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300 | postlaminectomy ossified extradural pseudocyst case report large ossified spurious meningocele accompanied recurrent lumbar disc herniation occurred 7 years posterior intervention laminectomy discectomy 53yearold man cyst wall histologically composed mature bone tissue sparsely covered connective tissue lined fibrocyte fibroblastlike cells inside ossified pseudocyst presumed originated minute defect dura mater occurred time first operation | 4 |
301 | optimizing heparin utilization angiographic flush solutions various concentrations heparin angiographic flush solutions employed angiography effort determine whether differences outcome seen either high low concentrations heparin angiographic flush solutions utilized two groups patients evaluated difference outcome small systemic effect heparin seen groups use low concentration heparin suggested routine angiography | 3 |
302 | locally recurrent endometrioid adenocarcinoma prostate radical prostatectomy endometrioid carcinoma prostate considered variant classical prostatic ductal carcinoma endometrioid carcinoma variant often unique clinical presentation gross hematuria propensity tumor spread within urothelium makes local failure curative therapy commonplace present 2 representative cases review followup surveillance procedures treatment options local recurrence identified | 0 |
303 | upperextremity deep venous thrombosis pulmonary embolism prospective study prospectively evaluated prevalence pulmonary embolism pe 30 consecutive patients proved deep venous thrombosis dvt upper extremity ten patients seven male three female mean age 43 years primary dvt 20 patients 14 male six female mean age 52 years catheterrelated dvt ventilationperfusion lung scans routinely performed time hospital admission one patient one patient critically ill died four days dvt diagnosis massive pe lung scan findings normal nine ten patients primary dvt indetermine remaining patient contrast perfusion defects considered highly suggestive pe four patients catheterrelated dvt two patients indeterminate lung scans 13 patients normal scans conclude pe rare complication upper extremity dvt patients catheterrelated dvt seem higher risk | 3 |
304 | rapid inactivation phosphorylation pyroglutamyl peptidase ii y79 human retinoblastoma cells exposure phorbol ester pyroglutamyl peptidase ii ec 3419 membranebound metalloproteinase highly specific trhdegrading enzyme exposure y79 human retinoblastoma cells 120tetradecanoyl phorbol 13acetate tpa decreased activity enzyme time concentrationdependent manner ic50 5 x 109 15 min tpa treatment 10 pyroglutamyl peptidase ii activity remained tpa treatment affect activity cytosolic enzyme pyroglutamyl peptidase ec 34193 membranebound enzyme dipeptidyl peptidase iv ec 34193 pretreatment cells protein kinase c inhibitors h7 sphingosine prevented inactivation pyroglutamyl peptidase ii tpa time course tpamediated effect paralleled time course translocation activation protein kinase c cell line immunoblot analysis demonstrated inactivation pyroglutamyl peptidase ii due dissociation internalization enzyme molecule incubation tpaactivated y79 cell membranes gamma32patp followed immunoprecipitation revealed timedependent phosphorylation 48 kilodalton subunit pyroglutamyl peptidase ii studies indicate phorbol ester effect mediated protein kinase c reveal mechanism potentiation action trh target sites | 0 |
305 | role antibiotic therapy prevention empyema patients isolated chest injury iss 910 prospective study purpose study determine impact antibiotic regimen incidence empyema patients admitted isolated chest trauma iss 910 hemopneumothorax requiring tube thoracostomy patients isolated chest trauma hemopneumothorax estimated iss 9 10 seen trauma center considered eligible study patients excluded following reasons age less 18 years presence shock time initial resuscitation ongoing antibiotic therapy unrelated disease documented preexisting infection documented abnormal immune status ninety patients randomized two treatment limbs antibiotics tube thoracostomy tube thoracostomy alone patients procedure performed trauma center standard fashion wound care tube care identical antibiotic therapy consisted firstgeneration cephalosporin cefazolin one dose given procedure q 6 h tube removal injury severity scores established described schwab manner baker statistical analysis performed using fishers exact test binary outcome study antibiotics able reduce incidence empyema patients isolated chest trauma patients antibiotic treatment appears justified work required determine effect patients severe injury multisystem involvement | 4 |
306 | rib infarcts acute chest syndrome sickle cell diseases absence evidence pneumonia pulmonary embolus primary pulmonary infarction assumed cause syndrome chest pain fever pulmonary infiltrate chest xray commonly complicates sickle cell anaemia find whether syndrome might due rib infarction 99mtcdiphosphonate bone scans done eleven episodes thus investigated 10 patients scans showed segmental areas increased radionuclide uptake ribs indicative bone infarction possible sequence events rib infarcts primary cause bone pain followed soft tissue reaction pleuritis splinting resultant hypoventilation leads atelectasis subsequent development radiographic changes acute chest syndrome prevention hypoventilation treatment bone pain important therapeutic goals | 4 |
307 | association diseasefree survival percent ideal dose adjuvant breast chemotherapy relationship percent ideal dose diseasefree survival examined 256 stage ii iii patients participated 2year breast adjuvant chemotherapy trial consisting cyclophosphamide methotrexate 5fluorouracil cmf given postoperatively analyzed analogously previous work results confirmed doseresponse relationship appeared improved diseasefree survival patients receiving higher doses adjuvant chemotherapy major criticism analysis bias bias addressed considering patients still receiving therapy 6 12 24 months doseresponse relationship longer seen although causality cannot inferred apparent differences diseasefree survival among dose groups attributed recurrences first 2 years among patients receiving lower doses chemotherapy | 0 |
308 | prostate tumour markers differentiation grade prostatic cancer serum acid phosphatase activity prostate specific phosphatase prostate specific antigen measured 100 patients prostatic cancer patients divided according differentiation grade 3 groups g1 well g2 moderately g3 poorly differentiated carcinoma bone metastases identified scintigraphy among 76 m0 patients mean levels 3 markers slightly higher patients moderately differentiated prostatic carcinoma among 24 m1 patients primary tumour either g2 18 patients g3 6 patients none g1 lesions significantly higher serum acp pap levels found patients g2 tumours g3 lesions concluded histological differentiation grade prostatic carcinoma affect serum levels prostatic tumour markers tendency towards higher levels g2 group noticeable nonmetastatic metastatic cases despite limited number patients latter category clinical practice information may important additional tool staging prostatic cancer | 0 |
309 | effects inosine glycolysis contracture myocardial ischemia effects inosine ino substrate metabolism rigor formation ischemic myocardium examined isolated rabbit hearts metabolite content assessed tissue extracts chemical analysis whole heart 13c 31p nuclear magnetic resonance spectroscopy ischemic hearts metabolizing either 313cpyruvate 113cglucose 1 mm ino increased total 13clabeled alanine content lactate content unaffected 3 minutes ischemia tissue alanine 181 011 micromg wet wt mean sem hearts perfused pyruvateino versus 123 015 micromg wet wt hearts perfused pyruvate alone p less 005 ino reduced tissue glycogen ischemia pyruvateperfused hearts tissue alanine content ischemic hearts supplied glucoseino 129 013 micromg wet wt greater ischemic hearts supplied glucose alone 065 014 micromg wet wt alanine found originate pyruvate glycolytic end product glucoseperfused hearts ino raised 313calanine313clactate ratio ischemic intact hearts glucose 024 007 versus glucoseino 060 009 pyruvate 049 008 versus pyruvateino 089 008 7 minutes ischemia atp content fell 70 3 glucoseino versus 58 5 glucose alone rigor stone heart delayed 147 13 232 16 minutes ino ino change atp content ischemic hearts supplied pyruvate delayed rigor pyruvate 99 12 minutes pyruvateino 156 10 minutes possibly expense glycogen supplemental glucose improved effectiveness ino pyruvate preserve atp pyruvateglucose 42 6 pyruvateglucoseino 72 6 delayed rigor pyruvateglucose 133 15 minutes pyruvateglucoseino 203 18 minutes glucose metabolism supported improved energetic contractile states ischemic hearts treated ino thus cardioprotection ischemic heart ino associated preservation functional integrity improved energy production due increased glycolytic activity activation glycolysis presence ino accommodated augmented alanine production without additional accumulation lactate | 3 |
310 | traumatic rupture aortacritical decisions trauma surgeons diagnosis initial stabilization patients traumatic rupture aorta tra performed trauma surgeons resuscitations 54 tra patients level trauma center reviewed although survival patients underwent attempted repair good 75 2127 78 deaths occurred phases treatment controlled trauma surgeon techniques sequencing resuscitation affect outcome pneumatic antishock garments beneficial prehospital setting patients tra fact pasg inflated patients presented cardiac arrest awake unanesthetized intubation caused fatal aortic rupture three patients pharmacologic control blood pressure intubation necessary amount fluid blood transfusion changes blood pressure secondary therapy statistically affect outcome average time arrival er angiogram 647 minutes average time er operating room 1597 minutes seven cases tra delayed diagnosis usually misinterpreted cxr 57 delay diagnosis directly contribute deaths associated abdominal injuries common cause preventable deaths fourteen patients combined abdominal injuries tra identified four six deaths occurred potentially reparable injuries operative diagnostic sequences must adjusted allow rapid control potentially fatal injuries | 3 |
311 | crystalluria medullary matrix crystal deposits bladder calculi associated acutely induced renal papillary necrosis single 100 mgkg intraperitoneal dose 2bromoethanamine hydrobromide induced renal papillary necrosis rpn acutely rodents caused transient crystalluria 4 8 h dosing crystals comprised struvite magnesium ammonium phosphate map assessed shape solubility infrared spectrum xray microprobe analysis acidsoluble birefringent crystals also present within renal medullary matrix time period crystalluria presence map associated loss anionic renal medullary mucopolysaccharides staining total 564 rats 2bromoethanamineinduced renal papillary necrosis monitored 160 days bladder calculi predominantly map data suggest medullary mucopolysaccharide matrix disruption associated rpn leads release previously bound cations supersaturation nucleation crystalline map processes could also implicated formation map bladder calculi | 4 |
312 | pachyonychia congenita complicated hidradenitis suppurativa family study family described five six members jacksonlawler type pachyonychia congenita also varying degrees hidradenitis suppurativa suggest association type pachyonychia congenita hidradenitis suppurativa | 4 |
313 | surgical treatment severe slipping upper femoral epiphysis used modified technique cervical osteotomy treat consecutive series 23 patients chronic slip upper femoral epiphysis successful correcting moderate severe deformities low incidence avascular necrosis comparable seen subtrochanteric osteotomies describe operative details discuss features make cervical osteotomy technically superior intertrochanteric subtrochanteric procedures | 4 |
