respectively similarly topical synthetic leucine enkephalin dynorphin elicited pial arteriolar dilation however betaendorphin produced arteriolar constriction hypotension attenuated methionine leucine enkephalininduced dilation reversed dynorphininduced dilation concentrationdependent constriction betaendorphininduced constriction changed hypotension therefore opioids could contribute control cerebral circulation hypotension
| 4 |
14,369 |
transferrin receptor activity marker transitional cell carcinoma bladder immunohistochemical staining method used study transferrin receptors tfr bladder tissue 10 patients benign conditions 33 bladder cancer patients bladder cancer followed cystoscopy intervals 3 months mean followup period 11 months relationship tfr activity recurrence rates investigated possible demonstrate tfr normal bladder mucosa except proliferating cells basal layer tfr activity malignant tissue correlated well histological grade pathological stage tumour patients low grade superficial tumours showing tfr activity higher recurrence rate tfr activity concluded tfr activity low grade superficial bladder tumours useful marker predicting recurrence rate
| 0 |
14,370 |
aspiration biopsy cytology occult breast lesions use scouting needle prospective study 261 cases increased use mammography detection impalpable breast lesions resulted need new diagnostic techniques prospective study 261 occult breast lesions aspiration biopsy done standard fine needle syringe scouting needle technique permits collection diagnostic cytologic material clinicians office without specialized radiologic equipment thirty 53 malignant lesions 57 detected cytologically benign cytologic diagnosis made 220 patients preclude additional investigation aspiration biopsy using scouting needle rapid lowcost easily performed initial procedure complements watchful waiting diagnostic carcinoma results immediate surgical intervention may obviate twostage surgical treatment
| 0 |
14,371 |
coarctation aorta coarctation aorta common cardiovascular disorder unknown etiology preductal type blood flows patent ductus distal aorta coarctation juxtaductal postductal blood flows lower extremities way subclavian arteries collaterals plain films may show reverse sign postductal coarctation arteriography gold standard making diagnosis however magnetic resonance imaging probably become increasingly important diagnostic tool treatment choice surgery complete resection stenosed segment
| 3 |
14,372 |
mechanisms vein graft atherosclerosis ldl metabolism endothelial actin reorganization explored effect arterial hemodynamics endothelial cell morphology lowdensity lipoprotein metabolism human saphenous vein segments harvested tissue donors arterial pulsatile perfusion system used impose physiologic pressures flows 20 hours saphenous vein companion control femoral artery segments venous perfusion apparatus also employed perfusion second control saphenous vein segment period time calculations fluid shearing wall tensile stresses performed related induced changes endothelial cell geometry cytoskeletal actin organization incorporation degradation localization intact lowdensity lipoprotein within vessel wall results indicate compared native arteries veins 20hour exposure test saphenous veins arterial hemodynamics induced 1 significant increase endothelial cell luminal surface area perimeter independent alignment flow 2 disassembly dense peripheral band actin concomitant assembly stress fibers 3 two fourfold elevation undegraded lowdensity lipoprotein content localized primarily within subendothelial intima although exact mechanisms underlying results uncertain focal accumulation intramural lowdensity lipoprotein may related loss normal barrier function endothelial cell enlargement accompanied transient cytoskeletal reorganization adaptation arterial flow
| 4 |
14,373 |
epitope mapping human thyroglobulin heterogeneous recognition thyroid pathologic sera thyroglobulin major ag thyroid gland involved autoimmune pathologies epitope mapping carried rabbit polyclonal immune serum fusion proteins expressed prokaryotic cells screening initial human thyroglobulin cdna library subcloning immunoreactive clones seven epitopes characterized localized human thyroglobulin monomeric molecule one close extremity molecule five others concentrated middle covering sixth 2748aminoacid chain immunoreactivities 18 autoimmune sera different thyroid pathologies tested seven previously characterized epitopes hashimotos thyroiditis immunoreactive immune responses heterogeneous sera different pathologies well pathology central epitopes nearcterminal epitope however epitopes often recognized immune sera findings show autoepitopes overlap accurately heteroepitopes characterized polyclonal immune serum directed mature protein
| 0 |
14,374 |
unfading acral microlivedo discrete marker thrombotic skin disease associated antiphospholipid antibody syndrome small erythematous cyanotic lesions hands feet four patients antiphospholipid antibodies described discrete lesions outline capillaries disappear pressure applied histologic features identical described skin thrombotic syndrome associated antiphospholipid antibodies microthrombi dermal vessels without inflammation addition indicating antiphospholipid antibodies apparently healthy patients sign could marker risk largevessel thrombosis