314 | randomized comparison ceftriaxone cefotaxime lyme neuroborreliosis prospective randomized open trial 33 patients lyme neuroborreliosis assigned 10day treatment either ceftriaxone 2 g intravenously iv every 24 h n 17 cefotaxime 2 g iv every 8 h n 16 33 patients 30 eligible analysis therapeutic efficacy neurologic symptoms improved even subsided 14 patients cefotaxime group 12 patients ceftriaxone group treatment period followup examinations mean 81 months 17 27 patients examined clinically asymptomatic one patient borrelia burgdorferi isolated cerebrospinal fluid csf 75 months ceftriaxone therapy csf antibiotic concentrations mic 90 level b burgdorferi nearly patients examined patients lyme neuroborreliosis may benefit 10day treatment ceftriaxone cefotaxime however 10 patients symptomatic followup borreliae persisted csf one patient prolongation therapy may necessary | 2 |
315 | acquired benign esophagorespiratory fistula report 16 consecutive cases sixteen cases acquired benign esophagorespiratory fistula treated 20year period delay diagnosis usual patients first seen pulmonary infection already developed contrast esophageal xray studies established diagnosis patients seven esophagotracheal nine esophagobronchial fistulas fistula esophageal diverticulum bronchus considered inflammatory origin developed 7 patients fistula consequence trauma developed 9 patients fistulas situated higher level respiratory tree patients underwent surgical treatment 12 definitive 4 temporary gastrostomy performed improve nutrition definite repair definitive repair consisted eventual diverticulectomy division fistula suture esophageal respiratory defects two patients required esophageal resection later reconstruction colon interposition one patient died creating operative mortality 83 definitiverepair group remaining 11 patients gratifying longterm result two deaths gastrostomy group due extremely poor condition patients debilitating pulmonary infection early diagnosis rare condition necessary severe pulmonary complications avoided early direct repair gives excellent results | 4 |
316 | association selected cancers service us military vietnam ii softtissue sarcomas selected cancers cooperative study group part series investigations health vietnam veterans conducted populationbased casecontrol study softtissue sarcomas 1984 1988 men born 1929 1953 diagnosed area covered eight cancer registries considered eligible controls selected randomdigit dialing analyses 342 men pathologically confirmed sarcoma 1776 controls showed vietnam veterans relative risk 10 sarcoma comparison men serve vietnam 95 confidence interval 06 16 restriction analysis 254 men softtissue sarcoma yielded relative risk 09 95 confidence interval 05 16 several attributes military service vietnam eg branch duration service military region characteristics may associated use agent orange examined none associated increased risk development sarcoma furthermore morphologic type sarcoma overrepresented among vietnam veterans results unchanged vietnam veterans compared 1 veterans 2 men never served military study 97 power detect relative risk 20 sarcomas provides evidence risk development softtissue sarcomas increased among veterans 15 25 years following service vietnam | 0 |
317 | optimal interpretation supine exercise electrocardiogram patients right bundle branch block detailed analysis exercise ecg performed 82 patients right bundle branch block underwent supine exercise equilibrium radionuclide angiography sensitivity specificity individual electrocardiographic lead detection positive radionuclide angiogram determined leads v5 v6 sensitivity 58 percent specificity 89 percent limb leads lead v4 lower sensitivity equivalent specificity leads v1 v3 clearly lower specificity ranged 56 67 percent receiver operating characteristic curve analysis demonstrated optimal interpretation exercise ecg included limb leads v4 v6 v1 v3 results coronary angiography subset 16 patients underwent procedure confirmed findings | 4 |
318 | echocardiographic assessment atrial mechanical behaviour relations movement atrioventricular ring changes left atrial ventricular dimensions studied echocardiography compared apexcardiography doppler mitral flow velocity traces 20 healthy controls patients left ventricular hypertrophy n 28 dilatation n 16 left ventricular systole atrioventricular ring structure common ventricle atrium moved towards ventricular apex thus increasing left atrial volume action matched pulmonary venous return phase transverse left atrial dimension measured aortic root posterior left atrial wall early diastole mitral ring moved rapidly towards atrium transmitral flow accelerated requires force directed ventricle atrium likely result elastic recoil arising compression ventricular myocardium stretching atrial myocardium ventricular systole two additional mechanisms ventricular filling atrial systole recognised increase ventricular volume atrioventricular ring moved upwards b transverse left ventricular expansion pressure driven transmitral flow former undetectable doppler apex accounted 10 ventricular filling healthy controls significantly less ventricular dilatation left ventricular hypertrophy left ventricular filling maintained mechanisms compensating reduced increase volume early diastole interactions atrium ventricle functionally important ventricular systole early diastole atrial systole included traditional separation atrial function reservoir conduit pump functions | 3 |
319 | developing improved observational methods evaluating therapeutic effectiveness therapeutic efficacy often studied observational surveys patients whose treatments selected nonexperimentally results surveys distrusted fear biased results occur absence experimental principles particularly randomization purpose current study develop validate improved observational study designs incorporating many design principles patient assembly procedures randomized trial specific topic investigated prophylactic effectiveness betablocker therapy acute myocardial infarction accomplish research objective three sets data compared first developed restricted cohort based eligibility criteria randomized clinical trial second assembled expanded cohort using design principles except restricting patient eligibility third used data beta blocker heart attack trial bhat whose results served gold standard comparison research treatment difference death rates restricted cohort bhat trial nearly identical contrast expanded cohort larger treatment difference observed bhat trial also noted important largely neglected role eligibility criteria may play ensuring validity treatment comparisons study outcomes new methodologic strategies developed may improve quality observational studies may useful assessing efficacy many medicalsurgical therapies cannot tested randomized clinical trials | 3 |
320 | pelvic pain lessons anatomy physiology pelvic pain often difficult differential diagnosis emergency department physiologic reasons pain pelvis difficult localize specific organ pelvic peritonitis hard recognize hand differences types pain useful arriving correct diagnosis clinician must learn recognize superficial deep somatic pain differentiate various types visceral pain originate inflammation ischemia colic review anatomy physiology pelvic pain helps identify problems well potential aids approaching patient pelvic pain | 1 |
321 | demographic social stress correlates hypertension among urban poor relationship demographic social psychological variables diagnosis hypertension population urban poor predominantly black outpatients reported subjects 182 patients presenting health care wayne state university family practice clinic age race marital status attendance religious services education employment status income source income interpersonal stress significantly related diagnosis hypertension sample characteristics found significantly related hypertension discriminative analysis showed age race education frequency church attendance important predicting diagnosis hypertension among outpatient sample urban poor implications clinical care future research needs considered | 3 |
322 | abdominal aneurysms childhood report case review literature abdominal aneurysms rare children usually found association congenital cardiac aortic malformations connective tissue disorders trauma previous arterial catheter placement 4yearold girl common iliac artery aneurysm history arterial catheter placement trauma evidence marfans ehlersdanlos syndrome arteritis coarctation aorta diseases associated childhood aneurysms presented resection aneurysm arterial reconstruction performed without use prosthetic material vein graft pathologic examination showed evidence inflammation medial degeneration layers arterial wall fourth report found literature documented idiopathic abdominal aneurysm child conditions associated abdominal aneurysms childhood discussed literature reviewed | 3 |
323 | hammanrich syndrome revisited article retrospectively review 29 cases hammanrich syndrome recent reports used term acute interstitial pneumonia emphasize clinical pathologic features cases distinguish common chronic interstitial pneumonias particularly idiopathic pulmonary fibrosis 29 patients 12 survived long complicated hospitalization histologic features organizing diffuse alveolar damage patients including survivors extensive fibroblastic distortion lung parenchyma overall survival among patients appreciably different survival patients adult respiratory distress syndrome general | 4 |
324 | clinicopathological experience pineocytomas report five surgically treated cases clinicopathological experience associated five cases pineocytoma presented patients treated surgical removal without postoperative radiotherapy three individuals 2000 cgy administered tumor presurgical diagnostic test evidence response cases demonstrated histological features pineocytoma according criteria borit et al socalled pineocytoma neuronal differentiation according criteria rubinstein experience obtained present series reveals tumors occur initial decades life cystic appearance presence calcifications distinctive features radiological evaluation good prognosis surgical removal even histological data indicate local invasion convenience reserving term pineocytoma tumors including socalled pineocytomas without differentiation within group pineoblastomas suggested order achieve practical clinicopathological assessment parenchymatous pineal tumors | 0 |
325 | occult inferior vena cava thrombosis diagnosis sonographycase reports ultrasound become effective tool evaluating inferior vena cava authors report 3 cases illustrate difficulty diagnosing partially adherent clots may high propensity pulmonary embolism | 3 |
326 | management aneurysms arteriovenous fistulae popliteal artery arising war trauma emphasis sigmoid operative approach 19861988 600 vascular cases arising iraniraq conflict dealt within 18 month period 60 cases popliteal artery andor venous disruption encountered presenting variable times injury policy management forward base hospital surgical teams introduced observing following broad categorizations assessmentreferral b assessmentfasciotomyreferral c immediate operationreferral operationreviewmanagement two types incision used enter popliteal fossa medial incision b sigmoid posterior incision favor results strategy management operative technique compared previous experience within time frame suggested improved outcome fiftyfour 60 cases satisfactory operative result belowknee amputation required four cases higher amputations two others operative postoperative deaths occurred implementation vetting policy front line appeared reduce number amputations assisted clarification management criteria assessing limb viability forward hospital large number casualties received operative access using sigmoid posterior incision associated complications offered better exposure medial incision technically easier surgeon perform | 4 |
327 | outbreak diarrhoea due escherichia coli o111b4 schoolchildren adults association vi antigenlike reactivity six days november 1987 611 pupils age range 719 years 39 adults 2357 school complex southern finland diarrhoea due escherichia coli o111b4 diarrhoea developed 137 household members two weeks school outbreak source organism remains unknown outbreak strains incubated 22 degrees c exposed ampicillin lost lipopolysaccharide antigen began react antisera salmonella typhi vi antigen vi antigenlike reactivity increased adherence organisms hep2 cells results indicate e coli o111b4 possibly enteropathogenic e coli strains considered diagnosis diarrhoea cases infantile diarrhoea expression vi antigen e coli may play part virulence enhancing adherence intestinal epithelium | 1 |
328 | inflammatory pseudosarcoma pseudotumor bladder inflammatory pseudosarcoma bladder rare benign entity cannot differentiated malignant tumor radiologic examination alone pathologic examination enable definitive diagnosis authors report two cases benign tumors patients history bladder disease trauma tumors large demonstrated invasion local tissues recurred one case incomplete transurethral resection | 0 |
329 | fundoplication gastrostomy familial dysautonomia fundoplication gastrostomy become frequent treatment patients familial dysautonomia evaluated use procedures 65 patients although patients differed widely presenting signs age 5 weeks 40 years gastroesophageal reflux documented 95 patients cineradiography ph monitoring panendoscopy useful adjunct preoperative symptoms gastroesophageal reflux included vomiting respiratory infections exaggerated autonomic dysfunction severe oropharyngeal incoordination frequently coexisted resulted misdirected swallows aspiration dependence gavage feedings poor weight gain dehydration followup surgical correction ranged 3 months 11 years 55 patients 85 available 1year postoperative assessment instances surgical death longterm mortality rate 14 primarily related severe preexisting respiratory disease beyond first postoperative year 30 patients pneumonia attributed continued aspiration exacerbation preexisting lung disease recurrence gastroesophageal reflux 11 patients vomited postoperatively six recurrence reflux recurrence gastroesophageal reflux documented eight patients 12 revised fundoplication three patients number patients cyclic crises reduced 18 7 retching replaced overt vomiting two seven patients neither recurrence reflux oropharyngeal incoordination prominent concomitant use gastrostomy antireflux procedure especially effective treatment younger patients familial dysautonomia development severe respiratory disease despite development severe morning nausea 15 patients combination procedure resulted significantly improved nutritional status decreased vomiting decreased respiratory problems appropriate use gastrostomy feedings also contributed success operation generally good outcome fundoplication gastrostomy confirms benefit procedure familial dysautonomia | 1 |
330 | distinctive triad malformations central nervous system meckelgruber syndrome distinct triad central nervous system cns malformations prosencephalic dysgenesis occipital exencephalocele rhombic roof dysgenesis present seven cases meckelgruber syndrome examined autopsy compared findings previously described microcephaly sloping forehead posterior occipital exencephalocele cerebellar hypoplasia chiari malformation hydrocephalus polymicrogyria arhinencephaly holoprosencephaly anencephaly constituted broad spectrum reported cns anomalies reports contained comprehensive description observed cns malformations reports cases features prosencephalic dysgenesis included agenesis olfactory bulbs tracts arhinencephaly hypoplasia optic nerves chiasm agenesis corpus callosum fused thalami complete holoprosencephaly occipital encephalocele consisted displacement rhombic roof elements including caudal third ventricle cerebellar vermis fourth ventricle extruded enlarged posterior fontanelle rather occipital cranium bifidum thus precisely labeled exencephalocele different degrees dysgenesis posterior fossa structures described variant dandywalker cyst features chiari malformation often associated occipital exencephalocele pattern cns anomalies represents triad malformations probably associated defective ventral induction developing cns prechordal mesoderm | 4 |
331 | adenocarcinoma arising barretts esophagus total gastrectomy 64yrold japanese male underwent partial gastrectomy duodenal ulcer age 21 total resection remnant stomach stomal ulcer age 25 barretts esophagus diagnosed age 47 found tumor distal esophagus operated thoracic esophagectomy tumor well moderately differentiated adenocarcinoma invading muscularis propria entire esophageal mucosa resected specimen lined columnar epithelium tumor thought derive barretts esophageal epithelium | 1 |
332 | retinal vasculitis complication rheumatoid arthritis two middleaged women developed retinal vasculitis moderately active phase classical rheumatoid arthritis fluorescein angiography disclosed diffuse leakage retinal capillaries cystoid macular edema subsided response oral steroid show clinical signs vasculitis parts body retinal vasculitis included list complications observed rheumatoid arthritis | 3 |
333 | combined electromyographic cineradiologic investigation patients defecation disorders records 20 patients defecography electromyography performed simultaneously defecation disorders analyzed according electromyographic investigation patients could divided three main groups 1 normal sphincter reaction 2 paradoxical sphincter reaction 3 combined reaction group characterized marked reduction muscular activity emptying pronounced closing reflex emptying followed return normal tonic activity patients group b relaxation sphincters emptying pronounced increased activity external sphincter puborectalis muscle also severe emptying difficulties defecography closing reflex seen group c electrical activity sphincters increased moderate straining emptying complete clear closing reflex seen study dynamic visualization defecation together registration electromyographic activity striated anal sphincters performed shown patients paradoxical sphincter reaction lacking closing reflex emptying complete reported previously important evidence paradoxical defecation pattern also shown patients rectoceles paradoxical sphincter reaction | 1 |
334 | colonic polyamine content ornithine decarboxylase activity markers adenomas polyamine content putrescine spermidine spermine ornithine decarboxylase odc activity measured normalappearing colonic mucosa patients undergoing colonoscopy comparisons made without adenomatous polyps colonic mucosal polyamine content measured 44 persons mean putrescine content 125 026 se nmolmg protein 22 patients adenomatous polyps compared 053 012 nmolmg protein patients without polyps p less 002 tissue content spermidine spermine differ two groups ornithine decarboxylase activity measured tissue 45 patients mean odc activity 284 073 pmolhrmg protein 23 persons adenomatous polyps compared 115 018 pmolhrmg protein persons without polyps p less 005 mucosal putrescine odc activity elevated patients adenomatous polyps compared patients without polyps biochemical markers may prove helpful improving surveillance methods colorectal cancer premalignant adenomatous polyps | 0 |
335 | modifying translabyrinthine approach preserve hearing acoustic tumour surgery removing acoustic schwannoma using translabyrinthine approach previously considered incompatible hearing preservation modifying approach preventing loss endolymph successfully removed intracanalicular acoustic schwannoma originated inferior vestibular nerve preserved hearing operated ear report represents preliminary findings using particular technique management intracanalicular acoustic tumour | 2 |
336 | myofibroblastoma tongue immunohistochemical ultrastructural flow cytometric study case myofibroblastoma arising tongue 77yearold man described patient presented submucosal tongue mass without associated symptoms tumor 2 cm diameter well circumscribed composed uniform spindle cells arranged fascicles electron microscopic examination immunohistochemistry demonstrated myofibroblastic origin tumor cells dna flow cytometric analysis showed diploid dna content tumor authors knowledge first report myofibroblastoma occurring tongue | 0 |
337 | risk cancer death firstdegree relatives patients hereditary nonpolyposis cancer syndrome lynch type ii study 130 kindreds united kingdom estimate relative risks cancer firstdegree relatives index patients 130 pedigrees dominantly inherited lynch type ii cancer family syndrome analysed risk death causes significantly increased women 45 years age overall liability cancer women greater men sevenfold increase risk colon cancer found sexes female relatives risk breast cancer increased fivefold lifetime risk breast cancer 1 37 screening programme based estimated risks could offered firstdegree relatives index patients lynch type ii cancer family syndrome | 1 |
338 | cerebral vein thrombosis shown mri 46 year old man short history left facial pain numbness subsequently headaches normal physical examination normal ct scan head lumbar puncture yielded normal csf increased pressure mri showed thrombosis superior sagittal sinus subsequently confirmed angiography mri sensitive test detecting intracranial venous thrombosis may investigation choice disorder suspected | 2 |
339 | adrenergic stimulation renal prostanoids lyon hypertensive rat young genetically hypertensive lyon lh rats exhibited increased renal vivo turnover norepinephrine elevated urinary excretion thromboxane b2 compared normotensive ln low blood pressure controls therefore effects norepinephrine 12 x 108 96 x 107 phenylephrine 5 x 108 19 x 106 renal function urinary excretion prostanoids assessed isolated perfused kidneys 8weekold lh ln rats addition effects norepinephrine assessed thromboxane a2prostaglandin h2 receptor blockade ah23848 4 x 106 drug infusion lh kidneys differed ln controls elevated renal vascular resistance decreased natriuresis glomerular filtration rate urinary output prostaglandin e2 f2 alpha 6ketoprostaglandin f1 alpha thromboxane b2 similar three strains constrictor effects norepinephrine phenylephrine significantly increased lh rat kidneys compared ln controls pressurenatriuresis markedly reduced norepinephrine phenylephrine induced 10 20fold dosedependent increase synthesis four prostanoids pronounced lh ln rats thromboxane b2 ah23848 infusion significantly reduced vascular effects norepinephrine increased natriuretic response lh ln rat kidneys | 3 |
340 | primary carcinoma gallbladder seventyfour patients primary carcinoma gallbladder diagnosed 18 years 1969 1987 studied retrospectively common presenting complaint abdominal pain followed jaundice weight loss surgery performed 61 patients patients two accurate preoperative diagnosis made ultrasonography twelve 13 patients treated medically disease diagnosed autopsy one 13 patients diagnosis gallbladder cancer findings ultrasonography abdominal computed tomography ct scanning resectability surgically managed group 361 majority patients advanced tumors 822 deemed unresectable common histologic type adenocarcinoma liver organ commonly invaded 765 direct extension andor metastases followed regional lymph nodes 529 overall 5year survival rate 54 high index suspicion disease intraoperative examination gallbladder specimen earlier aggressive surgical treatment may improve patient survival | 0 |