| 3 |
14,375 |
capillary leakage inflammation study vascular labeling local injection pure inflammatory mediators induces venular leakage test effect endogenous mediators dying tissue vascular leakage authors devised experimental model simulating infarct whereby living vessels would exposed fragments organs undergoing aseptic necrosis tissues donor rats implanted aseptically cremasteric sac control rats implanted materials deemed close possible nonirritating boiled tissues spheres teflon glass different points rats injected intravenously carbon black killed hour later whole cremaster mounts showed vascular labeling strictly venular 8 hours mixed capillary labeling 12 24 hours mainly exclusively capillary 48 hours histology showed acute inflammatory infiltrate labeled areas similar weaker labeling pattern accompanied milder inflammation seen controls results indicate vascular leakage aseptic inflammation biphasic first venular capillary capillary phase induced inflammatory reaction possibly form diffuse angiogenesis
| 4 |
14,376 |
trends basal cell carcinoma squamous cell carcinoma melanoma skin 1973 1987 major increases occurred incidence basal cell carcinoma squamous cell carcinoma skin well cutaneous malignant melanoma period 1973 1987 british columbia greatest increases basal squamous cell carcinomas head neck indicates exposure sunlight major causative factor greatest increase melanoma trunk men lower limbs women dramatic increases nonmelanoma skin cancers british columbia relatively low sunlight area suggest major prevention programs needed areas considered sunspots
| 0 |
14,377 |
origin epidermal melanocytes implications histogenesis nevi melanomas among venerable concepts dermatopathology unnas 19th century notion abtropfung ie melanocytes drop epidermis dermis histogenesis melanocytic tumors paradoxically however unnas basic premise epidermal origin melanocytes seriously questioned 40 years based experimental evidence favoring neural crest origin melanocytes recent work strengthened evidence neural crest origin epidermal melanocytes suggested concept abtropfung replaced concept hochsteigerung concept hochsteigerung holds melanocytes migrate dermis epidermisnot normal development also normal tissue maintenance seems likely precursor melanocytes normal abnormal differentiation may melanoblast primitive cell committed melanocytic differentiation rather pluripotential cell although axoninvesting schwann cells traditional focus closest relative epidermal melanocyte recent studies suggest another nerve sheath cell perineural cell might better candidate concepts profound implications histogenesis melanocytic nevi melanomas
| 4 |
14,378 |
postoperative lumbar spinal instability occurring progressing secondary laminectomy manifestations pathomechanism postoperative lumbar spinal instability occurring progressing secondary laminectomy clarified means functional radiographic analysis series 46 patients 40 years age relation instability clinical symptoms also discussed patients 60 years age instability operated level tended appear cases wide laminectomy often cases partial laminectomy occurrence progress instability seems promoted resection posterior spinal elements rather disc considered postoperative aggravation clinical symptoms may influenced instability also factors
| 2 |
14,379 |
interferon antibodies may negate antiviral effects recombinant alphainterferon treatment patients chronic hepatitis b virus infection randomized controlled trial recombinant alpha2a interferon chronic hepatitis b interferon antibodies developed 21 39 54 chinese adults received ifn correlation observed sex age pretreatment serum alt level liver histological findings development interferon antibodies antibodies significantly likely develop patients received lower doses 25 5 mum2 alpha2a interferon received higher dose 10 mum2 53 vs 11 p 0006 development interferon antibodies appeared reverse initial antiviral response treatment reappearance hepatitis b virus dna serum 12 patients hbeag three patients sustained clearance hbeag achieved one 5 patient achieved seven 21 patients without interferon antibodies mere presence interferon antibodies preclude antiviral response interferon therapy patients high titer neutralizing antibodies less likely respond findings suggest interferon antibodies may negate antiviral effects alpha2a interferon higher incidence interferon antibodies chinese vs white patients chronic hepatitis b may contribute poorer antiviral response chinese patients
| 4 |
14,380 |
lipomatous hypertrophy interatrial septum unusual intraoperative finding lipomatous hypertrophy interatrial septum incidental finding man 45 undergoing coronary artery bypass grafting unstable angina overweight rhythm disturbances diagnosis made frozen section
| 0 |
14,381 |
endosalpingosis cause chronic pelvic pain endosalpingosis condition characterized ectopic oviduct epithelium diagnosed histologically appearance benign ciliated nonciliated columnar cells abnormal location endosalpingosis typically without symptoms unusual case report shows symptomatic endosalpingosis first seen chronic pelvic pain various aspects disease also discussed
| 0 |
14,382 |
refractory parastomal ulcers multidisciplinary approach chronic parastomal ulcers patients ileostomy colostomy stomas unusual previous reports implicated infections fistulas recurrent inflammatory bowel disease ibd pyoderma gangrenosum trauma past 8 years evaluated 10 cases refractory parastomal ulcers occurred mean 11 years stomal surgery eight patients ileostomy ibd two undergone colostomy colon cancer five patients ibd diagnosed pyoderma gangrenosum ulcerations required systemic treatment mean 25 weeks effect ulcer healing five patients either parastomal ulcers basis dermatoses contact dermatitis eczema bullous pemphigoid contact ulcers due faceplate pressure parastomal dermatitis patients received topical treatment healing ulcers mean 4 weeks conclude parastomal ulcers occurring patients without ibd ibd patients without classic pyoderma gangrenosum require early dermatologic evaluation respond relatively quickly appropriate local therapy
| 1 |
14,383 |
detecting arrhythmia exercise electrocardiography pediatric patients assessment sensitivity influence clinical management studied 49 patients suspected arrhythmias group 1 92 patients previously documented arrhythmias group 2 underwent exercise electrocardiography eecg institution 1979 1987 among group 1 patients sinus rhythm exercise 10 20 abnormal findings eecg treatment modified 4 10 8 group 1 testing 24hour ambulatory transtelephonic electrocardiographic monitoring electrophysiologic study 39 patients normal eecg findings revealed 8 additional patients arrhythmias group 1 sensitivity eecg 56 negative predictive value 79 group 2 consisted 38 patients atrial arrhythmias 31 ventricular arrhythmias 23 atrioventricular conduction abnormalities eecg 92 patients 68 74 abnormal eecg findings 1 24 patients normal findings underwent testing rhythm abnormalities induced 16 patients atrial arrhythmias likely normal eecg results 42 ventricular arrhythmias 23 atrioventricular conduction abnormality 4 35 patients referred suppression arrhythmia 25 71 abnormal rhythm suppressed exercise clinical management modified 27 group 2 patients basis eecg findings
| 4 |
14,384 |
successful cpr severely hypothermic patient using continuous thoracostomy lavage severe hypothermia cardiopulmonary arrest often requires prolonged resuscitation rewarming procedures implemented 63yearold male cardiopulmonary arrest core body temperature 237 c resuscitated successfully core rewarming means twochesttube continuous thoracostomy lavage procedure lavage procedure resulted effective rapid rewarming conventional rewarming methods failed
| 4 |
14,385 |
elevated intracranial pressure computed tomography brain fulminant hepatocellular failure cerebral herniation leading cause death patients fulminant hepatocellular failure classical signs elevated intracranial pressure often absent patients reliable noninvasive method presence cerebral edema could determined much needed assess efficacy computed tomography brain setting compared radiographic findings intracranial pressure measured epidural monitor patients fulminant hepatic failure unfortunately considerable difference existed presence cerebral edema diagnosed computed tomography brain elevation intracranial pressure observations suggest patients fulminant hepatic failure advanced hepatic encephalopathy computed tomography brain little value detecting cerebral edema pressure monitoring important establish presence guide therapy intracranial hypertension
| 2 |
14,386 |
biotype determinant natural immunising effect cholera test hypothesis clinical vibrio cholerae o1 infections protect recurrent cholera treated cholera episodes rural bangladesh population 188153 people followed 1985 1988 analysed 2214 people initial episodes cholera 7 second episode incidence cholera 61 lower subjects earlier episode without episode whereas initial episodes classical cholera associated complete protection subsequent cholera initial episodes el tor cholera associated negligible protection
| 4 |
14,387 |
treatment spinal cord compression epidural malignancy childhood epidural spinal cord compression malignant tumor rare occurrence children tumors involved extent involvement vertebral column different children adults often epidural tumor child identified significant spinal canal compromise occurred children frequently managed radiation therapy andor chemotherapy group children however severe spinal canal encroachment tumor evidenced near complete complete block myelography study report group patients severe spinal cord compression documented imaging studies compared results decompressive laminectomy subtotal tumor resection followed adjuvant therapy results obtained radiation therapy andor chemotherapy alone thirtythree patients met criteria inclusion study twentysix treated laminectomy adjuvant therapy 7 treated without surgical intervention surgical therapy 25 26 epidurals either improved stable whereas 4 7 nonsurgical patients deteriorated especially notable decrease pain operative patients immediately procedure surgical mortality morbidity results study indicate children severe spinal cord compression evidenced near complete complete block myelography filling 50 spinal canal magnetic resonance imaging best treated combination surgical decompression tumor removal followed adjuvant therapy
| 0 |
14,388 |