341 | percutaneous transluminal coronary angioplasty accelerate atherosclerotic lesions recent reports suggested angioplasty may cause accelerate coronary arterial stenoses secondary traumatic injury ninetyfour coronary angiograms performed 1 yr period reviewed patients successful coronary angioplasty 6 30 mo mean 107 prior restudy restenosis found 43 140 dilated lesions 31 41 94 patients 44 thirtythree 35 patients new progressive lesions outside angioplasty site new progressive lesions occurred similar frequency arteries angioplasty 23155 15 arteries 13127 10 chisquare ns arteries underwent angioplasty new progressive lesions occurred commonly proximal ptca site 714 50 distal 613 46 new progressive lesions occurred 29 patients concomitant restenosis 40 without restenosis chisquare ns clinical angiographic procedural factors distinguished patients new progressive lesions target vessels without lesions target vessels patients progressive lesions anywhere coronary tree likely shorter duration anginal symptoms angioplasty family history coronary disease compared patients without progressive atherosclerosis conclusion new progressive lesions outside angioplasty site occur procedure appear unrelated restenosis process traumatic injury angioplasty instrumentation | 4 |
342 | prognostic significance exercise versus resting blood pressure hypertensive men outcome 143 male hypertensive patients investigated period 19721982 ascertained 1989 determine brachial artery pressure measured progressive graded exercise test bicycle ergometer better predictor mortality cardiovascular events pressure rest total followup time 1573 patient years 27 patients suffered least one fatal nonfatal cardiovascular event 13 patients died using cox regression model ageadjusted relative hazard rates systolic pressure supine rest 50 w peak work load 50 peak exercise capacity significant total mortality p less equal 001 cardiovascular events p less equal 003 pressure exercise however significantly p 011097 predict outcome patients age pressure rest taken account results similar diastolic pressure conclusion intraarterial pressures rest submaximal peak exercise significantly predict mortality incidence cardiovascular events hypertensive men independent age however additional prognostic precision exercise pressures age rest pressure taken account | 3 |
343 | simulated left ventricular aneurysm aneurysm repair swine patch reconstruction left ventricular aneurysm may superior linear closure hypothesis tested experimentally accordingly six anesthetized domestic pigs instrumented measure regional left ventricular wall thickening stroke volume systolic left ventricular pressure myocardial oxygen consumption total bypass cardioplegia 6 8 cm dacron patch inserted anteroapical left ventricle simulations follows left ventricular aneurysm patch open patch reconstruction 50 patch plication standard repair ventriculotomy edges approximated global function stroke work stroke volume x integral left ventricular pressureleft ventricular enddiastolic pressure curves depressed three simulations compared control tendency stroke work greater standard repair left ventricular aneurysm patch reconstruction higher preloads statistically significant mechanical efficiency stroke workmyocardial oxygen consumption joules per milliliter oxygen per beat 243 052 mean standard error mean control 222 094 standard repair 127 039 patch reconstruction 109 037 left ventricular aneurysm significant differences regional work calculated regional left ventricular wall thickening x integral left ventricular pressure slope regional workenddiastolic wall thickness relation decreased posterior wall 140 29 control versus 84 20 left ventricular aneurysm 69 14 patch reconstruction 74 14 standard repair p less 005 anterior wall contractility change significantly 74 12 control 78 27 left ventricular aneurysm 50 04 patch reconstruction 53 04 standard repair decreased enddiastolic wall thinning anteriorly suggested tethering results normal left ventricle suggest patch ventriculoplasty greater benefit linear repair either repair may impede function adjacent myocardium restriction regional diastolic lengthening | 3 |
344 | unusual malignant neoplasms esophagus oat cell carcinoma melanoma sarcoma primary noncarcinomatous malignant neoplasms esophagus uncommon data concerning treatment results sparse evaluate results therapy group reviewed records 32 patients primary esophageal malignant tumors unusual histologic type thirteen patients 41 sarcoma eight 25 melanoma 11 34 oat cell carcinoma dysphagia present 78 2532 patients median 13 weeks diagnosis location esophageal primary tumor upper third four patients 12 middle third 12 38 lower third 16 50 treatment consisted esophagectomy 10 13 patients sarcoma 77 seven eight melanoma 88 three 11 oat cell carcinoma 27 patients undergoing resection received chemotherapy radiation therapy 3 5year survival rates 46 23 sarcoma median 20 months 13 0 melanoma median 5 months 0 0 oat cell carcinoma median 5 months respectively distant disease initial form recurrence 73 1115 patients undergoing curative therapy surgical resection appears indicated localized primary esophageal sarcoma optimum treatment primary esophageal melanoma less clear surgical resection may benefit selected patients esophageal oat cell carcinoma systemic disease necessitating systemic therapy local therapy reserved palliation dysphagia | 4 |
345 | functional heart replacement spindle pump first results spindle pump nonpulsatile blood pump double function ie works centrifugally represses simultaneously first experiences type pump used biventricular assist device four shortterm animal experiments 13 hours described demonstrated cases normally beating heart bvad decompresses ventricles 6070 aortic pressure slightly increased hand case ventricular fibrillation bvad two spindle pumps maintained entire circulation arterial pressure 80 90 mmhg flow volume 35 4 lmin | 4 |
346 | arterial protection neglected crucial therapeutic goal hypertension accompanied 2 major types arterial pathologic conditions smooth muscle hypertrophy arteriolar resistance vessels atherosclerosis primarily involving larger arteries smooth muscle hypertrophy may develop either secondary defense elevated intravascular pressure primary defect responsible increased pressure insulin number trophic stimuli may play pathogenetic role vascular hypertrophy reducing blood pressure trophic stimuli may cause hypertrophy reversed atherosclerosis may markedly accelerated hypertension especially presence concomitant risk factors hypercholesterolemia cigarette smoking diabetes mellitus antihypertensive treatment may attenuate even reverse extent atherosclerosis causative factors also corrected commonly used antihypertensive agents eg diuretics beta blockers without intrinsic sympathomimetic activity often aggravate hypercholesterolemia glucose intolerance thereby diminishing potential protective value types drug therapy alpha blockers beta blockers intrinsic sympathomimetic activity vasodilator activity angiotensinconverting enzyme inhibitors calcium entry blockers may induce biochemical changes provide better control multiple risks thereby better protection atherosclerosis better understanding hypertension induces arterial damage clinicians able provide appropriate treatment hoped alleviate damage | 3 |
347 | endotheliumderived relaxing factors perspective vivo data review published studies endotheliumdependent vasodilation vivo endotheliumdependent vasodilation demonstrated conduit arteries vivo cerebral coronary mesenteric femoral vascular beds well microcirculation brain microcirculation cremaster muscle available evidence although complete strongly suggests endotheliumderived relaxing factor generated acetylcholine cerebral microcirculation nitrosothiol endotheliumderived relaxing factor generated bradykinin vascular bed oxygen radical generated association enhanced arachidonate metabolism via cyclooxygenase microcirculation skeletal muscle hand vasodilation bradykinin mediated partly prostacyclin partly endotheliumderived relaxing factor similar generated acetylcholine basal secretion endotheliumderived relaxing factor controversial vivo usually present vitro hand appears endotheliumderived relaxing factor mediates flowdependent vasodilation large vessels microcirculation vivo generation release endotheliumderived relaxing factor endothelium may abnormal variety conditions including acute chronic hypertension atherosclerosis ischemia followed reperfusion several mechanisms abnormalities identified include inability generate endotheliumderived relaxing factor destruction endotheliumderived relaxing factor oxidants release extracellular space abnormalities endotheliumdependent relaxation may contribute vascular abnormalities conditions | 3 |
348 | social environment social support research relevance social support cancer plentiful since first american cancer society workshop methodological issues behavioral psychosocial science nonetheless critical shortcomings continue characterize attempt empirically establish things extent social support predicts adjustment cancer diagnosis treatment prominent among failure adequately address large elements social structure social class urbanization investigate shape well persons risk cancer caregivers recommend psychosocial research link social support cancer conducted within populations beset poverty without adequate access health care funding needed training maintenance multidisciplinary multicultural teams researchers working within communitybased organizations hospitals serving underserved | 0 |
349 | lower leg subcutaneous blood flow walking passive dependency chronic venous insufficiency blood flow subcutaneous adipose tissue lower leg eight normal subjects 19 patients chronic venous insufficiency measured 133xewashout technique used portable cdt1c1 detectors data storage unit patients ulcers systolic blood pressure toe greater equal 60 mm investigated controls relative blood flow sitting 061 range 035080 patients 046 range 022087 difference significant walking blood flow increased controls well patients compared value determined sitting position p 00078 p 00028 respectively wilcoxon matchedpairs test relative bloodflow rate walking 096 range 060158 controls 104 range 049146 patients difference normal subjects patients significant p 079 conclude studies patients venous insufficiency able increase blood flow walking extent normal controls | 3 |
350 | comparison medical surgical therapy uncomplicated descending aortic dissection guide choice medical versus surgical therapy patients descending type b aortic dissection tear descending aorta without involvement ascending aorta multivariate survival analysis applied 136 patients admitted two medical centers 1975 1988 acute n 89 chronic n 47 descending dissection group 1 136 patients group 2 106 patients without rupture pulse loss visceral organ compromise group 3 56 patients group 2 without major cardiac renal disease 23 surgical 33 medical group 3 medical surgical subgroups well matched baseline characteristics potential candidates either mode therapy cox model analysis significant predictors mortality pleural rupture dissection complications increasing age cardiac disease p less 001 surgical versus medical therapy independent determinant survival three groups acute chronic dissection survival probabilities group 3 patients 1 5 10 years 094 087 032 medical 090 080 050 surgical despite limitations retrospective study including possibility undefined treatment selection biases data suggest medical early surgical therapy associated equivalent outcome selected patients uncomplicated acute chronic descending aortic dissection | 3 |
351 | autoimmune enteropathy colitis generalised autoimmune gut disorder children protracted diarrhoea circulating enterocyte autoantibodies enteropathy showing features inappropriate hla molecule expression jejunal crypt epithelium often present persistent blood mucus stools eight children autoimmune enteropathy investigated presence associated colonic disease six children protracted diarrhoea circulating autoantibodies enteropathy five undergoing colonoscopy used control subjects eight patients control subjects macroscopic microscopic evidence accompanying colitis variable severity thus indicating generalised intestinal disorder present might affect whole intestine aberrant expression dr molecules colonic surface crypt epithelium also detected autoimmunity may play role colitis | 1 |