comparison frtl5 cell growth vitro xenotransplanted cells thyroid recipient mouse present work designed compare vitro cell growth kinetics vivo growth conditions similar possible using labeling 3hthymidine purpose frtl5 cells cultured monolayers threedimensional spheroids embedded collagen gels transplanted simultaneously nude mice treated perchlorate low iodine diet growth transplants compared thyroids host mice intact thyroid fraction 3hthymidinelabeled follicular cells flc 24h labeling increased sluggishly maximum 10 3 weeks goitrogen exposure subsequent autoregulatory decrease 3 7 weeks 4fold higher flc found six adenomas indicating focal failure growthrestraining mechanisms nonconfluent monolayer cultures flc high 90 even within large individual clusters cells tight mutual contact solid highly cellular grafts growing transplanted monodispersed cells showed average flc 20 5 times higher flc identically stimulated mouse thyroid collagenembedded cells forming threedimensional spheroids mean flc decreased 70 1 week vitro 40 vivo 20 3 weeks vitro vivo suggesting effective autoregulation excessive growth conditions however flc much higher 3 flc simultaneously assessed host thyroids difference remained throughout 45day period studied conclude frtl5 cells growing monolayers threedimensional spheroids vitro xenotransplantation vivo invariably show much higher proliferation rates comparable environmental conditions normal follicular epithelium thyroids host mice one exception confluent monolayer nearzero growth densely packed threedimensional transplants still grow intensively although growthretarding cell cell interactions also clearly operative growing frtl5 cells less effective dampening replication rate thyrocytes within monolayer hull normal follicles local failure mechanisms allowing growth rates comparable grafted frtl5 cells results adenoma formation normal thyroids observations call caution transfer vitro growth studies frtl5 cells vivo conditions prevailing normal thyroid
| 0 |
14,389 |
acute deterioration renal function associated enteric hyperoxaluria enteric hyperoxaluria due malabsorption syndromes well documented cause renal calculi chronic tubulointerstitial renal damage rarely setting intestinal bypass operations morbid obesity enteric hyperoxaluria produced acute renal failure report two patients suffered acute deterioration renal function associated increased intestinal absorption renal excretion oxalate associated steatorrhea one patient large portion small bowel resected many years prior onset renal failure second patient chronic pancreatitis causing steatorrhea patients renal biopsy documentation acute nature tubular damage produced oxalate deposition mechanisms deterioration renal function may relate sudden increases steatorrhea association episodes volume depletion enteric hyperoxaluria may easily overlooked potentially preventable etiology acute renal dysfunction
| 4 |
14,390 |
fetus patient surgical considerations diagnosis treatment human fetal defects evolved rapidly past decade due improved fetal imaging techniques better understanding fetal pathophysiology derived animal models detection fetal anomaly may lead change timing delivery change mode delivery prenatal treatment therapeutic maneuvers involve risk fetus mother must reasonable expectation procedure feasible safe effective attempted humans requires reliable information pathophysiology natural history disease process efficacy fetal surgical intervention ameliorating disease feasibility safety proposed intervention paper focuses rationale initial clinical experience fetal surgery variety lifethreatening fetal anatomic defects
| 1 |
14,391 |
potentially fatal asthma syncope new variant munchausens syndrome sports medicine report case munchausens syndrome 19yearold female college athlete presented potentially fatal asthma recurrent syncopal episodes failure control asthma appropriate medications lack objective findings physical examination diagnostic testing raised possibility factitious disease munchausens syndrome although described frequency asthmatic patients considered differential diagnosis patients refractory aggressive medical management
| 2 |
14,392 |
upper tract tumours following cystectomy bladder cancer routine intravenous urography worthwhile incidence presentation upper tract tumours studied 180 patients previously undergone cystectomy transitional cell carcinoma bladder intravenous urography performed routinely 3 months cystectomy 1 year later 3yearly intervals thereafter ten patients developed upper tract tumours 1 presented loin pain remainder haematuria six patients underwent nephroureterectomy 5 lived least 4 years 4 inoperable 1 survived longer 6 months series patients upper tract tumours presented symptoms routine intravenous urography failed detect asymptomatic lesions routine radiological assessment upper tracts detect tumours justified following cystectomy
| 4 |
14,393 |
hypertension cigarette smoking decline stroke incidence eastern finland finland high rates cardiovascular disease cardiovascular disease risk factors studied random samples population 3059 years age risk factors two provinces eastern finland 1972 1977 followed cohorts 1985 linkage national hospital discharge death certificate registers prevalence hypertension smoking provinces declined 1972 1977 stroke incidence 8year period followup cohort observed differences stroke incidence two provinces relative risk stroke later period 19771985 071 058 men women respectively compared earlier period 19721980 overall 28 stroke events could attributed hypertension 17 smoking 43 two factors jointly decrease prevalence hypertension smoking accounted 29 decline
| 2 |
14,394 |
rectal bleeding patient delay presentation patient delay presentation rectal bleeding identified factor delayed diagnosis among patients colorectal cancer aim study identify demographic psychological factors beliefs behaviors related delay presentation rectal bleeding 93 patients presenting symptom general practitioner delay ranged 0 249 days median 7 days 27 29 percent delayed 14 days delay unrelated age sex ethnic origin competence english length schooling social status availability social support measured psychologic traits belief cause might cancer proportions delaying 14 days statistically significantly elevated among worried bleeding 47 percent delayed regularly look feces toilet paper use 37 percent took action presenting general practitioner 43 percent
| 0 |
14,395 |
vastus lateralis myocutaneous flap reconstruction defects around groin pelvis present experience using vastus lateralis myocutaneous flap repair defects around groin pelvis relatively new technique many advantages flaps used area though limitations history anatomy surgical technique raising flap described clinical cases discussed importance patient selection highlighted
| 0 |
14,396 |
topical fibronectin aprotinin keratectomy wound healing rabbits evaluated effect fibronectin adhesive protein aprotinin protease inhibitor single combined topical therapies primary healing prevention recurrent corneal epithelial defects rabbit keratectomy wound model biological activity prepared solutions rabbit plasma fibronectin 06 gl suggested vitro assays rabbit corneal epithelial cell adhesion gelatinbinding affinity first experiment compared fibronectin albumin control nonadhesive protein saline second third experiments fibronectin supplemented aprotinin aprotinin alone saline compared aprotinin used concentrations 40 1000 kallikrein inactivating units kiu per mililiter results suggest topical fibronectin 06 gl well aprotinin 40 1000kiuml concentrations given alone combination neither promote corneal epithelial wound healing prevent recurrent corneal epithelial defects rabbit keratectomy wounds
| 4 |
14,397 |
hepatocyte expression hbcag serum hbeag hepatitis b comparison polyclonal monoclonal antibodies trial interferon distribution quantitative expression hbcag relation serum hbeag liver histology trial interferon 50 patients chronic type b hepatitis evaluated using polyclonal monoclonal antibodies general antisera showed similar pattern terms distribution hbcag predominant localisation hbcag cytoplasm hbeag positive patients chronic active hepatitis semiquantitative analysis showed however higher degree cytoplasmic expression hbcag polyclonal monoclonal antihbc hbeag positive patients focal expression hbcag cytoplasm polyclonal antihbc showed expression hbcag monoclonal antihbc expression hbcag polyclonal antihbc correlated better histological features chronic active hepatitis persistence serum hbeag follow suggesting result nonspecific false positive staining hbeag negative patients minimal histological changes inactive cirrhosis hbcag negative antisera conclusion though polyclonal monoclonal antibodies produced quite similar distribution hbcag patients chronic type b hepatitis polyclonal antibody seemed sensitive detecting hbcag cytoplasm monoclonal antihbc expression hbcag polyclonal antihbc correlated better clinical histological outcome
| 1 |
14,398 |
fine surface structure intraspinal neurenteric cyst scanning transmission electron microscopy study case 11yearold boy intraspinal neurenteric cyst recurred 8 years 3 months surgery presented scanning transmission electron microscopy cyst epithelium revealed marked resemblance respiratory tract despite presence numerous goblet cells mimicking intestine light microscopy study detailed ultrastructural findings described
| 4 |
14,399 |
toxicity highdose cytosine arabinoside treatment advanced childhood tumors resistant conventional therapy pediatric oncology group study experience highdose cytosine arabinoside hdac pediatric solid tumors limited sixteen children solid tumors resistant conventional therapies registered pilot pediatric oncology group pog study required administration hdac 3 gm2 every 12 hours four doses four cases rhabdomyosarcoma two cases fibrosarcoma four cases neuroblastoma one case germ cell tumor wilms tumor retinoblastoma hepatocellular carcinoma ewings sarcoma burkitts lymphoma eligible patients advanced diseases previously received extensive chemotherapy thirteen patients received one course hdac three patients received two courses hdac due prior treatments patients less normal marrow reserves shortterm toxicity included nausea vomiting suppression hemopoiesis drug fever increased blood urea nitrogen bun creatinine liver enzymes evaluable patients recovered toxicities drugrelated deaths none patients neurologic problems including patient prior irradiation skull schedule hdac appears manageable toxicity
| 1 |
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