352 | gilles de la tourette syndrome linked d2dopamine receptor gilles de la tourette syndrome important genetic component pathophysiology disorder may involve dopamine system tested d2dopamine receptor locus drd2 recognized probe hd2g1 genetic linkage gilles de la tourette syndrome using genetic linkage map region drd2 long arm chromosome 11 restriction fragment length polymorphism data total four markers drd2 d11s84 d11s29 pbgd able exclude linkage candidate gene gilles de la tourette syndrome two extended kindreds segregating gilles de la tourette syndrome rules causation gilles de la tourette syndrome mutation drd2 kindreds studied genetic assumptions employed use map multipoint linkage analyses also allowed us exclude gilles de la tourette syndrome susceptibility locus larger genetic region | 2 |
353 | management recurrent malignant pleural effusion united kingdom survey clinical practice malignant pleural effusions often symptomatic tend recur simple aspiration pleurodesis may prevent recurrence effusion many agents techniques described questionnaire sent 448 clinicians united kingdom determine pleurodesis performed practice 56 overall response replies 101 respiratory physicians 88 general physicians 29 thoracic surgeons 35 general surgeons general surgeons saw cases malignant pleural effusion rarely performed pleurodesis patient recurrent malignant pleural effusion would usually managed pleurodesis 76 76 respiratory physicians 26 30 general physicians 23 81 thoracic surgeons 29 33 general physicians would refer patients another specialist medical pleurodesis performed junior staff whereas consultant thoracic surgeons likely concerned procedure thoracic surgeons used intercostal tube drain usually suction intercostal tube drain used routinely 54 54 respiratory physicians 28 32 general physicians thoracic surgeons preferred talc pleurodesis whereas physicians commonly used tetracycline variety methods use supports need randomised controlled studies determine effective technique pleurodesis | 4 |
354 | facial nerve injury hemifacial spasm studied evidence facial nerve damage patients hemifacial spasm three types evidence nerve damage analyzed objectively measured weakness eyelid protractor strength clinically evident weakness muscles innervated seventh nerve clinically evident aberrant seventh nerve regeneration 60 patients study 54 90 least one features seventh nerve damage objectively measured eyelid protractor weakness noted 27 58 patients 47 tested clinically apparent weakness least one four facial muscle groups noted 42 60 patients 70 aberrant seventh nerve regeneration documented 25 60 patients 42 findings indicate facial nerve damage common patients hemifacial spasm | 4 |
355 | effect indomethacin gastric mucosal blood flow around acetic acidinduced gastric ulcers rats repeated administration indomethacin markedly delays spontaneous healing experimental gastric ulcers induced rats elucidate underlying mechanism effect indomethacin gastric mucosal blood flow around ulcers examined gastric ulcers induced 5 days submucosal injection acetic acid solution stomachs rats blood flow determined hydrogen gas clearance method blood flow around ulcers significantly higher rats without ulcers 2 weeks ulceration returned within normal range 3 4 weeks later indomethacin administered sc 1 mgkg repeatedly 14 weeks little effect blood flow normal rats however treatment significantly reduced blood flow 2030 corresponding control levels rats ulcers prostaglandin e2 administered sc 3 mgkg markedly prevented reduction blood flow due indomethacin administration prostaglandin e2 indomethacin 4 weeks resulted significantly higher bloodflow level control prevented delay ulcer healing omeprazole administered sc 30 mgkg repeatedly indomethacin 4 weeks insignificant effect blood flow around ulcers prevented delay ulcer healing conclusion delayed ulcer healing caused indomethacin might partly related reduced blood flow around ulcers | 1 |
356 | effects tamoxifen somatostatin analogue growth human medullary follicular papillary thyroid carcinoma cell lines tissue culture nude mouse xenograft studies knowledge 1 normal thyroid contains somatostatin 2 polypeptide growth factors influence thyroid cell function 3 thyroid cells contain steroid hormone receptors prompted us add somatostatin analogue 201995 sms 5 ngml andor tamoxifen citrate tam 5 mumoll 7day monolayer cultures 50000 cellswell three separate human thyroid carcinoma cell lines dr081 medullary wr082 follicular npa87 papillary results tabulated cell numberswell x105 day 7 revealed tam inhibited growth medullary follicular cells tam plus sms inhibited growth papillary cells vivo studies subcutaneous tumor cell xenografts nude mice documented tam 5 mg subcutaneous pellet significantly inhibits growth medullary implants flow cytometric dna studies medullary cell cultures demonstrated reduced g2 phase tam treatment papillary cell implants tam plus sms 5 micrograms subcutaneously twice daily suppress tumor growth three cell lines negative estrogen receptor addition estradiol 5 ngml medullary cell cultures neither stimulated replication reversed inhibitory effects tam vitro conclude 1 tam slowed growth cell line human medullary carcinoma vitro vivo 2 effect reversed estradiol 3 tam plus sms inhibited replication papillary carcinoma cell line vitro vivo 4 tam alone tam plus sms inhibited replication cultures human follicular thyroid carcinoma cell line tam sms may useful treatment human thyroid carcinomas | 0 |
357 | safe performance difficult laparoscopic cholecystectomies laparoscopic cholecystectomy advocated treatment uncomplicated symptomatic gallstone disease widely advocated management complicated gallbladder disease acute cholecystitis previous surgery common duct stones last 9 months 360 patients underwent laparoscopic removal gallbladder total 138 complicated presentation making surgery difficult article discusses management patients acute cholecystitis previous surgery common duct disease using described techniques complications mortality laparoscopic management difficult gallbladder problems safe effective | 4 |
358 | traction injury internal mammary artery report case review literature internal mammary artery ima used routinely along saphenous vein myocardial revascularization procedures documented particular form nonperforating injury may reduce blood flow operation may lead early closure ima bypass graft traction injury intima well documented vessles previously reported ima present potentially disastrous example traction injury ima | 4 |
359 | basement membrane cervical adenocarcinoma immunoperoxidase study laminin type iv collagen basement membrane components type iv collagen laminin examined immunohistochemically 14 cases adenocarcinoma cervix patterns staining adenocarcinoma situ invasive adenocarcinoma early invasive adenocarcinoma compared see whether characteristic patterns could delineated adenocarcinoma situ uniform intact basement membrane whereas basement membrane invasive adenocarcinoma fragmented irregular cases early stromal invasion showed early gland buds outpouchings defective basement membrane staining degree histologic differentiation tumor clearly related amount basement membrane component staining concept early stromal invasion cervical adenocarcinoma supported immunohistochemical studies discussed relates possible pathogenic mechanism early invasion infiltration adenocarcinoma cervix | 0 |
360 | hilar malignancy treatment expandable metallic transhepatic biliary stent expandable metallic transhepatic biliary endoprosthesis used treat 20 patients hilar malignancy isolated right left intrahepatic ducts 12 patients one intrahepatic ductal system drained eight patients systems drained five patients systems drained single transhepatic track arrangement two stents configuration initial technical success rate placing stents achieving internal drainage 100 complications necessitating intervention occurred two 20 patients shortterm clinical followup available 19 20 patients two months stent insertion two patients complained persistent jaundice two patients died without jaundice 15 patients free symptoms biliary obstruction variety geometric configurations possible endoprosthesis relative merits stent arrangements discussed new technique placing stents configuration described | 4 |
361 | prospective randomized study three surgical techniques treatment acute ruptures anterior cruciate ligament treatment acl tears controversial recent reports nonoperative treatment shown poor results results primary repair deteriorated time leading augmentation procedures seem improved results however prospective randomized studies field goal compare primary repair bonepatellar tendonbone augmentation method new method using kennedy ligament augmentation device one hundred fifty patients aged 16 50 acute acl tears randomized closed envelope method one three groups treated open surgical methods fifty patients treated primary repair 50 patients patellar tendon augmentation 50 patients augmented kennedy ligament augmentation device patients operated within 10 days injury rehabilitation protocol identical consisting long leg cast 2 weeks followed brace weightbearing limited motion 6 weeks patients followed prospectively one surgeon le using lysholm functional score tegner activity level score clinical evaluation kt1000 arthrometer 6 months 1 2 years three patients lost followup age activity level difference groups sport activities led 85 injuries skiing soccer european handball representing 80 injuries three groups reduced activity level 1st year repair group remained level 2 years | 4 |
362 | effect epinephrine lidocaine therapy outcome cardiac arrest due ventricular fibrillation one hundred ninetynine patients outofhospital cardiac arrest persisted ventricular fibrillation first defibrillation attempt randomly assigned receive either epinephrine lidocaine next two shocks resulting electrocardiographic rhythms outcomes group patients compared group also compared results prior 2 years period similar patients primarily received sodium bicarbonate initial adjunctive therapy asystole occurred defibrillation threefold frequency repeated injection lidocaine 15 59 25 compared patients treated epinephrine four 55 7 p less 002 difference proportion patients resuscitated treatment either lidocaine epinephrine 51 106 48 vs 50 93 54 proportion surviving 18 19 vs 21 20 respectively resuscitation 64 vs 50 p less 0005 survival rates 24 vs 20 higher prior 2year period initial adjunctive drug treatment persistent ventricular fibrillation primarily consisted continuous infusion sodium bicarbonate negative effect lidocaine epinephrine treatment explained part influence delaying subsequent defibrillation attempts survival rates highest 30 subset patients received drug therapy shocks conclude currently recommended doses epinephrine lidocaine useful improving outcome patients persist ventricular fibrillation | 3 |
363 | managing geriatric arrhythmias general considerations cardiac arrhythmias become increasingly common people age always clinically significant sinus node dysfunction av conduction disturbances ventricular supraventricular arrhythmias found always symptomatic treatment asymptomatic arrhythmias controversial probably indicated symptomatic elderly therapy indicated since even elderly found benefit much younger patients specific guidelines however apply age group based susceptibility side effects | 4 |
364 | endoscopic retrograde cannulation gallbladder direct dissolution gallstones percutaneous transhepatic catheterization gallbladder dissolution cholesterol stones instillation methyl tertbutyl ether mtbe invasive therapeutic procedure noninvasive alternative available endoscopic retrograde cannulation cystic duct difficult cystic ducts tortuosity spiral valves therefore developed catheter system using conventional duodenoscopes routine endoscopic retrograde cholangiography erc procedure permits reliable safe catheterization gallbladder without need endoscopic sphincterotomy 18 22 patients 82 able place cystonasal catheter 14 patients mtbe dissolution therapy performed eight patients 57 completely free stones treatment six 43 residual debris 4 22 patients 18 cannulation attempts failed 3 patients due cystic duct blockage calculus endoscopic retrograde cannulation gallbladder ercg represents promising alternative invasive percutaneous transhepatic catheterization procedure | 1 |
365 | monozygotic twins discordant partial trisomy 1 25yearold primigravida delivered monozygotic twins discordant multiple anomalies partial trisomy 1 mosaicism phenotype partial trisomy 1 includes craniofacial central nervous system ocular anomalies likely explanation findings translocation occurred twinning occurred observation emphasizes monozygotic twins necessarily genetically identical identical conception subsequent mutation rearrangement genome may cause substantial phenotypic differences | 4 |
366 | neuropathy caused spontaneous intraneural hemorrhage case report case ulnar neuropathy elbow produced spontaneous intraneural hemorrhage patient acquired immunodeficiency syndrome thrombocytopenia reported intraneural hemorrhage patients bleeding disorders occurs infrequently consists acute intrafascicular bleeding presumably producing high elevations endoneurial fluid pressure clinical features treatment condition considered pertinent literature reviewed involved pathophysiological mechanisms discussed | 4 |
367 | intraosseous lipomatosis case report report case systemic intraosseous lipomatosis involving proximal femur ends tibia tarsal metatarsal bones lesions progressed fiveyear followup pathological fracture tibial plateau ct scans characteristic helpful diagnosis mr imaging added little information intraosseous lipomatosis hamartomatous malformation due hyperplasia adipose tissue fundamentally different solitary benign intraosseous lipoma management involves reconstruction pathological fracture large progressive lesions treated curettage grafting attempt prevent fractures | 0 |
368 | sudden infant death syndrome infants substanceabusing mothers populationbased study performed determine whether substance abuse perinatal period may risk factor sudden infant death syndrome sids incidence sids studied 2143 infants substanceabusing mothers isam born los angeles county 1986 1987 reported los angeles county department health services history drug exposure positive urine test results mother infant comparing isam birth reports records autopsyproven sids los angeles county found 19 sids cases population 2143 isam sids rate 887 cases per 1000 isam 95 confidence interval 53 138 significantly higher sids rate nonisam general population 396 sids deaths among 325372 live births incidence rate 122 cases per 1000 births p less 000001 age isam death 99 63 mean sd days compared 91 52 days nonisam population significant incidence sids significantly greater male infants winter months black infants nonhispanic white infants nonisam population differences observed isam group greater incidence symptomatic apnea reported sids isam nonisam population 22 vs 54 p 0022 conclude isam higher incidence sids nonisam general population however possible separate maternal substance abuse confounding variables may also impact sids risk isam group | 4 |
369 | prolonged response carboplatin infant brain stem glioma adults children brain stem gliomas mean survival time 15 months radiation therapy xrt infants tumor present additional complexities treatment possible neurotoxicity radiation developing brain report 15monthold child biopsyproven brain stem glioma clinical radiographic evidence disease progression treated 24 monthly courses carboplatin without radiation therapy 39 month response clinical response started 3 months radiographic evidence documented 10 months magnetic resonance imaging toxicity minimal longitudinal neuropsychological assessment demonstrated continued improvement 36 months post diagnosis motor functioning expected age levels cervicomedullary astrocytoma young patient may appropriate clinical setting future trials chemotherapy without xrt | 0 |
370 | pathologic bronchial vasculature case massive hemoptysis due chronic bronchitis cause bleeding patient recurrent massive hemoptysis apparent bronchoscopy gross examination lobectomy specimen histologic submission major bronchi uncovered dilated tortuous bronchial arteries bronchial mucosa sites current healing arterial rupture bronchial arterial abnormality common several chronic pulmonary diseases rarely diagnosed cause massive hemoptysis careful pathologic examination major bronchi setting hemoptysis unknown causation recommended | 4 |
371 | primary neuroendocrine carcinoma skin clinicopathologic study 18 cases clinical pathologic features primary neuroendocrine carcinoma skin 18 elderly patients reported carcinomas arose dermis subcutaneous tissues particularly head upper extremities one tumor occurred irradiated area using goulds clinicopathologic classification found four trabecular types eleven intermediate cell types two small cell types one tumor could classified noteworthy pathologic features association invasive squamous cell carcinoma lentiginous melanocytic hyperplasia presence intratumoral melanocytes immunoreactivity cytokeratins 56 kd neurofilaments neuronspecific enolase epithelial membrane antigen observed paranuclear globular staining pattern cytokeratins neurofilaments conspicuous ultrastructural features revealed paranuclear intermediate filament aggregates fibrous bodies neurosecretory granules cell junctions two metastatic tumors high levels catecholamines found trabecular types characterized localized disease good prognosis patients small cell types died distant metastases postoperative radiotherapy seemed reduce rate local recurrences | 0 |
372 | everted cervical vein carotid patch angioplasty theoretic benefits autologous vein undertook investigation evaluate cervical veins facial external jugular patch material carotid endarterectomy device stimulated circumferential fixation sutures radial tension exerted vivo patches constructed measure burst strength tissue mean bursting pressure groin saphenous vein n 10 945 151 pounds per square inch psi 755 89 psi ankle saphenous vein n 10 833 145 psi everted double layer cervical vein n 5 10 33 psi single layer cervical vein n 5 significant differences saphenous vein level everted double layer cervical vein significantly different single layer cervical vein p less 005 june 1987 november 1989 19 patients underwent 21 carotid endarterectomies complemented adjunctive everted cervical vein patch angioplasty indications surgery asymptomatic stenosis 53 transient ischemic attack 29 cerebrovascular accident recovery 18 patients studied surgery duplex scanning asymptomatic recurrent stenosis observed one patient transient hypoglossal nerve dysfunction occurred one patient one postoperative death occurred result massive aspiration results indicate everted cervical vein comparable saphenous vein resistance bursting yield similar results patch material carotid endarterectomy accordingly saphenous vein spared lower extremity incisions avoided | 3 |
373 | progress cardioprotection role calcium antagonists calcium antagonists widely used treatment clinical hypertension angina pectoris efficacious treatment vasospastic fixed atherosclerotic mixed angina reduce incidence silent ischemia shown reduce postmyocardial infarct angina experimental data suggest may certain cardioprotective properties cases acute myocardial ischemia infarction stunned myocardium diastolic dysfunction left ventricular hypertrophy atherosclerosis moreover shown improve exercise performance well diastolic abnormalities patients hypertrophic cardiomyopathy animals may delay reduce extent myocardial necrosis coronary occlusion coronary occlusion followed reperfusion low doses alter hemodynamic profile shown enhance return ventricular function animals stunned myocardium however early firstgeneration calcium antagonists nifedipine verapamil diltiazem shown reduce myocardial infarct size enhance survival patients acute myocardial infarction clinical studies suggest unlike beta blockers nitrates nifedipine may slow development atherosclerotic progression humans 2year period seems likely 1990s expansion use calcium antagonists angina hypertension also aspects cardioprotection calcium antagonists may delay prevent possibly regress atherosclerotic lesions exciting possibility | 3 |
374 | potential role igg avidity diagnosing toxoplasmosis sera 20 cases toxoplasmic lymphadenopathy examined enzyme linked immunosorbent assay toxoplasma igg avidity elisa two laboratories results obtained largely agreement showed sera patients acute infection low avidity igg 30 less whereas sera patients chronic infection high avidity igg 40 suggested type assay could useful complementary role antenatal testing toxoplasmosis | 4 |
375 | early late effects captopril treatment large myocardial infarction rats early 21 days late 4 months effects continuous treatment captopril left ventricular performance weight volumes studied rats myocardial infarction early effects examined rats subjected coronary ligation randomized either immediate treatment captopril 2 gliter drinking water starting 2 h surgery treatment 21 days treated group showed reductions mean arterial left ventricular systolic left ventricular enddiastolic pressures compared untreated rats right left ventricular weight left ventricular volumes decreased ejection fraction index increased captopril treatment study late effects captopril second group rats randomized immediate captopril treatment starting 2 h surgery delayed captopril treatment starting 21 days surgery treatment studied 4 months treatment rats started captopril treatment 2 h infarction showed differences compared rats started treatment 21 days infarction treatment captopril 4 months produced changes similar rats treated 21 days captopril treatment improved hemodynamic function myocardial infarction rats examined either 21 days 4 months treatment extent benefit similar two treatment periods initiation captopril therapy immediately infarction appear produce greater effect treatment started 21 days infarction rats studied drug administered 4 months | 3 |
376 | surgical management cervical soft disc herniation comparison anterior posterior approach anterior cervical fusion initially described 1950s cervical spondylotic radiculopathy indications procedure management soft disc herniation clearly defined addition controversy exists whether cervical soft herniation managed anterior approach posterior cervical laminotomyforaminotomy authors report results prospective study comparing anterior discectomy fusion posterior laminotomyforaminotomy management soft cervical disc herniation twentyeight patients underwent anterior discectomy fusion robinson horseshoe graft 16 patients underwent posterior laminotomyforaminotomy disc herniations classified two types type single level anterolateral herniations 33 patients type ii central soft disc herniations 11 patients clinically patients type herniations manifested signs symptoms radiculopathy patients type ii herniations manifested signs myelopathy neck pain bilateral upper extremity paresthesias 4 patients confirmatory studies myelography 12 patients myelography combined computed tomography ct 26 patients magnetic resonance imaging mri 6 patients type herniations 17 patients underwent anterior fusion 16 patients posterior laminotomyforaminotomy 11 patients classified type ii herniation underwent anterior discectomy fusion 27 men 17 women age range 21 52 years mean 41 years followup 16 82 years mean 42 years | 4 |
377 | oxygen supply utilization relationships reevaluation relationship oxygen transport to2 oxygen consumption vo2 studied patients number acute chronic disorders many patients shown linear relationship two variables wide range to2 considered evidence pathologic supply dependency supply dependency contrasts animal studies clearly demonstrated biphasic relationship to2 vo2 review available data concerning relationship oxygen transport supply conditions increased oxygen requirements reduced oxygen transport suggests possibility observed interaction patients may many cases represent normal physiologic behavior system rather abnormal manifestation impaired oxygen extraction | 3 |
378 | increased sensitivity endotoxemia tissue necrosis study interaction endotoxemia ischemic organ injury investigated rat model animals received lipopolysaccharide induce endotoxemia simultaneously subjected renal ischemia renal ischemia induced moderate azotemia occurred animals survived lipopolysaccharide treatment caused neither renal failure death however rats endotoxemia renal ischemia showed severe azotemia 50 animals died within 48 hours observed mortality rate unlikely related renal failure since animals subjected bilateral nephrectomy die within 48 hours treatment lipopolysaccharide exclude role renal failure enhanced effect endotoxemia experiments performed ischemic kidneys excised littermates placed abdomens lipopolysaccharidetreated animals similar effect observed 50 animals died within 48 hours azotemia occur since tumor necrosis factor tnf important cytokine involved endotoxemiainduced morbidity death studied role tnf model plasma levels tnf increased endotoxemia concomitant renal ischemic injury influence concentration tnf animals treated recombinant tnf subsequently subjected renal ischemic injury 50 mortality observed rate similar lipopolysaccharidetreated animals conclude sensitivity endotoxemia enhanced tissue necrosis may lead death experimental model used study | 4 |
379 | quantification leakage pressures durotomy repairs canine study undertaken investigate relative strengths dural repair using standard suture techniques suture supplemented tissue adhesive tissue adhesive alone uniform 2 mm dural defects created adult beagles repaired subjected pressurization testing defects repaired suture alone initially leaked within range physiologic pressurization supplemented tissue adhesive repaired tissue adhesive alone failed higher pressurization levels histologic sections obtained dura treated fibrin adhesive sealant demonstrated minimal inflammatory response significantly different sections examined sites repaired suture alone new substance fibrin adhesive sealant appears useful effecting dural repair due ability withstand pressures greater obtained suture alone | 4 |
380 | evidence hypomotility nonulcer dyspepsia prospective multifactorial study prospective multifactorial study symptoms disturbance gastrointestinal function undertaken 50 patients nonulcer dyspepsia objective tests including solid meal gastric emptying studies gastric acid secretion ehida scintiscan enterogastric bile reflux hydrogen breath studies carried patients validated control data gastroscopy biopsy carried nonulcer dyspepsia patients nonulcer dyspepsia patients categorised basis predominant symptoms dysmotilitylike dyspepsia n 22 essential dyspepsia n 14 gastrooesophageal refluxlike dyspepsia n 11 ulcerlike dyspepsia n 3 total nonulcer dyspepsia population solid meal gastric emptying delayed t50 mean sem 102 6 minutes patients v 64 6 minutes controls p less 001 high incidences gastritis n 26 helicobacter pyloridis infection n 18 found inverse correlation observed solid meal gastric emptying fasting peak acid output r 04 p less 001 indeed gastric emptying particularly prolonged eight patients t50 mean sem 139 15 minutes hypochlorhydria nonulcer dyspepsia population oral caecal transit time solid meal delayed mean sem 302 14 minutes patients v 244 12 minutes controls p less 001 seven patients dual peak breath hydrogen suggestive small bowel bacterial overgrowth association observed symptoms objective abnormalities | 4 |
381 | integrated magnetic resonance imaging phosphorus spectroscopy soft tissue tumors eighteen patients soft tissue masses underwent integrated magnetic resonance imaging mri phosphorus spectroscopy 31pmrs evaluate benign malignant tumor morphology metabolism spectra soft tissue tumors significantly higher proportion phosphate lowenergy portion 31p spectrum p less 0001 concomitant decrease phosphocreatine p less 001 compared 31p spectra normal muscle malignant tumors mean ph 735 013 greater muscle tissue mean ph 708 007 p less 0001 tumors greater relative levels phosphomonoesters inorganic phosphate phosphodiesters compared muscle tissue considerable variability among tumors noted due tumor size extent tumor necrosis muscle contamination integrated mrimrs studies necessary provide exact localization tumor correct interpretation 31pmrs data | 0 |
382 | enterogenous cyst cerebellopontine angle cistern case report case enterogenous cyst located cerebellopontine angle cistern presented cysts usually found spinal canal intracranial occurrence exceptional present case cyst lined histologically single epithelial layer cuboidal cells glandular structures resembling fundic glands stomach unusual location cyst histological features discussed | 0 |
383 | 125dihydroxyvitamin d3 receptor rna expression hematopoietic cells 125dihydroxyvitamin d3 125oh2d3 induces differentiation inhibits proliferation myeloid leukemic cells various lines patients effects probably mediated 125oh2d3 receptor little known expression 125oh2d3 receptor rna hematopoietic cells examined expression modulation expression 125oh2d3 receptor rna various proliferating nonproliferating hematopoietic cells constitutive expression 125oh2d3 receptor rna detected various kinds hematopoietic cells including macrophages activated lymphocytes well cell lines kg1 myeloblasts hl60 promyelocytes ml3 myelomonoblasts u937 thp1 monoblasts k562 erythroblasts slb1 htlv1transfected lymphocytes receptor transcripts 46 kilobases kb variant sizes observed cell lines examined group also expressed 125oh2d3 receptors b lymphocyte lines expressed negligible levels 125oh2d3 receptor rna protein however analysis lymphoidmyeloid somatic hybrid suggested suppression expression 125oh2d3 receptor rna b lymphocytes may dominant characteristic hl60 cells cultured 107 moll 125oh2d3 24 72 hours levels expression 125oh2d3 receptor rna examined levels rna coding receptor modulated exposure high levels ligand levels occupied 125oh2d3 receptor protein increased hl60 cells total number 125oh2d3 receptors decreased 50 24 hours returned toward normal 72 hours steadystate levels 125oh2d3 receptor rna affected terminal differentiation hl60 toward either granulocytes macrophages nondividing macrophages normal individuals also expressed 125oh2d3 receptor rna contrast nondividing peripheral blood lymphocytes normal individuals express 125oh2d3 receptor rna stimulation proliferation cells accumulation 125oh2d3 receptor rna increased markedly halflife t12 125oh2d3 receptor rna lymphocytes short 1 hour determined measuring decay message addition actinomycin consistent short t12 accumulation 125oh2d3 receptor rna increased cells protein synthesis inhibited studies required understand physiologic role 125oh2d3 receptors myeloid cells proliferating lymphocytes | 0 |
384 | corticosteroid treatment reduces mast cell numbers inflammatory bowel disease mast cell degranulation gut causes mucus secretion mucosal edema increased gut permeability may responsible symptoms signs inflammatory bowel disease used novel monoclonal antibody aai tryptase expressed exclusively granules mast cells enumerate mast cells rectal biopsies order study effect inflammatory bowel disease drug treatment upon rectal mast cell numbers rectal mast cell numbers significantly reduced inflammatory bowel disease patients taking corticosteroids mean 495 cellsmm2 compared control patients 101 p less 0001 inflammatory bowel disease patients taking corticosteroids 97 p less 0001 wilcoxon rank sum test reduction mast cell counts independent degree inflammation architectural distortion negative correlation dose corticosteroids mast cell count r 053 p less 005 spearman rank correlation mast cell count reduced within days treatment remained low throughout steroid therapy mucosal mast cell depletion may important mechanism action corticosteroids inflammatory bowel disease | 1 |
385 | effect tamoxifen serum insulinlike growth factor levels stage breast cancer patients insulinlike growth factor igfi shown potent mitogen breast cancer cells vitro igfi receptors demonstrated human primary breast neoplasms randomized placebocontrolled study document administration antiestrogen tamoxifen patients breast cancer associated statistically significant p 002 reduction serum level igfi mean igfi level 14 uml placebotreated group 09 uml tamoxifentreated group serum igfi level growth hormone gh dependent data suggest pubertal surge gh igfi levels sex steroid dependent speculate mechanism underlying observation may involve blockade tamoxifen estrogen action hypothalamicpituitary axis conclude tamoxifen treatment reduces igfi levels reduction may contribute therapeutic effect drug | 0 |
386 | hepatitis b virus integration hepatitis b virusrelated hepatocellular carcinoma childhood taiwan hepatocellular carcinoma one major malignancies children 5 14 yr age studied status hepatitis b virus dna hepatocellular carcinoma nontumorous liver tissues eight children positive serum hbsag maternal hbsag hepatocellular carcinoma tissues five eight children showed integration hepatitis b virus dna host cellular dna sequences pattern singlesite integration four children multiplesite integration pattern one child demonstrated remaining three children hepatitis b virus dna could demonstrated tumor tissues using subgenomic fragments hepatitis b virus genome probes found x gene fragment surface antigen gene fragment conserved sequences singlesite integration hepatitis b virus dna childhood hepatocellular carcinoma may hit critical region resulting insertional mutagenesis early development hepatocellular carcinoma short incubation period less exposure environmental carcinogens early life childhood hepatocellular carcinoma may provide good model study carcinogenic potential hepatitis b virus | 0 |
387 | relevance intrinsic sympathomimetic activity beta blockers intrinsic sympathomimetic activity isa characterizes group beta blockers able stimulate betaadrenergic receptors agonist effect oppose stimulating effects catecholamines antagonist effect competitive way partial agonists ligands elicit submaximal response bound beta receptors maximal occupancy isolated rat atrium acebutolol produces maximal stimulatory effect 17 8 maximal effect induced full beta agonist isoproterenol presence isa results less resting bradycardia less reduction cardiac output observed beta blockers without isa long term partial beta agonists may produce arterial vasodilation increase arterial compliance possibly leading additional beneficial effects treatment hypertension beta blockers isa adverse effects plasma lipoproteins longterm treatment addition presence isa could counteract upregulation beta adrenoceptors often observed beta blockers without isa finally presence isa conflicting issue use beta blockers secondary prevention myocardial infarction however impressive results acebutolol prevention secondary infarction trial highrisk patients myocardial infarction show acebutolol beta blocker moderate partial agonist activity effective decreasing postinfarction mortality rate exhibiting strikingly different hemodynamic profile beta blockers without isa partial beta agonists form intriguing pharmacologic class drugs prospective clinical trials extensively pursued | 3 |
388 | perioperative myocardial ischemia patients undergoing noncardiac surgeryii incidence severity 1st week surgery study perioperative ischemia spi research group importance postoperative myocardial ischemia substantial physiologic changes occur prolonged periods postoperatively incidence severity temporal course myocardial ischemia studied 100 high risk patients 1st week major noncardiac surgery electrocardiographic ecg changes consistent ischemia continuously monitored using ambulatory solid state ecg 100 patients risk coronary artery disease ischemic episodes defined reversible st segment depression greater equal 1 mm elevation greater equal 2 mm baseline value baseline adjusted respiratory positional variation temporal drift ischemic episodes confirmed three independent blinded investigators using hardcopy recordings total ecg monitoring time 10445 h twentyseven patients 27 developed 437 episodes ischemia 1st week surgery total duration ischemia 18658 min 18 min ischemiah monitored ischemia severe early days 0 3 versus late days 4 7 postoperative period 284 versus 153 episodes 22 versus 12 min ischemiah greatest severity occurred postoperative day 3 109 episodes 34 min ischemiah monitored 15 mm mean st change 130 min mean duration however 8 patients severe episodes also occurred late postoperative day 6 44 episodes 17 min ischemiah monitored 13 mm mean st change 59 greater equal 2 mm 92 min mean duration ischemic episodes 57 associated tachycardia | 3 |
389 | strokes africanamericans hypertension important risk factor stroke especially africanamericans improved control high blood pressure nationwide key factor recent dramatic decline stroke frequency notably africanamerican women hypertension control programs must adequately funded expanded africanamericans disproportionately high incidence risk factors stroke including hypertension evidence cerebral vessels involved ischemic stroke africanamericans may differ caucasians urgent need research stroke general risk factor relations particular mechanisms pathogenesis stroke africanamericans | 3 |
390 | helicobacter pylori infection pernicious anemia prospective controlled study although authors believe helicobacter pylori etiologic agent chronic nonspecific gastritis also suggested bacterium colonizes inflamed mucosa secondary event study documents prevalence h pylori 28 patients pernicious anemia compares findings group 28 age race sexmatched asymptomatic control subjects subjects underwent endoscopy biopsy gastric antrum corpus sample serum obtained endoscopy determination antibodies immunoglobulin immunoglobulin g h pylori prevalence h pylori biopsy patients pernicious anemia significantly less controls 11 vs 71 p less 00001 patients pernicious anemia abnormalities corpus histology inflammation andor atrophy addition 50 patients pernicious anemia lymphocytic infiltration antrum controls h pylori gastritis 50 active chronic gastritis atrophic changes corpus commonly found patients pernicious anemia 75 vs 7 p less 00001 serology biopsy results correlated poorly patients pernicious anemia 5 patients positive serology results negative biopsy results whereas 3 patients positive cultures biopsy negative serological studies conclusion patients pernicious anemia protected infection h pylori h pylori passively colonize mucosa inflamed unrelated process | 1 |
391 | vitamin b12 folate concentrations serum cerebrospinal fluid neurological patients special reference multiple sclerosis dementia vitamin b12 folate concentrations measured serum cerebrospinal fluid csf 293 neurological patients serum csf vitamin b12 concentrations showed positive correlation individual patients csf b12 concentrations varied considerably given serum concentration median serum vitamin b12 concentration alzheimers type dementia group significantly lower compared control group lower median csf vitamin b12 concentrations found groups patients multiple sclerosis alzheimers type dementia five patients heterogeneous clinical pictures unexplained low serum csf b12 concentrations without macrocytosis two patients high serum b12 lownormal csf concentrations could explained bloodbrain barrier transport defect serum csf folate concentrations show significant differences various groups | 2 |
392 | comparison early versus late experience percutaneous mitral balloon valvuloplasty immediate outcome first 150 patients group 1 last 161 patients group 2 underwent percutaneous mitral balloon valvuloplasty compared difference two groups age gender new york heart association functional class presence calcification atrial fibrillation degree mitral regurgitation mean pulmonary artery pressure left atrial pressure cardiac output pulmonary vascular resistance mitral valve gradient mitral valve area fewer patients group 1 group 2 echocardiographic score less equal 8 62 versus 69 respectively p 002 atrial septum dilated 8 mm balloon 74 patients group 1 5 mm balloon patients group 2 ratio effective balloon dilating area body surface area larger group 1 group 2 405 007 versus 37 003 cm2m2 p 00001 good result mitral valve area greater equal 15 cm2 obtained 77 75 groups 1 2 respectively p ns percutaneous mitral valvuloplasty greater equal 2 grade increase mitral regurgitation noted 12 group 1 6 group 2 p 002 left right shunt detected 22 group 1 11 group 2 p 00001 three procedurerelated deaths group 1 none group 2 | 3 |
393 | effect improved cementing techniques component loosening total hip replacement 11year radiographic review improved cementing techniques shown decrease rate aseptic loosening femoral components cemented total hip replacements five seven years report results 105 hips 93 patients 10 127 years mean 112 improved techniques included use medullary plug cement gun doughy mix simplex p collared stem chrome cobalt three femoral components definitely loosened none probably loose 24 graded possibly loose contrast incidence radiographic loosening acetabular side 42 improved cementing techniques produced marked reduction rate aseptic loosening femoral component incidence acetabular loosening unchanged | 2 |
394 | postoperative pancreatic abscess due plesiomonas shigelloides plesiomonas shigelloides recognized increasing frequency human pathogen organism ubiquitous fresh brackish water clinical illness associated foreign travel ingestion inadequately cooked seafood describe 64yearold filipino woman presented 2 weeks elective cholecystectomy pancreatic biopsy left upper quadrant pain abdominal distention fever computerized tomography abdomen revealed abscess tail pancreas fluid accumulation lesser omental sac percutaneous aspiration yielded purulent material p shigelloides recovered pure culture knowledge first reported case pancreatic abscess due p shigelloides | 1 |
395 | sleep apnoea syndrome associated maxillofacial abnormalities four cases obstructive sleep apnoea syndrome osas presented consisted two cases tmj ankylosis micrognathia one case treacher collins syndrome one case long face syndrome standard specific cephalometric parameters obtained detect site obstruction polysomnographic studies yielded information regarding patients sleepwake state respiratory cardiac functioning pre postoperatively temporary tracheostomy corrected symptoms one patient syndrome recurred closed surgical correction maxillofacial anomalies reestablish normal sleep patterns preventing osas | 2 |
396 | gallium uptake tryptophanrelated pulmonary disease describe patient developed fever fatigue muscle weakness dyspnea skin rash eosinophilia taking high doses tryptophan insomnia two years gallium67 scan revealed diffuse increased uptake lung abnormal uptake muscular distribution bronchoscopy biopsy confirmed inflammatory reactions infiltration eosinophils mast cells lymphocytes ct scan showed interstitial alveolar pattern without fibrosis emg demonstrated diffuse myopathy muscle biopsy right thigh showed inflammatory myositis eosinophilic lymphocytic infiltrations | 4 |
397 | percutaneous balloon pulmonic valvuloplasty following treated endocarditis patient congenital pulmonary valve stenosis 36yearold woman congenital pulmonary valve stenosis developed rare complication endocarditis valve successful sterilization valve patient underwent percutaneous balloon pulmonic valvuloplasty later date procedure successfully reduced peak pulmonary valve gradient 94 45 mm hg percutaneous balloon valvuloplasty procedure choice treatment congenital pulmonary valvular stenosis even unusual patient healed endocarditis pulmonary valve | 3 |
398 | longterm cardiopulmonary bypass peripheral cannulation model total heart failure decompression left heart percutaneous helical spring positioned within lumen tricuspid pulmonary artery valves performed longterm closedchest cardiopulmonary bypass animal model total heart failure induced ventricular fibrillation extracorporeal system included venous reservoir roller pump membrane lung blood pulsator system cannulated right external jugular vein venous drainage right subclavian artery arterial return decompress left heart passed percutaneous cannulation special helical spring mounted swanganz catheter baxter edwards divisions irvine calif positioned rest within pulmonary artery tricuspid valves rendered partly incompetent induced ventricular fibrillation blood flow raised keep central venous pressure baseline values lungs ventilated 5 carbon dioxide room air bypass mean pulmonary artery pressure 100 17 mm hg mean wedge pressure 119 18 mm hg mean blood pressure 952 56 mm hg 2 days four animals 3 days two animals hearts defibrillated immediate ejection sides heart sheep weaned bypass within 29 11 minutes lungs ventilated room air within 42 34 minutes autopsy hearts lungs grossly appeared normal conclude percutaneous helical spring resting within right heart valves provided excellent decompression throughout study full recovery heart lung function defibrillation | 4 |
399 | hyponatremiainduced inhibition magnocellular neurons causes stressorselective impairment stimulated adrenocorticotropin secretion rats chronically hyponatremic rats subjected various stressors order evaluate possible contribution magnocellular neurons regulation acth secretion since rats markedly inhibited secretion synthesis magnocellular arginine vasopressin avp oxytocin ot stress caused novel environment insulininduced hypoglycemia resulted moderate increases plasma acth similar magnitude hyponatremic normonatremic rats stressors caused increase plasma avp ot levels either group rats however exposed ether hyponatremic rats exhibited significantly blunted acth response compared normonatremic controls 331 49 vs 740 124 pgml p less 001 respectively plasma avp levels markedly increased normonatremic hyponatremic rats intravenous infusion 2 nacl also caused acth release hyponatremic rats significantly smaller normonatremic counterparts 228 52 vs 479 85 pgml p less 005 respectively case plasma avp ot levels markedly increased normonatremic hyponatremic rats however hyponatremic rats exhibited greatly increased plasma acth levels 2 96 h adrenalectomy adx statistically equivalent increases acth levels normonatremic rats adx seven days adx parvocellular neurons paraventricular nucleus showed strongly increased crf41 avpneurophysin otneurophysin immunoreactivities normonatremic hyponatremic rats results show parvocellular crf41avpproducing neurons paraventricular nucleus inhibited chronic hyponatremia contrast magnocellular neurons suggest acth secretion induced ether hypertonic saline novel environment insulininduced hypoglycemia partially mediated magnocellular avp andor ot | 4 |
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